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NOVEMBER 2025

In this issue of DataMatters, we are excited to announce a new research brief exploring medical debt in Massachusetts. The brief combines data from both the 2021 and 2023 Massachusetts Health Insurance Survey to produce a detailed analysis of sociodemographic patterns in the rates, amount, and age of medical debt, among other factors. Scroll to the “News You Can Use” section to read more about the brief and see results.

In the “Data User Profile” section, we feature a study that linked the Massachusetts All-Payer Claims Data (MA APCD) with the Massachusetts Cancer Registry to assess outpatient palliative care use. Read more about the study below.

As always, you can also see upcoming events related to health care and/or data that may be of interest to you.

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

CHIA has published a new research brief exploring family medical debt in Massachusetts. Findings show that cost-sharing—especially deductibles—is the most common source of medical debt for residents in the Commonwealth.

Despite near-universal health insurance coverage in Massachusetts, more than 1 in 8 residents carries family medical debt. Medical debt poses a persistent affordability challenge and is associated with a wide range of negative consequences, from forgoing medical care to facing food insecurity and housing instability.

The brief, Burdened by the Bill: Understanding Medical Debt in Massachusetts, combines data from the 2021 and 2023 Massachusetts Health Insurance Survey (MHIS) and breaks out findings by sociodemographic characteristics like race and income level.

Key findings:

• One in 8 Massachusetts residents hold medical debt. Residents in families with incomes between 139 percent and 500 percent of the federal poverty level and Black residents were more likely to have $2,000 or more in medical debt and to have held that debt for a year or longer.
• Residents who had periods of uninsurance in their family reported nearly double the rate of medical debt as those where all family members were continuously insured.
• Among residents whose families were continuously insured, cost-sharing was the most common source of medical debt, followed by care not covered by their health insurance.
• Residents currently enrolled in a high-deductible health plan (HDHP) were more likely to report medical debt than those not enrolled in an HDHP (17 percent vs. 13 percent).

This brief is one of a series of reports focused on health care equity in the Commonwealth and aims to provide a baseline understanding of medical debt, with attention to debt among historically marginalized groups. By paying close attention to residents’ experiences with medical debt, policymakers can enact safeguards to protect residents from incurring unmitigated medical debt.

Data User Profile

In the DataMatters newsletter, we highlight a recent user of CHIA data in this Data User Profile section. This issue, we are featuring a unique use of the Massachusetts All-Payer Claims Database (MA APCD). Dr. Nancy Keating, Professor of Health Care Policy at Harvard Medical School, used the MA APCD to evaluate outpatient palliative care use before death and its association with the intensity of end-of-life care.

The study, Outpatient palliative care and end-of-life care intensity: linking Massachusetts Cancer Registry with All-Payer Claims Database, linked the MA APCD with the Massachusetts Cancer Registry.

We are grateful to Dr. Keating and her fellow researchers for sharing their work with CHIA and walking us through their use of the MA APCD.

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

Research suggests that referral to outpatient palliative care for patients with advanced cancers is associated with better outcomes. We sought to understand how oncologists in Massachusetts were using outpatient palliative care for patients diagnosed with advanced-stage cancer at a time when the benefits of such care were becoming apparent. We further assessed the association of outpatient palliative care use with end-of-life care intensity, and we assessed variation in use across 8 provider networks in Massachusetts.

Which CHIA data did you use?

We linked the CHIA MA APCD for individuals with commercial insurance, Medicaid, or Medicare Advantage with Massachusetts Cancer Registry data.

What was your experience using CHIA data?

The linkage was much more complex and time-consuming than expected. As an example, we had a 2-year grant to do the work that started in late 2013, and it took more than 3 years before we had a preliminary linkage and then many more months working through the potential matches to ensure we had valid matches. We hope that our experience will make such linkages smoother for future research, which will allow for analyses of more timely data.

Please briefly describe your research and key findings.

We used our linked data to identify patients diagnosed with advanced-stage colorectal, lung, prostate, and breast cancers from 2010 to 2013 who died on or before December 31, 2014. We characterized outpatient palliative care visits in the 6 months before death and identified end-of-life hospitalizations, emergency department visits, intensive care unit admissions, chemotherapy, no/late hospice enrollment, and in-hospital deaths. We used regression models to assess factors associated with outpatient palliative care and to assess the association of palliative care with a composite measure summing individual end-of-life intensity measures.

We found that among 6,279 decedents, 11.3 percent had at least 1 outpatient palliative care visit in the 6 months before death. Palliative care use varied across the 8 Massachusetts provider networks from 6.0 percent to 19.3 percent. In adjusted analyses, younger age, longer duration from diagnosis to death, death in 2012-2014 vs. 2010, and provider network were associated with having outpatient visits with a palliative care specialist. We also found that intensity of end-of-life care intensity varied across provider networks. Finally, we found that patients with palliative care visits had lower adjusted odds of receiving intensive end-of-life care.

