Health Care Cost Growth Benchmark

The HPC Board may modify the statutory annual health care cost growth benchmark pursuant to a public hearing process and engagement with the Legislature.

Table of Contents

Benchmark Overview

Chapter 58 of the Acts of 2006 was passed by the Massachusetts state legislature to provide near universal health insurance coverage for state residents. Today, Massachusetts has the highest rate of insurance coverage in the nation.

Following the passage of Chapter 58, health care policy efforts in Massachusetts focused on enhancing the transparency of the state’s health care system and identifying health care cost drivers. While Massachusetts is a national leader in innovative and high-quality health care, it is also among the states with the highest health care spending. The rapid rate of growth in health care spending has contributed to a crowding-out effect for households, businesses, and government, reducing resources available to spend on other priorities.

Given these trends, the state enacted Chapter 224 of the Acts of 2012 with the ambitious goal of bringing health care spending growth in line with growth in the state’s overall economy by establishing the health care cost growth benchmark, a statewide target for the rate of growth of total health care expenditures.

The HPC Board of Commissioners sets the benchmark for the following calendar year annually between January 15 (when the potential gross state product is established) and April 15. The Center for Health Information and Analysis (CHIA) reports annually on the Commonwealth’s performance against the benchmark.

1-5 years: Benchmark established by law at PGSP (3.6%) / 6-10 years: Benchmark established by law at a default rate of at PGSP minus 0.5% (3.1%); HPC can modify the benchmark up to 3.6%, subject to legislative review / 10-20 years: Benchmark established by law at a default rate of PGSP; HPC can modify to any amount, subject to legislative review.

What is the Measure of Total Health Care Expenditures? 

Total health care expenditures (THCE) is a per-capita measure of total state health care spending growth. THCE includes three components:

  1. All medical expenses paid to providers by private and public payers, including Medicare and Medicaid (MassHealth);
  2. All patient cost-sharing amounts (for example, deductibles and co-payments); and
  3. The net cost of private insurance (for example, administrative expenses and operating margins for commercial payers).

THCE is calculated on a per capita basis to control for increases in health care spending due to population growth. The inclusion of public and private payers in the measure is intended to reduce the likelihood of “cost-shifting” among different payer types and ensure that gains are shared with both public and private purchasers.

The Commonwealth’s THCE is measured annually by the Center for Health Information and Analysis (CHIA). This data is then used to measure the state’s health care expenditures against growth of the Commonwealth’s economy.

Measuring Performance Against the Health Care Cost Growth Benchmark

The health care cost growth benchmark is set prospectively for the upcoming calendar year, while actual performance is measured retrospectively. ​

Image of an arrow showing the benchmark and the performance against the benchmark from years 2017 to 2024.

Chapter 224 defines three multi-year targets for THCE growth: 

  1. From 2013 through 2017, the benchmark had to be set equal to the growth rate of potential gross state product (PGSP), or 3.6%.
  2. From 2018 through 2022, the HPC had to set the benchmark equal to PGSP (3.6%) minus 0.5% (or 3.1% in 2018). During this time period, the HPC had limited authority to modify the benchmark back up to PGSP if it determined, after consideration of data, information, and testimony, that an adjustment was reasonably warranted. Click here for more information on the process of establishing the 2018 benchmark.
  3. For 2023 and beyond, the benchmark will be established by law at a default rate of PGSP, though the HPC Board can modify to any amount deemed reasonable, subject to legislative review.

2022 Benchmark Hearing

Hearing to Determine the 2023 Health Care Cost Growth Benchmark: Wednesday, March 16, 2022, 12:00 PM

Under the framework set forth in Chapter 224, from 2023 through 2032, the health care cost growth benchmark will be set equal to potential gross state product (PGSP), or 3.6%, unless the HPC determines that an adjustment to the benchmark is reasonably warranted. In that case, the HPC Board may choose to modify the benchmark to any amount.

2021 Benchmark Hearing

Hearing on the Potential Modification of the 2022 Health Care Cost Growth Benchmark: March 25, 2021

Under the framework set forth in Chapter 224, the HPC Board may modify the annual health care cost growth benchmark established in statute for calendar year 2022. As required by state law, the HPC will set the 2022 benchmark equal to potential gross state product minus 0.5 percent, or 3.1%, unless the HPC determines that an adjustment to the benchmark is reasonably warranted.

2020 Benchmark Hearing

Hearing on the Potential Modification of the 2021 Health Care Cost Growth Benchmark: March 11, 2020

Under the framework set forth in Chapter 224, the HPC Board may modify the annual health care cost growth benchmark established in statute for calendar year 2021. As required by state law, the HPC will set the 2021 benchmark equal to potential gross state product minus 0.5 percent, or 3.1%, unless the HPC determines that an adjustment to the benchmark is reasonably warranted.

2019 Benchmark Hearing

Hearing on the Potential Modification of the 2020 Health Care Cost Growth Benchmark: March 13, 2019

Under the framework set forth in Chapter 224, the HPC Board may modify the annual health care cost growth benchmark established in statute for calendar year 2020. As required by state law, the HPC will set the 2020 benchmark equal to potential gross state product minus 0.5 percent, or 3.1%, unless the HPC determines that an adjustment to the benchmark is reasonably warranted. The HPC held a hearing on Wednesday, March 13, 2019, to solicit feedback from market participants, stakeholders, and other interested parties on whether modification of the benchmark is appropriate.

2018 Benchmark Hearing

Hearing on the Potential Modification of the 2019 Health Care Cost Growth Benchmark: March 28, 2018

Under the framework set forth in Chapter 224, the HPC Board may modify the annual health care cost growth benchmark established in statute for calendar year 2019. As required by state law, the HPC will set the 2019 benchmark equal to potential gross state product minus 0.5 percent, or 3.1%, unless the HPC determines that an adjustment to the benchmark is reasonably warranted. The HPC held a hearing on Wednesday, March 28, 2018 to solicit feedback from market participants, stakeholders, and other interested parties on whether modification of the benchmark is appropriate.

Notice of Hearing - 2019 Benchmark Modification  
Agenda  

Presentation  
Testimony
Opportunities for Savings in Health Care 2018

2017 Benchmark Hearing

Hearing on the Potential Modification of the 2018 Health Care Cost Growth Benchmark: March 8, 2017

For the first time under the framework set forth in Chapter 224, the HPC Board may modify the annual health care cost growth benchmark established in statute for calendar year 2018. As required by state law, the HPC will set the 2018 benchmark equal to potential gross state product minus 0.5 percent, or 3.1%, unless the HPC determines that an adjustment to the benchmark is reasonably warranted. The HPC held a hearing on Wednesday, March 8, 2017 at 1:00 pm at our offices to solicit feedback from market participants, stakeholders, and other interested parties on whether modification of the benchmark is appropriate. Members of the public were invited to present up to three minutes of testimony at the hearing.

Notice of Hearing - 2018 Benchmark Modification  
Agenda  
Presentation  
Testimony

Contact

Phone

HPC-Info@state.ma.us

Address

Note that the building entrance is located on Devonshire Street.
50 Milk Street
8th Floor
Boston, MA 02109
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