DataMatters - May 2021 Edition

Data Matters Masthead

In this Issue:  


News You Can Use  

Data User Profile  


Upcoming Events and Resources  


Tolstoy once described spring as “the time of plans and projects.” Nearly 150 years later, this assessment still rings true at CHIA. Since the launch of DataMatters in March, the agency has produced several reports and data assets that provide the factual foundation for health policy development and performance measurement in Massachusetts. CHIA’s Annual Report on the Performance of the Massachusetts Health Care System, the agency’s most comprehensive picture of spending in the state’s health care economy, was released at the Health Policy Commission’s Health Care Cost Growth Benchmark Hearing. CHIA has also reported on the financial impact of COVID-19 on hospitals, profiled inpatient utilization during the pandemic, and completed a series on health care affordability issues—all of which and more we detail below.

As spring gives way to summer, CHIA will continue to plan and work to meet the needs of its stakeholders. Please let us know if there are topics you would like us to cover here in DataMatters.


News You Can Use

Newsletter THCE May 2021

CHIA’s Annual Report calculates Massachusetts’ Total Health Care Expenditures each year, based on summary data reported by commercial and public payers. In 2019, Massachusetts THCE was $64.1 billion, or about $9,300 per capita. This represented a 4.3 percent increase over the prior year, exceeding the health care cost growth benchmark, which was set at 3.1 percent by the Health Policy Commission. However, the Commonwealth’s per capita spending grew more slowly than U.S. health care spending, which rose 4.6 percent to reach $11,582 per capita in 2019 (as calculated by the Centers for Medicare and Medicaid Services).

Other notable findings from this year’s Annual Report are:

  • For the first time in several years, hospital outpatient spending was the largest component of total commercial expenditures in 2019, followed by spending on physician services.

  • Following several years of rapid growth, premiums for fully-insured plans increased 2.2% between 2018 and 2019, much slower than in the prior year (+5.7%).

  • Growth in average member cost-sharing also decelerated in 2019, rising 2.8% to $53 PMPM compared to 6.3% growth in 2018. However, there was substantial variation by market sector, with members in the merged market continuing to experience annual cost-sharing increases above 7% and paying more out of pocket, on average, than members enrolled through large employer plans.

Data User Profile

Each edition of DataMatters features an interview with a recent user of CHIA data, focusing on their experience obtaining and using the data in addition to research outcomes. We are grateful to Anna Sinaiko, PhD, and Ms. Micah B. Aaron, MPH, both of the Harvard T.H. Chan School of Public Health, who shared their experiences using CHIA’s APCD prescription drug spending dataset, which is available on the CHIA website, to inform their March 2021 JAMA Network publication, Spending and Out-of-Pocket Prices for Brand-Name Drugs Among Commercially Insured Individuals in Massachusetts, 2015-2017. Note: Responses lightly edited for space.


Newsletter JAMA Network May 2021


The above series of bar graphs from Dr. Sinaiko’s and Ms. Aaron’s recent JAMA Network publication, featuring CHIA APCD data, are the “picture is worth 1,000 words” version of their research, which found that patients spend more out of pocket on mid-priced drugs than on the highest-priced drugs.

What was your research question? Why did you choose that question?
AS: Surveys show that many people on prescription drugs find them unaffordable - but there is little evidence about what patients pay. That led to two research questions: 1) What are commercially insured individuals paying out of pocket (OOP) for their brand name drugs, and 2) Do we think current policy proposals to lower the prices of the highest priced drugs will reduce patient OOP spending? Our focus was on patient price, not overall spending.


Which CHIA data did you use?
AS: We used a dataset that CHIA derived from the APCD pharmacy claims and eligibility files [dataset released with the Commercial Prescription Drug Use & Spending, 2015-2017 report]. We wanted to focus on the commercial market because many commercial patients find their drugs unaffordable. 


What was your experience using CHIA data?

MA: The file was easy to download and use. It was pretty easily uploaded into [R statistical software]. Once the data was loaded it was ready to use – already aggregated at the year and drug level, with therapeutic class factored in.

AS: One of the advantages of using CHIA’s public use data is that we didn’t have to wait as long to begin addressing our research question. Data cleaning is such a significant process. With these data [already cleaned], we were able to move pretty quickly to the analysis.


Please briefly describe your research and a few key findings.
AS: We looked at where the majority of patient spending on drugs occurred. Our focus was on commercially insured patients and brand-name drugs. While the majority of total drug spending is on the highest price drugs, the majority of [patient OOP] spending was on mid-priced drugs.


Which findings were particularly interesting, or surprising for you?
AS: 1) The fact that OOP prices are not necessarily the highest for drugs with the highest total prices. This suggests that policy proposals to lower prices for the highest price drugs may not benefit patients in the short term. 2) OOP prices grew 43% during a time when the growth in brand name net pricing was flat. 


What "takeaway" information would you like to highlight?
AS: Policy proposals that aim to lower prices paid for the highest priced drugs will lower total spending, which could lower health insurance premiums and help [health care affordability] in the long run. But these proposals do not necessarily make higher priced drugs more affordable for patients. It is going to continue to be really important to study the medication adherence and health outcomes for patients who are paying the highest prices for their drugs.  


