Total Medical Expenses

TME Metric

TME is calculated using:

  • Insurer payments to providers

  • Member cost-sharing payments to providers

  • All non-claims related payments to providers, such as performance payments

TME Data

TME data is collected from commercial and public payers for commercial full claims, commercial partial claims, Medicaid and Commonwealth Care Managed Care Organizations (MCO), and Medicare Advantage health insurance categories. Payer data submissions are not available as a public record.

For More Information on Total Medical Expenses,
see CHIA's 2018 Annual Report

CHIA annual report 2018 cover

Massachusetts Commercial Total Medical Expenses by Town and Region

This map illustrates geographic variation in spending by commercial health insurers on behalf of their commercial full-claim members.

tme page map sm

The Center for Health Information and Analysis (CHIA) monitors health care spending by public and private payers using a metric called Total Medical Expenses (TME). TME represents the full amount paid to providers for health care services delivered to a payer’s member population, expressed on a per member per month (PMPM) basis. CHIA is statutorily mandated to collect and report TME data from private and public health care payers operating in the Massachusetts health care market.

TME includes the amounts paid by the payer and patient cost-sharing, and covers all categories of medical expenses and all non-claims related payments to providers, including provider performance payments.

TME is an important component of Total Health Care Expenditures (THCE), which measures total spending per capita for health care in the Commonwealth.


Key Findings from the 2018 annual report

  • TME increased in 2017 for commercial and MassHealth MCO members, and decreased for Medicare Advantage members.

  • Per member per month spending for commercial full-claim members slowed across all major service categories.

  • Adoption of APMs increased significantly in the MassHealth PCC plan, and remained nearly level in the commercial and MassHealth MCO markets.

  • Commercial APM adoption continued to increase in the PPO product type, increasing four percentage points between 2016 and 2017.


Click to view full size image. Previous Total Medical Expenses Publication Materials

Previous Total medical Expenses Publication Materials