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8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Health Policy Commission | 0
f
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Health Policy Commission | 1
What is the role of the Health Policy Commission?
Chapter 224 sets the ambitious goal of bringing health care spending growth in line with growth inChapter 224 sets the ambitious goal of bringing health care spending growth in line with growth inChapter 224 sets the ambitious goal of bringing health care spending growth in line with growth inChapter 224 sets the ambitious goal of bringing health care spending growth in line with growth in
the states oerall economy! "he Commission is wor#ing to adance this goal by$the states oerall economy! "he Commission is wor#ing to adance this goal by$the states oerall economy! "he Commission is wor#ing to adance this goal by$the states oerall economy! "he Commission is wor#ing to adance this goal by$
%ostering reforms to the health care payment system that aim to reward &uality care' improe
health outcomes' and more efficiently spend health care dollars
Promoting innoatie deliery models that will enhance care coordination' adance integration
of behaioral and physical health serices' and encourage effectie patient(centered care
)nesting in community hospitals and other proiders to support the transition to new payment
methods and care deliery models
)ncreasing the transparency of proider organi*ations and assessing the impact of health care
mar#et changes on the cost' &uality' and access of health care serices in +assachusetts
,naly*ing and reporting of cost trend through data e-amination and an annual public hearing
process to proide accountability of the health care cost(containment goals set forth by Chapter
224
.aluating the prealence and performance of initiaties aimed at health system transformation
.ngaging consumers and businesses on health care cost and &uality initiaties
Partnering with a wide range of sta#eholders to promote informed dialogue' recommend
eidence(based policies' and identify collaboratie solutions
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Health Policy Commission | 2
/oals for our annual report
"he Commission releases an annual cost trends report' intended to proide$"he Commission releases an annual cost trends report' intended to proide$"he Commission releases an annual cost trends report' intended to proide$"he Commission releases an annual cost trends report' intended to proide$
, profile of the +assachusetts health care deliery system
,n eidence(based discussion of trends in +assachusetts health care costs' leeraging new
data sets such as the ,ll(Payer Claims atabase
,nalysis of driers of growth' including factors leading the states growth to be aboe or
below the benchmar# set by Chapter 224
, fact base to inform the other actiities of the Commission' as well as the broader policy
discussion in +assachusetts
eep dies into specific cost driers in +assachusetts' including$
"opics of #nown importance that can be addressed with new or state(specific data
"opics that hae been insufficiently studied or ealuated
"opics where a comprehensie discussion integrating eidence from multiple sourcescan better inform policy dialogue
Thisyearsannualreportdoesnotmeasurecostgrowthagainstthebenchmarkestablishedin
Chapter224.Thebenchmarkwillbereviewedbeginningin2014.
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Health Policy Commission |
"opics in the 201 cost trends report
201 cost201 cost201 cost201 cost
trends reporttrends reporttrends reporttrends report
"rends in
spending
"he +,
deliery
system
uality
and
access
3eels of
spending
Profile ofProfile ofProfile ofProfile of
+assachusetts+assachusetts+assachusetts+assachusetts
eepeepeepeep((((diesdiesdiesdies Hospital
operating
e-penses
Wasteful
spending
High(cost
patients
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Health Policy Commission | 4
Hospital
operating
e-penses
Wasteful
spending
High(cost
patients
eepeepeepeep((((diesdiesdiesdies
"opics in the 201 cost trends report
"rends in
spending
"he +,
deliery
system
uality
and
access
3eels of
spending
201 cost201 cost201 cost201 cost
trends reporttrends reporttrends reporttrends report
Profile ofProfile ofProfile ofProfile of
+assachusetts+assachusetts+assachusetts+assachusetts
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
6/38Health Policy Commission |
Health care spending as a proportion of the +assachusetts economy
rose oer the last decade' but declined from 2005(2012
6 Personal health care e-penditures 7PHC8 are a subset of national health e-penditures! PHC e-cludes administration and the net cost of priate insurance' public health
actiity' and inestment in research' structures and e&uipment!
9999 +easured as gross domestic product 7/P8 for the :!;! and gross state product 7/;P8 for +assachusetts
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
7/38Health Policy Commission | @
1@!AB 1@!@B
1!1B
11!B
10B
11B
12B
1B
14B
1B
1@B
1CB
1AB
15B
20B
1550 1552 1554 155@ 155A 2000 2002 2004 200@ 200A 2010 2012
1!2B
12!B
12!AB12!5B
Profile of +assachusetts health care spending1111 2222
4444
1111
3eels of spending$3eels of spending$3eels of spending$3eels of spending$ what e-plains the
difference in +assachusetts spending
relatie to the :!;! aerage?
