MAHP Publications

Impact of the COVID-19 Pandemic on Health Plans and Hospital Finances in Massachusetts

The COVID-19 pandemic has had a historic impact on the health care sector at both the state and federal levels, impacting health care utilization and spending in 2020 and beyond. With decreased utilization caused by state and federally mandated closures of in-person care, many hospitals, and providers experienced revenue losses while many health plans experienced lower than predicted claims costs resulting in unexpected surplus.

The Premium Dollar: Requirements for Health Plan Spending

What’s included in “administrative expenses?” Administrative expenses include rebates to members under Medical Loss Ratio requirements set by the government. Administrative expenses may also include “surplus”, the portion of premiums that health plans are permitted to keep.

Prescription Drug Pricing: Efforts That Erode Cost-Containment Strategies

Rising prescription drug prices are one of the top contributors to health insurance premium increases and high out-of-pocket costs for consumers, placing a financial burden on patients, families, and the health care system.

Putting an End to Surprise Billing in Massachusetts

This OnPoint examines recent policies enacted at the federal level aimed at curtailing surprise billing and outlines recommendations for state policymakers to strengthen the Commonwealth’s efforts to protect consumers from out-of network charges.

MAHP Member Plans Community Giving Initiatives

Every year, MAHP member plans demonstrate a strong commitment to supporting the communities they serve and improving the quality of life and the health of individuals that live in these communities, with a focus on underserved and vulnerable populations.

Rx Reality Check: Prescription Drug Spending: Driving Health Care Costs at the State and Federal Levels

Pharmaceutical innovations provide significant opportunities for patients; however, prescription drug costs continue to skyrocket, which creates affordability challenges and ultimately results in limited access for many patients. A January 2021 RAND Corporation report found that United States drug prices were 256% higher than those in the 32 comparison countries combined.

The Cost Benchmark vs. Health Insurance Premiums: What’s the Difference?

While the two distinct measures of health care costs are often conflated, the Massachusetts health care cost growth benchmark and the process for determining annual health plan premiums are not the same. This policy brief outlines how health care spending is calculated and evaluated against the state’s cost growth benchmark, how health insurance premiums are developed, and the differences between the two.

Massachusetts Medicaid Managed Care Organizations Address Racial and Ethnic Health Disparities and Take Action to Advance Health Equity

The COVID-19 pandemic has brought to the forefront the long-standing racial and ethnic disparities that exist in health care. Over the past year, we have witnessed the harm that inequities have caused to communities of color and vulnerable populations, not only in Massachusetts but also across the country.

The Premium Dollar: How Does a Health Plan Spend the Money it Collects?

What’s included in”administrative expenses?” Administrative expenses include rebates to members under Medical Loss Ratio requirements set by the government. Administrative expenses may also include “surplus”, the portion of premiums that health plans are permitted to keep.

Surprise Medical Bills: Identifying A Comprehensive Policy Solution to Protect Consumers in the Commonwealth

Massachusetts has long been a leader in comprehensive health care coverage for its residents, boasting the highest rate of insured individuals in the nation at nearly 98%. Health plans in Massachusetts establish networks of physicians, hospitals and other types of providers in order to ensure that members have access to high-quality providers who can best meet their medical needs. To achieve cost savings, health plans enter into contracts with these providers, hoping to drive significant volume to them in exchange for lower contracted rates.

Assessing the Financial Health of Massachusetts Hospitals

This report evaluates the financial health of Massachusetts hospitals to determine (1) which hospitals had the least financial stability and (2) whether hospitals’ payment levels correlated with hospitals’ financial status. The report concludes that, based on the available data, the 27 hospitals that have an Relative Price (RP) below 90 percent are not significantly less profitable or less financially stable than hospitals with an RP above 90 percent.

MAHP OnPoint: Aging in Place: Senior Care Options Plans and the Dual-Eligible Population in Massachusetts

In Massachusetts and across the nation, advances in assistive and medical technology and greater access to health care coverage and services have contributed to longer life spans and more opportunities for seniors to age in place — to live in their own homes and communities safely, independently, and comfortably, regardless of age, income, or ability level. Over the next 30 years, the population of US residents over 65 years of age will increase significantly.

MAHP OnPoint: How Are Premiums Developed for Individuals and Small Groups?

The policy brief discusses how premiums are developed for individuals and small groups, examining the key factors that health plans consider in developing premiums, and provides an overview of how rate increases may vary across the marketplace.

MAHP OnPoint: Examining the Effect of a Repeal of the ACA on the MA Health Care Market: Immediate Priorities for the Marketplace

While the state’s landmark health reform law and other vital provisions in statute provide Massachusetts with the ability to maintain the gains in coverage realized under state and federal health reform, much is contingent on what provisions are ultimately repealed or changed. The enclosed brief discusses the immediate priorities for the marketplace and outlines a series of measures for maintaining market stability and universal health coverage in the Commonwealth.

MAHP OnPoint: Predictive Modeling Tools in the Market

The policy brief examines the field of predictive analytics and whether these tools can be used as a means to help identify children in need of assistance and help in protecting our state’s most vulnerable population.

MAHP OnPoint: Understanding the Massachusetts and Federal Mental Health Parity Laws

Health plans are subject to stringent standards in the coverage of behavioral health and substance use disorder conditions and other medical conditions. The policy brief examines state and federal mental health parity laws and regulations, providing an overview of what parity is and address misconceptions in the applicability, oversight, and enforcement of mental health parity.

MAHP Report on Expanded Use of SCOs

The white paper examines the differences between the benefits the Senior Care Option (SCO) plans offer and the services provided to dual-eligible individuals who receive care in the fee-for-service Medicare and Medicaid programs. The report concludes that the state could generate significant savings, offer enhanced benefits, and provide a simpler, more convenient process for providers by enrolling all eligible low-income seniors in one of the state’s five SCOs.