Total Medical Expense (TME) Trends Across Massachusetts Communities

Each year, CHIA collects Total Medical Expense (TME) data from public and private payers, and reports findings based on TME data pursuant to M.G.L. c. 12C. New this year, CHIA considered how medical spending varied across Massachusetts communities, and whether there was a relationship between certain spending categories and community characteristics. Findings are reported here in an interactive dashboard and trends report, presenting data on demographics by community as well as the relationship between these community characteristics and total medical expenses by insurance population and across TME service categories. Data is presented at the community level by municipality and ZIP Code Tabulation Area (ZCTA).

ZIP Code Tabulation Areas or ZCTAs (pronounced zik-tahs) are a geographic product of the U.S. Census Bureau created to allow mapping, display, and geographic analyses of the United States Postal Service (USPS) Zone Improvement Plan (ZIP) Codes dataset.¹ ZIP codes available in TME data were linked to ZCTAs available in the Census Bureau’s American Community Survey (ACS) data in order to apply a community lens to TME spending patterns. For more information on ZCTAs and CHIA’s approach to linking these two data sets, please see the Technical Appendix. Additional usage terms are outlined below on this page.

An executive summary and overview of key findings are also available.

 Total Medical Expense (TME) Trends Across Massachusetts Communities Dashboard

Updated March 2024

For more information about this dashboard, or if you would like more details on correlation statistics related to this dashboard's findings, please contact Shalome Sine at shalome.sine@chiamass.gov.

Terms 

• American Community Survey (ACS)
  An annual survey conducted by the United States Census Bureau. Data on community demographics is gathered and made publicly available at https://data.census.gov/table. For more details about the demographic variables used in this report, please see the technical appendix.
  
  
• Medical Expense Category
  Medical expense categories (or service categories) are gathered as part of TME data collection. The service categories available in this dashboard include hospital inpatient, hospital outpatient, physician, other professional, other medical, pharmacy, and total medical expenses. For more information on the specific claims captured in each service category, please see the TME-APM Data Specification Manual. An overview of the differences between the Other Professional and Other Medical service categories is below. 
  
  
  • • • Hospital Inpatient
        This service category captures all claims payments made to hospitals for inpatient care.
        
        
      • Hospital Outpatient
        This service category captures all claims payments made to hospitals for outpatient care.
  
  
  • • Other Professional
      A service category gathered as part of TME data collection. This service category captures all payments for services provided by licensed practitioners other than physicians, including occupational and physical therapists, nurse practitioners, physician assistants, and certain behavioral health providers. 
      
      
    • Other Medical
      This service category captures all claims payments for medical services not otherwise included in other categories, including skilled nursing facility services, home health services, durable medical equipment, freestanding diagnostic facility services, hearing aid services and optical services.
      
      
    • Physician
      This service category captures all claims payments for services provided by a doctor of medicine or osteopathy. Physician spending includes both primary care and specialty care doctors.
      
      
    • Pharmacy
      This service category captures all claims payments for prescription drugs, biological products, and vaccines administered outside of hospital settings.
      
      
    • Telehealth
      Telehealth spending captures all payments made to providers for services delivered remotely (i.e., over the phone or via video chat). Telehealth spending in this section refers to the aggregate of all telehealth spending across the physician, other professional, hospital outpatient, and other medical TME service categories.
      
      
    • Total Medical Expenses
      TME captures all categories of medical expenses and all non-claims related payments to providers, including provider performance payments and member cost-sharing.

• Per Member Per Month (PMPM) Spending
  Average per member spending on medical services each month within the stated insurance type.
  
  
• Physician Density
  Primary care physician density, as calculated for this report, reflects the number of primary care, internal medicine, and family practice physicians per 1,000 population within a county.
  
  

• ZIP Code Tabulation Area (ZCTA)
  ZIP Code Tabulation Areas or ZCTAs (pronounced zik-tahs) are a geographic product of the U.S. Census Bureau created to allow mapping, display, and geographic analyses of the United States Postal Service (USPS) Zone Improvement Plan (ZIP) Codes dataset. ZIP codes available in TME data were linked to ZCTAs available in the American Community Survey (ACS) data in order to apply a community lens to TME spending patterns. For more information on ZCTAs and CHIA’s approach to linking these two data sets, please see the Technical Appendix.

References:  

1. ZIP Code Tabulation Areas (ZCTAs). United States Census Bureau. 2024. https://www.census.gov/programs-surveys/geography/guidance/geo-areas/zctas.html