2222
"rends in spending"rends in spending"rends in spending"rends in spending$$$$ what contributed to
the growth in +assachusetts health care
spending oer the past two decades?
"he +assachusetts deliery system"he +assachusetts deliery system"he +assachusetts deliery system"he +assachusetts deliery system$$$$ how do
characteristics of the states deliery systemcontribute to spending leels and trends?
4444
uality and accessuality and accessuality and accessuality and access$$$$ how does
+assachusetts perform compared to the:!;! on measures of &uality and access?
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Profile of +assachusetts health care spending
1111
3eels of spending$3eels of spending$3eels of spending$3eels of spending$ what e-plains the
difference in +assachusetts spending
relatie to the :!;! aerage?
1111 2222
4444
1@!AB1@!AB1@!AB1@!AB 1@!@B
1!1B
11!B
10B
11B
12B
1B
14B
1B
1@B
1CB
1AB
15B
20B
1550 1552 1554 155@ 155A 2000 2002 2004 200@ 200A 2010 2012
1!2B1!2B1!2B1!2B
12!B
12!AB12!5B
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
9/38Health Policy Commission | A
Per capita health care spending in +assachusetts is the highest of
any state
D'524D@'2A
D@'C@DC'0C@
DC'C0
DA'41
D5'2CA
D@'A1
+,+,+,+, =E=E=E=E )3)3)3)3FHFHFHFHP,P,P,P,:!;!:!;!:!;!:!;! "G"G"G"GC,C,C,C,
;tate ran# 1 @ 10 1A 2A 42 4
"otaled 1@!A percent1@!A percent1@!A percent1@!A percent
of the +assachusettseconomy in 2005
"otaled 1!21!21!21!2
percentpercentpercentpercent of the :!;!
economy in 2005
6666 Personal health care e-penditures 7PHC8 are a subset of national health e-penditures! PHC e-cludes administration and the net cost of priate insurance' public health
actiity' and inestment in research' structures and e&uipment!
;ource;ource;ource;ource$$$$ Centers for +edicare and +edicaid ;erices> ureau of .conomic ,nalysis> HPC analysis
Per capita personal health care e-penditures6Per capita dollars' 2005
1111 2222
4444
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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%actor%actor%actor%actor+, compared+, compared+, compared+, compared
to :!;!to :!;!to :!;!to :!;!
.ffect on.ffect on.ffect on.ffect on
spendingspendingspendingspending
,ge Flder
Coerage and
access
roader
insurance
coerage
)nput costs9Higher
input costs
;pending differs significantly between +assachusetts and the :!;!'
een after adusting for certain factors
20B
ifference in per capita
spending between +, and :!;!
1@B
.stimated
contribution of
certain factors
Iemaining
difference in
spending
between +, and:!;! )ncrease
)ncrease
)ncrease
6 Personal health care e-penditures 7PHC8 are a subset of national health e-penditures! PHC e-cludes administration and the net cost of priate insurance' public health
actiity' and inestment in research' structures and e&uipment!
9999 ased on the +edicare /eographic ,dustment %actor 7/,%8' which adusts for wages' office rents' supplies' and medical malpractice insurance premiums!
;ource;ource;ource;ource$$$$ Centers for +edicare and +edicaid ;erices> +edical .-penditure Panel ;urey> Census ureau> ;mith ;' =ewhouse JP' %reeland +;!Health!!airs! 2005> Hadley
J' Holahan J! Health!!airs! 200> HPC analysis
ifference in per capita personal health care e-penditures between +assachusetts and the :!;!6Percent of :!;! per capita personal health care spending' 2005 dollars
1111 2222
4444
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Ferall$Ferall$Ferall$Ferall$ +assachusetts spends more than the :!;! aerage across
all categories' but especially in hospital care and long(term care
Professional
serices HPC analysis
per capita
difference
Per capita personal health care e-penditures6ollars' 2005
1111 2222
4444
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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+edicare+edicare+edicare+edicare$ all +assachusetts spending aboe the :!;! aerage is in
hospital care and long(term care
(D45(D21
(D15
Hospital care
KDA20
+edical durablesrugs and other
medical non(
durables
Professional
serices HPC analysis
Per beneficiary personal health care e-penditures6ollars' 2005
1111 2222
4444
per beneficiary
difference
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Health Policy Commission | 14
higher
"actorse#plainingdi!!erenceinclude$
ifferences in demographics and income
roader categories of eligibility
+edicaid$+edicaid$+edicaid$+edicaid$ differences in spending are drien by breadth of benefits'
reimbursement leels' and enrollment
6 Personal health care e-penditures 7PHC8 are a subset of national health e-penditures! PHC e-cludes administration and the net cost of priate insurance' public health
actiity' and inestment in research' structures and e&uipment!
