Health Care in Massachusetts: Key Indicators, February 2011 Edition

7/30/2019 Health Care in Massachusetts: Key Indicators, February 2011 Edition

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Health Care in Massachusetts: Key Indicators, February 2011 Edition

Released in July 2011

Deval Patrick, Governor

Commonwealth of Massachusetts

Timothy P. Murray

Lieutenant Governor

JudyAnn Bigby, Secretary

Executive Office of Health and Human Services

Seena Perumal Carrington, Acting Commissioner

Division of Health Care Finance and Policy

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http://www.mass.gov/dhcfp


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Key Indicators

Introduction..2

Health Insurance Coverage3Health insurance coverage information is collected and updated quarterlyEmployer Survey.9The employer survey, which was conducted every two years prior to 2009, is conducted annually

beginning with the 2009 survey. Results from the 2010 survey are presented in this edition of the

report.

Access to Health Care..12The Division of Health Care Finance and Policy health insurance survey and Behavioral Risk Factor

Surveillance System (BRFSS) survey are both conducted annually. Measures on insurance coverage

from the 2010 DHCFP health insurance survey are presented in this report.

Health Insurance Premiums..21Premium information for Group Insurance Commission (GIC), Commonwealth Care health plans, and

the Health Connector Affordability Schedule is updated once a year. Lowest-cost CommonwealthChoice plan premiums are updated quarterly. This edition includes updated information for GIC

premiums and the lowest-cost Commonwealth Choice plans. Results from the 2009 Employer Survey

are included in this edition and will be updated annually.

Health Safety Net24Health Safety Net information is collected and updated quarterly. Data for the second quarter of HSN

fiscal year 2010 will be presented in future editions of the report.

Health Plan Financial Performance..30Health plan financial performance information is obtained quarterly from reports that health plans

self-report to the Division of Insurance. Information for the second quarter of 2010 is included in this

edition.

Acute Hospital Financial Performance38Acute hospital financial performance information is submitted to the Division of Health Care Finance

and Policy quarterly. Data for the third quarter of 2010 is presented in this edition of the report.

Community Health Center Financial Performance.44Community health center financial performance is updated once a year. Information for fiscal year

2009 is included in this edition of the report

Other Indicators.49Information on MassHealth members ages 65 and older is updated quarterly. This edition provides

second quarter 2010 data for this population.

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About this Report

Health Care in Massachusetts: Key Indicators is a quarterly report from the Division of

Health Care Finance and Policy (DHCFP). Key Indicators provides an overview of theMassachusetts health care landscape based on data reported by providers, health plans,government, and surveys of Massachusetts residents and employers.

DCHFP found that as of September 30, 2010, 388,196 people have obtained healthinsurance since implementation of health care reform in June 2006. Total number ofpeople with health insurance declined slightly (by 0.1%) during the nine months betweenDecember 31, 2009 and September 30, 2010, but the individual market, CommonwealthCare, and MassHealth, respectively, experienced enrollment increases of 5.9%, 2.7%, and4.1% during the period. For the same period, total private group enrollment decreased by1.2%.

Health plan financial performance for the third quarter of the 2010 calendar year ispresented in this edition of the report. Also updated in this report are: results from the2010 DHCFP Employer Survey; service, demand, and payment information for the HealthSafety Net 2010 fiscal year; health insurance premiums from the Health Connector; andenrollment in the Prescription Advantage program by MassHealth members aged 65 andolder. This report does not update the DHCFP Health Insurance Survey; financialperformance of Acute Hospitals; financial performance of Community Health Centers(CHCs); health care access measures from the Behavioral Risk Factor Surveillance System(BRFSS) survey; and enrollment information on MassHealth members aged 65 and over.Data for these sections are carried over from the November 2010 edition of the report.

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Individuals with Health Insurance, 2006-2010

This slide has a bar graph which describes the numbers of individuals with health insurance from

2006 to 2010:

As of June 30, 2006 there were 5,078,573 insured Massachusetts residents. As of December 31, 2006 there were 5,192,814 insured Massachusetts residents, an increase

of 114,437 since June 30, 2006. As of December 31, 2007 there were 5,445,375 insured Massachusetts residents, an increase



of 394,684 since June 30, 2006. As of September 30, 2010 there were 5,466,591 insured Massachusetts residents, an increase

of 388,196 since June 30, 2006.

1,120,945

The Sidebar reads: The total number of insured residents decreased slightly by 6,488enrollees between December 31, 2009 and September 30, 2010, resulting in, for the period,a 1.6% decline (from 395,083 to 388,196) in the total number of newly-insured residents(change in enrollment since June 2006).

Note: Data reflect total enrollment as of the specified date. Totals include Massachusettsresidents enrolled in health insurance products offered by the following health plans and

their affiliates: Aetna Health, Blue Cross Blue Shield (BCBSMA, HMO Blue andMassachusetts residents insured through other Blue Cross Association plans), BostonMedical Center HealthNet Plan, CeltiCare, CIGNA, ConnectiCare, Fallon, Great-West HealthCare, Harvard Pilgrim Health Care, HealthMarkets (MEGA Life and Health InsuranceCompany, Mid-West National Life Insurance Company of Tennessee, and the ChesapeakeLife Insurance Company), Health New England, MassHealth, Neighborhood Health Plan,Tufts, UniCare and UnitedHealthcare. Third quarter enrollment data for Network Healthare not included. Data exclude the following insured Massachusetts residents: federalemployees not insured through a commercial carrier, active duty military personnel andtheir families who receive services through Champus/Tricare only, and inmates of theDepartment of Correction. Numbers may not match previous editions of Key Indicators, as

health plans may revise enrollment information in previous quarters.

Sources: Membership reported to DHCFP by health plans, and MassHealth;Commonwealth Care enrollment data are from the Health Connector.

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Insured Population by Insurance Type, 2006-2010 Excludes Medicare Enrollees

As of June 30, 2006, 85% of insured Massachusetts residents were members of Private, 14% were MassHealth members,1% were in Individual Purchase and 0% were Commonwealth Care members. The number of members was 4,333,014 in

Private, 40,184 in Individual Purchase, 705,179 in MassHealth and 0 in Commonwealth Care. The total number ofmembers without Medicare was 5,078,377.

As of December 31, 2006, 85% of insured Massachusetts residents were members of Private, 14% were MassHealthmembers, 1% were in Individual Purchase and 0% were Commonwealth Care members. The number of members was4,395,136 in Private, 740,633 in MassHealth, 38,718 in Individual Purchase, and 18,327 in Commonwealth Care. The totalnumber of members without Medicare was 5,192,814.

As of December 31, 2007, 82% of insured Massachusetts residents were members of Private, 14% were MassHealthmembers, 1% in Individual Purchase, and 3% were Commonwealth Care members. The number of members rounded tothe nearest thousand was 4,457,157 in Private, 764,559 in MassHealth, 65,465 in Individual Purchase and 158,194 inCommonwealth Care. The total number of members without Medicare was 5,445,375.

As of December 31, 2008, 81% of insured Massachusetts residents were members of Private, 14% were MassHealthmembers, 1% in Individual Purchase, and 3% were Commonwealth Care members. The number of members was

4,474,466 in Private, 780,727 in MassHealth, 81,073 in Individual Purchase and 162,725 in Commonwealth Care. Thetotal number of members without Medicare was 5,498,991.

As of December 31, 2009, 80% of insured Massachusetts residents were members of Private, 15% were MassHealthmembers, 2% in Individual Purchase, and 3% were Commonwealth Care members. The number of members was4,358,867 in Private, 848,528 in MassHealth, 114,668 in Individual Purchase and 150,998 in Commonwealth Care. Thetotal number of members without Medicare was 5,473,061.

As of September 30, 2010, 79% of insured Massachusetts residents were members of Private, 16% were MassHealthmembers, 2% in Individual Purchase, and 3% were Commonwealth Care members. The number of members was4,306,925 in Private, 883,066 in MassHealth, 121,440 in Individual Purchase and 155, 142 in Commonwealth Care. Thetotal number of members without Medicare was 5,466,573.

The overall change since June 30, 2006 for Private Group was 26,089. The change since June 30, 2006 for MassHealth

was +177,887. The change from June 30, 2006 for Commonwealth Care was +155,142. The change from June 30, 2006 forIndividual Purchase was +81,256.The change from June 30, 2006 for total members was +388,196.

The Sidebar reads: Of the newly insured since health reform, a significant number are MassHealth and CommonwealthCare members. The majority of residents (79%), however, continue to receive coverage through the private groupmarket. The economic downturn may be a contributor to the slight decline in the private group market, which sawsubstantial coverage increases during the first two years of health reform prior to the economic recession.

