Worcester Business Journal

30 2016 Central Mass By The Numbers • Worcester Business Journal • www.wbjournal.com Saint Vincent leads acute hopsitals in operating margin FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 Source: Mass. Center for Health Information and Analysis (Note: In 2012, Heywood and Athol Memorial hospitals merged their administrative functions in a cost-savings move.) Athol Memorial Hospital -3.8% -22.4% -11.6% 0.1% 5.9% -1.74% Clinton Hospital 1.6% 2.6% -1.8% -3.0% -1.0% -4.61% Harrington Memorial Hospital, Southbridge 2.5% 4.2% -2.5% 2.6% -0.2% 7.34% Health Alliance Hospital, Leominster 2.4% 5.6% 4.8% 2.6% 1.0% 4.15% Heywood Hospital, Gardner 2.8% -1.3% 2.2% 2.3% 2.4% 4.34% Marlborough Hospital 1.0% 0.9% -1.4% 0.7% 1.7% 5.67% Metrowest Medical Center, Framingham and Natick -4.3% -4.5% -2.5% -0.7% -2.6% 1.49% Milford Regional Medical Center 2.8% 5.8% 7.7% 4.0% 3.4% 3.72% Steward Nashoba Valley Medical Center, Ayer -1.8% -1.1% -3.7% 0.3% 6.4% 6.89% Saint Vincent Hospital, Worcester 9.0% 6.9% 9.9% 14.0% 15.6% 10.40% UMass Memorial Medical Center, Worcester 3.5% 3.3% 0.8% -2.3% 1.1% 3.91% Health Care FY 2017 $15,440.95 $761.10 $603.60 $1,690.00 FY 2016 $15,701.45 $740.48 $560.88 $1,605.37 Change $(260.5) $20.6 $42.7 $84.6 MassHealth Mental Public State employee (Medicaid) & health reform health health health insurance Source: Mass. Budget & Policy Center and its budget browser Note: FY 2016 figures are adjusted for inflation. Health spending makes up 43% of state budget Despite a 2-percent cut in MassHealth spending, rises in mental health, public health and state employee health care kept total state spending on health care as nearly half of the overall state budget. Central Mass. hospitals averaged a 3.8-percent total operating margin in FY 2015. 2013 PMPM 2014 PMPM 2015 PMPM % Change % Change Insurance Category Service Category Spending Spending Spending 2013-2014 2014-2015 Medicare Advantage spending on inpatient hospital visits is costliest expense category Change year-to-date, 2013-2015 (In millions) Source: 2015 Massachusetts Health Survey Insurance sources Type of health insurance coveraged among Massachuett's insured population Mass. total Central Mass. Medicare Employer-sponsored insurance MassHealth, ConnectorCare or other public coverage Private, non-group coverage including Connector Health Plan Other coverage or not reported 14.8% 57.5% 16.4% 10.5% 0.8% 19.1% 54.5% 18.2% 7.1% 1.1% 12.9% 65.7% 10.6% 10.6% 0.2% Metro West Commercial Full Claims Hospital Inpatient $72.89 $73.83 $74.95 1.3% 1.5% Commercial Full Claims Hospital Outpatient $104.59 $106.41 $108.82 1.7% 2.3% Commercial Full Claims Professional Physician $115.56 $117.70 $119.26 1.9% 1.3% Commercial Full Claims Professional Other $17.40 $19.74 $20.47 13.5% 3.7% Commercial Full Claims Pharmacy $62.14 $69.88 $75.79 12.5% 8.5% Commercial Full Claims Other $20.54 $21.69 $21.44 5.6% -1.2% Commercial Full Claims Non-Claims $21.45 $20.82 $16.77 -3.0% -19.5% MassHealth MCO Hospital Inpatient $90.15 $88.76 $84.88 -1.5% -4.4% MassHealth MCO Hospital Outpatient $90.87 $90.42 $89.86 -0.5% -0.6% MassHealth MCO Professional Physician $67.07 $69.23 $64.33 3.2% -7.1% MassHealth MCO Professional Other $27.68 $19.48 $17.66 -29.6% -9.4% MassHealth MCO Pharmacy $69.12 $79.25 $84.89 14.7% 7.1% MassHealth MCO Other $32.82 $30.30 $28.15 -7.7% -7.1% MassHealth MCO Non-Claims $46.94 $46.30 $44.46 -1.4% -4.0% Medicare Advantage Hospital Inpatient $276.87 $282.22 $280.58 1.9% -0.6% Medicare Advantage Hospital Outpatient $166.11 $177.96 $183.92 7.1% 3.3% Medicare Advantage Professional Physician $178.60 $177.78 $164.93 -0.5% -7.2% Medicare Advantage Professional Other $8.47 $11.91 $11.18 40.6% -6.2% Medicare Advantage Pharmacy $188.63 $191.51 $187.02 1.5% -2.3% Medicare Advantage Non-Claims $162.39 $81.99 $94.59 -49.5% 15.4% Medicare Advantage Other $252.04 $244.28 $250.87 -3.1% 2.7% Source: Mass. Center for Health Information & Analysis Note: Service category definitions are available at: 2015 data are preliminary. PMPM = Per month, per member

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