9 %igure is based on 200A data for +edicaid fee(for(serice 7%%;8 programs> "ennessee e-cluded from analysis since the state does not hae a +edicaid %%; program!
Comparable figure for 2012 is 21B!
;ource;ource;ource;ource$$$$ Centers for +edicare and +edicaid ;erices> Maiser %amily %oundation> "he :rban )nstitute> HPC analysis
1111 2222
4444
1@!B
+,:!;!
20!B
Iesidents enrolled in +edicaidPercent of population' 2005
+,
D@'A2@ DA'2A
:!;!higher
"actorse#plainingdi!!erenceinclude$
Health status of enrollees
readth of benefits
Higher +assHealth reimbursement ratesrelatie to national +edicaid aerage 7e!g!' 0B
higher on physician serices98
.-penditures per +edicaid enrollee6
ollars' 2005
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Health Policy Commission | 1
Ferall$Ferall$Ferall$Ferall$ hospital utili*ation is higher in +assachusetts than the :!;!
aerage' especially for outpatient serices
+,+,+,+, :!;!:!;!:!;!:!;! ifference 7B8ifference 7B8ifference 7B8ifference 7B8
Hospitalinpatient
)npatient admissions 7inde-ed to :!;!' age(adusted8 1!10 1!00 10B10B10B10B
)npatient aerage length(of(stay !0 !4 (B
)npatient days @1 @00 B
)npatient surgeries6 2 2 0B
Hospitaloutpatient9
.mergency department 7.8 isits 4@A 41 1B
Futpatient isits' e-cluding . 2'50 1'@51 2B2B2B2B
Futpatient surgeries6 1 @ 2B
6666 %igures for inpatient and outpatient surgeries are from 2010
9999 Futpatient hospital isits include all clinic isits' referred isits' obseration serices' outpatient surgeries' and emergency department isits
;ource;ource;ource;ource$$$$ Maiser %amily %oundation> ,merican Hospital ,ssociation> +edical .-penditure Panel ;urey> HPC analysis
+easures of hospital serice utili*ationPer 1'000 population' 2011 e-cept where noted
1111 2222
4444
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Health Policy Commission | 1@
Ferall$Ferall$Ferall$Ferall$ in addition to higher utili*ation' +assachusetts has higher
prices than the :!;! aerage across all payer types
/enerally' price differences/enerally' price differences/enerally' price differences/enerally' price differences
may include two factors$may include two factors$may include two factors$may include two factors$
:nit prices:nit prices:nit prices:nit prices$ the fee
schedules established
between payers and
proiders
Proider mi-Proider mi-Proider mi-Proider mi-$ whether
consumers choose to
receie their care in
higher(price or lower(
price settings
+assachusetts prices relatie to :!;! aeragePrice inde-' 200(05
;ource$;ource$;ource$;ource$ Centers for +edicare and +edicaid ;erices> Maiser %amily %oundation> "he :rban )nstitute> ,nalysis by Chapin White of a report from the 155(2005 "ruen
Health ,nalytics +ar#et;canN Commercial Claims and .ncounters atabase 7copyright O 2011 "ruen Health ,nalytics' all rights resered8> Harard :niersity
research conducted for )nstitute of +edicine> HPC analysis
1111 2222
4444
.stimate.stimate.stimate.stimate of priceof priceof priceof price
relatie to :!;!relatie to :!;!relatie to :!;!relatie to :!;! ,ailable,ailable,ailable,ailable eidenceeidenceeidenceeidence
+edicare+edicare+edicare+edicare ,boe :!;! aerage
,nalysis by C+; using standardi*ed prices
+ethod includes the effect of both unit prices and
proider mi-
ata for 2005
+assHealth+assHealth+assHealth+assHealth ,boe :!;! aerage
,nalysis by M%% based on surey of state
reimbursement leels for physician serices
+ethod only includes the effect of unit prices
ata for 200A
CommercialCommercialCommercialCommercial ,boe :!;! aerage
,nalysis by researchers on national commercial
data from large' multi(state employers
+ethod includes the effect of both unit prices andproider mi-
ata for 200(2005
8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report
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Health Policy Commission | 1