Notes: Private group includes large group, small group, and self-insured members reported by the health plans listed on page 6.Individual purchase includes Commonwealth Choice and residual non-group market. MassHealth enrollment does not include memberswith partial coverage or premium assistance; they are counted in the private plans. These members include Seniors, MassHealth Limited,individuals with third party liability (e.g., disabled with Medicare), and Family Assistance/Insurance Partnership. Commonwealth Careincludes enrollment in Boston Medical Center HealthNet Plan, Fallon, Neighborhood Health Plan. Third quarter enrollment data forNetwork Health are not included. Data reflect total enrollment, rounded to the nearest thousand, as of the specified date. Totals includeMassachusetts residents enrolled in health insurance products offered by the following health plans and their affiliates: Aetna Health,Blue Cross Blue Shield (BCBSMA, HMO Blue and Massachusetts residents insured through other Blue Cross Association plans), BostonMedical Center HealthNet Plan, CeltiCare, CIGNA, ConnectiCare, Fallon, Great-West Health Care, Harvard Pilgrim Health Care,HealthMarkets (MEGA Life and Health Insurance Company, Mid-West National Life Insurance Company of Tennessee, and theChesapeake Life Insurance Company), Health New England, MassHealth, Neighborhood Health Plan, Network Health, Tufts, UniCare andUnitedHealthcare. Data exclude the following insured MA residents: federal employees not insured through a commercial carrier, activeduty military personnel and their families who receive services through Champus/Tricare only and inmates of the Department ofCorrection. Numbers may not match previous editions of Key Indicators, as health plans may revise enrollment information in previousquarters. Percentages may not sum to 100 due to rounding. Sources: Membership reported to DHCFP by health plans, and MassHealth;Commonwealth Care enrollment data are from the Health Connector.

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Medical Security Program Enrollment, 2006-2010 Unemployment Claimants andDependents

This slide has a bar graph which shows us the number of medical security program

enrollment through 2006 to 2010 as follows:

As of June 30, 2006, there were 4,473 enrollees. As of December 31, 2006, there were 5,600 enrollees, an increase of 1,127 since June

30, 2006. As of December 31, 2007, there were 7,710 enrollees, an increase of 3,237 since June



30, 2006.

As of March 31, 2010, there were 38,457 enrollees, an increase of 33,984 since June 30,2006.

As of June 30, 2010, there were 36,958 enrollees, an increase of 32,485 since June 30,2006.

As of September 30, 2010, there were 36,160 enrollees, an increase of 31,687 since June30, 2006.

The Sidebar reads: The Medical Security Program (MSP) is a health care plan for low- andmoderate-income Massachusetts residents receiving unemployment insurance benefits.The third quarter of 2010 recorded the second consecutive decline in MSP enrollment.Total enrollment in the program has declined by 6% since the first quarter of 2010.*

*Quarterly results may not be indicative of year-end trends.

The MSP offers two types of coverage: premium assistance for COBRA-eligible individuals,and direct coverage for individuals who do not qualify for COBRA. Premium assistancemembers are counted in the private group market while direct purchase enrollees areincluded in individual purchase on page 4. MSP enrollees are included in the totalenrollment on page 3 and are reflected in total enrollment by insurer on page 7.More information on COBRA can be found at www.dol.gov/ebsa/cobra

Notes: Data reflect total enrollment including unemployment insurance enrollees and theirdependents.

Source: Massachusetts Division of Unemployment Assistance.

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Private Group Enrollment Distribution by Fully and Self-Insured Plans, 2006-2010

Excludes Medicare Advantage

This slide has a double bar graph which shows the percentage breakdown of fully insured

and self insured plans from 2006 through 2010:

As of December 31, 2006 55% were Fully-Insured and 45% were Self-Insured As of December 31, 2007, 53% were Fully-Insured and 47% were Self-Insured As of December 31, 2008, 51% were Fully-Insured and 49% were Self-Insured As of December 31, 2009, 49% were Fully-Insured and 51% were Self-Insured As of September 30, 2010 (Third Quarter), 47% were Fully-Insured and 53% were Self-

Insured.

The Sidebar reads: Membership in self-insured products has grown steadily sinceDecember 2006 and currently accounts for more than half of private group enrollment.

Self-insured products are arrangements in which an employer provides health benefits toemployees and assumes the insurance risk for claims payment. Unlike fully-insuredproducts, the health plan acts as a third party administrator for self-insured products and isnot at risk for medical costs. The Employee Retirement Income Security Act (ERISA)exempts self-insured plans from most state oversight and regulations.

Notes: Data reflect enrollment in large and small group health insurance. Self-insuredproducts are those reported by health plans listed on page 7 and do not include self-administered or third-party administered plans. As a result, the number of self-insuredmembers may be understated. Totals include Massachusetts residents enrolled in health

insurance products offered by the following health plans and their affiliates: Aetna Health,Blue Cross Blue Shield (BCBSMA, HMO Blue and Massachusetts residents insured throughother Blue Cross Association plans), CIGNA, ConnectiCare, Fallon, Great-West Health Care,Harvard Pilgrim Health Care, HealthMarkets (MEGA Life and Health Insurance Company,Mid-West National Life Insurance Company of Tennessee, and the Chesapeake LifeInsurance Company), Health New England, Neighborhood Health Plan, Tufts and UniCare.UnitedHealthcare does not report information on fully- and self-insured membership anddata are not included on this page. The Q3 2010 fully-insured rate reflects fully-insuredmembership data from CeltiCare health plan. CeltiCare did not report fully-insuredmembership for periods prior to September 30, 2010. Percentages may not sum to 100 dueto rounding.Sources: Membership reported to DHCFP by health plans.

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Enrollment by Insurer as of September 30, 2010 (Includes Medicare Advantage)

This slide shows a vertical bar graph with bars representing enrollment by insurer as of June 30,

2010.

Blue Cross Blue Shield - 2,126,000 enrollments

Harvard Pilgrim Health Care - 731,000 enrollments

Tufts - 660,000 enrollments

UnitedHealthCare - 271,000 enrollments

Boston Medical Center HealthNet Plan 248,000 enrollments

Neighborhood Health Plan - 217,000 enrollments

Fallon - 187,000 enrollments

Aetna 167,000 enrollments

CIGNA - 175,000 enrollments

Network Health - 163,000* enrollments UniCare 126,000 enrollments

Health New England -108,000 enrollments

CeltiCare- 34,000 enrollments

HealthMarkets- 15,000 enrollments

ConnectiCare- 4,000 enrollments

Great-West Healthcare- 1,000 enrollments

The Sidebar reads: Enrollment figures by insurer include all Massachusetts residentsenrolled in health insurance products offered by the identified insurer and its affiliates.

MassHealth, Medicare Advantage, and Commonwealth Care enrollment are included inaddition to fully and self-insured group and direct purchase products.As of the third quarter of 2010, Blue Cross Blue Shields share of the Massachusettsinsurance market is 40.8%.

*Membership for Network Health is as of June 30, 2010, as third quarter enrollment data were not availablefor this edition of the report.Notes: Data reflect total enrollment as of September 30, 2010, rounded to the nearest thousand. Figures byplan include Massachusetts residents who are enrolled in health insurance products administered by thelisted insurer and all of its affiliates. Enrollment includes group, non-group, Commonwealth Choice directpurchase, FEHBP, student health insurance, MassHealth, Medicare Advantage, Commonwealth Care, and fully-and self-insured members. Products offering limited health benefits or supplemental coverage are notincluded. Joint ventures between health plans are reported by the primary administrator. Blue Cross BlueShield includes HMO Blue, BCBSMA, Massachusetts residents enrolled in out-of-state association plans thatsubcontract with BCBSMA, and Massachusetts residents enrolled in other out-of-state association plans.Health New England (HNE) started offering Medicaid policies to its members in July 2010. HNE totalmembership includes approximately 4,000 Medicaid members. Total numbers of people with healthinsurance presented on pages 3 and 4 include MassHealth members not enrolled in private plans and excludeMedicare Advantage. Therefore, numbers by insurer will not sum to totals on pages 3 and 4 of this report.UniCare data, previously reported by GIC, are directly from UniCare and include both GIC and other fully andself-insured products. As DHCFP identifies self-insured members and enrollment in affiliated plans, numbers

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are not comparable to enrollment or financial information reported in quarterly and annual statements byhealth maintenance organizations to the Massachusetts Division of Insurance.Sources: Membership reported to DHCFP by health plans, MassHealth, and the Health Connector.

Change in Enrollment by Insurer June 2006 to Sept 2010 (Includes Medicare Advantage)

This slide shows a bar graph with each bar representing change in enrollment by insurer

groups since June 2006 to June 2010.

Aetna - increased by 29,000 enrollments BCBS decreased by 145,000 enrollments BMC HealthNet Plan increased by 91, 000

CeltiCare - increased by 34,000 enrollments CIGNA increased by 12,000 enrollments ConnectiCare decreased by 3,000 enrollments

Fallon increased by 22,000 enrollments Great-West Healthcare decreased by 17,000 enrollments

HPHC increased by 12,000 enrollments HealthMarkets - decreased by 23,000 enrollments HNE increased by 26,000 enrollments NHP increased by 53,000 enrollments

Network Health increased by 85,000* enrollments Tufts increased by 109, 000 enrollments UniCare increased by 3,000 enrollments

UnitedHealthcare increased by 29,000 enrollments

The Sidebar reads: The majority of health plans have seen growth in enrollment sinceimplementation of health care reform in Massachusetts, with significant membership

increases for Boston Medical Center HealthNet Plan, Neighborhood Health Plan, and TuftsHealth Plan.BCBS enrollment has declined by 145,000 members since June 2006.

