Massachusetts Commercial Total Medical Expenses by Town and Region (Published December 2015)


The Massachusetts Commercial Total Medical Expenses by Town and Region map illustrates geographic variation in spending by commercial health insurers on behalf of their commercial full-claim members in 2014. 1 The map also depicts variation in Total Medical Expenses (TME) growth from 2013 to 2014 as well as the share of TME by specific service categories. For more information on commercial TME related to this map, please refer to Variation in Massachusetts Commercial Total Medical Expenses by Town and Region (PDF).

TME, expressed on a per member per month basis, represents the full amount paid to providers, including payments from insurers and member cost-sharing payments, as well as all non-claims-related payments to providers (such as incentive payments for meeting quality or financial performance targets).

Note: The map displays unadjusted TME, meaning that the measure does not account for differences in commercial members’ health status or other factors. Therefore, higher spending may to some extent reflect sicker member populations.

TME map showing swipe tool

 (click map to activate the web application)


How to Use the Map

Note: The following instructions apply to users viewing the map application on a computer running the Windows operating system.  Application layout and map functionality may differ when viewing the application using other operating system or on mobile devices. When viewing maps, it is recommended you use the latest version of Mozilla Firefox, Google Chrome, or Safari. Users of older versions of these browsers, as well as versions of Internet Explorer, may experience viewing and performance limitations.

After opening the map application, the viewer displays a topographical map of the Commonwealth of Massachusetts. The right-hand-side pane contains a “Layer List” with seven selectable layers, five at the town level and two at the region level.

You can select and deselect layers by clicking on the box to the left of the layer name. When a layer is activated, a shaded overlay will appear on the map. The Towns layers outline the boundaries of each of the 351 cities and towns in Massachusetts 2 The Regions layers outline eight regions, as defined by the Massachusetts Health Policy Commission (HPC). 3

The following table provides a brief description of each layer:

Layers

Description for Total Medical Expenses Map
Towns – Commercial TME, 2014 Towns are color coded according to Commercial TME level, expressed in dollars per member per month, in 2014. Towns with higher TME are shaded dark blue and those with lower TME are shaded in lighter blue or beige.
Towns – Percent change in Commercial TME, 2013-2014

Towns with higher TME growth between 2013 and 2014 are colored dark orange, while those with low or negative TME growth are colored light orange.

Towns – Hospital (Inpatient and Outpatient) share of Commercial TME, 2014 Towns where hospital spending (inpatient and outpatient services combined) comprises a higher share of overall TME are colored dark purple. Towns where hospital spending represents a smaller share of TME are colored light purple or beige.
Towns – Professional (Physician and Other provider) share of Commercial TME, 2014 Towns where spending on professional services (for physician and other non-physician providers) comprises a higher share of overall TME are colored dark maroon. Towns where professional spending represents a smaller share of TME are colored light maroon or beige.
Towns – Pharmacy share of Commercial TME, 2014 Towns where pharmacy spending comprises a higher share of overall TME are colored dark green. Those where pharmacy spending represents a smaller share colored light green or beige.
Regions – Commercial TME, 2014 Regions with higher TME are colored dark blue and those with lower TME are colored light blue or beige.
Regions – Percent change in Commercial TME, 2013-2014 Regions with higher growth in Commercial TME are colored dark orange and those with low or negative TME growth are colored light orange or beige.


 

Selecting the legend icon, pop-up windows, and themes

To the left of the layer icon, the legend icon reveals the color gradient scale(s) for the activated layer(s). This allows the user to determine the range of values associated with different color shades.

Clicking on a town or region activates a pop-up window. If any information is unavailable, the entry is blank.4 The measure of interest for each layer—which determines the color gradient—is highlighted in bold, blue text.

 

Pop-up contents and data sources are listed in the table below:

 Data
Years Included
Source & Notes
Town or City
n/a
MassGIS – Community Boundaries (Towns) from Survey Points
County
n/a

MassGIS – Community Boundaries (Towns) from Survey Points

Region
n/a
Health Policy Commission (HPC)
Population
2010
MassGIS, U.S. Census Town Population: 2010
Commercial Total Medical Expenses (TME)
2013, 2014

Unadjusted TME, per member per month.

Payer-reported data to CHIA

Percent change in TME
2013-2014
Payer-reported data to CHIA
Average Income
2013
Average Adjusted Goss Income in 2013
Internal Revenue Service 5

TME by service category

  • Hospital – Inpatient
  • Hospital – Outpatient
  • Professional – Physician services
  • Professional – Non-physician provider services
  • Pharmacy
  • Other Medical services
  • Non-claims
2014

Payer-reported data to CHIA

Data presented in a pie chart.

Move the cursor over each segment to reveal a label with the category name and its share of total TME.

Percent change in TME by service category
2013-2014

Payer-reported data to CHIA.

