Mass General Brigham Reports Fiscal Year 2023 Financial Results

Continued progress on system transformation despite persistent financial, capacity, and labor challenges

BOSTON – Mass General Brigham, a not-for-profit, integrated healthcare system, today reported its financial results for the fiscal year ending September 30, 2023, which reflect continued capacity and labor challenges that persist across the healthcare landscape. Excluding onetime revenues largely related to federal transfers connected to the COVID-19 pandemic, the system generated an operating loss of $48 million (-0.3% operating margin), including losses from provider activity of $45 million (-0.3% operating margin) and insurance activity of $3 million (-0.2% operating margin). Inclusive of onetime revenues described below, the system reported income from operations of $95 million.

Labor and supply cost pressures which intensified in 2022 have moderated but continue to impact the system’s operating performance.  Mass General Brigham is responding to these ongoing challenges by improving efficiency in systemwide capacity management, focusing on reducing its long-term expense trend, and continuing clinical integration efforts that are helping patients more easily access care at the right place, for the right amount of time.

In FY2022, the system reported a loss from operations of $432 million (-2.6% operating margin). Provider activity resulted in a loss of $395 million (-2.5% operating margin), reflecting the impact of the COVID-19 Omicron surge in addition to unprecedented cost inflation and staffing shortages which limited inpatient and outpatient capacity. Insurance activity resulted in a loss of $37 million (-3.8% operating margin), including a $21 million premium deficiency reserve for anticipated losses related to the launch of Mass General Brigham Health Plan’s Medicare Advantage program on January 1, 2023.

“This past year, healthcare systems across the country continued to confront major financial, capacity, and labor headwinds that threaten the ability to invest in mission, and Mass General Brigham has been no different. At Mass General Brigham, we are deeply committed to sustaining and funding our mission of high-quality patient care, world-class research, top-notch education, and a strong focus on supporting our communities,” said Anne Klibanski, MD, President and CEO of Mass General Brigham. “Despite persistent capacity and labor challenges, we continue to make progress in transforming our system to meet the needs of an evolving healthcare landscape. In the year to come, we are committed to expanding access for patients, investing in our workforce, sustaining our world-class research enterprise, and lowering costs while providing the best patient care.”

The system reported total operating revenue of $18.8 billion in 2023. This includes $143 million nonrecurring revenue, primarily from governmental sources to partially mitigate losses incurred during the COVID-19 pandemic.  Excluding this nonrecurring revenue, total operating revenue increased $2.0 billion (12%) over 2022. Patient care revenue grew to $12.8 billion, an increase of $901 million (8%). Ongoing efforts to coordinate systemwide capacity management resulted in a slight decline in the average acute care length of stay (-0.5% to 6.1 days) and contributed to growth in discharges (3%). Robust outpatient activity also contributed to revenue growth. The system also generated $1.5 billion in premium revenue (63% increase, reflecting the addition of approximately 160,000 MassHealth members under a new Accountable Care Organization), $2.7 billion in research and academic revenue (8% increase) and $1.7 billion in other revenue (20% increase, driven by outpatient pharmacy).

Operating expenses totaled $18.7 billion, an increase of $1.6 billion (9%) over 2022, reflecting increases in medical claims ($364 million or 51%, related to the increase in Health Plan membership), wages ($543 million or 8%, including market adjustments for certain employees and ongoing use of temporary staffing), costs and use of clinical ($127 million or 14%) and pharmaceutical ($320 million or 26%) supplies, and depreciation and interest ($9 million, 1%).

“While our financial results show significant progress in addressing capacity and labor challenges, they also demonstrate the need to continue focusing on initiatives that reduce costs, generate revenue growth, and position our system for long-term financial stability,” said Niyum Gandhi, Chief Financial Officer and Treasurer at Mass General Brigham. “Looking ahead to 2024, we will enhance our efforts to reduce our long-term expense trend by creating a culture and mindset around resource stewardship and utilization. At the same time, we will double down on initiatives that generate sustainable revenue outside of traditional care delivery, like the continued growth and integration of our Mass General Brigham Health Plan, and innovative solutions that improve patient outcomes.”