*Change in enrollment for Network Health is between June 2006 and June 30, 2010, as third quarter 2010 data were not available for thisedition of the report.Notes: Data reflect the change in total enrollment, rounded to the nearest thousand, between June 30, 2006 and September 30, 2010.Figures by plan include Massachusetts residents who are enrolled in health insurance products administered by the listed insurer and allof its affiliates. Enrollment includes group, non-group, Commonwealth Choice direct purchase, FEHBP, student health insurance,MassHealth, Medicare Advantage, Commonwealth Care, and fully- and self-insured members. Products offering limited health benefits orsupplemental coverage are not included. Joint ventures between health plans are reported by the primary administrator. HPHC lossesinclude enrollees in a plan that is jointly administered by UnitedHealthcare and are included in UnitedHealthcares enrollment tally. BlueCross Blue Shield includes HMO Blue, BCBSMA, Massachusetts residents enrolled in out-of-state association plans that subcontract withBCBSMA, and Massachusetts residents enrolled in other out-of-state association plans. Total numbers of people with health insurance

presented on pages 3 and 4 include MassHealth members not enrolled in private plans and exclude Medicare Advantage. Therefore,numbers by insurer will not sum to totals on pages 3 and 4 of this report. UniCare data previously reported by GIC, are directly fromUniCare and include both GIC and other fully- and self-insured products. As DHCFP identifies self-insured members and enrollment inaffiliated plans, numbers are not comparable to enrollment or financial information reported in quarterly and annual statements byhealth maintenance organizations to the Massachusetts Division of Insurance.Sources: Membership reported to DHCFP by health plans, MassHealth, and the Health Connector.

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Percent of Massachusetts Employers Offering Health Insurance, 2001-2010

This slide shows a bar graph with bars that measure the percent of Massachusetts employers who

offer health insurance to their employees from 2001 to 2010.

In 2001, 69% of employers offered health insurance to their employees. In 2003, 68% of employers offered health insurance to their employees. In 2005, 70% of employers offered health insurance to their employees. In 2007, 72% of employers offered health insurance to their employees. In 2009, 76% of employers offered health insurance to their employees. In 2010, 77% of employers offered health insurance to their employees.

The Sidebar reads: Seventy-seven percent (77%) of employers in the Commonwealthoffered health insurance to their employees in 2010, compared to 69% of employers who

did so in 2001. In 2010, 69% of national employers offered coverage.*Employers offering health insurance represents the proportion of all employers inMassachusetts (excluding federal and state public agencies) with at least three employeeswho make health insurance available to employees. Changes in the employer offer rate donot reflect employment and/ or unemployment fluctuations in the states economy.

*The national average was 60% in 2009. According to Kaiser/HRET, the reason for the large

increase [from 60% to 69%] in offer rate is unclear. Because of the poor economic climate in 2010,

it is unlikely that many firms began offering coverage this year. A possible explanation is that non-

offering firms were more likely to fail during the past year, with the attrition of non-offering firms

leading to a higher offer rate among surviving firms. (Kaiser/HRET News Release, September 2,2010).

Sources: DHCFP Employer Surveys for selected years in the period 2001-2010. National average

Kaiser/HRET Survey of Employer Sponsored Benefits, 2010. For further information on the DHCFP

Employer Survey Report, visit www.mass.gov/dhcfp and follow the Publications and Analyses

link.

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Percent of Eligible Massachusetts Employees Enrolled in Employer-Based Health

Insurance, 2001-2010

This slide shows a bar graph with each bar representing the percent of eligible employees whoenroll in their employers health plan.

In 2001, 80% of eligible employees enrolled in their employers health plan. In 2003, 85% of eligible employees enrolled in their employers health plan. In 2005, 78% of eligible employees enrolled in their employers health plan. In 2007, 78% of eligible employees enrolled in their employers health plan. In 2009, 80% of eligible employees enrolled in their employers health plan. In 2010, 75% of eligible employees enrolled in their employers health plan.

The Sidebar reads: Three out of every four (75%) eligible employees in Massachusetts was

enrolled in employer-based health plans in 2010. The proportion of eligible employeesenrolled in employer-sponsored health plans peaked at 85% in 2003.

Employee take-up rate of employer-sponsored insurance may be affected by changes inthe employment status if, for example, someone who had been covered under an employerplan and purchasing family coverage loses his or her job, an employed spouse who mayhave previously opted out of coverage, may choose to opt into employer coverage to coverthe family.

Note: Data reflect medians.Sources: DHCFP Employer Survey for 2001, 2003, 2005, 2007, 2009, and 2010. For further

information on the 2010 Employer Survey Report, visitwww.mass.gov/dhcfp and followthe Publications and Analyses link.

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Percent Contribution to Individual and Family Health Insurance Premiums by

Massachusetts Employers, 2001-2010

This slide shows a double bar graph with pairs of bars that measure the median percent ofemployer contributions to health insurance for individual and family premiums.

In 2001, employers contributed 82% to individual premiums and 75% to family premiums. In 2003, employers contributed 78% to individual premiums and 75% to family premiums. In 2005, employers contributed 77% to individual premiums and 75% to family premiums. In 2007, employers contributed 75% to individual premiums and 75% to family premiums. In 2009, employers contributed 72% to individual premiums and 68% to family premiums. In 2010, employers contributed 75% to individual premiums and 70% to family premiums.

The Sidebar reads:The proportion of individual and family health insurance premiumspaid for by employers went up in 2010, compared to rates for 2009.

Note: Data reflect medians.Sources: DHCFP Employer Survey for 2001, 2003, 2005, 2007, 2009, and 2010. For furtherinformation on the 2010 Employer Survey Report, visitwww.mass.gov/dhcfp and followthe Publications and Analyses link.

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Percent of all Massachusetts Residents without Health Insurance Coverage, 2000-

2010

This slide shows a bar graph with each bar representing the percentage of all uninsured stateresidents from 2000 to 2009. The bar graph displays data from 2000, 20002, 2004, 2006, 2007,2008 and 2009.

In 2000, 5.9% of Massachusetts residents where without access to health insurance








The Sidebar reads: More than 98% of Massachusetts residents had health insurance at thetime of DHCFPs 2010 Massachusetts Health Insurance Survey (MHIS). This suggests that asof 2010, only 120,000 Massachusetts residents (1.9% of the total population) remainwithout health insurance coverage. Virtually all children in Massachusetts (99.8%) arenow insured. The national uninsurance rate was 16.7% in 2009, the most recent year forwhich data was available.

DHCFP implemented a new survey methodology beginning in 2008, therefore somecaution should be taken when comparing data before 2008 to data after 2008, due to

methodological differences.

Population estimates are based on estimates of the total civilian non-institutionalized population in Massachusetts fromthe March Current Population Survey for the relevant year.Sources: DHCFP Household Surveys for 2000, 2002, 2004, 2006, and 2007; surveys from 2000 through 2006 wereconducted February through June of the survey year; survey for 2007 was conducted January through July of 2007. Datafor 2008, 2009 and 2010 are from the Urban Institute tabulations on the Massachusetts Health Insurance Survey for therespective years. For more information, please visit www.mass.gov/dhcfp. Click on Publications and Analyses then go toHousehold Health Insurance Survey. National uninsured rate is as reported by the US Census Bureau in Income, Poverty,and Health Insurance Coverage in the united States, 2008 and 2009 data. Online at http://www.census.gov

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Percent of Uninsured Massachusetts Residents by Race and Ethnicity, 2008-2010

This slide shows a double bar graph with pairs of bars representing the percent of people

uninsured by race and ethnicity for 2008 and 2010.

2.6% of Massachusetts residents ("Total Population") were uninsured in 2008; 2.7% in2009; 1.9% in 2010

2.2% of Massachusetts residents who classified themselves as White, Non-Hispanicwere uninsured in 2008; 2.4% in 2009; 1.7% in 2010

2.8% of Massachusetts residents who classified themselves as Other Race, Non-Hispanic were uninsured in 2008; 2.9% in 2009; 1.5% in 2010

7.2% of Massachusetts residents who classified themselves as Hispanic were uninsuredin 2008; 5.1% in 2009; 3.9% in 2010

The Sidebar reads: Hispanic residents in Massachusetts were more likely to be uninsuredthan residents in other racial/ethnic groups in 2010. The rate of uninsurance for thisgroup, however, has declined by 45% since 2008.

In some cases, what appears to be relatively large differences in estimates between 2008and 2009 are not statistically significant. This arises because estimates based on smallsubgroups of the overall population have larger variances, making point estimates lessprecise. A test of significance was not conducted for the 2009 2010 period.

