Annual Report on the Performance of the Massachusetts Health Care System (March 2022)

AnNual Report on the performance of
the Massachusetts health care system

The Annual Report on the Performance of the Massachusetts Health Care System includes a final calculation of Total Health Care Expenditures (THCE) for 2020. THCE is a measure of total statewide health care spending in the Commonwealth.

You can use an interactive graphic to view CHIA's analysis of the cost drivers of total health care expenditures in the Commonwealth. The components, or payers of health care services, are outlined on the left side of the graphic and the categories of health care services are outlined on the right.

To learn more about Total Health Care Expenditures and CHIA's analysis of COVID-era data, please watch the short video "Examining Health Care Spending in Massachusetts" on the right of this page.

The Annual Report includes information from public and private sources related to specific health care expenditures for Massachusetts residents and examines adoption of alternative payment methods (APMs); commercial and public insurance enrollment, premium, and cost-sharing trends; as well as quality of care in the Commonwealth compared to national performance. The report also contains new sections examining trends in provider and health system finances and utilization throughout the first year of the pandemic.

Findings from the report will be presented at the Health Policy Commission’s Hearing on the 2023 Health Care Cost Growth Benchmark. The annual public hearing, scheduled for Wednesday, March 16, 2022, solicits data, information, and feedback from market participants, stakeholders, and other interested parties regarding whether modification of the Health Care Cost Growth Benchmark for calendar year 2023 is necessary. Members of the state Legislature’s Joint Committee on Health Care Financing, led by Senate Chair Cindy Friedman and House Chair John Lawn Jr., will co-host the hearing alongside the HPC’s Board. The hearing will be livestreamed on the HPC’s YouTube channel.

Please hover over each icon in the graphic below for more information. Each dot represents one percent of THCE.



Key Findings from the Annual Report (March 2022)

    • THCE totaled $62.6 billion in 2020, or $8,912 per capita. This represented a decrease of 2.4% from 2019, below the health care cost growth benchmark.

    • From 2019 to 2020, spending on hospital inpatient services declined 1.8%, spending on hospital outpatient services declined 11.1%, and spending on physician services declined 12.0%; only prescription drugs and non-claims payments to providers experienced expenditure growth.

    • Overall hospital utilization declined in 2020. Both inpatient discharges and emergency department visits fell during peak periods of the COVID-19 pandemic. Hospitals also reported decreases in outpatient visits during their fiscal year 2020.

    • Between 2019 and 2020, the portion of health care spending borne by private commercial health plan members (member cost-sharing) experienced an unprecedented 17.2% decline as utilization decreased due to the COVID-19 pandemic.

    • The statewide median acute hospital total margin in HFY 2020 was 2.6%, a decrease of 0.9 percentage points in comparison to the prior fiscal year. Without COVID-19 relief funds, the median total margin would have been –4.5%.

    • There were 11.7 million nursing facility resident days in 2020, a 14% reduction in utilization compared to the prior year.

    • Premium rates in effect for 2020 were developed prior to the pandemic. The portion of premium dollars spent on non-medical expenses or that remained as surplus increased 35.4% to $85 PMPM in 2020 amid unexpectedly low utilization of health care services.

    • On selected clinical quality metrics, statewide scores were higher in 2020 than in 2018 for measures in the Behavioral Health domain, and lower for measures in the Screening and Prevention domain.

Previous CHIA Annual Reports