oth utili*ation differences and price differences factor into
+assachusetts spending aboe the :!;! aerage
3eels of spending3eels of spending3eels of spending3eels of spending
PePePePer capitar capitar capitar capita
sssspendingpendingpendingpending
@B higher than national aeragehigher than national aeragehigher than national aeragehigher than national aerage
:tili*ation:tili*ation:tili*ation:tili*ation
Higher utili*ationHigher utili*ationHigher utili*ationHigher utili*ation for state as a whole$
- )npatient 7age(adusted8$ 10B higher
- Hospital outpatient$ 2B higher
FerallFerallFerallFerall +edicare+edicare+edicare+edicare utili*ation comparableutili*ation comparableutili*ation comparableutili*ation comparable to
national aerage' although differences may
e-ist for particular categories of serice
PricePricePricePrice
=ational claims data sets suggest ccccommercialommercialommercialommercial
pricespricespricesprices are higherhigherhigherhigher than national aerages
+edicare prices+edicare prices+edicare prices+edicare prices are A percent higherhigherhigherhigher' drienby wage and teaching adustments
+edicaid unit prices+edicaid unit prices+edicaid unit prices+edicaid unit prices for physician serices are
0 percent higherhigherhigherhigher than national aerages
;ource$;ource$;ource$;ource$ Centers for +edicare and +edicaid ;erices> ,merican Hospital ,ssociation> Maiser %amily %oundation> "he :rban )nstitute> ,nalysis by Chapin White of a report
from the 155(2005 "ruen Health ,nalytics +ar#et;canN Commercial Claims and .ncounters atabase 7copyright O 2011 "ruen Health ,nalytics' all rights
resered8> Harard :niersity research conducted for )nstitute of +edicine> HPC analysis
1111 2222
4444
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Health Policy Commission | 1A
Profile of +assachusetts health care spending
"rends in spending"rends in spending"rends in spending"rends in spending$$$$ what contributed to
the growth in +assachusetts health care
spending oer the past two decades?
2222
1111 2222
4444
1@!AB1@!AB1@!AB1@!AB 1@!@B1@!@B1@!@B1@!@B
1!1B
11!B
10B
11B
12B
1B
14B
1B
1@B
1CB
1AB
15B
20B
1550 1552 1554 155@ 155A 2000 2002 2004 200@ 200A 2010 2012
12!AB12!AB12!AB12!AB
1!2B
12!B
12!5B
11 22
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Health Policy Commission | 15
(@ pp
(4 pp
(2 pp
0 pp
2 pp
4 pp
@ pp
A pp
11(12
05(10
0(0A
0(0@
0(04
01(02
55(00
5(5A
5(5@
5(54
51(52
;lower health care growth in the 1550s was followed by faster
growth in the 2000s
Health care spending grew
slower than the economy
Health care spending grewfaster than the economy
:!;!
+, 7estimated8 ureau of .conomic ,nalysis> HPC analysis
=i-on .-ecutie
Frder free*ing
prices and wages
Health care industry
oluntary effort on
cost containment
)ntroduction of
+edicare I/
payment system
Iise of
managed care
plans
1111 2222
4444
1111 2222
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Health Policy Commission | 21
%rom 2001 to 2005' the difference between +assachusetts and
the :!;! grew
D0
D2'000
D4'000
D@'000
DA'000
D10'000
2005200200200200115551551551551551
+, per
capita PHC
:!;! per
capita PHC
differencedifferencedifferencedifference
in 2001in 2001in 2001in 2001
differencedifferencedifferencedifference
in 2005in 2005in 2005in 2005
percentage point growth in gappercentage point growth in gappercentage point growth in gappercentage point growth in gap
between +, and :!;! 701between +, and :!;! 701between +, and :!;! 701between +, and :!;! 701((((058058058058
ifference between +assachusetts and :!;! per capita personal health care e-penditures6Percent difference from national aerage
6 Personal health care e-penditures 7PHC8 are a subset of national health e-penditures! PHC e-cludes administration and the net cost of priate insurance' public health
actiity' and inestment in research' structures and e&uipment!