Note: Other race, non-Hispanic includes black and Asian in addition to other races.Source: Urban Institute tabulations on the 2008, 2009, and 2010 Massachusetts HeathInsurance Survey. For more information, please visit www.mass.gov/dhcfp. Click onPublications and Analyses then go to Household Health Insurance Survey.

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Percent of Uninsured Massachusetts Residents by Federal Poverty Level, 2008-2010

This slide shows a double bar graph with pairs of bars measuring the percent of all

Massachusetts residents who were uninsured by Federal Poverty Level (FPL) for 2008, 2009 and2010.

Total Population - 2.6% of Massachusetts residents did not have health insurance. 2.7% in2009; 1.9% in 2010

Less than 150% of the Federal Poverty level (FPL) 5.8% of Massachusetts residents did nothave health insurance in 2008. 4.3% in 2009. 3.8% in 2010

150% to 299% of the Federal Poverty level (FPL) 4.7% of Massachusetts residents did nothave health insurance in 2008. 5.0% in 2009. 2.9% in 2010

300% to 499% of the Federal Poverty level (FPL) 2.0% of Massachusetts residents did nothave health insurance in 2008. 2.5% in 2009. 1.4% in 2010

500% and higher of the Federal Poverty level (FPL) 0.2% of Massachusetts residents didnot have health insurance in 2008. 0.7% in 2009. 0.4% in 2010

The Sidebar reads: In 2010, Massachusetts residents with income less than 300% of thefederal poverty level (FPL) were more likely to go without coverage than were those withhigher incomes.

In some cases, what appears to be relatively large differences in estimates between 2008and 2009 are not statistically significant. This arises because estimates based on smallsubgroups of the overall population have larger variances, making point estimates lessprecise. A test of significance was not conducted for the 2009 2010 period.

Source: Urban Institute tabulations on the 2008, 2009, and 2010 Massachusetts HealthInsurance Survey. For more information, please visit www.mass.gov/dhcfp. Click onPublications and Analyses then go to Household Health Insurance Survey.

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Adult Residents who Needed Care but for whom Cost Was an Obstacle, 2000-2010

Percent of Massachusetts Residents Ages 19-64

This slide shows a double bar graph measuring the percent of uninsured and insured adults, ages19-64, who needed care, but identified cost as an obstacle.

In 2000, 85% of uninsured adults and 29% of insured adults identified cost as an obstacle. In 2002, 77% of uninsured adults and 22% of insured adults identified cost as an obstacle. In 2004, 78% of uninsured adults and 34% of insured adults identified cost as an obstacle. In 2006, 79% of uninsured adults and 32% of insured adults identified cost as an obstacle. In 2007, 86% of uninsured adults and 37% of insured adults identified cost as an obstacle. In 2008, 64% of uninsured adults and 24% of insured adults identified cost as an obstacle. In 2009, 67% of uninsured adults and 25% of insured adults identified cost as an obstacle. In 2010, 66% of uninsured adults and 28% of insured adults identified cost as an obstacle.

The Sidebar reads:Since 2007, cost has become less of an obstacle to accessing health carefor Massachusetts residents, but remains a significant barrier for people without healthcoverage. In the 2010 household survey, among adults aged between 19 and 64 years, 66%of uninsured residents compared to 28% of insured residents reported that cost affectedtheir ability to access care.DHCFP implemented a new survey methodology beginning in 2008, therefore somecaution should be taken when comparing data before 2008 to data after 2008, due tomethodological differences.

Notes: Beginning in 2008, DHCFP contracted with a new vendor for the Massachusetts household survey onhealth insurance. The 2008 survey had a number of methodological changes from prior year surveys which

may affect comparability of the results to prior years. The differences between insured and uninsuredresidents are statistically significant for 2002, 2004, and 2007.Sources: DHCFP Household Survey for 2000, 2002, 2004, 2006, and 2007. The surveys from 2000 through2006 are conducted from February through June of the survey years. The 2007 survey was conducted fromJanuary through July of the survey year. The 2008 through 2010 data are from the Urban Institute tabulationson the Massachusetts Health Insurance Survey. For more information, please visit www.mass.gov/dhcfp. Clickon Publications and Analyses then go to Household Health Insurance Survey.

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Adult Residents who Reported Being in Fair or Poor Health, 2000-2010


This slide shows a double bar graph measuring the percent of uninsured and insured adultresidents, ages 19-64, who reported being in fair or poor health from 2000 to 2010

In 2000, 10% of uninsured and 8% of insured adults reported being in "fair or poor health." In 2002, 20% of uninsured and 9% of insured adults reported being in "fair or poor health." In 2004, 18% of uninsured and 10% of insured adults reported being in "fair or poor health." In 2006, 14% of uninsured and 11% of insured adults reported being in "fair or poor health." In 2007, 14% of uninsured and 10% of insured adults reported being in "fair or poor health." In 2008, 18% of uninsured and 10% of insured adults reported being in "fair or poor health." In 2009, 19% of uninsured and 11% of insured adults reported being in "fair or poor health." In 2010, 16% of uninsured and 11% of insured adults reported being in "fair or poor health."

The Sidebar reads: The proportion of uninsured adults between the ages of 19 and 64 whoreported fair or poor health declined from 19% in 2009 to 16% in 2010. The proportion ofinsured adults who reported fair or poor health remained unchanged at 11% over the sameperiod.DHCFP implemented a new survey methodology beginning in 2008; therefore somecaution should be taken when comparing data before 2008 to data after 2008, due tomethodological differences.

Notes: Beginning in 2008, DHCFP contracted with a new vendor for the Massachusetts household survey on healthinsurance. The 2008 survey had a number of methodological changes from prior year surveys which may affectcomparability of the results to prior years. The differences between insured and uninsured residents are statistically

significant for 2002, 2004, and 2007.Sources: DHCFP Household Survey for 2000, 2002, 2004, 2006, and 2007. The surveys from 2000 through 2006 areconducted from February through June of the survey years. The 2007 survey was conducted from January through July ofthe survey year. The 2008 through 2010 data are from the Urban Institute tabulations on the Massachusetts HealthInsurance Survey. For more information, please visit www.mass.gov/dhcfp. Click on Publications and Analyses then goto Household Health Insurance Survey.

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Adult Residents who Reported Having a Dental Visit in the Past Year, 2000-2010


This slide shows a double bar graph measuring the percent of uninsured and insured adultresidents, ages 19-64, who reported having a dental visit in the past year from 2000 to 2010

In 2000, 46% of uninsured and 83% of insured adults reported having a dental visit In 2002, 45% of uninsured and 83% of insured adults reported having a dental visit In 2004, 41% of uninsured and 82% of insured adults reported having a dental visit In 2006, 47% of uninsured and 84% of insured adults reported having a dental visit In 2007, 43% of uninsured and 84% of insured adults reported having a dental visit In 2008, 37% of uninsured and 79% of insured adults reported having a dental visit In 2009, 46% of uninsured and 75% of insured adults reported having a dental visit In 2010, 30% of uninsured and 75% of insured adults reported having a dental visit

The Sidebar reads:From 2009 to 2010, there was a 16 percentage point decline in theproportion of uninsured adults who reported having a dental visit in the past year (46%

compared to 30%).

DHCFP implemented a new survey methodology beginning in 2008, therefore some

caution should be taken when comparing data before 2008 to data after 2008, due to

methodological differences.

Notes: Beginning in 2008, DHCFP contracted with a new vendor for the Massachusetts

household survey on health insurance. The 2008 survey had a number of methodologicalchanges from prior year surveys which may affect comparability of the results to prior

years. The differences between insured and uninsured residents are statistically significant

for 2002, 2004, and 2007.

Sources: DHCFP Household Survey for 2000, 2002, 2004, 2006, and 2007. The surveys

from 2000 through 2006 are conducted from February through June of the survey years.

The 2007 survey was conducted from January through July of the survey year. The 2008

through 2010 data are from the Urban Institute tabulations on the Massachusetts Health

Insurance Survey. For more information, please visit www.mass.gov/dhcfp. Click on

Publications and Analyses then go to Household Health Insurance Survey.

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Adult Residents who Have a Personal Health Care Provider, 2004-2009

Percent of Massachusetts Residents Ages 18 and over

This slide shows a bar graph representing the percent of adults ages 18 and over that have apersonal health care provider in a given year from 2004 through 2009.

In 2004, 87% of adults reported having a personal health care provider. In 2006, 88% of adults reported having a personal health care provider. In 2007, 88% of adults reported having a personal health care provider. In 2008, 89% of adults reported having a personal health care provider. In 2009, 90% of adults reported having a personal health care provider.

