One of the government. The biggest Charlie Baker initiative that he tried to pass, but failed to pass, had redirected health care spending, so a greater portion of health care spending went toward primary and behavioral health care, rather than specialty care.
Becker-sponsored legislation would have required health care providers and payers to increase spending on primary and behavioral health care by 30 percent over three years over 2019 levels, while staying below the health care standard that sets targets for total health care spending.
The legislature did not take Baker’s bill, and the governor is not running for reelection, so his proposal is likely dead. But a report from the state’s Center for Health Information and Analysis, released Tuesday, puts specific numbers on exactly how much Massachusetts spends on primary and behavioral health care — key figures should show similar proposals to Baker in the future. The report will also be important as the legislature monitors implementation of a new law aimed at improving access to mental health care, which tasks the CHIA with monitoring state spending on mental health services.
“When CHIA began collecting this data, comprehensive information was limited on the level of investment in primary care and behavioral health services in the Commonwealth and this report significantly expands our understanding of spending in these important areas,” said Ray Campbell, Executive Director of CHIA. “The ability to measure both primary care and behavioral health expenditures makes Massachusetts separate at the national level and creates a realistic basis for supporting public policy discourse.”
In raw numbers, spending on primary care totaled $2.1 billion in 2019, declining to $1.9 billion in 2020. The decline was attributed to the onset of the COVID-19 pandemic, which resulted in mass cancellations of routine and non-urgent health care visits. The country was closed in March 2020. Data shows a significant decrease in office visits, particularly preventive care, between 2019 and 2020.
Spending on behavioral health care reached $2.1 billion in 2019, but rose to $2.2 billion in 2020. This increase represents a huge leap for mental health care in a year in which spending on behavioral health jumped 9.1 percent despite a decline in spending on All other services increased by 4.2 percent.
The report attributes rising spending on behavioral health care to the growing need, due to the effects of the pandemic, and the increased use of telehealth for mental health care. It has proven to be much easier to expand the use of telehealth services for mental health care than for physical health care. Spending on outpatient behavioral health care jumped 17.1 percent for commercially insured patients between 2019 and 2020. For lower-income Medicaid patients, the largest jump was in inpatient care, which rose 18.3 percent between 2019 and 2020. .
In 2020, the report found that primary and behavioral healthcare combined made up 16.2% of total healthcare spending.
The report also breaks down spending by type of insurance and finds that Medicaid spent a much higher percentage of its expenditures on behavioral health care, compared to commercial insurance or Medicare. This likely reflects a fundamental difference between the population — with Medicaid reporting more patients with behavioral health diagnoses — and generous Medicaid coverage, under which more mental health services are covered without significant contributions compared to commercial insurance.
When asked why the report was released now, when Baker first made his proposal in 2019, Erin Bonney, director of health informatics and reporting at CHIA, said the agency began collecting data in the fall of 2019, but the organization wanted to complete two years of data collection And research the quality of the data before publishing, to ensure the accuracy of the information.