In 2023, the Commonwealth Fund’s Scorecard on State Health System Performance ranked Massachusetts the seventh worst-performing state on “avoidable use and costs.” While the primary driver of health care costs in Massachusetts is unit price, unnecessary utilization of health care services, including those deemed to be avoidable, also drives excess medical spending.
As health care spending continues to rise at both the state and federal levels, employers and consumers find themselves grappling with mounting expenses. This OnPoint provides insight into the regulatory and financial oversight requirements on three key sectors of the health care ecosystem.
Every year, MAHP member plans demonstrate a strong commitment to supporting the communities they serve and improving the quality of life and the health of individuals that live in these communities, with a focus on underserved and vulnerable populations.
Pharmaceutical innovations can provide significant opportunities for patients; however, prescription drug costs continue to skyrocket, creating affordability challenges and ultimately resulting in limited access for many patients. A RAND Corporation report found that United States drug prices were 256% higher than those in the 32 comparison countries combined.
While the two distinct measures of health care costs are often conflated, the Massachusetts health care cost growth benchmark and the process for determining annual health plan premiums are not the same. This policy brief outlines how health care spending is calculated and evaluated against the state’s cost growth benchmark, how health insurance premiums are developed, and the differences between the two.
Every year, MAHP member plans demonstrate a strong commitment to supporting the communities they serve and improving the quality of life and the health of individuals that live in these communities, with a focus on underserved and vulnerable populations.
The COVID-19 pandemic has had a historic impact on the health care sector at both the state and federal levels, impacting health care utilization and spending in 2020 and beyond. With decreased utilization caused by state and federally mandated closures of in-person care, many hospitals, and providers experienced revenue losses while many health plans experienced lower than predicted claims costs resulting in unexpected surplus.
Rising prescription drug prices are one of the top contributors to health insurance premium increases and high out-of-pocket costs for consumers, placing a financial burden on patients, families, and the health care system.
This OnPoint examines recent policies enacted at the federal level aimed at curtailing surprise billing and outlines recommendations for state policymakers to strengthen the Commonwealth’s efforts to protect consumers from out-of network charges.
Every year, MAHP member plans demonstrate a strong commitment to supporting the communities they serve and improving the quality of life and the health of individuals that live in these communities, with a focus on underserved and vulnerable populations.