In 2023, the system absorbed $2.4 billion in Medicare, Medicaid, and Health Safety Net shortfalls due to certain government reimbursements that do not cover the full cost of providing care to Medicare, low-income, and uninsured patients, an increase of $112 million (5%) compared to the shortfall absorbed in 2022.

The system reported an overall gain of $1.2 billion in 2023, including a nonoperating gain of $1.1 billion. Nonoperating activity includes gains and losses on investments and interest rate swaps, which can vary significantly year to year due to volatility in the financial markets, and philanthropic activity. In 2022, the system reported an overall loss of $2.3 billion, including a nonoperating loss of $1.8 billion.

Driving impact for patients, communities, and the world

Mass General Brigham’s strategy is designed to sustain its four-part mission, which focuses on delivering excellent patient care, sustaining its world-class research enterprise, educating the next generation of healthcare providers, and serving the broader community. The system’s strategy is focused on several key priorities:

Enhancing patient access despite an ongoing capacity crisis

In 2023, Mass General Brigham continued to integrate clinical operations to deliver patients a seamless, unified experience. The system launched a new Patient Transfer and Access Center this fall, bringing together clinical experts and bed placement specialists from both its academic medical centers to work in a coordinated way at its Assembly Row headquarters. The Center coordinates care for patients being transferred to or within the system, to connect a patient with the right bed across the system’s academic medical centers, specialty hospitals, and community hospitals. Since the launch of the Center on October 4, the system has seen a 15% increase in the number of patient transfer requests accepted into either MGH or BWH when compared to the acceptance percentage prior to launch of the Center. Last year, before the creation of the Center, MGH and BWH processed over 3,000 overlapping transfer requests. Mass General Brigham also continued its efforts to integrate clinical services, building on previous integration of emergency medicine, pathology, radiology, and anesthesiology. This year, as part of its comprehensive approach to address the behavioral health crisis, Mass General Brigham developed a new, integrated approach to inpatient behavioral health, with a single point of entry, which is reducing extended emergency department (ED) stays, speeding up access to vital inpatient care, and getting patients in beds best suited to address their needs. Since its launch in October 2022, this program has decreased the number of patients waiting in the ED by 3%, decreased patients waiting more than 100 hours in the ED by 16%, and increased placement to an inpatient behavioral health unit by 8%. This work will continue in the new year with a continued focus on new service lines that bring together clinical operations to ease patient access and navigation. The system is also harnessing the power of artificial intelligence (AI) to streamline clinical administrative work, allowing caregivers to spend more time with patients, while always keeping clinicians in the loop in all processes.

Delivering care closer to home and in the home

Mass General Brigham Healthcare at Home is expanding the home-based care continuum by growing its Home Hospital service to reach even more patients across the region. The system already operated one of the largest Home Hospital programs in the country, combining the successful hospital at home efforts in operation at Massachusetts General Hospital and Brigham and Women’s Hospital since 2016. This fall, the system expanded Home Hospital to reach more patients at Brigham and Women’s Faulkner Hospital, Newton-Wellesley Hospital, and Salem Hospital. Mass General Brigham is also taking an innovative approach to scaling Home Hospital through a new collaboration with Best Buy Health to leverage state-of-the-art technology and support the future workforce pipeline. As part of its efforts to deliver value-based care, Mass General Brigham announced a partnership with Concert Health to integrate behavioral healthcare services in its primary care practices across the communities it serves. This year, Mass General Brigham Health Plan (previously AllWays Health Partners until 2023), began managing the system’s Medicaid population through an Accountable Care Organization model, and was ranked #1 in Member Satisfaction among Commercial Health Plans in Massachusetts according to the J.D. Power 2023 U.S. Commercial Member Health Plan Satisfaction Study.

Prioritizing health equity to break down generational disparities

Now entering its third year, Mass General Brigham’s United Against Racism initiative is driving greater impact as the system continues its work to address the impact of racism on Mass General Brigham patients, staff, and community. In 2023, the system continued to expand access to substance use disorder (SUD) care through its Bridge Clinics, particularly in underserved communities. Over the past two years, these efforts have increased SUD visit rates by 5% for Black, Hispanic and non-English speaking patients. Mass General Brigham Community Care Vans continue to provide free screenings and interventions for chronic health issues, having administered well over 20,000 vaccines to community residents as of this year. To address social determinants of health, patients are screened for issues related to housing, access to healthy food, and personal safety, and connected with relevant resources. The system’s health equity strategy is pursuing a targeted focus on key drivers of mortality in communities facing health disparities: namely substance use disorder, cardiovascular disease, certain types of cancer, and maternal health. Mass General Brigham is also pursuing initiatives that build a diverse workforce pipeline, including $20 million new investment in a proven nurse training partnership with UMass Boston.

