Annual Report on the Performance of the Massachusetts Health Care System: 2016


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The 2016 Annual Report on the Performance of the Massachusetts Health Care System includes a final calculation of the Commonwealth’s 2014 Total Health Care Expenditures (THCE) and an initial calculation of 2015 THCE. THCE is a measure of total statewide health care spending in the Commonwealth.

The report also includes information from public and private sources related to specific health care expenditures for Massachusetts residents, quality of care in the Commonwealth compared to national performance, enrollment and coverage trends, premiums and member cost-sharing, and payer use of funds.

This report will inform the Health Policy Commission’s 2016 Health Care Cost Trends Hearing, which will take place October 17 and 18, 2016.

Key Findings

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  • 2015 initial THCE was $57.2 billion, or $8,424 per capita, representing a 3.9% increase from 2014 and exceeding the health care cost growth benchmark by 0.3 percentage points.

  • PMPM spending for commercial full-claim members grew 1.7%; and declined 3.1% for MassHealth Direct, as enrollment outpaced medical spending. Traditional Medicare spending rose faster than enrollment, resulting in PBPY growth of 2.0%.

  • After several years of increases, the proportion of commercial members whose care was paid for using alternative payment methods declined by 1.9 percentage points in 2015 to 35.1%.

  • Pharmacy spending continues to grow at a substantial rate (10.1% in 2015, following 13.5% in 2014). This spending growth accounts for one-third of the  overall growth in THCE.

  • Individual enrollment more than doubled to 170,000 enrollees as subsidized and unsubsidized coverage became available through the Health Connector.

  • One in five Massachusetts commercial members (21%) were enrolled in a high deductible health plan. Membership increased by 14% to nearly one million members.

  • Cost-sharing among private commercial members continued to increase faster inflation and wage growth. Members continue to bear a greater share of health care costs.

  • The quality of Massachusetts providers was generally at or above national benchmarks, but there was performance variation across providers.

Briefs on related topics will be published in the fall and early winter as part of the 2016 Performance of the Massachusetts Health Care System Briefing Series.


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