Financial Performance of Acute Hospitals, Health Systems, and Physician Organizations
April 2021, May 2021

CHIA published a preliminary FY2020 annual report on the financial performance of the Commonwealth’s acute care hospitals, associated health systems, and affiliated physician organizations this spring. This report provided information on profitability, liquidity, and solvency for these entities with a fiscal year end date of June 30 or September 30 (data for entities with fiscal year end dates of December 2020 was not due until after the analysis took place). The report incorporated the financial impact of COVID-19 on hospitals during fiscal year 2020. Additionally, the first FY2021 quarterly report on data through December 31, 2020 was released in May. For most entities included in this report, the data reflects first quarter results. For more information on CHIA’s acute hospital and health system financial performance reports and other hospital-related analysis, visit


"Inside Look" Series
April 2021

CHIA has released the last two installments of its six-part "Inside Look" series covering health care affordability issues in Massachusetts: The Burden of Medical Debt is a Struggle for Some and Unmet Health Care Needs Due to Cost are Still Common among the Insured. Previous installments were released earlier in the spring. The six-part series provides a detailed analysis of health care affordability issues in Massachusetts, despite a high rate of insurance coverage. Findings are derived from CHIA’s 2019 Massachusetts Health Insurance Survey.


Monthly Enrollment Monitoring
April 2021

The Monthly Enrollment Monitoring series, which was added to CHIA’s publication mix last year to offer more timely insight into the impact of COVID-19 on health insurance coverage in Massachusetts, has been released with data through February 2021. The report provides a summary of insurance enrollment by market sector (commercial, Medicare, Medicaid). 


Massachusetts Acute Care Hospital Inpatient Discharge Data Summary: Quarterly Update
April 2021

CHIA released quarterly updates on inpatient data to its new Reports on Acute Hospital Case Mix Databse series in order to provide timely trend information on inpatient utilization measures during the period leading up to, and including, the outbreak of COVID-19. The updates rely on interim data and will be revised as more complete information becomes available. They are being produced as a supplement to CHIA’s December 2020 Massachusetts Acute Care Hospital Inpatient Discharge Data (FFY 2016-2019) report. 


Annual Report on the Performance of the Massachusetts Health Care System
March 2021

CHIA’s Annual Report on the Performance of the Massachusetts Health Care System was released on March 25 at the Health Policy Commission’s Annual Benchmark Modification Hearing. The report examines trends in cost and quality indicators in the Commonwealth’s health care sector, including a preliminary calculation of Total Health Care Expenditures (THCE) for 2019 and a final calculation for 2018. Note: The Annual Report is typically released in October; the current publication was delayed as CHIA elected to extend data collection deadlines due to the COVID-19 pandemic.


Hospital Profiles
March 2021

CHIA’s Hospital Profiles for FY2019, along with the Health System Profiles feature, were released on March 19. Hospital and Health System Profiles provide descriptive and comparative information on hospitals based on hospital characteristics, services, payer mix, utilization trends, cost trends, financial performance, and quality over a five-year period. They have been produced since 2012 and include data going back to 2008. The latest edition includes interactive data and profiles which are also available as pdfs.


National Health Care Statistics
May 2021

National Health Care Statistics (NHCS), which CHIA has published since 2016, was released this week with updates including public sector and U.S. Census enrollment data. NHCS highlights U.S. and Massachusetts frequently-requested federal health care data points that are similar or related to CHIA’s own reported data points. It includes measures of health insurance enrollment, access, costs, and spending that are reported for both Massachusetts and the nation by national, non-CHIA sources.


Upcoming Events and Resources

AcademyHealth Research Meeting
June 14-17 (Virtual)
CHIA’s Director of User Support Sylvia Hobbs will chair the conference session, “Telemedicine to support patient care during the COVID-19 pandemic ,” at the 2021 research meeting of AcademyHealth next month. The session takes place on June 17 (registration required to attend). 


CHIA Oversight Council
June 22
CHIA’s activities are guided by an 11-member Oversight Council with a wide range of experience and expertise in health care, technology, and related fields. The Oversight Council meets quarterly and meetings are live streamed and available as recordings on CHIA’s YouTube channel. The June agenda is forthcoming.


Massachusetts Health Connector Lower Premiums Available Through 2022
The Massachusetts Health Connector is the state's Marketplace for health and dental insurance. Health Connector plans are open to Massachusetts individuals and families who do not already have access to affordable coverage through a job, and financial assistance is available to those who qualify. Starting immediately, additional assistance is available to Health Connector health plan members and new enrollees through the new American Rescue Plan law. Even if you already have a financial subsidy, you might receive additional help; also, those not currently receiving financial assistance may now qualify. Visit here for more information about the American Rescue Plan subsidy, who qualifies, and how to receive assistance. For information about applying for specific Health Connector plans, see links in the Open Enrollment announcement below.


Massachusetts Health Connector Open Enrollment
Through July 23, 2021
Massachusetts Health Connector Open Enrollment has been extended through July 23, 2021 in order to allow individuals to take advantage of lower premiums available as a result of the American Rescue Plan law (see above). See the Health Connector’s website for more information or the Health Connector Navigator website for help choosing the right plan.



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