DataMatters - March 2024 Edition
In this Issue:
Publications and Data Releases
Opening Message
Last week marked the official start of spring in Massachusetts—let’s hope for sunny and warm weather ahead!
In this month’s DataMatters, we explore CHIA’s recent publication on medical spending trends across Massachusetts. This first-time analysis explores the relationship between community characteristics and total medical expenses by insurance population and service categories. Read more about this new reporting series in the “News You Can Use” section below.
Earlier this month CHIA also released its Annual Report on the Performance of the Massachusetts Health Care System. This report includes the calculation of the Commonwealth’s total health care expenditures – a measure of statewide health care spending – which is used to evaluate the state’s performance relative to the health care cost growth benchmark set by the Health Policy Commission. The report additionally examines trends in costs, utilization, coverage, and quality indicators through 2022. CHIA’s Executive Director Lauren Peters presented key findings from the report at the 2025 Cost Growth Benchmark Hearing. (See a video of the event here.)
We are also excited to feature work from the Health Policy Commission using the Massachusetts All-Payer Claims Database (MA APCD) in the “Data User Profile” segment, for their analysis of shifts in where commercially insured residents in Massachusetts received their flu vaccines.
CHIA also held its March Oversight Council meeting last week. Watch the livestream of the meeting here.
As always, we hope that you enjoy this newsletter and learn something new. We welcome your feedback at newsletter@chiamass.gov.
News You Can Use
We are excited to feature a recent CHIA publication in this month’s DataMatters. For the first time, CHIA examined how medical spending varied across Massachusetts communities, and the relationship between certain spending categories and community characteristics, presented in an interactive dashboard.
Variation in community medical spending trends may be influenced by multiple interrelated factors, including individual health status, adequacy and proximity of provider networks, provider prices, and insurance coverage. Geographic variation in community medical claims spending patterns may also be attributed to social and economic risk factors, which can impact access to care.
This publication includes data on demographics by community as well as the relationship between these community characteristics and total medical expenses (TME) by insurance population and across TME service categories for data year 2021. Data is presented at the community level by municipality and ZIP Code Tabulation Area (ZCTA).
Key findings include:
- Higher median income in a community was associated with greater per member per month (PMPM) spending on telehealth and physician services.
- Communities with higher proportions of individuals identifying as non-Hispanic Black or African American, as well as communities with higher proportions of individuals identifying as Hispanic or Latino, correlated with lower PMPM spending on physician services.
- PMPM spending on telehealth services tended to be higher in communities with higher proportions of individuals who are not US citizens and communities with higher proportions of individuals born outside the US, while total medical spending PMPM tended to be lower in those communities.
Go to CHIA’s website to explore this new interactive dashboard and executive summary that provide comparative insights into how medical spending varies by community demographics.
Data User Profile
The “Data User Profile” section of DataMatters always includes an interview with a user of CHIA data. In this issue we feature the work of another state health care agency, the Health Policy Commission (HPC).
The HPC regularly publishes an online brief—HPC DataPoints—spotlighting new research and findings about health care costs in Massachusetts. These briefs provide overviews and interactive graphics on relevant health policy topics, with analyses conducted by HPC research staff.
The November 2023 DataPoints uses the Massachusetts All-Payer Claims Database (MA APCD) to explore shifts in where commercially insured residents in Massachusetts received their flu vaccines and seeks to expand the understanding of gaps in access and spending related to the cost of flu vaccinations.
CHIA is grateful to the staff at the HPC for answering our questions in this month’s newsletter.
What was your research question? Why did you choose that question?
Influenza (flu) vaccines are widely considered to be an important preventive care service, having been found to reduce severity of illness and the risk of flu-associated hospitalization. Massachusetts has a higher flu vaccination rate than the national average (64.9% versus 49.3% during the 2022-2023 influenza season, respectively), and that rate has increased over time. Flu vaccines can be administered in a variety of settings, including doctors’ offices, hospital outpatient departments (HOPDs), pharmacies and retail clinics, and mass immunization centers, and different settings of vaccine administration may have different spending and access implications.
