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Health Care Costs & Payments

CHIA examines health care cost and payment trends through a variety of methods. Our broadest look at health care spending is under a combined heading of Total Health Care Expenditures, Total Medical Expenses and Alternative Payment Methods.

Our Commercial Insurance: Premiums and Member Cost Sharing research shows trends in both total cost to health plan members and changes in the quality of the benefits over time. Cost-sharing research and data is also included in findings from CHIA’s Massachusetts Health Insurance Surveys (MHIS). The survey findings reflect the impacts of medical costs on Massachusetts households with all forms of insurance coverage (including private commercial, MassHealth, and Medicare) as well as the uninsured.

Relative Price and Price Variation is a calculated measure that compares different provider prices within a payer’s network for a standard mix of insurance products (e.g. HMO, PPO, and Indemnity) to the average of all providers’ prices in that network. Commercial payers’ prices for similar services vary considerably among Massachusetts hospitals.

Primary care and behavioral health care (PCBH) comprise an array of vital services that can meaningfully shape patient outcomes and are often associated with lower health care costs and higher quality. CHIA's has reported on spending for primary care services for members enrolled in private commercial, Medicaid MCO/ACO-A, and Medicare Advantage plans.

 

Health care cost and payment trends are related to a variety of other factors, including utilization and population health. A broad group of these topics are brought together in our look at overall Health System Performance and in our Hospital Profiles sections of the website

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(What is this?)

CHIA monitors health care spending by public and private payers in Massachusetts using three key metrics: Total Health Care Expenditures (THCE), Total Medical Expenses (TME), and alternative payment methods (APMs). These measures are all reported in CHIA's Annual Report on the Performance of the Massachusetts Health Care System.

 

Read more about about THCE, TME, and APMs...

(What is this?)

Primary care and behavioral health care (PCBH) comprise an array of vital services that can meaningfully shape patient outcomes and are often associated with lower health care costs and higher quality. CHIA's latest report, released in August 2024, focuses on spending for primary care services for members enrolled in private commercial, Medicaid MCO/ACO-A, and Medicare Advantage plans for calendar years 2021 and 2022.  Read more....

(What is this?)

To advance transparency into this sector of the health care market for policy makers, researchers, and the public, CHIA has recently published an interactive dashboard and detailed dataset, allowing users to see drivers of prescription drug spending as well as the associated conditions these drugs treat. Read more.....

(What is this?)

Relative price is a calculated measure that compares different provider prices within a payer’s network for a standard mix of insurance products (e.g. HMO, PPO, and Indemnity) to the average of all providers’ prices in that network. Commercial payers’ prices for similar services vary considerably among Massachusetts hospitals. Read more...

(What is this?)

CHIA collects annual commercial health insurance premiums and premium-equivalent data from health care payers, allowing for insights into the costs borne by both Massachusetts employers and employees. CHIA also monitors membership concentrations, premium values scaled by full benefits, and consumer cost-sharing over time. Read more...

(What is this?)

CHIA examines Massachusetts hospital financial performance on a quarterly and annual basis to monitor each acute hospital’s financial health. Hospital performance for profitability, liquidity, and solvency metrics are published in quarterly and annual reports, and in individual hospital trend analysis.  Read more

(What is this?)

CHIA collects detailed financial information from hospitals to increase transparency for the Commonwealth, and has improved our process of collection and distribution. Beginning with Fiscal Year 2015, Massachusetts Hospital Cost Report Data is available online.  It contains details such as cost, revenue, payer mix, and utilization data.  Read more