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HPC DataPoints Series

A series of online briefs that spotlight new research and data findings relevant to the HPC's mission to drive down the cost of health care. 
HPC DataPoints

 

HPC DataPoints showcases brief overviews and interactive graphics on relevant health policy topics. The analysis underlying these briefs is conducted by HPC research staff. As you read through HPC DataPoints, we encourage you to engage with the interactive graphics by hovering your mouse over different data points to obtain additional information. We recommend using Internet Explorer to display the interactive graphics.

    Issue 19: Persistently High Out-of-Pocket Costs Make Health Care Increasingly Unaffordable and Perpetuate Inequalities in Massachusetts (January 13, 2021)

    • For the population with persistently high out-of-pocket (OOP) spending, cost-sharing for prescription drugs comprised a larger portion of total OOP spending (27.2%) than for other individuals.
    • In 2017, OOP spending for members with persistently high OOP spending would consume almost 8% of income in the lowest-income areas of the state (areas in the bottom 10% by income), versus just over 2% among members living in the highest-income areas in the state (areas in the top 10% by income).
    • Individuals with persistently high OOP were more likely to have a chronic condition, be employed by a smaller firm, and live in the Cape and Islands region.

    Issue 18: HPC-Certified Accountable Care Organizations in Massachusetts (October 13, 2020)

    • 2.6 million (91%) of ACO-attributed patients fall under contracts that include downside risk.
    • Every HPC-certified ACO reported having strategies to address unnecessary utilization in at least two areas of low-value care.
    • 12 of the 14 HPC-certified ACOs reported having a strategy for the integration of behavioral health services into primary care.

    Issue 17: Changes in the Massachusetts Physician Market: Data from the Massachusetts Registration of Provider Organizations (MA-RPO) Program (June 23, 2020)

    • The share of Massachusetts physicians affiliated with the largest provider organizations is significant and increasing. The share of physicians in the 10 largest provider organizations in Massachusetts was 88.7% in 2015 and 90.3% in 2018. 
    • Of the 21,358 physicians in the 2018 MA-RPO physician roster, 5,908 (27.7%) were PCPs and 15,450 (72.3%) were specialists. 
    • Since 2015, the number of physicians in the MA-RPO roster increased 3.0%. The number of specialists increased more than the number of PCPs (3.4% compared to 2.0%), with pediatricians increasing 9% during the same period. 

    Issue 16: The Doctor Will (Virtually) See You Now (March 12, 2020)

    • Commercially-insured patients who had at least one telehealth visit in 2017 were more likely to be women and younger than the overall population
    • More than half of all telehealth visits were for mental health services, with generalized anxiety disorder as the most common diagnosis 
    • The highest volume service delivered in 2017 as a 45-minute psychotherapy session
    • The median cost of a telehealth visit was $77 and the median patient cost-sharing amount was $20
      • Cost-sharing for telehealth visits was generally quite low, with 23 percent of visits in 2017 delivered with zero cost-sharing
    • Variation was widespread across the insurers and providers analyzed

    Issue 15: Mother and Infant-Focused Neonatal Abstinence Syndrome Investments (September 30, 2019)

    • Hospitals have seen a 53% reduction in median hospital length of stay for infants. Median length of stay decreased from 17 days to 8 days over the 24 months following the launch of the program.
    • Hospitals identified a reduced need for pharmacologic therapy. Need for pharmacologic therapy decreased significantly from 66% of infants to 42% of infants, as a result of the enhanced non-pharmacologic care methods deployed by these initiatives.
    • Infants requiring care in the NICU decreased by 23%. Due to the decrease in pharmacologic therapy, which is often administered in the NICU, hospitals decreased the percentage of infants needing care in the NICU or special care nursery.
    • Enhanced non-pharmacologic care for opioid-exposed newborns could have significant implications for cost savings. Shorter length of stay and a decreased reliance on the NICU or special care nursery could have an impact on the cost of care for this population.

    Issue 14: Variation in Potential Out-of-Network Provider Payment Benchmarks (August 14, 2019)

    Issue 13: Opioid-Related Emergency Department Utilization (June 26, 2019)

    Issue 12: Cracking Open the Black Box of Pharmacy Benefit Managers (June 5, 2019)

    • In 2018, MCO/PBM drug prices were higher than the acquisition prices for 95% of the unique drugs analyzed by the HPC and exceeded FFS prices for 42% of unique drugs.
    • For the drugs where the MCO/PBM price was higher than the FFS price, the difference was often substantial, leading to higher average drug prices overall. MCO prices exceeded FFS prices by an average of $15.97 per unique drug.
    • For several widely prescribed generic drugs, a drop in acquisition costs has not translated to lower prices for the MassHealth MCO program. For example, from 2016 Q1 to 2018 Q4, the average acquisition cost for Buprenorphine fell by 60% while the MCO/PBM price increased by 13%.
    • PBM prices for generic drugs were markedly higher than the drugs’ acquisition costs in the commercial market. The price for generic Gleevec, used in treatment of leukemia, was an average of $1,811 more per prescription than the pharmacy acquisition cost. This per prescription difference translated to more than $278,000 in aggregate spending above acquisition cost.