Data presented in a bar chart. To view, click the small arrow to the right of the TME by service category pie chart to advance to the next chart. Move the cursor over each bar to reveal a label with the category name and percent change in TME.

 

You can use the following icons to modify your map view:

zoom
 Zoom in or out of the map; located at the top-left corner of the application.
home
 Returns the map to the original view; located just below the zoom tools.
location
 Allows the network to detect your physical location and zoom the map to it.
search
 Search for and zoom to a specific hospital or street address.
about
 Learn more about the Patient Origin map.
base  Change the display of the underlying map. Choose between various topographic and street-level maps. Note that changing maps will not alter the data.
swipe  Use the swipe tool to compare two map layers. Click to activate. A vertical bar will appear in the center of the map. Use the cursor to grab and move the vertical bar left or right to simultaneously hide one layer and reveal the other selected layer.
layer  Display layer list.
legend  Display legend for activated layer(s).
print
 Print the current map.

 

Notes about the Total Medical Expenses (TME) Map

  • Only Massachusetts towns and cities are included in the map.

  • TME data for 2014 are considered preliminary because payers submit data before the full claims run-out period has elapsed, and often before some non-claims payment settlements (e.g., bonuses for quality or shared savings payments) are finalized. In order to allow for comparison with previous years’ data, payers apply completion factors, which include estimates for spending on services that have been incurred but not reported (IBNR) as well as estimates for final non-claims settlements.

  • Some ZIP codes reported by payers were invalid and could not be assigned to towns. These ZIP codes were omitted from the map. Nearly all of these areas had fewer than 100 member months. In addition, some payers were unable to ascribe ZIP codes to some members. Corresponding data were omitted since they could not be assigned to towns. Some ZIP codes span more than one town. In these cases, the ZIP code is assigned to the town with the larger share of the ZIP code’s total population. As a result, some towns do not have corresponding TME or income data, because their component ZIP codes were assigned to other towns according to this criterion.

  • In some cases, clicking on a town will active more than one pop-up window, allowing you to scroll to the pop-up of one or more neighboring towns. This capability typically goes away when you zoom closer in on the map.

  • Some towns span more than one region because their component ZIP codes belong to different hospital service areas that correspond to different regions. 6

TME Map Data Source

TME calculations are based on data submitted to CHIA by Massachusetts payers. CHIA collects TME from the largest commercial payers in the Massachusetts commercial health insurance market. Payers report data for all Massachusetts residents based on ZIP code of residence as of the last day of the reported year, or the resident’s last day of membership in the payer’s plan. Payers report member months and payment amounts by ZIP code. Payment amounts are reported according to seven service categories: hospital inpatient, hospital outpatient, physician, other provider, pharmacy, other medical and non-claims-based payments. For the purposes of this map, ZIP codes are assigned to towns and regions, and unadjusted TME is calculated as the sum of commercial spending across all service categories divided by the sum of commercial member months within each town or region.

For additional information on TME, including data specification manuals, calculation examples, methodology, and related publications, please see CHIA's Information for Data Submitters: Payer Data Reporting.

 

Footnotes

1 Commercial, full claims data include both self- and fully insured commercial business for which claims for all medical services were available to the reporting payer. In contrast, commercial partial claims data include self- and fully insured commercial business where the employer separately contracts for one or more specialized service, such as pharmacy or behavioral health. In these cases, the reporting payer does not have access to the claims for these carved-out services. Because the full spectrum of medical expenses is not captured in the partial claims data, they are omitted from the analysis.

2 The town and city boundaries layer comes from the Office of Geographic Information (MassGIS), Commonwealth of Massachusetts, MassIT, available at http://www.mass.gov/anf/research-and-tech/it-serv-and-support/application-serv/office-of-geographic-information-massgis/datalayers/townsurvey.html (accessed Nov. 6, 2015).

3 The Health Policy Commission (HPC) defined a set of 15 geographic regions for use in its analyses of cost trends. CHIA has rolled up these regions into a set of eight larger regions. For a description of the HPC regions, see http://www.mass.gov/anf/docs/hpc/2013-cost-trends-report-technical-appendix-b3-regions-of-massachusetts.pdf (accessed Nov. 6, 2015).

4 Note that missing income data appears as $0.

5 Adjusted Gross Income (AGI) is an individual’s total gross income minus relevant deductions (e.g., medical expenses, retirement plan contributions). Average AGI is computed as total adjusted gross income divided by the total number of returns within each town or region. Data available at https://www.irs.gov/statistics/soi-tax-stats-individual-income-tax-statistics-2013-zip-code-data-soi. (Accessed Nov. 10, 2015.)

6 HPC regions are based upon Hospital Service Areas as designated by the Dartmouth Atlas of Health Care. E.g., Falmouth spans both Cape and Islands and Southcoast. Town level data represents all zip codes in Falmouth, while different zips will be assigned to different regions when computing region-level data.