Delivering global impact through world-class research and innovation

Mass General Brigham is the largest hospital system-based research enterprise in the country, and research from the system has inspired hundreds of accessible, lifesaving treatments and technologies. This year, the system advanced several collaborations and innovations that are deepening its impact on the healthcare landscape. The Gene and Cell Therapy Institute (GCTI), launched late last year, has grown into a hub of innovation and collaboration, uniting more than 400 researchers and clinicians dedicated to advancing gene and cell therapy and pushing the boundaries of technology and clinical applications. This fall, the GCTI awarded its first-ever Spark Grants, providing crucial funding to fuel groundbreaking projects, and also hosted its inaugural Gene and Cell Therapy Symposium. Mass General Brigham played a leading role in Massachusetts’ successful bid to host the Investor Catalyst Hub for ARPA-H, a new federal research agency that will fund and accelerate life-changing cures and therapies to bring the most innovative ideas to the bedside as rapidly as possible. The system harnessed its national research expertise and relationships to support the bid to secure this new hub, which will now build on these partnerships to drive groundbreaking solutions for patients. In 2023, Mass General Brigham’s World Medical Innovation Forum, which celebrates its 10^th anniversary next year, once again brought together global leaders to address the latest opportunities and challenges in the healthcare investment landscape.

Elevating quality and leveraging patient-centric solutions to sustain our mission

In 2023, Mass General Brigham launched For Every Patient, a unified, data-driven systemwide quality strategy that seeks to deliver the best possible care for every patient who needs us, every time they need us, from the common to the complex. The initiative will pursue improvements to make care more effective, safe, equitable, and personalized for every patient. The initiative has seen early success: For example, as part of For Every Patient’s focus on ensuring the safest possible care, Mass General Brigham has improved the follow-up rate for higher-risk findings from colonoscopies to 40%. To sustain its mission for years to come, Mass General Brigham is pursuing a diversified strategy focused on innovative solutions that deliver impact for patients and generate sustainable revenue outside of traditional care delivery. For example, Mass General Brigham Specialty Pharmacy provides patients access to self-administered, specialty medications with 24/7 support. The program delivers high levels of patient and prescriber satisfaction, and practices that join the specialty pharmacy program routinely see the “time-to-first-fill” metric for highly-specialized medications drop from 40-50 days to 10-15 days.

Fourth Quarter Financial Results

The system reported income from operations of $33 million for the quarter ended September 30, 2023. This includes $99 million prior year revenue. Excluding those funds, the system generated an operating loss of $66 million (-1.4% operating margin). Provider activity resulted in a loss of $69 million (-1.6% operating margin) and insurance activity generated income of $3 million (0.7% operating margin).

Total operating revenue increased $564 million (13%; excluding prior year revenue) to $4.9 billion for the three months ended September 30, 2023, reflecting increases in net patient service revenue ($224 million, 7%), premium revenue ($291 million, 121%), research and academic revenue ($24 million, 4%) and other revenue ($25 million, 7%). Total operating expenses increased $501 million (11%) to $4.9 billion, reflecting increases in wages and benefits ($175 million, 8%; including market wage adjustments and ongoing use of temporary staffing), supplies and other expenses ($131 million, 11%), medical claims ($181 million, 91%) and depreciation and interest ($6 million, 3%).

In the comparable 2022 quarter, the system reported an operating loss of $128 million (-3.0% operating margin).  This includes an operating loss of $105 million (-2.6% operating margin) from provider activity. Insurance activity resulted in an operating loss of $23 million (-9.1% operating margin, including the $21 million premium deficiency reserve related to the launch of Mass General Brigham Health Plan’s Medicare Advantage program).

The system reported an overall loss of $41 million for the three months ended September 30, 2023, including a nonoperating loss of $74 million. In the comparable 2022 three-month period, the system reported an overall loss of $547 million, including a nonoperating loss of $419 million.