This slide has a table which shows the percent of adults ages 18+ by race/ethnicity (95%confidence interval):2004: White 89% (87-90CI) Black 90% (85-94 CI) Hispanic 75% (71 - 79 CI) Asian 88% (84-93 CI)2006: White 89% (88-90 CI) Black 89% (85-92 CI) Hispanic 75% (71-79 CI) Asian 83% (76-90 CI)2007: White 90% (90-91 CI) Black 84% (80-87 CI) Hispanic 76% (72-80 CI) Asian 86% (82-91 CI)2008: White 90% (89-91 CI) Black 83% (78-88 CI) Hispanic 80% (77-83 CI) Asian 84% (78-90 CI)2009: White 91% (90-92 CI) Black 84% (80-88 CI) Hispanic 82% (78 CI-85 CI) Asian

84% (76 CI-92 CI)

The Sidebar reads: Since 2004, there has been a slight increase in Massachusetts adultsaged 18 and over who report having a personal health care provider (or a primary caredoctor). In 2009 the proportion of black, Hispanic, and Asian adults with a personal healthcare provider ranged from 82% to 84% compared to 91% of White adults.

Note: Percentages are age adjusted to 2000 US population to control for difference in agedistributions among race groups.Source: Behavioral Risk Factor Surveillance System (BRFSS) for 2004, 2006, 2007, 2008

and 2009; Massachusetts Department of Public Health (DPH), Health Survey Program,Bureau of Health Statistics. The BRFSS is an annual survey conducted throughout the year.

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Adult Female Residents with a Mammogram in the Past Two Years, 2004-2008

Percent of Massachusetts Women Ages 40+

This slide shows a bar graph with four bars representing the percent of women ages 40 and overwho reported having a mammogram in the past two years.

In 2004, 83% of women reported having a mammogram in the past two years.




This slide also shows a data table which provides a breakdown of the percentage of women ages40 and over by race/ethnicity (95% confidence interval) who in the past 2 years had amammogram:

In 2004, 82% White (81-84 CI), 80% Black (64-95 CI), 88% Hispanic (82-93 CI),Insufficient data for Asian



In 2008, 85% White (84-86 CI), 87% Black (82-91 CI), 89% Hispanic (85-92 CI), 86%Asian (77-95 CI)

The Sidebar reads: Most Massachusetts female residents ages 40 and older reported

having a mammogram to screen for breast cancer in the last two years.In 2008, the most recent year with available data, there was not a significant differenceamong racial groups for women who reported having had a mammogram.

Note: The 2009 BRFSS survey did not measure the proportion of respondents who had amammogram screening thin the past 2 years. For this metric data from the 2008 survey isthe most current available information. Percentages are not age-adjusted and datapresented for 2004 2007 will not match previous editions ofKey Indicators.Source: Behavioral Risk Factor Surveillance System (BRFSS) for 2004, 2006, 2007 and2008; Massachusetts Department of Public Health (DPH), Health Survey Program, Bureau

of Health Statistics. The BRFSS is an annual survey conducted throughout the year.

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Adult Residents with a Sigmoidoscopy or Colonoscopy in the Past 5 Years, 2004-2009

Percent of Massachusetts Residents Ages 50+

This slide shows a bar graph representing the percent of adults ages 50 and older who reportedhaving a sigmoidoscopy or colonoscopy in the past five years.

In 2004, 54% of adults ages 50 and older reported having had a sigmoidoscopy orcolonoscopy in the past five years.



In 2008, 64% of adults ages 50 and older reported having had a sigmoidoscopy or

colonoscopy in the past five years. In 2009, 63% of adults ages 50 and older reported having had a sigmoidoscopy orcolonoscopy in the past five years.

This slide also shows a data table which provides a breakdown of the percentage of men ages 50and over by race/ethnicity (95% confidence interval) who in the past 2 years had a mammogram:




In 2008, 64% White (63-66 CI), 60% Black (52-67 CI), 57% Hispanic (50-63 CI), 56%Asian (39-72 CI)


The Sidebar reads: In 2009, nearly two-thirds of Massachusetts residents aged 50 and overindicated theyve had a sigmoidoscopy or colonoscopy in the past five years.Sigmoidoscopy is a medical examination of the large intestine to screen for colorectalcancer. Colonoscopy is a test that examines the colon, and is intended to screen for colon

cancer. Compared to previous years, the estimate for 2009 is based on a smaller samplesize due to a change in survey design. This produces higher variability in estimates,especially for minorities. Data, therefore, may not be indicative of an upward trend forBlacks. Caution should be exercised when interpreting data as more data and years ofobservation may be needed to make inferences about this group.

Note: Percentages are not age-adjusted and data presented for 2004 2007 will not match previous editions ofKey Indicators.Source: Behavioral Risk Factor Surveillance System (BRFSS) for 2004, 2006, 2007, 2008, and 2009; Massachusetts Department of PublicHealth (DPH), Health Survey Program, Bureau of Health Statistics. The BRFSS is an annual survey conducted throughout the year.

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Monthly Cost of Health Insurance in Massachusetts

Employer and Health Connector Plans for Individuals

This slide shows a double bar graph that represents the median monthly cost of health insurance by types ofhealth plans in Massachusetts for individuals (subscribers). Even further, each bar is doubly stacked to showthe dollar breakdown by employee/subscriber contribution, employer contribution and state subsidy toemployer and connector plans for individuals.

Employer based plans include two bars that represent monthly cost of health insurance for all agesstatewide.

o The first bar represents GIC (hired after 7/01/03). The employee /subscriber contribution is $83

and the employer contribution is $331, for a total cost of $413.o The second bar represents the mean of employer-based health insurance. The mean employee

contribution is $116 and the mean employer contribution is $326, for a total mean cost of $442.

Health Connector Plans include two subcategories that represent monthly cost of health insurance.o

Commonwealth Care Plans include four stacked bars with categories for state subsidy andemployee/subscriber contribution. For an individual within 0% to 150% of the federal poverty level, the subscriber

contribution is $0 and the state subsidy is $423, for a total cost of $423. For an individual within 150.1% to 200% of the federal poverty level, the subscriber



contribution is $116 and the state subsidy is $307, for a total cost of $423.o Lowest Cost Commonwealth Choice Plans include four bars that represent the subscribers

contribution.

For the lowest cost YAP (Young Adult Plans) with Rx, the subscriber contribution is

$189. For the lowest cost Bronze plan with Rx, the subscriber contribution is $233.

For the lowest cost Silver plan, the subscriber contribution is $329.

For the lowest cost Gold plan, the subscriber contribution is $404.

The graph also includes horizontal lines to show the maximum affordable premiums according to theConnector Affordability Standard for 2010 for individuals:

o The maximum affordable premium for income of $54,600 is $354 a month.



The Sidebar reads: Subscriber contributions to Commonwealth Care plans is comparable to the median employee contribution foremployer-based coverage as estimated in the 2010 Massachusetts Employer Survey (MES). All Commonwealth Choice products comparefavorably to the median total cost of employer-based insurance.

Employer-based premiums, Commonwealth Choice plan, GIC premiums, and Commonwealth Care plan premiumswere compared to theaffordability schedule that was established by the Health Connector effective for the calendar year 2010. For more details, please visit:www.MAhealthconnector.org.

Notes: The calculation of median premiums for private, employer-based insurance does not include premiums paid by governmentemployees. Commonwealth Care premiums reflect average composite FY2011 capitation rates for the total Commonwealth Carepopulation. There is variation in actual capitation amounts across plan types and managed care organizations based on memberdemographics. The premium for Commonwealth Choice YAP with Rx plan was calculated for a 25-year-old individual living in Boston.Premiums for Commonwealth Choice Bronze, Silver, and Gold are the lowest priced plans available for a 35-year-old individual living inBoston (in the zip code 02111). The premium for a YAP with a Rx plan is for a 25-year old living in Boston (in the zip code 02111). AllBronze, Silver and Gold plans include Rx. Data are rounded to the nearest whole dollar.

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Sources: 2010-2011 GIC Benefit Decision Guide; 2009 DHCFP Employer Survey; Health Connector Affordability Schedule for 2010;Health Connector for Commonwealth Choice plan premiums as of March 2011 and Commonwealth Care premiums as of February 1,2010.

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Monthly Cost of Health Insurance in Massachusetts

Employer and Health Connector Plans for Families

This slide shows a double bar graph that represents the median monthly cost of healthinsurance by types of health plans in Massachusetts for families (subscribers). Evenfurther, each bar is doubly stacked to show the dollar breakdown by employee/subscriberand employer contribution to health insurance premiums for families. The bars aregrouped into two categories: employer based health insurance and Commonwealth ChoicePlans.

Employer based plans include two bars that represent monthly cost of health insurancefor all ages and sizes statewide and all ages statewide respectively.

o The first bar represents GIC (hired after 7/01/03). The employee contribution is

$197 and the employer contribution is $786, for a total cost of $983.

o The second bar represents the median of employer-based health insurance. Themedian employee contribution is $350 and the median employer contribution is$839, for a total median cost of $1,189.

Commonwealth Choice Plans include three bars that represent the lowest costsubscriber contribution for three levels of health plans

o For the lowest cost Bronze plan with Rx, the subscriber contribution is $874.

o For the lowest cost Silver plan, the subscriber contribution is $1,153.

o For the lowest cost Gold plan, the subscriber contribution is $1,575.

