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.
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.