CHIA has accomplished a lot since the last newsletter sent out in late January. We published our eighth report on Hospital-Wide Adult All-Payer Readmissions in Massachusetts, covering state fiscal years 2011 through 2021. Last week CHIA hosted its first Oversight Council meeting in 2023, which is available for viewing on CHIA’s YouTube channel. The agency also updated its enrollment trend data and filed several mandated benefit reviews with the legislature.
Earlier this month we also published this year’s Annual Report on the Performance of the Massachusetts Health Care System and presented findings from the report at the HPC’s Annual Cost Growth Benchmark Hearing. See more details on the Annual Report in the “News You Can Use” section, as well as an exciting online supplement to the report. “The Second Act: The Massachusetts Health Care System Charts a New Normal” highlights key themes from the report using new data visualizations. Read more below.
The “Data User Profile” highlights an article exploring trends in pediatric mental health emergency department (ED) visits using the MA APCD. As we do in each DataMatters, the “Publications and Data Releases” and “Upcoming Events” sections of this newsletter will keep you up to date on recent reports CHIA has released and events of interest to the local health data community.
We hope you enjoy this newsletter today and learn something new. If there’s something you enjoyed or if you have suggestions for improvement, we would appreciate your feedback at email@example.com.
News You Can Use
Earlier this month CHIA published its tenth Annual Report on the Performance of the Massachusetts Health Care System, focusing on data through 2021 — a volatile period for the Massachusetts health care system, which continued to evolve in response to the COVID-19 pandemic. CHIA’s Annual Report is the authoritative retrospective on what happened in the Massachusetts health care system in 2021. The comprehensive report explores trends in spending, utilization, and quality, as well as a new examination of behavioral health and telehealth.
Alongside the full report, CHIA has released a special online supplement that uses data visualizations to put some of the report’s key themes into a more qualitative context. “The Second Act: The Massachusetts Health Care System Charts a New Normal” explores utilization trends and the continued strain on the health care system, the emergence of new COVID-19 treatments and testing, and the adoption of telehealth as an essential part of the delivery system. Click through to learn more.
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Data User Profile
Each edition of DataMatters includes an interview with a user of CHIA data, exploring their experience using our data. Today we are diving into an article published in the Journal of Pediatrics in July 2022, which explores trends in pediatric mental health emergency department (ED) visits using the MA APCD.
Dr. Megan B. Cole, Associate Professor of Health Law, Policy, and Management at Boston University, along with Dr. Meng-Yun Lin, Dr. Jihye Kim, Dr. Christopher Sheldrick, Dr. Megan H. Bair-Merritt, Dr. Michelle P. Durham, and Dr. Emily Feinberg sought to evaluate longitudinal changes in pediatric mental health ED visits in Massachusetts—a state with a history of addressing pediatric mental health access through policy and care delivery models.
We are grateful to Dr. Cole and her co-authors for participating in this month’s newsletter.
Our primary objective was to describe longitudinal trends in pediatric emergency department (ED) visits with mental health diagnoses in Massachusetts. Our secondary objective was to characterize the nature of these trends according to diagnosis type and key patient characteristics.
About 1 in 5 children have mental health care needs, yet most children with needs are not connected to appropriate or timely mental health care. In turn, they may rely on the ED for mental health care or may end up using the ED when the underlying issue could have been otherwise managed through appropriate screening and treatment in an outpatient setting. These pediatric mental health care challenges have grown over time, as reflected by increasing rates of pediatric mental health-related ED visits across the U.S. However, Massachusetts has been a leader in pediatric mental health for nearly two decades, with a number of policies and initiatives in place that aim to improve access to pediatric mental health services. Therefore, we sought to explore whether the policy environment of Massachusetts may have led to different trends in pediatric mental health ED visits as compared to what we see nationwide.
Our research question is also foundational to our broader research study, which examines the impact of integrating mental health services into pediatric primary care at federally qualified health centers that are part of the Transforming and Expanding Access to Mental Health Care in Urban Pediatrics (TEAM UP) model. By understanding the landscape of pediatric ED use for mental health reasons, it also allows us to identify opportunities to improve access to mental health care through primary care integration, particularly for populations that we identified as having higher rates ED use for mental health reasons.
We used the 2014-2017 All-Payer Claims Database (APCD), including the medical claims and member eligibility files.
This represents one of several research papers I’ve conducted to date that use the CHIA MA APCD data. These data are an important resource, as they allow us to examine the universe of patients in Massachusetts and capture key outcomes, including health service utilization like ED visits.
The data are very large and therefore require a full team to manage them, including multiple statistical programmers, a data manager, and a team of faculty and PhD students to guide and support the process. Having a secure data storage environment with ample storage space, plus computing servers with ample processing power, are both critical for creating and managing the datasets.