The graph also includes horizontal lines to show the maximum affordable premiums

according to the Health Connector Affordability Standard for 2010 for Families andChildren:




The Sidebar reads: The total cost of health insurance for a Commonwealth Choice Silverfamily plan is comparable to the average total cost of health insurance for an employer-based family health plan.

Commonwealth Choice plan premiums and GIC premiums were compared to theaffordability schedule that was established by the Health Connector effective for thecalendar year 2010. For more details, please visit: www.MAhealthconnector.org.Notes: Commonwealth Care plans provide coverage for adult individuals only and, therefore, do not have family plans. The calculation ofmedian premiums for private employer-based insurance does not include premiums paid by government employees. Premiums forCommonwealth Choice Bronze, Silver, and Gold plans are the lowest price for a family of four with two 35-year-old parents and twochildren living in Boston (in the zip code 02111). All Bronze, Silver and Gold plans include Rx. Data are rounded to the nearest wholedollar.Sources: 2010-2011 GIC Benefit Decision Guide; 2009 DHCFP Employer Survey; Health Connector Affordability Schedule for 2010;Health Connector for Commonwealth Choice plan premiums as of March 2011.

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Commonwealth Choice Bronze Premiums, 2008-2011 Highest and Lowest-Cost Plans(with Rx coverage)

This slide shows a line graph with two lines that represent the premiums for lowest cost Bronze

health plans and the highest cost Bronze health plans.

Prominent data points on the graph for Lowest-Cost and Highest-Cost Bronze health plans:

January 2008 $196 Lowest-Cost and $282 Highest-Cost Bronze health plans.

July 2008 $193 Lowest-Cost and $285 Highest-Cost Bronze health plans.

January 2009 $205 Lowest-Cost and $286 Highest-Cost Bronze health plans.


December 2009 $221 Lowest-Cost and $333 Highest-Cost Bronze health plans.

January 2010* $215 Lowest-Cost and $318 Highest-Cost Bronze health plans.


Jan 2011 $233 Lowest-Cost and $396 Highest-Cost Bronze health plans.

The Sidebar reads: Premiums for the lowest-cost Commonwealth Choice Bronze planshave increased only slightly since January 2010. Premiums for the highest-cost BronzePlans have varied since January 2010.*Beginning in January 2010, premiums for Commonwealth Choice plan benefit packageschanged to create three tiers within Bronze. Reported here are the highest and lowest-costfor the Bronze Low Tier.Notes: Premiums are for a 35-year-old individual living in Boston (in the zip code 02111).As of January 2008, Bronze products are no longer offered without Rx coverage. Monthly

premium costs are selected from the highest- and lowest-priced products in the givenmonth therefore trend lines do not track the same product from the same carrier over time.Premiums effective January 2010 and after represent significantly different health benefitspackages and may not be comparable to data reported on periods preceding this date.Beginning January 2010, Bronze plans are offered in three tiers; lowest and highestpremiums shown are selected from the Bronze Low Tier. Prior to January 2010, lowest andhighest premiums represent the lowest and highest in the single Bronze category.Source: Health Connector

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Health Safety Net Total Demand and Payment Trends, 2008-2010

The slide displays a double bar graph with bars showing demands and payments made to

Hospital and Community Health Center (CHC) for Health Safety Net (HSN) Fiscal Year 2008,2009 and 2010.

HSN08: Hospital demanded and received the payment of $359 Million; CHC demandedand received the payment of $37 Million. HSN in the FY08 paid a total of $396 Million.

HSN09: Hospital demanded and received the payment of $372 Million; CHC demandedand received the payment of $42 Million. HSN in the FY09 paid a total of $414 Million.

HSN10: Hospital received the payment of $359 Million; CHC received the payment of$47 Million. HSN in the FY10 paid a total of $405 Million out of a total $475 Milliondemand. There was a $70 Million shortfall in this FY.

Demand increased by 5% between HSN08 and HSN09 and 15% between HSN09 and HSN10.However, there was a 2% decrease in payment between HSN09 and HSN10.

The Sidebar reads: Total Health Safety Net (HSN) payments declined by 2% in HealthSafety Net fiscal year 2010 (HSN10) compared to the prior year, while demand increasedby 15%.Demand represents the amount that providers would have been paid in the absence of afunding shortfall. Because HSN10 demand exceeded HSN10 funding, hospital providersexperienced a $70 million shortfall during HSN10.

Notes: The Health Safety Net fiscal year runs from October 1 through September 30 of the

following year. Hospital and community health center payments are reported in the monthin which payment was made. Previously reported HSN08 payments were projected andhave been updated. Numbers are rounded to the nearest million and may not sum due torounding; percent changes are calculated prior to rounding.Source: DHCFP Health Safety Net Data Warehouse as of 10/25/10. For further informationon the Health Safety Net Report visitwww.mass.gov/dhcfp and follow the Publicationsand Analyses link.

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Health Safety Net Total Service Volume Trends, 2008-2010

The slide displays a double bar graph with bars showing total service volume by Hospital and

Community Health Center (CHC) for Health Safety Net (HSN) Fiscal Year 2008, 2009 and2010.

HSN08: 715K served by Hospital and 262K served by Community Health Center. HSNtotal service volume is 977K.

HSN09: 703K served by Hospital and 287K served by Community Health Center. HSNtotal service volume is 990K.

HSN10: 800K served by Hospital and 312K served by Community Health Center. HSNtotal service volume is 1,112K.

Demand increased by 1% between HSN08 and HSN09 and 12% between HSN09 and HSN10.

The Sidebar reads: Health Safety Net (HSN) total volume for hospitals and communityhealth centers increased 12% in Health Safety Net fiscal year 2010 (HSN10) compared tothe prior year.Hospital volume is the sum of inpatient discharges and outpatient visits for whichpayments were made to hospital providers in the years shown. Community health centervolume is the sum of visits for which payments were made to community health centerproviders in the years shown.

Notes: The Health Safety Net fiscal year runs from October 1 through September 30 of thefollowing year. Hospital and community health center volume exclude pharmacy claims.

HSN08 CHC volume differs from data previously published due to a technical change madeto the methodology used to calculate CHC visits. HSN09 hospital and CHC volume reflectsupdated hospital and CHC claims activity and may differ from data previously published.Numbers are rounded to the nearest thousand and may not sum due to rounding; percentchanges are calculated prior to rounding.Source: DHCFP Health Safety Net Data Warehouse as of 10/25/10. For further informationon the Health Safety Net Report visitwww.mass.gov/dhcfp and follow the Publicationsand Analyses link.

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Health Safety Net Hospital Demand and Payment Trends, 2008-2010

The slide displays a double bar graph showing HSN hospital demand and payment trends with

each bar providing a dollar and demand breakdown for Health Safety Net (HSN) Fiscal Year2008, 2009 and 2010.

HSN08: $150 Million Outpatient; $125Million Inpatient, $30 Million OutpatientEmergency Room Bad Debt; $19 Million Inpatient Emergency Room Bad Debt; $17Million Pharmacy; $19 Million Others; $359 Million Total hospital demand.

HSN09: $165 Million Outpatient; $144 Million Inpatient, $23 Million OutpatientEmergency Room Bad Debt; $13 Million Inpatient Emergency Room Bad Debt; $17Million Pharmacy; $11 Million Others; $372 Million Total hospital demand.

HSN10: $153 Million Outpatient; $135 Million Inpatient, $23 Million OutpatientEmergency Room Bad Debt; $12 Million Inpatient Emergency Room Bad Debt; $17

Million Pharmacy; $20 Million Others; $70 Million Shortfall; $429 Million Totalhospital demand and $358 Million payments made by HSN.

Demand increased by 4% between HSN08 and HSN09 and 15% between HSN09 and HSN10.However, there was a 4% decrease in payment between HSN09 and HSN10.

The Sidebar reads: Hospital payments declined by 4% in Health Safety net fiscal year 2010(HSN10) compared to the prior year, while hospital demand increased by 15%.Demand represents the amount that providers would have been paid in the absence of afunding shortfall.

Notes: The Health Safety Net fiscal year runs from October 1 through September 30 of the following year.Other HSN Payments include adjustments that are not attributable to a service category. Hospital paymentsare reported in the month in which payment was made. The HSN10 shortfall allocation is distributedproportionally by service type. Previously reported HSN08 payments were projected and have been updated.HSN09 payments differ from data previously published due to a technical change made to the methodologyused to determine the payment amount attributable to each service category, Numbers are rounded to thenearest million and may not sum due to rounding; percent changes are calculated prior to rounding.Source: DHCFP Health Safety Net Data Warehouse as of 10/25/10. For further information on the HealthSafety Net Report visitwww.mass.gov/dhcfpand follow the Publications and Analyses link.

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Health Safety Net Hospital Service Volume Trends, 2008-2010

The slide displays a double bar graph showing HSN hospital service volume trends with each barproviding a dollar and demand breakdown for Health Safety Net (HSN) Fiscal Year 2008, 2009and 2010.

