2022 Health Care Cost Trends Report
The Attorney General’s Office examines how a commonly-used calculation for determining health care payments fails to accurately measure health needs and causes funding to be moved away from low-income communities in Massachusetts. Confidential insurance company data and public data from the Massachusetts Department of Public Health is used to examine four topics:
- How population health risk scores compare with community-level indicators of health and health care access.
- How the Centers for Medicare & Medicaid Services (CMS) risk adjustment program shifts funds across insurers serving different populations
- How changes to the CMS risk adjustment formula could address the unintended consequences of these transfers.
- How service closures and lack of capital investment by hospitals in low-cost networks risk further limiting access to care in the same low-income communities where utilization is already lower than social determinants of health would predict.
Health Scores and Access Barriers
Health risk scores based upon a population’s history of health care utilization entrench resource disparities and health care access barriers. Communities who face barriers that depress their use of health care – like difficulties accessing transportation, housing, childcare, or broadband – are coded as “healthier,” contributing to a cycle of underfunding for their health care services.