;ource$;ource$;ource$;ource$ Centers for +edicare and +edicaid ;erices> ureau of .conomic ,nalysis> Center for Health )nformation and ,nalysis> +assHealth> Census ureau> HPC analysis
1111 2222
4444
1111 2222
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Health Policy Commission | 22
Commercial prices were the primary drier of the increased
difference from the :!;! aerage
3eels of spending "rend from 2001 to 2005"rend from 2001 to 2005"rend from 2001 to 2005"rend from 2001 to 2005
PePePePer capitar capitar capitar capita
sssspendingpendingpendingpending
@B higher than national aerage ifference between +assachusetts and the
national aerage grew by 10 percentage pointsgrew by 10 percentage pointsgrew by 10 percentage pointsgrew by 10 percentage points
:tili*ation:tili*ation:tili*ation:tili*ation
Higher utili*ation for state as a whole$
- )npatient 7age(adusted8$ 10B higher
- Hospital outpatient$ 2B higher
Ferall +edicare utili*ation comparable to
national aerage' although differences may
e-ist for particular categories of serice
Hospital utili*ation grew at appro-imately the
same rate as national aeragesame rate as national aeragesame rate as national aeragesame rate as national aerage
PricePricePricePrice
=ational claims data sets suggest commercial
prices are higher than national aerages
+edicare prices are A percent higher' drienby wage and teaching adustments
+edicaid unit prices for physician serices are
0 percent higher than national aerages
Commercial hospitalCommercial hospitalCommercial hospitalCommercial hospital inpatientinpatientinpatientinpatient pricespricespricesprices grew 10
percentage points relatie to national aeragerelatie to national aeragerelatie to national aeragerelatie to national aerage
;ource$;ource$;ource$;ource$ Centers for +edicare and +edicaid ;erices> ,merican Hospital ,ssociation> Maiser %amily %oundation> "he :rban )nstitute> ,nalysis by Chapin White of a report
from the 155(2005 "ruen Health ,nalytics +ar#et;canN Commercial Claims and .ncounters atabase 7copyright O 2011 "ruen Health ,nalytics' all rights
resered8> Harard :niersity research conducted for )nstitute of +edicine> HPC analysis
1111 2222
4444
1111 2222
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Health Policy Commission | 2
%rom 2005 to 2012' growth rates slowed in line with the :!;!
/rowth in personal health care e-penditures relatie to growth in economy6Per capita compound annual growth rate
@!B
!B
2!5B2!AB
:!;! +,
/;P/P growth
Personal health care e-penditure growth
!1B!1B
!CB
!2B
+,:!;!
2001200120012001 (((( 2005200520052005 2005200520052005 (((( 2012 7estimated82012 7estimated82012 7estimated82012 7estimated8 9999
1111 2222
4444
6 Personal health care e-penditures 7PHC8 are a subset of national health e-penditures! PHC e-cludes administration and the net cost of priate insurance' public health
actiity' and inestment in research' structures and e&uipment!
9999 C+; state(leel personal health care e-penditure data hae only been published through 2005! 2010(2012 +, figures were estimated based on 2005(2012 e-penditure
data proided by C+; for +edicare' ,=% budget information statements and e-penditure data from +assHealth' and CH), "+. reports for commercial payers!
;ource$;ource$;ource$;ource$ Centers for +edicare and +edicaid ;erices> ureau of .conomic ,nalysis> Center for Health )nformation and ,nalysis> +assHealth> Census ureau> HPC analysis
1111 2222
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Health Policy Commission | 24
Fur focus is on statewide' per capita growth
What is the benchmar#What is the benchmar#What is the benchmar#What is the benchmar#
measured against?measured against?measured against?measured against?
.stimates of per capita per.stimates of per capita per.stimates of per capita per.stimates of per capita per
member medical trendmember medical trendmember medical trendmember medical trend6666
in 2005in 2005in 2005in 2005((((12121212
+edicare
+assHealth
Commercial
;tatewide%igure is higher
than for any
indiidual payer
enchmar# is measured
against statewide' per capitahealth care growth
,ggregate statewide health,ggregate statewide health,ggregate statewide health,ggregate statewide health
care e-penditurescare e-penditurescare e-penditurescare e-penditures
Population of +assachusettsPopulation of +assachusettsPopulation of +assachusettsPopulation of +assachusetts
1111 2222
4444
6666 +edical trend is one component of total health care e-penditures' but does not capture the entire measure! "he measure that will be compared to the Chapter 224
benchmar# also includes the net cost of priate health insurance!