HSN08: 615K Outpatient Visits; 77K Outpatient Emergency Room Bad Debt; 22KInpatient Discharges; 2K Inpatient Emergency Room Bad Debt; 715K total.

HSN09: 610K Outpatient Visits; 70K Outpatient Emergency Room Bad Debt; 22KInpatient Discharges; 1K Inpatient Emergency Room Bad Debt; 703K total.

HSN10: 695K Outpatient Visits; 78K Outpatient Emergency Room Bad Debt; 26KInpatient Discharges; 1K Inpatient Emergency Room Bad Debt, 800K total.

Demand decreased by 2% between HSN08 and HSN09 and 14% between HSN09 and HSN10.

The Sidebar reads: Hospital volume increased by 14% in Health Safety net fiscal year 2010

(HSN10) compared to the prior year. During HSN10, total inpatient volume increased 17%

and total outpatient volume increased 14% compared to the prior year.

Notes: The Health Safety Net fiscal year runs from October 1 through September 30 of the

following year. Hospital volume is the sum of inpatient discharges and outpatient visits for

which payments were made to hospital providers in the months shown. HSN09 volume

reflects updated hospital claims activity and may differ from data previously published.

Numbers are rounded to the nearest thousand and may not sum due to rounding; percent

changes are calculated prior to rounding.

Source: DHCFP Health Safety Net Data Warehouse as of 10/19/10. For further information

on the Health Safety Net Report visitwww.mass.gov/dhcfp and follow the Publications

and Analyses link.

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Health Safety Net Community Health Center Payment Trends, 2008-2010

This slide displays a bar graph representing HSN Community Health Center (CHC) payments

trends with each bar representing the CHC payments for Health Safety Net (HSN) Fiscal Year2008, 2009 and 2010.

HSN08: $37 Million

HSN09: $42 Million

HSN10: $47 Million


The Sidebar reads: Community health center (CHC) payments increased by 11% in HSN10compared to the prior year.

Notes: The Health Safety Net fiscal year runs from October 1 through September 30 of thefollowing year. Community health center payments are reported in the month in whichpayment was made. Numbers are rounded to the nearest million and may not sum due torounding; percent changes are calculated prior to rounding.Source: DHCFP Health Safety Net Data Warehouse as of 10/25/10. For further informationon the Health Safety Net Report visitwww.mass.gov/dhcfp and follow the Publicationsand Analyses link.

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HSN Community Health Center Service Volume Trends, 2008-2010

This slide displays a bar graph representing HSN Community Health Center (CHC) service

volume trends with each bar representing the CHC service volume for Health Safety Net (HSN)Fiscal Year 2008, 2009 and 2010.

HSN08: 262K

HSN09: 287K

HSN10: 312 K


The Sidebar reads: Community health center (CHC) volume increased 9% in HSN10compared to the prior year.

Notes: The Health Safety Net fiscal year runs from October 1 through September 30 of thefollowing year. Community health center volume is the sum of visits for which paymentswere made to community health center providers in the years shown. Community healthcenter volume excludes pharmacy claims. CHCs have been moving from a voucher-based toa claims-based adjudication and payment system since April 2009; this transition mayresult in shifts in volume that is expected to stabilize once all CHCs have transitioned to thenew system. HSN08 volume differs from data previously published due to a technicalchange made to the methodology used to calculate CHC visits. HSN09 volume reflectsupdated CHC claims activity and may differ from data previously published. Numbers arerounded to the nearest thousand and may not sum due to rounding; percent changes are

calculated prior to rounding.Source: DHCFP Health Safety Net Data Warehouse as of 10/25/10. For further informationon the Health Safety Net Q1 Report visitwww.mass.gov/dhcfp and follow the Publicationsand Analyses link.

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Trends in Medical Expense Ratio for Massachusetts Health Plans, 2007-2010

Percentile represents a value below which, or above which, a certain percent of all values fall.

For example, a 50th percentile value of 90% means that one half of all health plans for whomdata are reported had a medical expense ratio of less than 90% and one-half had a ratio above90%.

This slide has a trend graph which shows the percentile value trends in medical expense ratio forMassachusetts health plans from 2007 to 2010:

CY2007: 89% 75th Percentile; 87% 50th Percentile (median); 85% 25th Percentile



CY2010 (Q1): 95.9% 75th Percentile; 93.9% 50th Percentile (median); 93.1% 25thPercentile

CY2010 (Q2): 94% 75th

Percentile; 93.2% 50th

Percentile (median); 89.3% 25th

Percentile CY2010 (Q3): 90.7% 75th Percentile; 89.7% 50th Percentile (median); 89.0% 25th

Percentile

The Sidebar reads: On average, the proportion of total health care related revenue spentby health plans on medical services received by members declined by 4.5 percentage pointsbetween the first and third quarters of 2010 (93.9% v 89.7%).**Quarterly results may not be indicative of year-end trends.

Health plan financial information is derived from quarterly and annual financialstatements that health plans self-report to the Division of Insurance. Percentile represents

a value below or above which a certain percent of all values fall. For example, a 50thpercentile value of 90% means that one half of all health plans for whom data are reportedhad a medical expense ratio of less than 90% and one-half had a ratio above 90%.

Notes: Medical expense ratio is calculated by dividing the total hospital and medical expenses by revenue. In accordancewith NAIC reporting standards, revenue here includes premium income and aggregate write-ins for other health carerelated revenues. It does not include write-ins for non-health revenues or investment income. Information is self-reportedby plans to the Massachusetts Division of Insurance (DOI) and represents both in-state and out-of-state business inprivate insurance products, Medicare, MassHealth and Commonwealth Care. Information is limited to the healthmaintenance organizations (HMOs) licensed with DOI or under contract with MassHealth. HMOs registered with DOI butwith less than 10,000 covered lives are excluded from this analysis as financial information for these companies is morevolatile. CeltiCare is a health plan that began providing coverage for Massachusetts residents in October 2009. Licensingof CeltiCare increased the number of plans for whom financial data are reported from 12 in 2007/2008 to 13 in 2009.

However, financial ratios for CeltiCare are not included in this analysis. As health plan expenses may change over time, itis likely for a plan to move across percentiles from one period to the next. MassHealth 4B reports were used to calculatefinancial ratios for Network Health during calendar year 2009. Blue Cross Blue Shield of Massachusetts (BCBSMA)includes the combined performance of BCBSMA and HMO Blue.Sources: DOI annual financial statements as self-reported by carriers.

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Trends in Administrative Expense Ratio for Massachusetts Health plans, 2007-2010

Percentilerepresents a value below or above which a certain percent of all values fall. For

example, a 50th percentile value of 12% means that one half of all health plans for whom dataare reported had an administrative expense ratio of less than 12% and one-half had a ratio above12%.

This slide shows a line-graph displaying 75th Percentile, 50th Percentile (median) and 25thPercentile trend in administrative expense ratio through CY2007, CY2008, CY2009 and firstthree quarters of CY2010.

Prominent data points for the graph:



CY2009: 13% 75

th

Percentile; 10% 50th

Percentile (median); 8% 25th

Percentile CY2010 (Q1): 9.5% 75th Percentile; 8.9% 50th Percentile (median); 6.8% 25th Percentile

CY2010 (Q2): 10.1% 75th Percentile; 9.5% 50th Percentile (median); 7.4% 25th Percentile

CY2010 (Q3): 10.3% 75th Percentile; 9.5% 50th Percentile (median); 7.5% 25th Percentile

The Sidebar reads: Health plans reported an increase in the proportion of total health carerelated revenue that went towards plan administration between the first and thirdquarters of 2010. Overall, administrative expense ratios have declined since 2007.**Quarterly results may not be indicative of year-end trends.

Health plan financial information is derived from quarterly and annual financial

statements that health plans self-report to the Division of Insurance. Percentilerepresentsa value below or above which a certain percent of all values fall. For example, a 50thpercentile value of 10% means that one half of all health plans for whom data are reportedhad an administrative expense ratio of less than 10% and one-half had a ratio above 10%.

Notes: Administrative expense ratio is calculated by dividing the total administrative expenses (includingclaims adjustment and general administrative expenses) by revenue. In accordance with NAIC reportingstandards, revenue here includes premium income and aggregate write-ins for other health care relatedrevenues. It does not include write-ins for non-health revenues or investment income. Massachusetts Divisionof Insurance (DOI) financial information represents both in-state and out-of-state business in privateinsurance products, Medicare, MassHealth and Commonwealth Care. Information is limited to the healthmaintenance organizations licensed with DOI or under contract with MassHealth. HMOs registered with DOI

but with less than 10,000 covered lives are excluded from this analysis as financial information for thesecompanies is more volatile. CeltiCare is a plan that began providing coverage for Massachusetts residents inOctober 2009. Licensing of CeltiCare increased the number of health plans for whom data are reported from12 in 2007/2008 to 13 in 2009. However, financial ratios for CeltiCare are not included in this analysis. Asplan expenses may change over time, it is possible for a health plan to move across percentiles from oneperiod to the next. MassHealth 4B reports were used to calculate financial ratios for Network Health duringcalendar year 2009. Blue Cross Blue Shield of Massachusetts (BCBSMA) includes the combined performanceof BCBSMA and HMO Blue.Sources: DOI annual financial statements.

