Total Medical Expense (TME) Trends Across Massachusetts Communities

Report Materials (February 2026)

Overview

Each year, CHIA collects data on total medical expenses (TME) from public and private payers and reports findings based on TME data according to M.G.L. c. 12C. Using this data, CHIA’s Total Medical Expense Trends Across Massachusetts Communities report considers how medical spending varies by geography and whether there is a relationship between certain spending categories and community characteristics. Data is presented at the community level by municipality and ZIP Code Tabulation Area (ZCTA).

Key Findings

English language proficiency
Communities with higher proportions of residents who do not speak English well tended to have lower PMPM spending on services delivered by a primary care or specialty physician, total member cost-sharing, and total medical expenses.

Health insurance status
Communities with higher proportions of uninsured residents tended to have lower levels of spending on services delivered by a primary care or specialty physician as well as total member cost-sharing PMPM.

Education
Communities with higher proportions of residents who have not completed a high school education tended to have lower spending on services
delivered by a primary care or specialty physician, total member cost-sharing, and total medical spending PMPM.

Citizenship status
Communities with higher proportions of non-U.S. citizens tended to have lower spending on services delivered by a primary care or specialty physician, total member cost-sharing, and total medical spending PMPM.

Race and ethnicity
Communities with higher proportions of Hispanic/Latino and non-Hispanic Black residents tended to have lower spending on services delivered by a primary care or specialty physician as well as total member cost-sharing PMPM.

Median family income
Communities with higher median family incomes tended to have higher levels of spending on services delivered by physicians and other clinical professionals as well as higher total medical spending and member cost-sharing PMPM.

Interactive Dashboard: Total Medical Expense (TME) Trends Across Massachusetts Communities

(published February 26, 2026)

Additional Information

ZIP Code Tabulation Areas or ZCTAs (pronounced zik-tahs) were created by the U.S. Census Bureau to allow mapping, display, and geographic analyses of the U.S. Postal Service (USPS) Zone Improvement Plan (ZIP) Codes dataset. ZIP codes available in TME data were linked to ZCTAs in the American Community Survey (ACS) data to apply a community lens to TME spending patterns. For more information on ZCTAs and CHIA’s approach to linking these two data sets, see the technical appendix.

Terms

American Community Survey (ACS): An annual survey conducted by the United States Census Bureau. Data on community demographics is gathered and made publicly available at https://data.census.gov/table. For more details about the demographic variables used in this report, see the technical appendix.

Medical Expense Category: Medical expense categories (also known as service categories) are gathered as part of TME data collection. The service categories available in this dashboard include hospital inpatient, hospital outpatient, physician, other professional, other medical, pharmacy, and total medical expenses. For more information on the specific claims captured in each service category, see the TME-APM Data Specification Manual.

Hospital Inpatient: All claims payments made to hospitals for inpatient care.
Hospital Outpatient: All claims payments made to hospitals for outpatient care.
Physician: All claims payments for services provided by a doctor of medicine or osteopathy. Physician spending includes both primary care and specialty care doctors.
Other Professional: All payments for services provided by licensed practitioners other than physicians, including occupational and physical therapists, nurse practitioners, physician assistants, and certain behavioral health providers.
Other Medical: All claims payments for medical services not otherwise included in other categories, including skilled nursing facility services, home health services, durable medical equipment, freestanding diagnostic facility services, hearing aid services, and optical services.
Pharmacy: All claims payments for prescription drugs, biological products, and vaccines administered outside of hospital settings.

Total Medical Expenses: All categories of medical expenses and all non-claims related payments to providers, including provider performance payments and member cost-sharing.

Telehealth: All payments made to providers for services delivered remotely (i.e., over the phone or via video chat). Spending in this section refers to the aggregate of all telehealth spending across hospital outpatient, physician, other professional, and other medical service categories.

Per Member Per Month (PMPM) Spending: Average per-member spending on medical services each month within the stated insurance type.

Physician Density: Primary care physician density, as calculated for this report, reflects the number of primary care, internal medicine, and family practice physicians per 1,000 people within a county.

PAST REPORTS

March 2024