Highlighted in this issue of DataMatters is CHIA’s report on the quarterly financial performance of Massachusetts hospitals and health systems, with data through June 30, 2022. Read the “News You Can Use” section for key findings. In this month’s “Data User Profile” we explore whether Medicaid expansion in Massachusetts changed coverage continuity for child Medicaid enrollees entering young adulthood.
Last week, CHIA released it first-ever report on primary care and behavioral health expenditures in Massachusetts. This report covers data for calendar years 2019 and 2020, including data from the onset of the COVID-19 pandemic. To better understand the Commonwealth’s investments in primary care and behavioral health, CHIA launched a new report series that examines spending on these services in Massachusetts. To read the report and see key findings, click here.
The “Publications and Data Releases” and “Upcoming Events” sections of DataMatters will, as always, keep you up to date on reports CHIA has released recently and events of interest to the local health data community.
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News You Can Use
This issue of DataMatters highlights the latest quarterly acute hospital and health system financial performance report with data through June 30, 2022. Each quarter CHIA publishes this report on the profitability, liquidity, and solvency of hospital health systems and their affiliated acute hospitals, as well as the profitability of affiliated physician organizations. CHIA additionally reports on the annual financial performance of acute care hospitals in the Commonwealth (see below in the newsletter for the most recent FY 2021 report).
This edition of the quarterly report includes 59 of the 61 acute hospitals. Cambridge Health Alliance and Trinity Health are not included in this report as they have a June 30 fiscal year end and as such, their data is not due until October.
Data User Profile
In this month’s edition of DataMatters, we interviewed Dr. Vicki Fung, Associate Professor of Medicine at Harvard Medical School and Investigator at the Mongan Institute for Health Policy, Massachusetts General Hospital. We are grateful to Dr. Fung for speaking with us about her experience using CHIA data.
Changes in Insurance Coverage Continuity After Affordable Care Act Expansion of Medicaid Eligibility for Young Adults With Low Income in Massachusetts uses CHIA’s Massachusetts All-Payer Claims Database (MA APCD) to explore whether Medicaid expansion in Massachusetts changed coverage continuity for child Medicaid enrollees entering young adulthood.
We examined the impact of expanding eligibility for Medicaid in Massachusetts in 2014 on insurance coverage continuity for young adults in Massachusetts. Young adults have historically the highest uninsured rates among all age groups. Moreover, prior to the Affordable Care Act (ACA), children who were entering adulthood may have been particularly likely to face gaps in insurance coverage as they aged out of Medicaid eligibility. Therefore, we examined changes in insurance enrollment patterns for Medicaid enrollees as they transitioned between ages 18-21 years old before and after the ACA Medicaid expansion.
We used the Massachusetts All-Payer Claims Database (APCD), release 6.0, which covered years 2012-2016.
In contrast to prior studies that have examined these questions, the advantage of using the APCD was that it provides individual-level and longitudinal data on insurance coverage. This allowed us to capture movement in and out of Medicaid to other types of insurance coverage, including employer-sponsored or individual market commercial coverage, and quantify potential gaps in insurance coverage and time spent under each type of coverage at different ages both before and after Medicaid expansion.
There is no direct measure of whether someone was uninsured, thus, we defined periods of being uninsured as months without documented insurance coverage in the eligibility file. However, this could overestimate uninsured rates if, for example, individuals in the cohort moved out of state or died. For this reason, we focused on differences in uninsured rates between the post- vs. pre-expansion cohorts as we did not expect movement out of the state to differ across these time periods. We also faced some related challenges due to the loss of data from some self-funded employer plans in 2016 and conducted sensitivity analyses to address these concerns.
We found that among individuals with Medicaid at age 18, the likelihood of being uninsured for at least three months was significantly lower at ages 19 and 20 years old, after vs. before Medicaid expansion (between an 18 and 22 percentage point difference). Similarly, the likelihood that individuals maintained continuous insurance coverage for at least 12 or 24 months during their transition to adulthood also increased significantly post- vs. pre-expansion, suggesting that this policy helped smooth fluctuations in insurance coverage during this period. These findings were similar for individuals with mental health diagnoses at baseline, which could have important implications regarding whether these individuals were able to maintain access to mental health treatment.