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Trends in Profit Margin for Massachusetts Health Plans, 2007-2010

Percentile represents a value below or above which a certain percent of all values fall. Forexample, a 50th percentile value of 0.8% means that one half of all health plans for whom dataare reported had a profit margin ratio of less than 0.8% and one-half had a ratio above 0.8%.

This slide shows a line-graph displaying 75th Percentile, 50th Percentile (median) and 25thPercentile trend in profit margin through CY2007, CY2008, CY2009 and first three quarters ofCY2010.

CY2007- 4.6% 75th Percentile; 2.8% 50th Percentile (median); 1.9% 25th Percentile

CY2008- 4.5% 75th Percentile; 2.7% 50th Percentile (median); 1.2% 25th Percentile

CY2009- 1.7% 75th Percentile; 0.8% 50th Percentile (median); -1.9% 25th Percentile

CY2010 (Q1) 0.6% 75th Percentile; -1.5% 50th Percentile (median); -3.6% 25th

Percentile CY2010 (Q2) 0.8% 75th Percentile; -0.9% 50th Percentile (median); -2.2% 25thPercentile

CY2010 (Q3) 2.9% 75th Percentile; 1.3% 50th Percentile (median); 0.1% 25th Percentile

The Sidebar reads:Profit margin reflects resources available to health plans after payingmedical claims and administrative costs for the year. Health plan profit margins improvedbetween the first (Q1) and third (Q3) quarters of 2010, with the overall average marginincreasing from -1.5% in Q1 2010 to 1.3% during Q3 2010.**Quarterly results may not be indicative of year-end trends.

Health plan financial information is derived from quarterly and annual financialstatements that health plans self-report to the Division of Insurance. Percentile representsa value below or above which a certain percent of all values fall. For example, a 50thpercentile value of 0.8% means that one half of all health plans for whom data are reportedhad a profit margin ratio of less than 0.8% and one-half had a ratio above 0.8%.

Notes: Profit margin is calculated by dividing net income by total revenue. Total revenue hereincludes premium income, aggregate write-ins for other health care related revenues, andinvestment gain/loss. It does not include write-ins for non-health revenues. Massachusetts Divisionof Insurance (DOI) financial information represents both in-state and out-of-state business inprivate insurance products, Medicare, MassHealth and Commonwealth Care. Information is limitedto the health maintenance organizations licensed with DOI or under contract with MassHealth.

HMOs registered with DOI but with less than 10,000 covered lives are excluded from this analysisas financial information for these companies is more volatile. CeltiCare is a health plan that beganproviding coverage for Massachusetts residents in October 2009. Licensing of CeltiCare increasedthe number of health plans for whom financial data are reported from 12 in 2007/2008 to 13 in2009. However, financial ratios for CeltiCare are not included in this analysis. As health planexpenses may change over time, it is likely for a health plan to move across percentiles from oneperiod to the next. MassHealth 4B reports were used to calculate financial ratios for Network

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Health during calendar year 2009. Blue Cross Blue Shield of Massachusetts (BCBSMA) includes thecombined performance of BCBSMA and HMO Blue.Sources: DOI annual financial statements.

Trends in Days in Reserve for Massachusetts Health Plans, 2007-2010

This slide shows a graph displaying 75 th Percentile, 50th Percentile (median) and 25th Percentile

trend for days in reserve through CY2007, CY2008, CY2009 and first three quarters ofCY2010 for Days in Reserve.

Prominent data points for the graph:

CY2007: 75th Percentile -91 days; 50th Percentile 84 days; 25th Percentile 51 days

CY 2008: 75th Percentile 84 days; 50th Percentile 69 days; 25th Percentile 48 days

CY 2009: 75th Percentile 88 days; 50th Percentile 58 days; 25th Percentile 42 days

CY2010 (Q3):75th Percentile 73 days; 50th Percentile (median) 54 days; 25 th Percentile 42 days

The Sidebar reads:Days in reserve is a measure of financial solvency. It reflects thenumber of days a plan could fund medical expenses from its net worth. Based on healthplan self-reported financial information, the average number of days that health planscould fund medical expenses from their net worth (reserves) improved from 45 days in Q12010 to just under 60 days in Q3 2010.

Health plan financial information is derived from quarterly and annual financialstatements that health plans self-report to the Division of Insurance. Percentile representsa value below or above which a certain percent of all values fall. For example, a 50thpercentile value of 58 means that one half of all health plans for whom data are reported

had more than 58 days in reserve and one-half had less than 58 days in reserve.

Notes: Days in reserve is calculated by dividing net worth (including total capital andsurplus) by the result of dividing total medical and administrative expenses by the numberof days in the year. Massachusetts Division of Insurance (DOI) financial informationrepresents both in-state and out-of-state business in private insurance products, Medicare,MassHealth and Commonwealth Care. Information is limited to the health maintenanceorganizations licensed with DOI or under contract with MassHealth. HMOs registered butwith less than 10,000 covered lives are excluded from this analysis as financial informationfor these companies is more volatile. CeltiCare is a health plan that started providingcoverage for Massachusetts residents in October 2009. Licensing of CeltiCare increased the

number of health plans for whom financial data are reported from 12 in 2007/2008 to 13in 2009. However, financial ratios for CeltiCare are not included in this analysis. As healthplan expenses may change over time, it is likely for a health plan to move across percentilesfrom one period to the next. MassHealth 4B reports were used to calculate financial ratiosfor Network Health during calendar year 2009. Blue Cross Blue Shield of Massachusetts(BCBSMA) includes the combined performance of BCBSMA and HMO Blue.Sources: DOI annual financial statements.

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Variation in Medical Expense Ratios for Massachusetts Health Plans, 3 rd Quarter of

2010

This slide shows a bar graph that shows the medical expense ratio trend of each health plan inMassachusetts. The lowest medical expense ratio for the third quarter of 2010 was 83%; thehighest was 94% while the overall median was 89.7%.

The Sidebar reads: Based on health plan self-reported financial information, during thethird quarter of 2010, only three health plans spent less than 90% of total health carerelated revenue on medical services received by members.**Quarterly results may not be indicative of year-end performance.Health plan financial information is derived from quarterly and annual financialstatements that health plans self-report to the Division of Insurance. For detailedinformation on health plan financials by plan, see Study of the Reserves and Surpluses of

Health Insurers in Massachusetts.

Notes: Medical expense ratio is calculated by dividing the total hospital and medicalexpenses by revenue. In accordance with NAIC reporting standards, revenue here includespremium income and aggregate write-ins for other health care related revenues. It does notinclude write-ins for non-health revenues or investment income. Massachusetts Division ofInsurance (DOI) financial information represents both in-state and out-of-state business inprivate insurance products, Medicare, MassHealth and Commonwealth Care. Information islimited to the health maintenance organizations (HMOs) licensed with DOI or undercontract with MassHealth. HMOs registered with DOI but with less than 10,000 coveredlives are excluded from this analysis as financial information for these companies is more

volatile. CeltiCare is a health plan that began providing coverage for Massachusettsresidents in October 2009. Licensing of CeltiCare increased the number of plans for whomfinancial data are reported from 12 in 2007/2008 to 13 in 2009. However, financial ratiosfor CeltiCare are not included in this analysis. MassHealth 4B reports were used to calculatefinancial ratios for Network Health during calendar year 2009. Blue Cross Blue Shield ofMassachusetts (BCBSMA) includes the combined performance of BCBSMA and HMO Blue.Sources: DOI annual financial statements.

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http://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/10/insurer_reserve_report_05-2010.pdfhttp://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/10/insurer_reserve_report_05-2010.pdfhttp://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/10/insurer_reserve_report_05-2010.pdfhttp://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/10/insurer_reserve_report_05-2010.pdfhttp://www.mass.gov/Eeohhs2/docs/dhcfp/r/pubs/10/insurer_reserve_report_05-2010.pdf


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Variation in Administrative Expense Ratios for Massachusetts Health Plans, 3rd

Quarter of 2010

Administrative expense ratio is calculated by dividing the total administrative expenses byrevenue. This slide has a bar graph that shows the lowest administrative expense ratio by healthplan for 3rd quarter of 2010 to be 6%, the highest being 14% and the median for almost all thehealth plans in Massachusetts to be 9.5%.

The Sidebar reads: Self-reported health plan financial data show that the overall medianadministrative expense ratio went up from 8.9% during Q1 2010 to 9.5% in Q3 2010,although there were variations across health plans.**Quarterly results may not be indicative of year-end performance.

Health plan financial information is derived from quarterly and annual fin

Health Care in Massachusetts: Key Indicators, February 2011 Edition

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