From the Executive Director
Welcome. Last year brought a lot of change, as COVID-19 dramatically altered our lives and workplaces. The pandemic placed unprecedented strain on our health care delivery system and challenged policymakers to craft responses in a rapidly shifting landscape. But amidst all the turmoil, one thing remained constant: the importance of reliable information.
CHIA is uniquely positioned to collect and share data that establishes the factual foundation for health policy development and performance measurement. But CHIA's work doesn't exist in a vacuum; it supports an ecosystem of policymakers, payers, providers, researchers and others striving to make health care more affordable, accessible, and higher quality.
Simply put, data matters. It's why we chose DataMatters as the name for CHIA's new newsletter. In this newsletter, we will share recent reporting highlights and put our data into a broader context. The reports and analyses you'll see are examples of our offerings, but just part of the story.
Over the past year, we've ramped up the cadence of data collection streams and reports to offer timely understanding of the impacts of the pandemic, and we're actively working to incorporate metrics of health equity into our reporting. The coming year will surely bring more changes in health care, which CHIA's data and reports will document.
Our goal is to get this information to the many stakeholders working to improve the Massachusetts health care system. We hope you'll partner with us by sharing.
News You Can Use
In May 2020, CHIA began publishing monthly Enrollment Monitoring reports to provide more timely insight into insurance coverage in Massachusetts during the COVID-19 pandemic. This visual from the current report, which covers data through December 2020, highlights the unexpected relationship between overall employment levels and employer-sponsored insurance (ESI) coverage since March 2020. Although employment fell considerably in April, these job losses were predominantly temporary and did not trigger a correspondingly large drop in ESI. However, as overall employment levels began to recover, an undercurrent of more permanent job losses during the summer began to accelerate declines in ESI coverage. This analysis underscores the importance of closely examining headline economic statistics in order to understand their potential impact on the health care system.
See here for a closer look at CHIA's insurance enrollment reporting, including the agency's traditional Enrollment Trends publications as well as the new monthly Enrollment Monitoring series, which includes analysis of MassHealth and Medicare enrollment in addition to commercial coverage.
Data User Profile
Each edition of DataMatters will showcase the work of a CHIA data user. The Massachusetts Health Policy Commission – producer of Massachusetts' Annual Health Care Cost Trends Hearing – is a primary user of several CHIA data sources. The HPC publishes a DataPoints series to spotlight new research and data findings relevant to its mission to reduce health care cost growth. For this inaugural edition, we spoke with HPC Senior Research Associate Lyden Marcellot, primary author of DataPoints Issue 19 (January 2021): "Persistently High Out-of-Pocket Costs Make Health Care Increasingly Unaffordable and Perpetuate Inequalities in Massachusetts." Please note: Responses have been lightly edited for space.
Commercial member out-of-pocket spending, 2015-2017
Massachusetts residents experiencing three years of high out-of-pocket spending (3%) spend nearly nine times more a year on average than those not experiencing persistent high out-of-pocket spending, as shown in this graphic from the HPC's recent DataPoints issue covering that topic.
What was your research question? Why did you choose that question?
LM: "What are the characteristics of commercially insured members experiencing high out-of-pocket (OOP) spending, 2015-2017?" OOP is defined as co-pay, coinsurance, and deductibles, and high spending defined as spending that places an insured person in the highest 10% of the residents studied. Access to care is very important in terms of equity, and high spending in terms of premiums and OOP costs can threaten people's access to care.
Which CHIA data did you use?
LM: APCD medical, pharmacy and enrollment files for calendar years 2015-2017.
What was your experience using CHIA data?
LM: We receive APCD, Case Mix, the Massachusetts Household Survey and Massachusetts Employer Survey every year as part of one master data use agreement with CHIA. We produce our report using Tableau and therefore there is interactivity for the user….[Our report is] bringing APCD data into a publicly available data structure.
Please briefly describe your research and a few key findings.
LM: We found that 3% of the commercially insured population exceeded our high-spending definition for all three years studied. That translates to about 120,000 Massachusetts residents. Another main finding was that [within this group], annual out of pocket spending averaged $3,247 over the three years…. These numbers are drastic. And these costs are growing over time.
