CHIA Standard Statistics


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Please contact CHIA regarding these measures or the information contained within the fact sheets.

This page was last updated: March 13, 2023.

CHIA maintains a  set of standard statistics that measure the performance of the Massachusetts health care system. The information in the tables below is derived from CHIA's unique data sets or other Massachusetts-specific reliable sources. The standard statistics information has two focus areas:


Spending and Insurance Coverage

Measure
Current
Data
Antecedent Data
Prior Data
Fact Sheet

Total Health Care Expenditures
(THCE)
(Learn More)

$67.9 billion in 2021
$9,715 per capita
+9.0% from 2020
(exceeds health care benchmark)
Note: 3.2% annualized from 2019 to 2021
$62.6 billion in 2020
$8,912 per capita
-2.3% from 2019
(below health care benchmark)

$63.0 billion in 2019
$9,130 per capita
+4.1% from 2018
(exceeds health care benchmark)

Link to fact sheet

Total Medical Expenses for
Commercially-Insured Members

(Learn More)
$592 PMPM in 2020
+16.1% from CY2020 to CY2021
$510 PMPM in 2020
-1.9% from CY2019 to CY2020
$522 PMPM in 2019
+3.6% from CY2018 to CY2019
Link to fact sheet

Insurance Rate of
Massachusetts Residents
(Learn more)
97.6 % in 2021
97.1% in 2019
96.3% in 2016
Link to fact sheet

Percent of Massachusetts Employers Offering Health Insurance
(Learn More)

74% in 2021
71% in 2018
65% in 2016
Link to fact sheet

Average Cost of
Commercial Coverage

(Learn More)

Fully-Insured Premiums
$563 PMPM in 2021
+6.6% from
CY2020 to CY2021
$529 PMPM in 2020
+2.6% from
CY2019 to CY2020
$516 PMPM in 2019
+2.3% from
CY2018 to CY2019
Link to fact sheet

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

(Learn More)


Fully-
and Self-Insured
0.895 in 2021
0.897 in 2020
0.885 in 2019
Link to fact sheet

Fully-Insured
0.880 in 2021
0.888 in 2020
0.873 in 2019

Self-Insured

0.908 in 2021
0.905 in 2020
0.894 in 2019

Average Commercial
Member Cost-Sharing
Level

(Learn More)

Fully-
and Self-Insured

$58 PMPM in 2021
+16.9% from
CY2020 to CY2021

$49 PMPM in 2020
-15.7% from
CY2019 to CY2020

$59 PMPM in 2019
+3.9% from
CY2018 to CY2019

Link to fact sheet
Fully-Insured

 

$69 PMPM in 2021
+23.3% from
CY2020 to CY2021

 

$56 PMPM in 2020
-15.9% from
CY2019 to CY2020

 

 

$66 PMPM in 2019
+6.5% from
CY2018 to CY2019

 

Self-Insured
$50 PMPM in 2021
+11.6% from
CY2020 to CY2021
$45 PMPM in 2020
-15.4% from
CY2019 to CY2020

 

$54 PMPM in 2019
+2.0% from
CY2018 to CY2019

 


Enrollment in
Health Insurance

(Learn More)

Private Commercial

3,916,305 in Sept. 2021
(-0.9% Sept. 2020
to Sept. 2021)

3,937,651 in Sept. 2020
(-2.3% Sept. 2018
to Sept. 2020)


4,055,344 in Sept. 2018
(-0.7% Sept. 2017
to Sept. 2018)
Link to fact sheet
MassHealth (Direct)

1,419,611 in Sept. 2021
(+9.6% Sept. 2020
to Sept. 2021)

1,287,493 in Sept. 2020
(+3.5% Sept. 2018
to Sept. 2020)


1,237,091 in Sept. 2018
(-1.0% Sept. 2017
to Sept. 2018)
SCO, One Care, PACE

104,863 in Sept. 2021
(+7.9% Sept. 2020
to Sept. 2021)

98,365 in Sept. 2020
(+18.8% Sept. 2018
to Sept. 2020)


82,817 in Sept 2018
(+13.8% Sept. 2017
to Sept. 2018)
Medicare

1,140,586 in Sept. 2021
(+1.4% Sept. 2020
to Sept. 2021)

1,128,063 in Sept. 2020
(+2.8% Sept. 2018
to Sept. 2020)

1,097,691 in Sept. 2018
(+1.5% Sept. 2017
to Sept. 2018)

Percent of Members
Whose Care is Covered
by Alternative
Payment Methods

(Learn More)

Commercial
40.1%
-0.6 pp from
CY2020 to CY2021
40.7%
-0.2 pp from
CY2019 to CY2020
40.93%
-0.9 pp from
CY2018 to CY2019
Link to fact sheet

MassHealth MCOs

87.2%
+0.5 pp from
CY2020 to CY2021

86.8%
+2.8 pp from
CY2019 to CY2020

84.5%
+17.1 pp from
CY2018 to CY2019

 

 
 

Massachusetts Provider Utilization and Performance

Measure
Current Data
Antecedent Data
Prior Data
Fact Sheet

Total Number of
Inpatient Discharges

(Learn More)

749,443 in FY2020
-7.5% from FY2019 to FY2020
810,357 in FY2019
-0.4% from FY2018 to FY2019
813,618 in FY2018
-0.2% from FY2017 to FY2018
Link to fact sheet

Most Frequent Inpatient Discharges by Diagnostic
Related Group (DRG)

(Learn More)

FY20

Normal Neonate Births
(57,875 / -4.5.%)

Vaginal Delivery
(43,941 / -2.0%)

Septicemia & Infections
(36,364 / +2.7%)

Heart Failure
(24,127 / -12.9%)

Cesarean Delivery
(21,388 / +0.5%)

FY19

Normal Neonate Births
(60,625 / -0.2%)

Vaginal Delivery
(44,843 / -1.1%)

Septicemia & Infections
(35,425 / +0.2%)

Heart Failure
(27,700 / +3.0%)

Cesarean Delivery
(21,286 / -2.2%)

FY18

Normal Neonate Births
(60,761 / -0.8%)

Vaginal Delivery
(45,348 / -1.3%)

Septicemia & Infections
(35,371 / +6.0%)

Heart Failure
(26,893 / +4.0%)

Cesarean Delivery
(21,757 / -0.3%)

Link to fact sheet

Statewide Number of
Emergency Department Visits

(Learn More)

2,571,277
in FY2020
3,150,303
in FY2019
3,146,507
in FY2018
Link to fact sheet

Statewide Unplanned
Readmission Rate

(Learn More)

15.9%
in 2020
15.4%
in 2018
15.4%
in 2017
Link to fact sheet

Median Hospital
Total Margin
(Statewide)
(Learn More)

2.6%
in 2020
3.5%
in 2019
4.5%
in 2018
Link to fact sheet

Relative Price
Statewide Relative Price
(S-RP) Results

(Learn More)

Note: RP values are not
comparable year to year.

CY2019

Range of S-RP Values: 0.7171.870

Median S-RP: 0.920

- - Link to fact sheet