;ource$;ource$;ource$;ource$ Centers for +edicare and +edicaid ;erices> ureau of .conomic ,nalysis> Center for Health )nformation and ,nalysis> +assHealth> Census ureau> HPC analysis
1111 2222
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Health Policy Commission | 2
,ccounting for shifts in payer mi- is important when trac#ing
statewide growth
D12
D10DA
D@
D4
D2
D12
D10
DA
D@
D4
D2
Payer 1Payer 1Payer 1Payer 1 Payer 2Payer 2Payer 2Payer 2 ;tatewide;tatewide;tatewide;tatewide
)llustratie e-amplePer member per year spending
;tatewide growth of 0B0B0B0B
D12
D10
DA
D@
DAD10
D12
D4
D2Eear2
,g$ D4
,g$ D
,g$ D10
,g$ D
,g$ D
Payer 1 growth
of ((((2B2B2B2B
,g$ D5
D@
D4
D2Eear1
Fne member
changes plans
Eear1
Eear2
Payer 2 growth
of ((((10B10B10B10B
Payer 1Payer 1Payer 1Payer 1 Payer 2Payer 2Payer 2Payer 2 ;tatewide;tatewide;tatewide;tatewide
1111 2222
4444
1111 2222
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Health Policy Commission | 2@
PayerPayerPayerPayer .nrollment.nrollment.nrollment.nrollment
Per personPer personPer personPer person
e-penditurese-penditurese-penditurese-penditures
+edicare 2!B !@B
+assHealth 4!B !@B
Commercial (1!0B !@B
+assachusetts Q total population 0!2B !0B!0B!0B!0B!0B!0B!0B!0B
.nrollment shifts from 2005(2012 affected total +assachusetts
e-penditure growth
PayerPayerPayerPayer .nrollment.nrollment.nrollment.nrollment
Per personPer personPer personPer person
e-penditurese-penditurese-penditurese-penditures
+edicare 2!B 1!B
+assHealth 4!B 0!AB
Commercial (1!0B 2!AB
+assachusetts Q total population 0!2B !1B!1B!1B!1B
6 C+; state(leel personal health care e-penditure data hae only been published through 2005! 2010(2012 +, figures were estimated based on 2005(2012 e-penditure
data proided by C+; for +edicare' ,=% budget information statements and e-penditure data from +assHealth' and CH), "+. reports for commercial payers!
;ource$;ource$;ource$;ource$ Centers for +edicare and +edicaid ;erices> ureau of .conomic ,nalysis> Center for Health )nformation and ,nalysis> +assHealth> Census ureau> HPC analysis
.stimated.stimated.stimated.stimated6
growthgrowthgrowthgrowth
)llustratie)llustratie)llustratie)llustratie
e-ample$e-ample$e-ample$e-ample$statewide growth
at hypothetical
payer growth rates
with same
enrollment shifts
!2B!2B!2B!2B
1111 2222
4444
+assachusetts health care cost trends' 2005 ( 2012Compound annual growth rate
1111 2222
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Health Policy Commission | 2
Price has drien recent commercial e-penditure growth' while
utili*ation has drien +edicare e-penditure growth
riers ofriers ofriers ofriers ofe-pendituree-pendituree-pendituree-penditure
growthgrowthgrowthgrowth
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4444
econstruction of e-penditure growth in the commercial and +edicare mar#ets/rowth of drier relatie to oerall growth' 2005(2011
6666 +edicare fee(for(serice unit prices are set according to a fee schedule established by the Centers for +edicare L +edicaid ;erices 7C+;8' which is adusted to reflect
input cost differences due to geography and teaching status! Cost growth attributable to price may occur if C+; updates fee schedules or if +edicare beneficiaries
choose to receie care in settings with higher input costs!
;ource;ource;ource;ource$$$$ ,ll(Payer Claims atabase> HPC analysis
rierrierrierrier escriptionescriptionescriptionescription
CommercialCommercialCommercialCommercial
changechangechangechange
2005200520052005((((2011201120112011
+edicare+edicare+edicare+edicare
changechangechangechange
2005200520052005((((2011201120112011
Iis# Changes in aerage health status across all
members
:tili*ation
Changes in the &uantity of serices used'
adusted for changes in aerage health
status
Price
Changes in unit prices$ the fee schedules
established between payers and proiders
Changes in proider mi-$ whether
consumers choose to receie their care in
higher(price or lower(price settings
3imited change
3imited change
3imited change
3imited change6)ncrease
)ncrease
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Health Policy Commission | 2A
Profile of +assachusetts health care spending1111 2222
4444
1@!AB 1@!@B
1!1B
11!B
10B
11B
12B
1B
14B
1B
1@B
1CB
1AB
15B
20B
1550 1552 1554 155@ 155A 2000 2002 2004 200@ 200A 2010 2012
12!AB12!5B1!2B
12!B
"he +assachusetts deliery system"he +assachusetts deliery system"he +assachusetts deliery system"he +assachusetts deliery system$$$$ how do
characteristics of the states deliery systemcontribute to spending leels and trends?
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Health Policy Commission | 25
"he +assachusetts deliery system uses maor teaching hospitals
for far more of its inpatient care than the national aerage
1C21
40 2
20129999
100
4
2002
100
4
Fther hospitals not in systems with maor teaching hospitals
+aor teaching hospitals
Fther hospitals in systems with maor teaching hospitals
6666 +aor teaching hospitals are defined as those with at least 2 residents per 100 beds!
9999 ased on systems in 2012! oes not include impact of seeral transactions 7Cooley ic#inson Hospital' Jordan Hospital8 completed in 201!
