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MARCH 2025

Happy Spring!

As the days get longer and the weather warmer, CHIA is excited to share what we’ve been working on in the past 2 months.

Earlier this month, CHIA released its latest Annual Report on the Performance of the Massachusetts Health Care System. The Annual Report presents results on health care spending and cost trends, access and affordability, hospital utilization and financial performance, key quality metrics, and behavioral health trends. This report primarily focuses on data through 2023, although select hospital utilization and financial measures are also included through June 2024, where possible.

We are also excited for the first time to share a companion special report in the “News You Can Use” segment below that explores the impact of health care costs on the monthly expenses of Massachusetts residents.

In the “Data User Profile,” CHIA features our sister agency, the Health Policy Commission (HPC). The HPC walks us through its use of the MA APCD in its recent publication that explores policy options to address the challenges facing the Massachusetts primary care system. 

As always, we also highlight upcoming health care-related events that may be of interest to our readers.

If you have any questions or opinions you want to share, please send your feedback to newsletter@chiamass.gov. We always want to hear from our readers.

As CHIA has reported previously, 98.3 percent of Massachusetts residents have health insurance—the highest insurance coverage rate in the country. Yet the Commonwealth also has some of the highest health care costs, with 41.3 percent of residents managing medical debt, skipping needed care because of cost, or experiencing other affordability issues.

In our latest special report, “Failing To Make Ends Meet: How Rising Health Care Costs Impact MA Residents,” we delve deeper into affordability metrics shared in CHIA’s recent Annual Report to look at how the typical monthly budgets for four Massachusetts residents are impacted by the rising costs of health care. Across the board, the trends show that Massachusetts residents fall short when health care costs are added to typical household expenses—in some cases, leading to trade-offs that might affect their long-term health and well-being.

In DataMatters we always have a “Data User Profile” which includes an interview with a user of CHIA data. In this issue we are highlighting the work of our sister agency, the Health Policy Commission (HPC). 

In January 2025, the HPC published a report outlining the issues facing primary care in Massachusetts and offered possible policy solutions to address these challenges. One of the data sources of this report was the Massachusetts All-Payer Claims Database (MA APCD).  

CHIA is grateful to the staff at the HPC for answering our questions in this month’s newsletter.  

What was your research question? Why did you choose that question?



The aim of the Health Policy Commission’s (HPC) recently published report, A Dire Diagnosis: The Declining Health of Primary Care in Massachusetts and the Urgent Need for Action, was to explore trends and challenges specific to providers of primary care, and understand the current state of primary care in the Commonwealth—including which types of clinicians provide care, Massachusetts residents’ use of and spending on primary care, and current challenges for primary care providers and for patients’ access to care.

This report follows the HPC’s 2023 study, Health Care Workforce Trends and Challenges in the Era of COVID-19: Current Outlook and Policy Considerations for Massachusetts, in which the HPC examined the impact of COVID-19 on sectors of the Massachusetts workforce.

Which CHIA data did you use?

The Massachusetts All-Payer Claims Database (MA APCD), v2021 and v2022.

What was your experience using CHIA data?

This primary care report required the use of many data elements available in the MA APCD, as well as linking the MA APCD with other data resources. For example, to measure the types of clinicians providing primary care visits, it was necessary to not only identify primary care services using Current Procedural Terminology (CPT) and site of service codes in the MA APCD, but to use clinician taxonomy information available from the Centers for Medicare and Medicaid Services (CMS) to be able to measure which type of clinician was associated with each visit.

Please briefly describe your research and key findings.

• The share of primary care visits provided to commercially insured residents by physicians has fallen over time, with the share of visits provided by nurse practitioners (NPs) and physician assistants (PAs)—including incident-to-billing indicating that a visit was provided by an NP or PA—rising from 23% in 2019 to 30% in 2021.
• Commercial medical spending for primary care represents a declining share of medical spending over time: primary care spending grew half as fast as spending on all other medical services from 2017 to 2022.
• Massachusetts residents living in the lowest-income communities are much more likely to have no primary care utilization at all than those living in the highest-income communities. These results were particularly striking for children: children living in low-income areas were three times more likely to have no primary care visits than children in the highest-income areas.
• The HPC’s findings indicate that there are significant challenges facing primary care in the Commonwealth, including burnout for providers and access barriers for patients.

Which findings were particularly interesting or surprising for you?