Which findings were particularly interesting or surprising for you?

The large variation in use of outpatient palliative care across provider networks was interesting, as was the strong association between outpatient palliative care and less intensive care at the end of life, highlighting the importance of access to palliative care services.

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

It is wonderful that CHIA has made all-payer claims data available to researchers as there is so much that can be learned from research using these data. My most important takeaway is that data linkages that seem straightforward and have strong support from organizations that oversee the data sources can still be very complex.

Comprehensive Mandated Benefit Review

October 2025

Last month, CHIA published the 2025 Comprehensive Mandated Benefit Review. Every four years, CHIA is required to review the impacts of currently mandated benefits to health insurance premiums and public health. This comprehensive review of health benefit mandates focuses primarily on the financial impact of mandated benefits and summarizes their medical efficacy.

This report included a review of 59 health insurance mandates and found that the total marginal cost of the mandates, representing the additional expenditures directly attributable to the mandates, is estimated at $159 million with a total estimated impact on premiums of 0.93%.

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

Massachusetts Association of Health Plans (MAHP) Annual Conference

Health Care at a Crossroads: How Federal and State Polices Are Impacting Change

Friday, November 21, 2025, 8 AM – 3 PM

Everett, MA

Join the leading voices in health care at MAHP’s 2025 Annual Conference, where more than 500 health care professionals will discuss issues impacting the health care system in Massachusetts and across the country. Visit the MAHP conference webpage to view the agenda, register for the event, and learn more about available sponsorship opportunities.

CHIA Data User Workgroup

Tuesday, November 25, 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. For more information, including past presentations and user support materials, visit the data user workgroup information page or the CHIA Data page.

Primary Care Access, Delivery, and Payment Task Force

Wednesday, December 3, 2025, 10 AM – 12 PM

Virtual

The next meeting of the task force can be livestreamed on the HPC’s YouTube channel. This task force was charged with studying and making recommendations to improve primary care access, delivery, and payment in the Commonwealth. See the task force website for more information.

Massachusetts Health and Hospital Association (MHA) Conference

2025 Annual Women Leaders in Healthcare Conference

Friday, December 5, 2025, 8 AM – 2:30 PM

Boston, MA

The Massachusetts Health & Hospital Association’s (MHA’s) annual Women Leaders in Healthcare Conference is on Friday, December 5 at the Westin Seaport in Boston. This year's conference features, among many other dynamic speakers, Modupe Akinola, who will discuss stress and leadership in the workplace; and clinical psychologist and author Ellen Hendrickson, author of How to Be Enough, who will discuss simple mindset shifts to quiet the inner critic while keeping your drive. There will be a "fireside chat" featuring hospital CEOs, a legislative leaders panel, and much more. See the full agenda and register here.

CHIA Oversight Council Meeting

Wednesday, December 10, 2025, 2 PM

Virtual

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

CHIA & Blue Cross Blue Shield of Massachusetts Foundation Event

Current and Future State of Health Care Access in the Commonwealth: Insights from CHIA’s 2025 Massachusetts Health Insurance Survey

Thursday, December 11, 2025, 8:30 – 11:30 AM

Boston, MA

CHIA and the Blue Cross Blue Shield of Massachusetts Foundation are hosting an in-person event focused on health care coverage, access, and affordability in Massachusetts. This event will open with a presentation from CHIA on the 2025 Massachusetts Health Insurance Survey (MHIS) results releasing at that time. It also features a panel that will respond to the MHIS findings and explore how changes in federal health care policy will impact health care in the Commonwealth. A formal agenda and list of speakers is forthcoming. Registration for the event is open.

Massachusetts Health Policy Commission Board Meeting

Thursday, December 11, 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 stream live on HPC’s YouTube channel.

Massachusetts Health and Hospital Association (MHA) Annual Meeting

Thursday, January 29, 2026, 9:30 AM – 4 PM

Boston, MA

The Massachusetts Health & Hospital Association (MHA) celebrates its 90th year at the association’s annual meeting on Thursday, January 29 at the Westin Copley Place in Boston. This event will bring together senior executives and leaders from across the health care sector to discuss the latest trends, innovations, and challenges facing health care today. Keynote speakers include Atul Gawande, M.D., author of Being Mortal, and Joseph Betancourt, M.D., president of the Commonwealth Fund. The full lineup of speakers and panelists will be announced soon. Take advantage of early bird pricing here.

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.

Research Analyst

Research Team

CENTER FOR HEALTH INFORMATION AND ANALYSIS

www.chiamass.gov