LM: We also reference publicly reported Census Bureau data [in our reporting]. The upper North Shore and the Cape and Islands had the highest OOP spending. We also found higher OOP spending associated with employees of smaller firms, which is consistent with findings from CHIA's Annual Report.
On March 11th, CHIA published "Massachusetts Health Insurance Enrollment: September 2018 through September 2020." Enrollment Trends is produced every six months and includes quarterly data (e.g., for March, June, September and December) as well as data segmented by age, insurance company name, and market sector, among other factors. The current edition provides a lookback at insurance coverage trends during the first six months of the COVID pandemic.
Monthly Enrollment Monitoring
The latest edition of the monthly Enrollment Monitoring series, with data through December 2020, was released was released on March 11. The report provides an insurance enrollment data summary by market sector, offering insight into the impact of COVID-19 on health insurance coverage in Massachusetts. It shows different types of coverage changes in different sectors. See our "News You Can Use" section for a look at one key finding and visit the report page for more.
"Inside Look" Series
February 2021, March 2021
In February and early March, CHIA released the first four research notes in a six-part "Inside Look" series covering health care affordability issues in Massachusetts. The research notes released to date include: Unexpected Medical Bills are a Challenge for Many, Problems Paying Family Medical Bills are a Burden for Some, Family Spending on Health Care is High for Some and Affordability Issues are More Common in High Deductible Health Plans. Findings are derived from CHIA's 2019 Massachusetts Health Insurance Survey. The final installment will be released next month.
Financial Performance of Hospitals, Health Systems, and Physician Organizations
CHIA's quarterly report on the financial performance of the Commonwealth's acute care hospitals, associated health systems, and affiliated physician organizations provides an update on profitability, liquidity, and solvency for these entities. The scope was expanded last year in order to include the financial impact of COVID-19 on hospital health care operations.
Massachusetts Hospital Inpatient Discharge Data Summary
The Massachusetts Acute Care Hospital Inpatient Discharge Data: FFY 2016-2019 report is the first in a series documenting trends in CHIA's hospital discharge Case Mix database, a well-established database of patient encounters with acute care hospitals going back more than 20 years. The report documents hospital inpatient utilization patterns over a four-year period leading up to the outbreak of COVID-19.
Mandated Benefit Reviews
CHIA published two mandated insurance benefit reviews in January, for the proposed "Act providing coverage for hearing aids/S597" and "Act providing hearing aids for persons with sensory impairedness/S540." The reviews provide background information to the Massachusetts Legislature on the clinical efficacy and potential financial impact (on insurance companies and the insured) of proposed mandated insurance benefits. Massachusetts is one of 29 states to perform similar studies.
Executive Director Ray Campbell on Importance of Data Transparency
CHIA Executive Director Ray Campbell was featured in the Betsy Lehman Center's December 16 Patient Safety Beat reflecting on ways in which the COVID-19 pandemic underscores the importance of data transparency for quality improvement.
Upcoming Events and Resources
Health Policy Commission, Annual Benchmark Modification Hearing
March 25, 2021
CHIA Executive Director Ray Campbell will present key findings from CHIA's 2020 Annual Report on the Performance of the Massachusetts Health Care System, due out later this month, at this hearing, an annual event hosted by the Health Policy Commission at which policymakers, researchers, and health care market participants address challenges and discuss opportunities for improving care and reducing costs in Massachusetts.
CHIA Oversight Council
March 31, 2021, noon
CHIA's activities are guided by an 11- member Oversight Council with a wide range of experience and expertise in health care and related fields. The Oversight Council meets quarterly and meetings are live streamed and available as recordings on CHIA's YouTube channel. The March agenda is forthcoming.
Massachusetts Health Connector Open Enrollment
Through May 23, 2021
The Massachusetts Health Connector is the state's official Marketplace for health and dental insurance. Health Connector plans are open to any Massachusetts individuals and families who do not have access to health coverage through a job or through another program like MassHealth or Medicare. Most people applying for coverage qualify for subsidies to make it more affordable. See the Health Connector's website for more information or the Health Connector's Navigator website for help choosing the right plan.