The HPC’s exploration of primary care visits by clinician type found that non-physicians are providing a steadily increasing amount of care. While we know from other areas of our research that the distribution of primary care clinician types has changed over time, it is striking to be able to see that change reflected in how care is provided—and suggests that the persistent challenges facing primary care in the Commonwealth (such as high administrative burden) are related to the provision of primary care, rather than to the types of clinicians providing the care.

What "takeaway" information would you like to highlight from your research and/or experience using our data?

The MA APCD offers a unique opportunity to understand the delivery of medical care in detail, including not only care utilization, but which types of clinicians provide care, to which patients, and how that care is billed and paid for over time. Additionally, the ability to identify primary care services using CPT codes rather than simply provider-reported specialty was something that the MA APCD offered that many other data sources could not. This identification method informed a better understanding of whether provider types beyond traditional PCPs were providing primary care in the Commonwealth.

Quarterly Case Mix Dashboards

February 2025

The most recent quarterly interactive dashboards on hospital inpatient discharge data (HIDD), emergency department data (EDD), and outpatient observation data (OOD) are now available. These updates show trends revealed by Case Mix data from October 2019 to September 2024. Quarterly reports are based on interim data and are updated as more complete information becomes available.

Enrollment Trends (data through September 2024)

March 2025

CHIA updated its detailed Enrollment Trends analysis for the most recent 2-year period to give researchers and policymakers insight into the market. The latest edition covers the period between September 2022 and September 2024 and includes breakouts by payers and product types in private commercial and public market sectors. 

Annual Report on the Performance of the Massachusetts Health Care System

March 2025

Earlier this month, CHIA published its Annual Report on the Performance of the Massachusetts Health Care System. In this report, CHIA examines trends in costs, coverage, and quality indicators to inform policymaking.

The Annual Report presents results on health care spending and cost trends, access and affordability, hospital utilization and financial performance, key quality metrics and behavioral health trends. This report primarily focuses on data through 2023; select hospital utilization and financial measures are included through June 2024, where possible.

This section includes events and announcements of interest to our community, organized by CHIA, other Commonwealth agencies, and others.

MHA Children’s Behavioral Health Summit

Tuesday, April 1, 2025, 8:30 AM - 3:30 PM

MCLE Conference Center, Boston, MA

The Massachusetts Health and Hospital Association, along with Boston Children’s Hospital, are reconvening behavioral health experts to discuss and review progress and areas for improvement in pediatric behavioral health care, focusing on innovation and prevention. See the event website for more information. 

Massachusetts Health Policy Commission Board Meeting

Thursday, April 17, 2025, 12 PM

Virtual

The HPC’s 11-member Board meets approximately every 6 weeks throughout the year to review the agency’s major workstreams and other topics related to health care cost containment and reform. Major reports, statutory regulations, and publications are authorized by a majority vote at these meetings. Meetings will stream live on HPC’s YouTube channel.

CHIA Data User Workgroup

Tuesday, April 22, 2025, 3 PM

Virtual

These ongoing meetings are designed for data users and other interested parties to connect with CHIA to discuss analytical techniques and best practices in research using CHIA’s MA APCD and Case Mix databases.

The next virtual workgroup meeting will be Tuesday, April 22, at 3 PM. For more information, including past presentations and user support materials, visit the data user workgroup information page. To learn more about CHIA data, visit https://www.chiamass.gov/chia-data.

Health Equity Trends Summit

Wednesday, June 11, 2025

JFK Library and Museum, Boston, MA 02125



The Health Equity Trends Summit is an event hosted by the Health Equity Compact for a public discussion on actions to achieve health equity reform across Massachusetts. For more details, go to the Summit event page.

CHIA Oversight Council Meeting

Thursday, June 18, 2025, 2 PM

Virtual

CHIA’s appointed Oversight Council meets quarterly to discuss agency priorities and agenda-setting. The next meeting is scheduled for June 18 and will stream live on CHIA’s YouTube channel.

National Academy for State Health Policy (NASHP) Annual Conference

September 8-10, 2025

San Diego, CA



NASHP’s 38th Annual Conference aims to bring attention to the issues facing state health policymakers and highlight possible solutions shared by the nation’s leading experts. Topics will include lowering prescription drug costs, hospital costs, Medicaid, telehealth, social determinants of health, behavioral health, and more. Registration opens in early May. Go to the event page to learn more. 

Join Our Team

A selection of open positions at CHIA. Please feel free to share broadly with your network. Follow CHIA on LinkedIn for more regular updates.

Data Strategy and Client Insights Manager

Data Operations and Technology Team

Manager, User Experience and Technical Writer with UX Experience

Data Operations and Technology Team

CENTER FOR HEALTH INFORMATION AND ANALYSIS

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