Hidden Link

June 17, 2024

By jennifer smith

Massachusetts is in the unique position of having a designated agency to wave a red flag when health care systems start trending in troubling directions, and the head of that agency is seeing some cause for concern on health care spending and physician retention.

"Massachusetts is on par with the national average when it comes to primary care spending as a percent of total health care spending, but Massachusetts has a higher rate of physicians leaving primary care than the national average,” Lauren Peters, executive director of the Center for Health Information and Analysis (CHIA), said on The Codcast. “So I think that while we still have a lot of work to do here in Massachusetts, the trends that we're seeing are not so dissimilar from what we're seeing elsewhere in the country.”

CHIA is an independent state agency and primary hub of health care data and analytics for Massachusetts. It maintains a robust catalog of interactive data reports, updated regularly. 

Peters ran through some of the significant system indicators in conversation with John McDonough, a professor at the T. H. Chan School of Public Health at Harvard University, and Paul Hattis, senior fellow at the Lown Institute.

CHIA’s most recent total health care expenditure data show a 5.8 percent growth rate, Peters said, which represents the highest one-year growth trend since measurement began in 2012, with the exception of the “anomalous” COVID year of 2021. 

“While some of the spending trends can be attributed to, and should be viewed in the context of, the extraordinary circumstances of the pandemic, I'm not optimistic that the spending trends will improve absent meaningful reforms given that, as a system, we've exceeded the benchmark in the last four of five years and many of the trends and cost drivers,” including pharmacy and outpatient, “have been consistent contributors to overall cost growth even prior to the pandemic,” she said.

Provider assets can also offer a clue to the overall system’s health, Peters said. While some of the state’s largest and historically wealthiest health care systems – like Mass General Brigham, Boston Children’s Hospital, or Dana-Farber – have seen their net assets grow, “systems experience a varying degree of financial impact,” she said.

“I think the pandemic had a compounding effect,” she said. “Many of our safety net and less resourced hospitals were often those serving communities that were disproportionately affected by Covid, and it was the same hospitals that had to rely more on temporary labor factors that had a compounding impact on their bottom line. But it is worth noting that the state was really intentional about targeting relief funding to mitigate the impact on these hospitals.”

Massachusetts, which established CHIA in 2012 as part of health care cost containment legislation, is the only state in the country with this type of independent entity focused on the local health care system.

“In talking with counterparts in other states, CHIA is often sort of the envy, in terms of our all-payer claims database, our case mix data, and some of the more advanced initiatives and efforts that we're doing with that data,” Peters said. “I think we're always trying to evolve and improve our various data and analytic strategies, but I will say that CHIA does have a leg up just given the amount of time that we've been at this.”

The agency has been in the mix on Steward Health Care’s crash and burn for years, fining the health organization in 2016 for failure to submit required financial filings. Steward then sued CHIA, arguing that it lacked the statutory authority to collect their audited financial statements.

After a Superior Court ruled last year that CHIA does have the authority, Steward appealed and the case is currently under review. The attorney general’s office is representing CHIA in the case, Peters said. 

As Steward’s bankruptcy proceeding unfurls in Texas, and Massachusetts regulators consider the fate of its Bay State hospitals, Peters said, the agency is “actively supporting our sister agencies across state government, through the provision of data and analysis related to hospital utilization and financial performance, as folks try to plan and continue to stay prepared for whatever situation may unfold."