Because of these factors, the HPC was interested in exploring where commercially-insured residents in Massachusetts received flu vaccines between 2017 and 2021 and published these findings in an issue of our DataPoints series: Not Throwing Away My Shot.
Which CHIA data do you use?
We used medical and pharmacy claims data for commercially-insured Massachusetts residents from CHIA’s Massachusetts All-Payer Claims Database (MA APCD), version 2021.
What was your experience using CHIA data?
There are multiple strengths to the MA APCD that facilitated our analysis. Having access to both medical and pharmacy claims in the MA APCD was essential to answering our research question, as vaccines that are provided in a pharmacy are billed under pharmacy claims, whereas vaccines that are provided in other settings are generally billed under medical claims. The MA APCD is also rich in patient-specific information and allowed us to report on differences in flu vaccination rates by patient age and community income (based on patient zip code). Finally, because the MA APCD had claims data through 2021, we were able to take a brief but informative look at where COVID-19 vaccinations were administered that year.
Please briefly describe your research and key findings.
- By 2021, most flu vaccines among commercially-insured residents who had an insurance claim were administered in pharmacies (60%), followed by offices (35%), and other settings (6%). This is a dramatic change from previous years where most vaccines were administered in offices.
- An increasing proportion of flu vaccines occurring in pharmacies was observed among commercially-insured residents of all age and income groups, though particularly for children.
- In 2021, the price for a flu vaccine at a hospital outpatient department ($108) was almost double the price at an office ($56), due to high prices for vaccine administration. The price at an office was double the price at a pharmacy ($28).
Which findings were particularly interesting or surprising for you?
The shift in where vaccines were administered between 2017 and 2021 was particularly striking. In the publication, we discuss that this shift may reflect a number of factors, including an increase in patient hesitancy to seek care in medical settings due to disruptions in services during the COVID-19 pandemic and pharmacies offering advantages in access compared to traditional sites of care (e.g., evening and weekend hours).
In addition, the finding that an increasing proportion of commercially-insured children received their flu vaccine in a pharmacy was interesting, and likely due to the Massachusetts Department of Public Health’s expansion in pharmacists’ authorization to administer vaccines to children.
What "takeaway" information would you like to highlight from your research and/or experience using our data?
Our analysis of MA APCD data finding a dramatic shift towards pharmacies as the setting of care for flu vaccines showed the impact of policy changes in pharmacists’ authorization to administer vaccines. While expanded authorization for vaccine administration in pharmacies has expanded access to care, pharmacy locations vary by region, income, and race/ethnicity, among other factors.
Improving equitable access to vaccines at pharmacies could help further increase vaccination rates.
While this DataPoints issue highlights trends in flu vaccination by setting among commercially-insured residents, additional study into trends among residents covered by other payers (i.e., MassHealth, Medicare) is warranted. This would help to develop a greater understanding of potential disparities in access between different populations to flu shots and other vaccines, such as COVID-19.
Publications and Data Releases
(January 2024 through March 2024)
Annual Report on the Massachusetts Health Care System
March 2024
Earlier this month CHIA published its latest Annual Report. The report examines trends in costs, coverage, and quality among other metrics to inform policymaking.
This year’s report also includes a new chapter on health care affordability, as well as a new section on community total medical expenses.
Total Medical Expenses Across Massachusetts Communities
March 2024
In the Annual Report as well as in a standalone publication, CHIA considered how medical spending varied across Massachusetts communities, and whether there was a relationship between certain spending categories and community characteristics. Findings are reported in an interactive dashboard and trends report (see more details in the “News You Can Use” segment).
Enrollment Trends with Data through September 2023
March 2024
CHIA updated its detailed Enrollment Trends analysis for the most recent two-year period to give researchers and policymakers insight into the market. The latest edition covers the period between September 2021 and September 2023 and includes breakouts by payers and product types in private commercial and public market sectors.
