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					Center for Health Information and Analysis


Massachusetts Total Medical Expenses:
Results from 2010 - 2012

October, 2013

Data Appendix
CY 2010 Member Months and Unadjusted Total Medical Expenses by Payer by Insurance Category

CY 2011 Member Months and Unadjusted Total Medical Expenses by Payer by Insurance Category

CY 2012 Member Months and Unadjusted Total Medical Expenses by Payer by Insurance Category
ance Category

ance Category

ance Category
CY 2010 Total Medical Expenses

  Year   Payer
  2010   Aetna Health, Inc.
  2010   Blue Cross Blue Shield of Massachusetts
  2010   Celticare Health Plan of Massachusetts
  2010   Connecticut General Life Insurance Company
  2010   Fallon Health and Life Assurance Company
  2010   Harvard Pilgrim Health Care
  2010   Health New England, Inc.
  2010   Neighborhood Health Plan
  2010   Tufts Health Plan
  2010   United Healthcare Insurance Company
  2010   BMC HealthNet Plan, Inc.
  2010   Celticare Health Plan of Massachusetts
  2010   Fallon Health and Life Assurance Company
  2010   Neighborhood Health Plan
  2010   Network Health, LLC
  2010   Aetna Health, Inc.
  2010   Blue Cross Blue Shield of Massachusetts
  2010   Fallon Health and Life Assurance Company
  2010   Harvard Pilgrim Health Care
  2010   United Healthcare Insurance Company - Medicare Advantage
  2010   Tufts Medicare Advantage

Note: Celticare only offered Commercial full-claims and Commonwealth Care plans.
          Insurance Category       Member Months      Unadjusted TME
          Commercial Full Claims          1,145,068       $290.00
          Commercial Full Claims         13,221,482       $427.98
          Commercial Full Claims                969       $57.48
          Commercial Full Claims            989,012       $185.90
          Commercial Full Claims          1,460,867       $379.25
          Commercial Full Claims          7,457,896       $407.53
          Commercial Full Claims          1,284,144       $301.23
          Commercial Full Claims            428,639       $338.76
          Commercial Full Claims          3,964,914       $412.15
          Commercial Full Claims            809,160       $471.90
          Medicaid MCO/CommCare           2,934,259       $378.42
          Medicaid MCO/CommCare             377,803       $175.17
          Medicaid MCO/CommCare             234,642       $389.99
          Medicaid MCO/CommCare           2,098,167       $390.17
          Medicaid MCO/CommCare           1,988,464       $369.75
          Medicare Advantage                110,264       $382.58
          Medicare Advantage                323,372      $1,019.86
          Medicare Advantage                364,984       $994.71
          Medicare Advantage                300,329      $1,004.14
          Medicare Advantage              1,084,246       $647.22
          MedicareAdvantage                 972,135       $963.93

mmonwealth Care plans.
CY 2011 Total Medical Expenses

  Year   Payer
  2011   Aetna Health, Inc.
  2011   Blue Cross Blue Shield of Massachusetts
  2011   Celticare Health Plan of Massachusetts
  2011   Connecticut General Life Insurance Company
  2011   Fallon Health and Life Assurance Company
  2011   Harvard Pilgrim Health Care
  2011   Health New England, Inc.
  2011   Neighborhood Health Plan
  2011   Tufts Health Plan
  2011   United Healthcare Insurance Company
  2011   BMC HealthNet Plan, Inc.
  2011   Celticare Health Plan of Massachusetts
  2011   Fallon Health and Life Assurance Company
  2011   Neighborhood Health Plan
  2011   Network Health, LLC
  2011   Aetna Health, Inc.
  2011   Blue Cross Blue Shield of Massachusetts
  2011   Fallon Health and Life Assurance Company
  2011   United Healthcare Insurance Company - Medicare Advantage
  2011   Tufts Medicare Advantage

