CHIA Standard Statistics

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This page was last updated: March 27, 2024.

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

Massachusetts Provider Utilization and Performance

Spending and Insurance Coverage

Measure		Current Data	Antecedent Data	Prior Data

Total Health Care Expenditures (THCE) (Learn More)		$71.7 billion in 2022 $10,264 per capita +5.8% from 2021 (exceeds health care benchmark)	$67.8 billion in 2021 $9,715 per capita +9.0% from 2020 (exceeds health care benchmark) Note: 3.2% annualized from 2019 to 2021	$62.7 billion in 2020 $8,912 per capita -2.3% from 2019 (below health care benchmark)

Total Medical Expenses for Commercially-Insured Members (Learn More)		$615 PMPM in 2022 +3.9% from CY2021 to CY2022	$592 PMPM in 2020 +16.1% from CY2020 to CY2021	$510 PMPM in 2020 -1.9% from CY2019 to CY2020

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

Percent of Massachusetts Employers Offering Health Insurance (Learn More)		74% in 2021	71% in 2018	65% in 2016

Average Cost of Commercial Coverage (Learn More)	Fully-Insured Premiums	$595 PMPM in 2022 +5.8% from CY2021 to CY2022	$563 PMPM in 2021 +6.6% from CY2020 to CY2021	$529 PMPM in 2020 +2.6% from CY2019 to CY2020

Commercial Health Insurance Benefit Levels (Paid-to-Allowed Claims Ratio) (Learn More)	Fully- and Self-Insured	0.891 in 2022	0.895 in 2021	0.897 in 2020
	Fully-Insured	0.872 in 2022	0.880 in 2021	0.888 in 2020
	Self-Insured	0.905 in 2022	0.908 in 2021	0.905 in 2020

Average Commercial Member Cost-Sharing Level (Learn More)	Fully- and Self-Insured	$61 PMPM in 2022 +6.0% from CY2021 to CY2022	$58 PMPM in 2021 +18.4% from CY2020 to CY2021	$49 PMPM in 2020 -16.7% from CY2019 to CY2020
	Fully-Insured	$76 PMPM in 2022 +9.7% from CY2021 to CY2022	$69 PMPM in 2021 +22.1% from CY2020 to CY2021	$57 PMPM in 2020 -14.8% from CY2019 to CY2020
	Self-Insured	$52 PMPM in 2022 +2.8% from CY2021 to CY2022	$51 PMPM in 2021 +15.7% from CY2020 to CY2021	$44 PMPM in 2020 -17.4% from CY2019 to CY2020

Enrollment in Health Insurance (Learn More)	Private Commercial	3,780,185 in Sept. 2023 (-0.3% Sept. 2022 to Sept. 2023)	3,792,662 in Sept. 2022 (-2.8% Sept. 2021 to Sept. 2022	3,902,002 in Sept. 2021 (-1.1% Sept. 2020 to Sept. 2021)
	MassHealth (Direct)	1,522,450 in Sept. 2023 (-0.2% Sept. 2022 to Sept. 2023)	1,525,326 in Sept. 2022 (+7.0% Sept. 2021 to Sept. 2022)	1,425,468 in Sept. 2021 (+10.1% Sept. 2020 to Sept. 2021)
	SCO, One Care, PACE	120,311 in Sept. 2023 (+8.4% Sept. 2022 to Sept. 2023)	110,959 in Sept. 2022 (+5.8% Sept. 2021 to Sept. 2022)	104,870 in Sept 2021 (+7.9% Sept. 2020 to Sept. 2021)
	Medicare	1,145,176 in Sept. 2023 (+0.2% Sept. 2022 to Sept. 2023)	1,143,373 in Sept. 2022 (+0.3% Sept. 20218 to Sept. 2022)	1,139,829 in Sept. 2021 (+1.3% Sept. 2020 to Sept 2021)

Percent of Members Whose Care is Covered by Alternative Payment Methods (Learn More)	Commercial	41.4 -0.8 pp from CY2021 to CY2022	42.2% +0.7 pp from CY2020 to CY2021	41.5% +0.6 pp from CY2019 to CY2020
	MassHealth MCOs	87.4% consistent from CY2021 to CY2022	87.4% +0.5 pp from CY2020 to CY2021	86.9% +2.4 pp from CY2019 to CY2020

Massachusetts Provider Utilization and Performance

Measure	Current Data	Antecedent Data	Prior Data

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

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%)

Statewide Number of Emergency Department Visits (Learn More)	2,571,277 in FY2020	3,150,303 in FY2019	3,146,507 in FY2018

Statewide Unplanned Readmission Rate (Learn More)	15.9% in 2020	15.4% in 2018	15.4% in 2017

Median Hospital Total Margin (Statewide) (Learn More)	2.6% in 2020	3.5% in 2019	4.5% in 2018

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: 0.717–1.870 Median S-RP: 0.920	-	-