;ource$;ource$;ource$;ource$ Center for Health )nformation and ,nalysis> +edicare Payment ,disory Commission> HPC analysis
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4444
of +edicare discharges inof +edicare discharges inof +edicare discharges inof +edicare discharges in
+assachusetts+assachusetts+assachusetts+assachusetts are in maor
teaching hospitals6
of +edicare dischargesof +edicare dischargesof +edicare dischargesof +edicare discharges
nationwidenationwidenationwidenationwide are in maorteaching hospitals6
Percent of discharges in
maor teaching hospitals
across all payers
,ll(payer discharges in systems with maor teaching hospitals 6
Percent of total statewide discharges
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Health Policy Commission | 0
Profile of +assachusetts health care spending 4444
1@!AB 1@!@B
1!1B
11!B
10B11B
12B
1B
14B
1B
1@B
1CB
1AB
15B
20B
1550 1552 1554 155@ 155A 2000 2002 2004 200@ 200A 2010 2012
1!2B12!5B
12!B
12!AB
uality and accessuality and accessuality and accessuality and access$$$$ how does
+assachusetts perform compared to the:!;! on measures of &uality and access?4444
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Health Policy Commission | 1
"he +assachusetts population has relatiely low chronic disease
prealence' although asthma rates are high
4444
Prealence of common chronic diseasesPercent of population
=ote$=ote$=ote$=ote$ +easures aboe were collected through the ehaioral Iis# %actor ;ureillance ;ystem and are defined as follows$
iabetes$ Iesponded REesS to R7.er told8 you hae diabetes? S
,ngina coronary heart disease$ Iesponded REesS to R7.er told8 you had angina or coronary heart disease?S
Cancer$ Iesponded REesS to R7.er told8 you had s#in cancer?S or to R7.er told8 you had any other types of cancer? R
epression$ Iesponded REesS to R7.er told8 you hae a depressie disorder' including depression' maor depression'
dysthymia' or minor depression?S
,sthma$ Iesponded REesS to R7.er told8 you had asthma?S
;ource$;ource$;ource$;ource$ Centers for isease Control and Preention> HPC analysis
Healthiest &uartile of states
2nd &uartile of states
rd &uartile of states
3east healthy &uartile of states
+,+,+,+, :!;!:!;!:!;!:!;! +, uartile+, uartile+, uartile+, uartile
iabetes A!0B 5!B
,ngina coronary heart disease !AB 4!1B
Cancer 12!0B 12!4B
epression 1@!B 1!B
,sthma 1!4B 1!@B
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Health Policy Commission | 2
isease prealence aries greatly by region within the state 4444
;ource$;ource$;ource$;ource$ ,ll(Payer Claims atabase> HPC analysis
Fer 2@!B prealence
etween 21!B and 2@!B prealence
elow 21!B prealence
etween !B and !B prealence
Fer !B prealence elow !B prealence
;tatewide prealence;tatewide prealence;tatewide prealence;tatewide prealence of
diabetes within +edicare+edicare+edicare+edicare
;tatewide prealence;tatewide prealence;tatewide prealence;tatewide prealence of
diabetes within commercialcommercialcommercialcommercial
CF++.IC),3CF++.IC),3CF++.IC),3CF++.IC),3+.)C,I.+.)C,I.+.)C,I.+.)C,I.
iabetes prealence by regionPayer(specific prealence rate
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Health Policy Commission |
6 ,dmissions for asthma per 100'000 population' age 1A and oer> =% measure counts all discharges of age greater than 1A and less than 40 years old
;ource$;ource$;ource$;ource$ +assachusetts Health uality Partners> Maiser %amily %oundation> ,gency for Healthcare Iesearch and uality> +assachusetts )mmuni*ation ,ction
Partnership> Centers for isease Control and Preention> Center for Health )nformation and ,nalysis> HPC analysis
+assachusetts outperforms national aerages on many &uality
measures' but often falls short of a 50th percentile benchmar#
:!;!:!;!:!;!:!;! +,+,+,+, Ielatie performanceIelatie performanceIelatie performanceIelatie performance
Preention andPreention andPreention andPreention and population healthpopulation healthpopulation healthpopulation health
Childhood immuni*ation status @1B @B
3ow birth weight rate A!1B !B
Iate of older adults receiing flu shots 0B B
Iate of female adolescents receiing HPT accine 24B 41B
Chronic careChronic careChronic careChronic care
Iate of cholesterol management for patients with
cardioascular conditionsA5B 52B
Iate of controlling high blood pressure @B 1B
Iate of diabetes short(term complications admissions 7adult8 A per 100'000 4A per 100'000
=umber of admissions for CH% A per 100'000 4 per 100'000
=umber of adults admitted for asthma6 114 per 100'000 140 per 100'000
=umber of CFP admissions 155 per 100'000 24 per 100'000
Patient safetyPatient safetyPatient safetyPatient safety
Iate of iatrogenic pneumothora- 7ris#(adusted8 0!42 per 1'000 0!41 per 1'000 =,
Iate of postoperatie respiratory failure A! per 1'000 @!@ per 1'000 =,
