Performance of the Massachusetts Health Care System

Performance of the Massachusetts Health Care System

Annual Report March 2021

Performance of the Massachusetts Health Care System

Annual Report March 2021

CENTER FOR HEALTH INFORMATION AND ANALYSIS

Table of Contents

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Total Health Care Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Components of Total Health Care Expenditures, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Private Commercial Insurance by Product Type, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Medicare Programs, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 MassHealth by Program Type, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 Net Cost of Private Health Insurance by Market Sector, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Other Public Programs, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Total Health Care Expenditures by Service Category, 2018-2019: Gross of Prescription Drug Rebates . . . . . . . . . . . . . . . . .19 Total Health Care Expenditures by Service Category, 2018-2019: Net of Prescription Drug Rebates . . . . . . . . . . . . . . . . . .20 Change in Total Health Care Expenditures by Service Category, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Commercial Spending by Service Category, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 MassHealth Spending by Service Category, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Per Capita Total Health Care Expenditure Trends, 2013-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Understanding the Differences: Comparing Initial and Final 2018 THCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Estimated Impact of Rebates on Pharmacy Spending and Growth, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Range of Payer-Reported Commercial Rebates as a Percentage of Gross Pharmacy Expenditures, 2017-2019 . . . . . . . . . . . .27 Total Health Care Expenditures Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Total Medical Expenses & Alternative Payment Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Change in Preliminary Commercial HSA TME by Payer, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Change in Preliminary MassHealth MCO and ACO-A HSA TME by Payer, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . .33

CHIA center for health information and analysis

Annual Report on the Performance of the Massachusetts Health Care System | March 2021 1

Table of Contents (continued)

Change in Final Managing Physician Group Commercial HSA TME, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . .34 Adoption of Alternative Payment Methods by Insurance Category, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Alternative Payment Methods by Commercial Product Type, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 HMO and PPO Alternative Payment Method Adoption by Commercial Payer, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . 37 APM Adoption Trends by Commercial Payers, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Commercial Adoption of Alternative Payment Methods by Managing Physician Group, 2019 . . . . . . . . . . . . . . . . . . . . . 39 APM Adoption Trends by MassHealth MCOs and ACO-As, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Total Medical Expenses & Alternative Payment Methods Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Private Commercial Contract Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Enrollment by Market Sector, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .45 Enrollment by Product Type, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 Enrollment by Market Sector and Product Type, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47 Enrollment by Funding Type, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Largest Payers by Market Sector, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Enrollment Changes by Payer, 2018-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Enrollment by Benefit Design, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 High Deductible Health Plan (HDHP) Enrollment by Market Sector, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .52 Private Commercial Contract Enrollment Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Private Commercial Premiums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Fully-Insured Premiums by Market Sector, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57 Fully-Insured Benefit Levels by Market Sector, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58

CHIA center for health information and analysis

Annual Report on the Performance of the Massachusetts Health Care System | March 2021 2

Table of Contents (continued)

Fully-Insured Premiums by Payer, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 ConnectorCare Premiums and Market Share, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .60 Unsubsidized Individual Premiums and Market Share, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .61 Private Commercial Premiums Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62

Private Commercial Member Cost-Sharing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Cost-Sharing by Market Sector, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 Cost-Sharing by Deductible Level, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .67 Enrollment by Deductible and Maximum Out-of-Pocket Level, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68 Private Commercial Insurance Affordability, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Private Commercial Member Cost-Sharing Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Private Commercial Payer Use of Funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Fully-Insured Payer Use of Premiums by Market Segment, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74 Understanding the Differences: Federal Medical Loss Ratio and CHIA's Annual Financial Loss Ratio . . . . . . . . . . . . . . . . . .75 Fully-Insured Premium Retention by Market Segment, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 Fully-Insured Premium Retention Components by Market Segment, 2017-2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Private Commercial Payer Use of Funds Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80

Quality of Care in the Commonwealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Patient-Reported Experience During Acute Hospital Admission, 2019 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83 Primary Care Patient-Reported Experiences for Adults, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84

CHIA center for health information and analysis

Annual Report on the Performance of the Massachusetts Health Care System | March 2021 3

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