HIDD and EDD Case Mix Quarterly Dashboards
February 2024
CHIA published its latest interactive dashboard on emergency department (ED) visits and hospital inpatient and discharge data (HIDD). This quarterly update shows trends revealed by the emergency department Case Mix data from October 2018 – September 2023. Quarterly reports are based on interim data and are updated as more complete information becomes available.
HFY 2022 Hospital Profiles
February 2024
The Profiles provide information on acute and non-acute hospitals over a five-year period through HFY 2022. These profiles allow comparison against statewide performance and peer cohorts.
Hospital and Health System Performance Dashboard
February 2024
CHIA has merged hospital and hospital health system data into one interactive dashboard in an effort to provide a more comprehensive look at the acute hospital industry in HFY 2022. The new Hospital and Hospital Health System Overview Dashboard includes financial and utilization data sourced from the standardized financial statements, hospital cost reports, relative price, and Case Mix data.
Upcoming Events and Resources
Events and announcements of interest to our community, organized by CHIA, our data partners, and others
Massachusetts Health Policy Commission Board Meeting
Thursday, April 11, 2024, 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.
CHIA Oversight Council FY 2025 Budget Hearing
Tuesday, April 16, 2:00 PM
CHIA's Oversight Council will hold a remote public hearing on the agency's upcoming fiscal year 2025 (FY 2025) budget. The purpose of this hearing is to afford all interested members of the public the opportunity to provide comments on CHIA’s FY 2025 budget.
Those wishing to provide testimony during the hearing may sign up to do so by emailing legal@chiamass.gov by April 12, 2024. Written comments will also be accepted at the same email address through April 30, 2024.
CHIA Data User Workgroups
Tuesday, April 23, 2024, 3:00 PM
These ongoing meetings are designed for data users and other interested parties to connect with CHIA to discuss analytical techniques and best practices in research using CHIA's MA APCD and Case Mix databases.
The next virtual workgroup meeting will be on Tuesday, April 23, at 3:00 PM. . For more information including past presentations and user support materials, visit the information page. To learn more about CHIA data, please visit https://www.chiamass.gov/chia-data/.
CHIA Oversight Council Meeting
Wednesday, June 18, 2024, 3:00 PM
CHIA’s appointed Oversight Council meets quarterly to discuss agency priorities and agenda-setting. The next meeting is scheduled for Tuesday, June 18, 2024 at 3:00 p.m. and will stream live on CHIA’s YouTube channel.
National Academy for State Health Plans (NASHP) 37th Annual Conference
September 9-11, 2024
Nashville, TN
Join hundreds of state leaders from all 50 states and DC, as #NASHPCONF24 brings attention to the most timely, cutting-edge issues facing state health policymakers, and highlights innovative solutions shared by the nation’s leading experts on topics including: lowering prescription drug costs, hospital costs, Medicaid, health insurance marketplaces, telehealth, social determinants of health, behavioral health, and more.
American Public Health Association (APHA) Annual Meeting Expo
October 27-30, 2024
Minneapolis, MN
The 2024 APHA Annual Meeting and Expo will take place in Minneapolis, MN on Oct. 27-30, 2024. The annual conference provides high-quality, science-based education, engaging networking opportunities, and cutting-edge resources to thousands of public health professionals from across the nation. Registration and housing will open in June 2024. This year’s theme is “rebuilding trust in public health and science.”
The submission deadline for research extracts is Friday, March 29! Submissions related to all areas of public health are welcome, but abstracts related to the 2024 meeting theme are encouraged.
Massachusetts Association of Health Plans (MAHP) 2024 Annual Conference
SAVE THE DATE! Friday, November 15, 2024
MAHP will be holding next year's conference at the Seaport Hotel on November 15th. Individual registrations will open in June. Please reach out to Ann Chamberlin at chamberlin@mahp.com to get information on sponsorship opportunities.
Join Our Team
A selection of open positions at CHIA. Please feel free to share broadly with your network. Follow CHIA on LinkedIn for more regular updates.
Director of Communications and Content Strategy
Communications and External Affairs Team
CENTER FOR HEALTH INFORMATION AND ANALYSIS
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