Between 2013 and 2017, Massachusetts experienced a statistically significant decline in pediatric ED visits with mental health (MH) diagnoses and all-cause ED visits—the largest declines occurred within 2013, then we see somewhat stable trends thereafter. In analyses stratified by diagnosis subcategory, depressive disorder was the most common mental health diagnosis presented at pediatric MH ED visits, followed by anxiety disorder and ADHD. While trends in pediatric ED visit rates for most MH conditions declined between 2013 and 2017, rates of pediatric ED visits related to autism and suicide increased. Furthermore, in subgroup analyses, we found that although the disparity in MH-related ED visit rates between Medicaid-insured versus privately insured children narrowed during the study period, substantial disparities remained, with Medicaid-insured children being much more likely to use the ED for MH needs.
I think two findings in particular were surprising. First, the fact that overall pediatric ED use for mental health in Massachusetts deviates from national trends was somewhat surprising. While there is still unquestionably significant unmet need in pediatric mental health within Massachusetts, these data suggest that the mental health policies and resources within Massachusetts could be contributing to improved access, at least relative to other states. Second, we see lots of heterogeneity when we examine subpopulations, particularly related to autism and suicide, where we observed increases in ED visits over time. This highlights the importance of disaggregating data by clinical subgroups, as without doing so, we are unable to target groups with the greatest unmet needs.
Our findings suggest that Massachusetts’ policies and care delivery models aimed at pediatric mental may hold promise. However, there are important opportunities to improve access to MH care, as evidenced by continued reliance on the ED for MH, despite some declines over time. In particular, there are opportunities to enhance access to MH services through integration into pediatric primary care, particularly for Medicaid enrollees and children with autism or suicidal ideation, for whom MH ED rates were persistently high or increasing during our study period.
Publications and Data Releases
Annual Report on the Performance of the Massachusetts Health Care System
On March 13, CHIA released its latest Annual Report on the Performance of the Massachusetts Health Care System. The report examines trends in costs, coverage, and quality indicators to inform policymaking. This year’s Annual Report includes new sections on behavioral health, telehealth, and COVID-19 spending.
Mandated Benefit Reviews
Last week CHIA published two mandated benefit reviews, H2338/S1471 An Act Relative to Newborn Screenings for Congenital Cytomegalovirus and H2116/S1292 An Act Providing Access to Full Spectrum Addiction Treatment Services. CHIA regularly evaluates the impact of mandated benefit bills referred by the Legislature for review. The reports are comprised of a medical efficacy analysis and an estimate of the effect that the proposed mandated benefit would have on the cost of health insurance premiums.
An Act Relative to Newborn Screenings for Congenital Cytomegalovirus (cCMV) would require health insurers to cover the costs for enrollees receiving a required universal screening for cCMV at all Massachusetts hospitals and birthing facilities. An Act Providing Access to Full Spectrum Addiction Treatment Services would amend current mandated benefits laws to require insurance carriers to cover medically necessary transitional support services (TSS) for up to 30 consecutive dates without prior authorization. It would also expand coverage for acute treatment services (ATS) and medically necessary clinical stabilization services (CSS) from the currently mandated 14 days to 30 consecutive days without prior authorization.
Enrollment Trends with Data through September 2022
CHIA updated its Enrollment Trends analysis for the most recent two-year period to give researchers and policymakers insight into the market. The latest edition covers the period between September 2020 and September 2022 and includes breakouts by payers and product types in private commercial and public market sectors.
Upcoming Events and Resources
Events and announcements of interest to our community, organized by CHIA, our data partners, and others
American Public Health Association
National Public Health Week Forum
Monday, April 3, 2023 2:00 – 3:00 PM
Join the American Public Health Association (APHA) and public health leaders from across the country in discussing the intersections of public health and how public health can collaborate with community leaders to build trust and a strong foundation for healthy change. The Forum is the national kickoff for National Public Health Week (NPHW.) The theme for this year’s forum is “Centering and Celebrating Cultures in Health.” Registration details here.
Massachusetts Health Policy Commission
Wednesday, April 12, 2023, 12:00 PM
The HPC’s 11-member Board meets approximately every six weeks throughout the year to review staff- (or guest)- presented overviews of the agency’s major workstreams, and other topics related to health care cost containment and reform. Major reports, statutory regulations, and publications are authorized by a majority vote at these meetings.
Webinar Series: Keeping or Getting Coverage through MassHealth and the Health Connector
Wednesday, April 12, 2023, 12:00 PM
Beginning on April 1, MassHealth will be redetermining the eligibility of all 2.3 million MassHealth members over a 12-month timeframe. Most of those people will stay in MassHealth, but many people will no longer qualify and will need new health insurance coverage. MassHealth and the Health Connector will be co-hosting a series of public webinars to share information and resources with members who are being redetermined, and with the employer community to support their employees who may be going through the redetermination process. Join MassHealth and the Health Connector on April 12th at 12pm for “Keeping or Getting Coverage through MassHealth and the Health Connector,” the first webinar of this series focused on providing individuals and families experiencing the redetermination process with what they need to know about the process. For more information and to register for future employer focused and member focused webinars please visit: https://betterhealthconnector.com/events.
