Mass General Brigham Health Plan

What it reported doing in 2024

Health care delivery: mass general brigham health plan (mgbhp) promotes the general welfare of the people in the community by facilitating the delivery of comprehensive health services on a prepaid basis to members at 2,059 primary care locations. Fully insured members include 233,978 individuals covered by medicaid, medicare advantage, small and large employer groups and low-income, high-risk individuals. During 2024, members incurred approximately 4.4 million ambulatory encounters and incurred 169,638 hospital patient days. Mgbhp offers members access to 8,385 primary cary physicians and 53,275 specialty care providers. Since 2008, mass general brigham health plan has been accredited by the national committee for quality assurance (ncqa). The ncqa accreditation survey process includes on- and off-site evaluations of over 60 standards and performance measures conducted by a team of physicians and managed care experts. Nearly every part of the mass general brigham health plan was evaluated including utilization management, care management, quality, member experience/customer service, network operations, population health, and credentialing. Mass general brigham health plan voluntarily pursued ncqa accreditation and will continue to strive for this recognition because we know our members deserve the highest quality care. In the latest health plan survey ratings (2024), we achieved a 4.0 out of 5.0-star rating for both our commercial and medicaid plans.

Financial Efficiency

• Mission deployment rate: 100%; rating input score 100
• Program expense ratio: 99.2%; rating input score 99
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 100%; rating input score 100; 71st percentile among comparable filings
• Pay-setting controls: 5 of 6 controls in place; rating input score 83
• Foreign activity oversight: Limited
• Grant itemization coverage: Limited
• Major donor itemization: Limited
• Related-party transparency: Yes; rating input score 100
• Public monitoring controls: 0 of 8 controls in place; rating input score 0
• Public policy transparency: 0 of 7 controls in place; rating input score 0
• Public financial transparency: 0 of 5 controls in place; rating input score 0
• Impact reporting controls: 1 of 7 controls in place; rating input score 14
• Public relationship transparency: No; rating input score 0

Accountability

• Independent voting board: 70%; rating input score 70; 20th percentile among comparable filings
• Governance controls: 9 of 9 controls in place; rating input score 100
• Public governance controls: 0 of 4 controls in place; rating input score 0
• Zakat policy transparency: Limited

Sustainability

• Operating margin: -1.1%; rating input score 22; 22nd percentile among comparable filings
• Operating reserve ratio: 0.34; rating input score 11; 11th percentile among comparable filings
• Liabilities to assets ratio: 0.72; rating input score 20; 20th percentile among comparable filings
• Officer compensation ratio: 0.1%; rating input score 94; 94th percentile among comparable filings

Growth

• Program expense growth: -1.8% per year; rating input score 0; 4th percentile among comparable filings
• Revenue growth: 1.2% per year; rating input score 100; 9th percentile among comparable filings
• Asset growth: 3.9% per year; rating input score 100; 27th percentile among comparable filings