Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report

8/13/2019 Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report

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Health Policy Commission | 0

f


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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


3/38


/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.


4/38

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


5/38


Hospital

operating

e-penses

Wasteful

spending

High(cost

patients

eepeepeepeep((((diesdiesdiesdies


"rends in

spending

"he +,

deliery

system

uality

and

access

3eels of

spending






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


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?


8/38Health Policy Commission |

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


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



;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


10/38Health Policy Commission | 5

%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



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



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



+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


15/38


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



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


16/38


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


17/38

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


18/38


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


19/38

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


20/38


(@ 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


22/38


%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



;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


23/38


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


24/38


%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



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!


1111 2222


25/38


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!


1111 2222


26/38


,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


27/38

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!


.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


28/38


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

1111 2222

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

1111 2222


29/38

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?

1111 2222


30/38


"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

1111 2222

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

1111 2222


31/38


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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"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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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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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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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

4444


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Hospital

operating

e-penses

Wasteful

spending

High(cost

patients

"rends in

spending

"he +,

deliery

system

uality

and

access

3eels of

spending

eepeepeepeep((((diesdiesdiesdies




37/38

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


38/38

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

Documents

Massachusetts Health Policy Commission 2013 Preliminary Cost Trends Report