Performance of the Massachusetts Health Care System

Performance

of the

Massachusetts

Health Care

System

Annual Report

October 2019

Performance

of the

Massachusetts

Health Care

System

Annual Report

October 2019

CENTER FOR HEALTH INFORMATION AND ANALYSIS

Table of Contents

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

Total Health Care Expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Components of Total Health Care Expenditures, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

Private Commercial Insurance by Product Type, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Medicare Programs, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

MassHealth by Program Type, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Net Cost of Private Health Insurance by Market Sector, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Other Public Programs, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Total Health Care Expenditures by Service Category, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Change in Total Health Care Expenditures by Service Category, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Estimated Impact of Rebates on Pharmacy Spending and Growth, 2016-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Range of Payer-Reported Commercial Rebates as a Percentage of Gross Pharmacy Expenditures, 2016-2018 . . . . . . . . . . . .20

Per Capita Total Health Care Expenditure Trends, 2013-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Understanding the Differences: Comparing Initial and Final 2017 THCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Total Health Care Expenditures Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Total Medical Expenses & Alternative Payment Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Change in Preliminary Commercial HSA TME by Payer, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Change in Preliminary MassHealth MCO and ACO-A HSA TME by Payer, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . .29

Change in Final Managing Physician Group Commercial HSA TME, 2016-2017 . . . . . . . . . . . . . . . . . . . . . . . . . . . .30

Adoption of Alternative Payment Methods by Insurance Category, 2016-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31

Alternative Payment Methods by Commercial Product Type, 2017-2018 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

CHIA

center for health information and analysis

Annual Report on the Performance of the Massachusetts Health Care System | October 2019

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