one of the government. Charlie Baker’s biggest unsuccessful initiative was to reorient health care spending, with the majority of health care spending directed toward primary and behavioral health care rather than specialty care.
Baker-sponsored legislation required health care providers and payers to increase spending on primary and behavioral health care by 30% over three years compared to 2019 levels.
Since the state legislature has not taken up Baker’s bill and the governor is not running for re-election, his proposal is likely invalid. It gives you concrete numbers on exactly how much money you’ve spent on primary and behavioral health care. The report is important as Congress oversees the implementation of new legislation aimed at improving access to mental health care.
“When CHIA began collecting this data, comprehensive information was limited to levels of investment in primary care and behavioral health services within the Commonwealth. It greatly expands our understanding,” said Ray Campbell, CHIA Executive Director. “The ability to measure spending on both primary care and behavioral health care sets Massachusetts apart nationally and creates a factual foundation to support public policy discourse.”
In raw numbers, spending on primary care totaled $2.1 billion in 2019, dropping to $1.9 billion in 2020. This decline was due to the outbreak of the COVID-19 pandemic, which resulted in mass cancellations of routine and non-urgent healthcare visits. The state was put on lockdown in March 2020. The data show that visits to clinics, especially for preventive care, declined significantly from 2019 to 2020.
Behavioral health spending increased from $2.1 billion in 2019 to $2.2 billion in 2020. This increase represents a significant increase in mental health care in a year when spending on behavioral health care increased by 9.1%, even as spending on all other services declined. 4.2 percent.
The report attributes increased spending on behavioral health care to increased needs due to the impact of the pandemic and increased use of telemedicine for mental health care. It has proven much easier to extend the use of telemedicine to mental health care than to physical health care. Between 2019 and 2020, spending on outpatient behavioral health care for patients with commercial insurance increased by 17.1%, he said. For low-income Medicaid patients, the largest increase was in hospital care, an increase of 18.3% from 2019 to 2020.
According to the report, in 2020, primary care and behavioral health care together will account for 16.2% of total health care spending.
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The report also breaks down spending by insurance type and finds that Medicaid spends a much higher percentage of its spending on behavioral health, compared to commercial insurance and Medicare. This may reflect differences in baselines in patients (more reports of patients undergoing behavioral health examinations on Medicaid) and generous Medicaid coverage. It covers more mental health services without a large out-of-pocket cost compared to commercial insurance.
Asked why Baker was making the report public now when Baker first made the proposal in 2019, CHIA’s director of health informatics and reporting, Erin Bonney, said the agency plans to launch in the fall of 2019. He said he had started collecting data, but the organization wanted to complete two years of data. Collect and dig into data quality before publishing to ensure the information is accurate.
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