Note: Celticare only offered Commercial full-claims and Commonwealth Care plans.
          Insurance Category       Member Months      Unadjusted TME
          Commercial Full Claims          1,121,007       $310.02
          Commercial Full Claims         12,576,719       $442.63
          Commercial Full Claims              2,924       $72.43
          Commercial Full Claims          1,097,935       $195.54
          Commercial Full Claims          1,338,176       $381.16
          Commercial Full Claims          7,421,176       $434.31
          Commercial Full Claims          1,251,364       $309.99
          Commercial Full Claims            584,627       $353.60
          Commercial Full Claims          3,930,848       $425.96
          Commercial Full Claims            837,195       $469.69
          Medicaid MCO/CommCare           2,932,701       $396.67
          Medicaid MCO/CommCare             407,409       $233.21
          Medicaid MCO/CommCare             226,431       $392.89
          Medicaid MCO/CommCare           2,228,040       $428.56
          Medicaid MCO/CommCare           2,107,304       $377.97
          Medicare Advantage                 93,356       $413.91
          Medicare Advantage                324,414      $1,028.24
          Medicare Advantage                351,568      $1,001.00
          Medicare Advantage              1,408,964       $572.98
          Medicare Advantage              1,052,591      $1,003.93

mmonwealth Care plans.
CY 2012 Total Medical Expenses
* 2012 data is preliminary. Reported data only allows for 3-4 months of claims run-out. Settlements for quality and eff
**Payers submitted completion factors to estimate the TME for CY 2012. These factors have been applied to the data.

  Year    Payer                                                            Insurance Category
  2012    Aetna Health, Inc.                                               Commercial Full Claims
  2012    Blue Cross Blue Shield of Massachusetts                          Commercial Full Claims
  2012    Celticare Health Plan of Massachusetts                           Commercial Full Claims
  2012    Connecticut General Life Insurance Company                       Commercial Full Claims
  2012    Fallon Health and Life Assurance Company                         Commercial Full Claims
  2012    Harvard Pilgrim Health Care                                      Commercial Full Claims
  2012    Health New England, Inc.                                         Commercial Full Claims
  2012    Neighborhood Health Plan                                         Commercial Full Claims
  2012    Tufts Health Plan                                                Commercial Full Claims
  2012    United Healthcare Insurance Company                              Commercial Full Claims
  2012    BMC HealthNet Plan, Inc.                                         Medicaid MCO/CommCare
  2012    Celticare Health Plan of Massachusetts                           Medicaid MCO/CommCare
  2012    Fallon Health and Life Assurance Company                         Medicaid MCO/CommCare
  2012    Neighborhood Health Plan                                         Medicaid MCO/CommCare
  2012    Network Health, LLC                                              Medicaid MCO/CommCare
  2012    Aetna Health, Inc.                                               Medicare Advantage
  2012    Blue Cross Blue Shield of Massachusetts                          Medicare Advantage
  2012    Fallon Health and Life Assurance Company                         Medicare Advantage
  2012    United Healthcare Insurance Company - Medicare Advantage         Medicare Advantage
  2012    Tufts Medicare Advantage                                         Medicare Advantage

Note: Celticare only offered Commercial full-claims and Commonwealth Care plans.
ments for quality and efficiency performance as well as incentive payments normally require about 12 months to be finalized.
een applied to the data.

           Member Months           Unadjusted TME
                     1,089,631         $334.50
                    11,648,834         $448.12
                         4,054         $74.44
                     1,188,114         $204.63
                     1,374,825         $406.38
                     7,326,611         $451.72
                     1,302,753         $318.14
                       699,581         $338.97
                     3,847,843         $433.38
                       849,579         $482.76
                     2,854,704         $408.62
                       368,041         $302.89
                       207,151         $393.98
                     2,249,814         $437.39
                     2,560,289         $369.58
                       122,498         $384.71
                       307,569        $1,017.34
                       351,989        $1,026.89
                     1,196,567         $487.72
                     1,076,048         $990.96
hs to be finalized.

				
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