CHIA Standard Statistics

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This page was last updated: March 13, 2023.

CHIA maintains a set of standard statistics that measure the performance of the Massachusetts health care system. The information in the tables below is derived from CHIA's unique data sets or other Massachusetts-specific reliable sources. The standard statistics information has two focus areas:

Spending and Insurance Coverage

Massachusetts Provider Utilization and Performance

Spending and Insurance Coverage

Measure		Current Data	Antecedent Data	Prior Data

Total Health Care Expenditures (THCE) (Learn More)		$67.9 billion in 2021 $9,715 per capita +9.0% from 2020 (exceeds health care benchmark) Note: 3.2% annualized from 2019 to 2021	$62.6 billion in 2020 $8,912 per capita -2.3% from 2019 (below health care benchmark)	$63.0 billion in 2019 $9,130 per capita +4.1% from 2018 (exceeds health care benchmark)

Total Medical Expenses for Commercially-Insured Members (Learn More)		$592 PMPM in 2020 +16.1% from CY2020 to CY2021	$510 PMPM in 2020 -1.9% from CY2019 to CY2020	$522 PMPM in 2019 +3.6% from CY2018 to CY2019

Insurance Rate of Massachusetts Residents (Learn more)		97.6 % in 2021	97.1% in 2019	96.3% in 2016

Percent of Massachusetts Employers Offering Health Insurance (Learn More)		74% in 2021	71% in 2018	65% in 2016

Average Cost of Commercial Coverage (Learn More)	Fully-Insured Premiums	$563 PMPM in 2021 +6.6% from CY2020 to CY2021	$529 PMPM in 2020 +2.6% from CY2019 to CY2020	$516 PMPM in 2019 +2.3% from CY2018 to CY2019

Commercial Health Insurance Benefit Levels (Paid-to-Allowed Claims Ratio) (Learn More)	Fully- and Self-Insured	0.895 in 2021	0.897 in 2020	0.885 in 2019
	Fully-Insured	0.880 in 2021	0.888 in 2020	0.873 in 2019
	Self-Insured	0.908 in 2021	0.905 in 2020	0.894 in 2019

Average Commercial Member Cost-Sharing Level (Learn More)	Fully- and Self-Insured	$58 PMPM in 2021 +16.9% from CY2020 to CY2021	$49 PMPM in 2020 -15.7% from CY2019 to CY2020	$59 PMPM in 2019 +3.9% from CY2018 to CY2019
	Fully-Insured	$69 PMPM in 2021 +23.3% from CY2020 to CY2021	$56 PMPM in 2020 -15.9% from CY2019 to CY2020	$66 PMPM in 2019 +6.5% from CY2018 to CY2019
	Self-Insured	$50 PMPM in 2021 +11.6% from CY2020 to CY2021	$45 PMPM in 2020 -15.4% from CY2019 to CY2020	$54 PMPM in 2019 +2.0% from CY2018 to CY2019

Enrollment in Health Insurance (Learn More)	Private Commercial	3,916,305 in Sept. 2021 (-0.9% Sept. 2020 to Sept. 2021)	3,937,651 in Sept. 2020 (-2.3% Sept. 2018 to Sept. 2020)	4,055,344 in Sept. 2018 (-0.7% Sept. 2017 to Sept. 2018)
	MassHealth (Direct)	1,419,611 in Sept. 2021 (+9.6% Sept. 2020 to Sept. 2021)	1,287,493 in Sept. 2020 (+3.5% Sept. 2018 to Sept. 2020)	1,237,091 in Sept. 2018 (-1.0% Sept. 2017 to Sept. 2018)
	SCO, One Care, PACE	104,863 in Sept. 2021 (+7.9% Sept. 2020 to Sept. 2021)	98,365 in Sept. 2020 (+18.8% Sept. 2018 to Sept. 2020)	82,817 in Sept 2018 (+13.8% Sept. 2017 to Sept. 2018)
	Medicare	1,140,586 in Sept. 2021 (+1.4% Sept. 2020 to Sept. 2021)	1,128,063 in Sept. 2020 (+2.8% Sept. 2018 to Sept. 2020)	1,097,691 in Sept. 2018 (+1.5% Sept. 2017 to Sept. 2018)

Percent of Members Whose Care is Covered by Alternative Payment Methods (Learn More)	Commercial	40.1% -0.6 pp from CY2020 to CY2021	40.7% -0.2 pp from CY2019 to CY2020	40.93% -0.9 pp from CY2018 to CY2019
	MassHealth MCOs	87.2% +0.5 pp from CY2020 to CY2021	86.8% +2.8 pp from CY2019 to CY2020	84.5% +17.1 pp from CY2018 to CY2019

Massachusetts Provider Utilization and Performance

Measure	Current Data	Antecedent Data	Prior Data

Total Number of Inpatient Discharges (Learn More)	749,443 in FY2020 -7.5% from FY2019 to FY2020	810,357 in FY2019 -0.4% from FY2018 to FY2019	813,618 in FY2018 -0.2% from FY2017 to FY2018

Most Frequent Inpatient Discharges by Diagnostic Related Group (DRG) (Learn More)	FY20 Normal Neonate Births (57,875 / -4.5.%) Vaginal Delivery (43,941 / -2.0%) Septicemia & Infections (36,364 / +2.7%) Heart Failure (24,127 / -12.9%) Cesarean Delivery (21,388 / +0.5%)	FY19 Normal Neonate Births (60,625 / -0.2%) Vaginal Delivery (44,843 / -1.1%) Septicemia & Infections (35,425 / +0.2%) Heart Failure (27,700 / +3.0%) Cesarean Delivery (21,286 / -2.2%)	FY18 Normal Neonate Births (60,761 / -0.8%) Vaginal Delivery (45,348 / -1.3%) Septicemia & Infections (35,371 / +6.0%) Heart Failure (26,893 / +4.0%) Cesarean Delivery (21,757 / -0.3%)

Statewide Number of Emergency Department Visits (Learn More)	2,571,277 in FY2020	3,150,303 in FY2019	3,146,507 in FY2018

Statewide Unplanned Readmission Rate (Learn More)	15.9% in 2020	15.4% in 2018	15.4% in 2017

Median Hospital Total Margin (Statewide) (Learn More)	2.6% in 2020	3.5% in 2019	4.5% in 2018

Relative Price Statewide Relative Price (S-RP) Results (Learn More) Note: RP values are not comparable year to year.	CY2019 Range of S-RP Values: 0.717–1.870 Median S-RP: 0.920	-	-