CHIA examines health care cost and payment trends through a variety of studies.
Our broadest look at spending is Total Health Care Expenditures (THCE). Total Medical Expenses (TME) is one component of THCE, and is the best way to understand spending at the health plan, physician group, and regional level. Our premiums analyses show trends in both total cost to health plan members and changes in the quality of the benefits over time. We also look at contracting trends between providers and health plans, reporting both on price variation among providers, and on the payment methods used by health plans.
Health care cost and payment trends are related to a variety of other factors, including utilization and population health. A broad group of these topics are brought together in our look at overall Health System Performance and in our Hospital Profiles.
Total Health Care Expenditures (THCE) is a calculated measure of total spending per capita for health care in the Commonwealth from both public and private sources. The THCE measure includes Total Medical Expenses (TME), which accounts for all categories of medical expenses and all non-claims related payments to providers as well as patient cost sharing amounts, and the net cost of private health insurance. The year-over-year growth in THCE is compared to a health care cost growth benchmark to determine if the state has met its health care spending target. Read more
Total Medical Expenses (TME) measures the amount insurers pay to providers for health care services delivered to members, expressed on a per member per month basis. TME represents the full amount paid to providers, including both insurer payments and member cost-sharing payments. TME also includes all non-claims related payments to providers, such as provider performance payments. TME is an important component of Total Health Care Expenditures, which measures total spending per capita for health care in the Commonwealth. Read more
Health plan purchasers typically pay a monthly or annual premium for a health plan, which payers use to pay for enrollee medical expenses as well as general administrative and other expenses. Premiums are an important component of funding for the Massachusetts health care system, and are examined in combination with the benefit levels members receive. Read more
Alternative Payment Methods (APMs) are non-fee for service (FFS) based payments between payers and providers in which some of the financial risk associated with both the occurrence of medical conditions as well as the management of those conditions is shifted from payers to providers to incentivize cost-containment and quality care delivery. Read more
Relative price is a calculated measure that compares different provider prices within a payer’s network for a standard mix of insurance products (e.g. HMO, PPO, and Indemnity) to the average of all providers’ prices in that network. Commercial payers’ prices for similar services vary considerably among Massachusetts hospitals. Read more
CHIA examines Massachusetts hospital financial performance on a quarterly and annual basis to monitor each acute hospital’s financial health. Hospital performance for profitability, liquidity, and solvency metrics are published in quarterly and annual reports, and in individual hospital fact sheets. Read more
In December 2016, CHIA released its first edition of Medical Expenditure Trends. Expanding off the work done for CHIA's Enrollment Trends, Medical Expenditure Trends begins to use payers' Massachusetts All-Payer Claims Database (MA APCD) submissions to monitor medical claims spending in the Commonwealth over time. This report highlights aggregate medical claims spending trends by payer, funding type, and product type.