    Issue 11: Insulin Price Growth and Patient Out-of-Pocket Spending (May 1, 2019)

    • Annual health care spending increased by $4,016 (31%) per person between 2013 and 2016 for individuals who use insulin to manage their diabetes.
    • Annual spending on insulin for this population increased by $1,562 (50%), accounting for 39% of the total spending increase.
    • In 2016, average out-of-pocket spending for insulin was $28 per month, or $340 per year; 18% of individuals paid more than $500 annually on insulin.
    • Although Massachusetts residents paid relatively similar amounts out-of-pocket for their care, the affordability of care varied by region.

    Issue 10: Health Care Cost Growth Benchmark (February 11, 2019)

    Issue 9: Office of Patient Protection Medical Necessity Appeals (December 20, 2018)

    • Since 2014, the total number of internal appeals has increased each year, and the percentage of consumers who have received a favorable outcome (i.e., coverage for treatment) from the internal appeal process increased from 44% in 2014 to 57% in 2017.
    • Despite the increase in the total number of internal appeals filed between 2014 and 2017, there was a decrease in both the total number of internal appeals related to coverage of BH treatment, and the percentage of appeals related to BH treatment compared to medical/surgical treatment.
    • Between 2014 and 2017, OPP received fewer eligible requests for external reviews related to BH treatment.
    • While OPP reported a declining percentage of external reviews regarding BH treatment resolved in favor of the consumer from 2014-2016, in 2017, 59% of those external reviews were resolved in favor of the consumer, the highest percentage in the past four years.

    Issue 8: Urgent Care Centers and Retail Clinics (August 9, 2018)

    • The number of retail clinics in Massachusetts nearly tripled from 20 in 2010 to 57 in 2018. The number of urgent care centers increased eight-fold from 18 in 2010 to 145 at the end of 2017.
    • The average ED visit costs just over $1200 with the patient copayment averaging $164, compared to the average urgent care center cost of $172 with patient copayments averaging $35, and $69 at retail clinics with patient copayments averaging $20. (ED and urgent care center figures were updated in December 2018)
    • Sore throats and acute sinusitis accounted for 30 percent of the conditions that retail clinics saw during visits. Urgent care centers treated a wider range of conditions but also saw sore throats (and upper respiratory infections a close second) as the top condition for visits.

    Issue 7: Variation in Imaging Spending (May 4, 2018)

    • Massachusetts ranks as the 4th highest spending state for imaging services with $892 in annual costs per Medicare beneficiary, 14 percent higher than the U.S. average. This is a contributing factor to higher overall health care costs in Massachusetts.
    • Massachusetts has relatively high facility use for imaging procedures, ranking 18th among states.
    • Prices are typically more than twice as high when the service is provided in a hospital outpatient department or other facility, compared to the same service performed in a doctor’s office or other non-facility setting. For example, the average price in Massachusetts for an MRI of the brain with contrast was more than twice as expensive at a facility setting ($699), compared to a non-facility setting ($337).

    Issue 6: Provider Organization Performance Variation (March 1, 2018)

    • After adjusting for differing health needs, spending for patients in the highest-cost organization was 32 percent higher than in the lowest-cost organization. 
    • Among categories of service, hospital outpatient services saw the greatest spending variation, both in total spending and across provider groups. 
    • Patients whose PCPs are associated with the Southcoast Health System are from the lowest-income areas in the state and have the highest health risk, 9 percent above the statewide average. These patients also had the highest rates of hypertension (18.5 percent), cardiovascular disease (15.6 percent), and diabetes (6.7 percent).

    Issue 5: Quality Measurement Misalignment in Massachusetts (January 10, 2018)

    • The three largest MA commercial payers vary in their scope of quality measure use in APM contracts; one payer reported use of 26 measures in at least ten APM contracts while the others reported use of over 40 measures in at least ten APM contracts.
    • Only 17 quality measures are used in at least ten APM contracts by all three payers, including two common outcome measures.

    Issue 4: The growing opioid epidemic in Massachusetts hospitals (July 26, 2017)

    • Between 2014 and 2015, the number of opioid-related hospital (ED and inpatient) discharges grew drastically, by 18%.
    • A new, interactive map displays the rate of opioid-related hospital discharges by zip code and provides new insights into the disproportionate impact of the opioid epidemic on certain residents, communities, and hospitals.
    • Young adults experienced the sharpest increase in discharges, rising by 192% from 2011 to 2015.

    Issue 3: The ACA’s Preventative Coverage Mandate and MA (June 26, 2017)

    • Average out-of-pocket spending by women for prescription drugs declined 14.2% from 2011-2014.

    Issue 2: Avoidable Emergency Department Use in Massachusetts (May 23, 2017)

    • 42% of all ED visits in Massachusetts in 2015 were avoidable with fairly consistent rates throughout the Commonwealth in 2015.

    Issue 1: Update on preventable oral health ED visits in MA (April 27, 2017)

    • The HPC identified 33,467 oral health ED visits in Massachusetts in 2015.
    • The HPC found a five-fold regional variation in the number of oral health ED visits per population.
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