CHIA Standard Statistics


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Comparative Statistics:
Massachusetts and the United States

CHIA identifies, calculates, disseminates, and maintains a specific set of standard statistics that measure the performance of the Massachusetts health care system. The information in the table below is derived from CHIA's unique data sets or other Massachusetts-specific reliable sources. This page was last updated: November 8, 2018.

CHIA's two main areas under its standard statistics:

 

 

 


Spending and Insurance Coverage

MeasureMost Recent DataPrevious DataData
book
Additional
Data
Fact
Sheet

Total Health Care Expenditures
(Learn More)

$8,663 per capita
+2.8% from CY2015 to CY2016
$8,429 per capita
+4.8% from CY2014 to CY2015
Link to data

Link to fact sheet

Total Medical Expenses for Commercially-Insured Members
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$466 PMPM in 2016
+3.4% from CY2015 to CY2016
$451 PMPM in 2015
+2.7% from CY2014 to CY2015
Link to data

Link to fact sheet
Insurance Rate of Massachusetts Residents
(Learn more)

96.3% in 2016

96.4% in 2015
Link to data
Link to fact sheet

Percent of Massachusetts Employers Offering Health Insurance

(Learn More)

65% in 2016
(See footnote) *
Link to data
Link to fact sheet

Average Cost of Commercial Coverage

(Learn More)

Fully-Insured Premiums
$483 PMPM in CY2017
+4.9% from CY2016 to CY2017
$460 PMPM in CY2016
+2.0% from CY2015 to CY2016
Link to data
Link to fact sheet

Commercial Health Insurance Benefit Levels (Paid-to-Allowed Claims Ratio)

(Learn More)

Fully- and Self-Insured
0.879 in 2017
0.895 in 2016
Link to data
Link to fact sheet
Fully-Insured
0.880 in 2017
0.887 in 2016
Self-Insured
0.879 in 2017
0.901 in 2016

Average Commercial Member Cost-Sharing Level

(Learn More)

Fully- and Self-Insured
$52 PMPM in 2017
+5.7% from CY2016 to CY2017
$49 PMPM in 2016
+4.3% from CY2015 to CY2016
Link to data
Link to fact sheet
Fully-Insured
$57 PMPM in 2017
+7.6% from CY2016 to CY2017
$53 PMPM in 2016
+4.8% from CY2015 to CY2016
Self-Insured
$47 PMPM in 2017
+4.2% from CY2016 to CY2017
$45 PMPM in 2016
+3.4% from CY2015 to CY2016

Enrollment in Health Insurance

(Learn More)

Private Commercial
4,108,714 in March 2018
(+0.5% March 2017 to March 2018)
4,087,738
in March 2017
Link to data

Link to fact sheet
MassHealth (Direct) 1,255,262 in March 2018
(-3.8% March 2017 to March 2018)

1,304,736
in March 2017

SCO, One Care, PACE
77,594 in March 2018
(+15.7% March 2017 to March 2018)

67,070
in March 2017

Medicare
1,086,949 in March 2018
(+0.4% March 2017 to March 2018)
1,082,238
in March 2017

Percent of Members Whose Care is Covered by Alternative Payment Methods

(Learn More)

Commercial
42.0%
+6.3 pp from CY2015 to CY2016
35.7%
-1.3 pp from CY2014 to CY2015
Link to data

Link to fact sheet
MassHealth MCOs
35.7%
-0.9 pp from CY2015 to CY2016
36.6%
+2.4 pp from CY2014 to CY2015
MassHealth PCC
23.5%
+0.5 pp from CY2015 to CY2016
23.0%
+1.4 pp from CY2014 to CY2015


Massachusetts Provider Utilization and Performance

MeasureMost Recent DataPrevious DataData
Book
Additional
Data
Fact Sheet

Total Number of Patient Inpatient Discharges

Hospital Profiles FY16 Databook
(Appendix E)

806,908 in FY2016
-0.1% from FY2015 to FY2016
807,457 in FY2015
+2.0% from FY2014 to FY2015
Link to data

Link to fact sheet

Most Frequent Inpatient Discharges by Diagnostic Related Group (DRG)

Hospital Profiles FY16 Databook
(Appendix H)

FY16

Normal Neonate Births
(61,758 / +1.6%)

Vaginal Delivery
(46,596 / -0.3%)

Septicemia & Infections
(33,831 / +0.3%)

Heart Failure
(23,959 / +1.2%)

Cesarean Delivery
(21,759 / -0.2%)

FY15

Normal Neonate Births
(60,806 / -3.7%)

Vaginal Delivery
(46,743 / -0.3%)

Septicemia & Infections
(32,772 / +23.3%)

Heart Failure
(23,670 / +7.1%)

Cesarean Delivery
(21,807 / -0.9%)
Link to data
Link to fact sheet

Statewide Number of Emergency Department Visits

Hospital Profiles FY16 Databook
(Appendix E)

3,126,166
in FY2016
3,042,611
in FY2015
Link to data
Link to fact sheet

Statewide Unplanned Readmission Rate

(Learn More)

15.3%
in 2014
15.2%
in 2013
Link to data
Link to fact sheet

Median Hospital Total Margin (Statewide)

(Learn More)

3.2%
in 2017
3.1%
in 2016
Link to data
Link to fact sheet

Relative Price

(Learn More)

 N/A  N/A  Link to data Link to fact sheet

 

* In 2016, the Massachusetts Employer Survey sample was redesigned to capture responses from firms (e.g., CVS Pharmacy as an organization) rather than establishments (e.g., an individual CVS Pharmacy worksite), as decision making about health benefits is almost always made at the firm rather than the establishment level. Such change has made comparisons to data from previous surveys more complex. For details, please see the 2016 Summary of Results  and the 2016 Field Report.