Iate of central enous catheter(related blood stream infections 0!5 per 1'000 0!2A per 1'000 =,
etter than 50th percentile etween aerage and 50th percentile elow aerage
4444
Condition and procedure &uality measures:nits ary by measure
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Health Policy Commission | 4
Conclusion for profile of +assachusetts health care spending
;pending in +assachusetts is the highest of any state in the :!;!' crowding out other;pending in +assachusetts is the highest of any state in the :!;!' crowding out other;pending in +assachusetts is the highest of any state in the :!;!' crowding out other;pending in +assachusetts is the highest of any state in the :!;!' crowding out otherpriorities for consumers' businesses' and goernmentpriorities for consumers' businesses' and goernmentpriorities for consumers' businesses' and goernmentpriorities for consumers' businesses' and goernment
Fer the past decade' +assachusetts health care spending has grown much fasterthan the national aerage' drien primarily by faster growth in commercial prices
+assachusetts residents continue to use health care serices at a higher rate than
the nation' especially in hospital care and long(term care' although the differencebetween +assachusetts and the :!;! aerage has been stable oer the past
decade
While spending growth in +assachusetts since 2005 has slowed in line with slowerWhile spending growth in +assachusetts since 2005 has slowed in line with slowerWhile spending growth in +assachusetts since 2005 has slowed in line with slowerWhile spending growth in +assachusetts since 2005 has slowed in line with slower
national growth' sustaining lower growth rates will re&uire effortnational growth' sustaining lower growth rates will re&uire effortnational growth' sustaining lower growth rates will re&uire effortnational growth' sustaining lower growth rates will re&uire effort
Past periods of slow health care growth in +assachusetts' such as the 1550s' haebeen followed by sustained periods of higher growth
While obsered growth rates for indiidual payers are low' the statewide growthrate is higher' drien by enrollment shifts between payers due to trends such as
the aging of the population
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Health Policy Commission |
Profile ofProfile ofProfile ofProfile of
+assachusetts+assachusetts+assachusetts+assachusetts
"opics in the 201 cost trends report
Hospital
operating
e-penses
Wasteful
spending
High(cost
patients
"rends in
spending
"he +,
deliery
system
uality
and
access
3eels of
spending
eepeepeepeep((((diesdiesdiesdies
201 cost201 cost201 cost201 cost
trends reporttrends reporttrends reporttrends report
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Health Policy Commission | @
)n the commercial and +edicare mar#ets' persistence within the high(
cost patients is 25 percent
,naly*ing persistence of high(cost 7top B by e-penditures8 patient status6Percent of medical e-penditures 7e-cludes drug spending8 in 2010 and 2011
6666 "he sample for analysis was limited to patients who had continuous enrollment from 112010 Q 1212011 and costs of at least D1 in each year! %igures do not capture
pharmacy costs' payments outside the claims system' +edicare cost(sharing' or end(of(life care for patients who died in 2010 or 2011!
;ource$;ource$;ource$;ource$ ,ll(Payer Claims atabase> HPC analysis
CommercialCommercialCommercialCommercial
+edicare+edicare+edicare+edicare
of patients remained topof patients remained topof patients remained topof patients remained topB in cost in 2011B in cost in 2011B in cost in 2011B in cost in 2011
of patients remained topof patients remained topof patients remained topof patients remained top
B in cost in 2011B in cost in 2011B in cost in 2011B in cost in 2011
Ff patients who were top BFf patients who were top BFf patients who were top BFf patients who were top Bin cost in 2010Uin cost in 2010Uin cost in 2010Uin cost in 2010U
Ff patients who were top BFf patients who were top BFf patients who were top BFf patients who were top B
in cost in 2010Uin cost in 2010Uin cost in 2010Uin cost in 2010U
CF++.IC),3CF++.IC),3CF++.IC),3CF++.IC),3
+.)C,I.+.)C,I.+.)C,I.+.)C,I.
UUUU
UUUU
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Patients with behaioral health and chronic conditions hae
significantly higher medical e-penditures
6 "he sample for analysis was limited to patients who had continuous enrollment from 112010 Q 1212011 and costs of at least D1 in each year! %igures do not capturepharmacy costs' payments outside the claims system' +edicare cost(sharing' or end(of(life care for patients who died in 2010 or 2011!
9999 ehaioral health comorbidity includes child psychology' seere and persistent mental illness' mental health' psychiatry' and substance abuse