In both the pre- and post-expansion cohorts, we found over twenty percent of individuals at age 20-21 had at least three months without insurance coverage. While we should be cautious interpreting the exact magnitude of our estimates (as noted above, these could include some individuals who moved out of state or died), the trends suggest that as individuals aged from 18-21, there was a declining likelihood of having continuous insurance coverage. Work is needed to understand and address the reasons for potential increases in the likelihood of being uninsured at these ages, such as changes in eligibility or redetermination requirements.
The key takeaway from our study is that Medicaid expansion in Massachusetts was associated with reductions in the likelihood of becoming uninsured for child Medicaid enrollees entering adulthood, largely owing to increases in Medicaid coverage.
The APCD was a valuable dataset with which to examine this question since it allowed us to follow individuals’ changes in insurance coverage over time before and after the implementation of Medicaid expansion.
Publications and Data Releases
NEW! FY 2021 Annual Hospital and Health System Financial Performance Report
Today CHIA released its latest Annual Hospital and Health System Financial Performance Report for fiscal year (FY) 2021. This publication reports on the profitability, liquidity, and solvency of hospital health systems and their affiliated acute hospitals, as well as the profitability of affiliated physician organizations and health plans.
It also includes a comparison of the performance of four hospital cohorts (academic medical centers, teaching, community, and community-high public payer) on each metric over a five-year period, fiscal years 2017 through 2021. CHIA is also releasing with this report an interactive dashboard containing information on five-year trend analyses for each acute hospital and their hospital health system. This report is also accompanied by the databook used to calculate these metrics and a technical appendix.
Primary Care and Behavioral Health Report
Last week, CHIA published its first report on primary care and behavioral health expenditures in Massachusetts. This report covers data for calendar years 2019 and 2020, including data from the onset of the COVID-19 pandemic. This report offers policymakers and stakeholders valuable baseline data that can be used to track the Commonwealth’s investments in these essential areas.
Upcoming Events and Resources
Events and announcements of interest to our community, organized by CHIA, our data partners, and others
Department of Public Health
Public Health Council Meeting
Wednesday, October 12, 2022, 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 Determination of Need applications submitted by health facilities. It meets once per month at DPH’s Boston office.
CHIA Data User Workgroups
Tuesday, October 25, 2022, 3:00 p.m.
CHIA hosts monthly, public workgroups as opportunities for users of the APCD and Case Mix databases to meet with CHIA’s in-house data experts to discuss analytical techniques and data questions. Meetings alternate between APCD and Case Mix; the next workgroup, focusing on APCD data, will be hosted on Zoom, Tuesday, October 25 at 3 p.m. For more information or to register, visit the information page.
National Association of Health Data Organizations (NAHDO)
37th Annual Conference - Putting Healthcare Data to Work
Virtual Sessions October 25 through October 27, 2022
Once again, the NAHDO annual conference is completely virtual this year, and also includes several pre-conference events, starting October 5. The conference will focus on several themes this year, including health equity and disparities, data governance as it related to protection patient privacy, data linkage, among several others. Registration began on July 8.
Massachusetts Association of Health Plans (MAHP) Annual Conference Health Care 2022
– Challenges and Opportunities in the Years Ahead
Thursday, November 17, 2022, 7:30 a.m. – 2:00 PM
MAHP 2022 Annual Conference has sold out! Anyone interested in being added to the waitlist should email Jessica Lussier at firstname.lastname@example.org. Individuals from the waitlist are often able to register as the date of the conference draws closer.
Michael Osterholm, PhD, MPH, epidemiologist and COVID-19 Expert and Director of the Center for Infectious Disease Research and Policy will offer keynote remarks. Dr. Mallika Marshall, MD, Medical Reporter for WBZ 4, CBS News Boston, will serve as Master of Ceremonies.
CHIA Oversight Council
Tuesday, December 6, 2022, 2:00 PM
CHIA’s appointed Oversight Council meets quarterly to discuss agency priorities and agenda-setting. The next meeting is scheduled for Tuesday, December 6, at 2:00 p.m. and will stream live on CHIA’s YouTube channel.
Massachusetts Health Policy Commission
Wednesday, December 14, 2022, 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.
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.
Health Policy and Data Analyst
Health Informatics and Reporting
Strategy and Research Team
Data Quality Analyst
Data Operations and Technology