Massachusetts Association of Health Plans (MAHP) Policy Forum: MassHealth Redeterminations - What You Need to Know
Friday, April 14, 2023, 10:00 a.m. – 11:30 a.m. at UMass Club, Boston
MA MAHP will be holding a Policy Forum on MassHealth Redeterminations. The Policy Forum will have presentations and a panel discussion. Speakers include Mike Levine, Assistant Secretary for MassHealth, Audrey Gasteier, Executive Director, Massachusetts Health Connector, and Amy Rosenthal, Executive Director, Health Care for all of Massachusetts. This is an invitation only event, but please contact Ann Chamberlin at firstname.lastname@example.org if you are interested in attending.
CHIA’s Budget Hearing
Wednesday, April 19, 2023, 10:00 AM
CHIA’s Oversight Council will hold a remote public hearing on CHIA’s upcoming fiscal year 2024 budget. The purpose of this hearing is to afford all interested members of the public the opportunity to provide comments on the proposed budget for CHIA. More details here.
Department of Public Health
Public Health Council Meeting
Wednesday, April 19, 2023, 9:00 AM
The Public Health Council of the Department of Public Health promulgates regulations, advises the Department on certain major policy decisions and actions and is responsible for voting on Determination of Need applications submitted by health facilities. It meets once per month at DPH’s Boston office.
CHIA Data User Workgroups
Tuesday, April 25, 2023, 3:00 PM
These ongoing meetings are designed for data users and other interested parties to connect with CHIA to discuss analytical techniques and best practices in research using CHIA's MA APCD and Case Mix databases.
The next virtual workgroup meeting will be on Tuesday, February 28, 2023 at 3:00 p.m. For more information including past presentations and user support materials, visit the information page. To learn more about CHIA data, please visit https://www.chiamass.gov/chia-data/.
Massachusetts Health Policy Forum
“A Roadmap to Health Care Safety for Massachusetts”
Wednesday, April 26, 2023, 8:00 -11:30 AM
The Roadmap to Health Care Safety for Massachusetts, produced by a statewide consortium of policymakers, providers, payers, and patient advocates led by the Betsy Lehman Center for Patient Safety, is an innovative plan to break new ground on safety through investment and change management. At the forum, health care leaders from across the state will present the Roadmap goals and discuss immediate action steps. Please register for the free event here.
The Massachusetts Health and Hospital Association (MHA) DE&I Series for 2023
The Massachusetts Health & Hospital Association (MHA) is presenting four (4) events through its 2023 Diversity, Equity & Inclusion (DE&I) series on topics ranging from Health Equity Data and the 1115 Waiver to the Human Resources/Chief Diversity Officers Summit to LGBTQ+ Health and Wellness to Clinical Outcomes. You may register for each event separately or MHA is offering a special bundle price for the series. Click the links below for more information. If you are interested in purchasing the bundle for the DE&I Series, please contact Amy Smalarz, MHA’s Director of Healthcare Education and Professional Development, at email@example.com.
Thursday, May 11: Health Equity, Data and the 1115 Waiver (Virtual Educational Program, 9 a.m. – 12:30 p.m.)
Tuesday, May 23: Human Resources and Chief Diversity Officer Summit (In-Person Event, 8:30 a.m. – 1:30 p.m.)
Thursday, June 8: LGBTQ+ Health and Wellness/Wellbeing (Virtual Education Program, 9 – 11:30 a.m.)
Thursday, June 15: DE&I: Clinical Outcomes (In-person Event, 8:30 a.m. – 12:30 p.m.)
NASHP’s 36th Annual Conference
August 14 – August 16, 2023
The National Academy for State Health Policy (NASHP) is hosting their annual conference in Boston this year. Join state leaders from around the country to discuss issues facing state health policymakers. More details to follow. Registration opens in early May.
Massachusetts Association of Health Plans (MAHP) 2023 Annual Conference:
Health Care Affordability, Quality and Equity in a Post Pandemic World
SAVE THE DATE! Thursday, November 17, 2023, 7:30 a.m. – 2:00 p.m.
MA MAHP will be holding this year's conference at the Seaport Hotel on November 17th. Individual registrations will open in June. Please reach out to Ann Chamberlin at firstname.lastname@example.org to get information on available sponsorship opportunities.
Join Our Team
A selection of open positions at CHIA. Please feel free to share broadly with your network. Follow CHIA on LinkedIn for more regular updates.
Manager, Health Informatics and Reporting
Health Informatics and Reporting Team
Health Policy and Data Analyst
Health Informatics and Reporting Team
Software Test Engineer
Data Operations and Technology Team