Links of Interest
Approved Policies and Reports
Maryland Hospital Acquired Conditions
Readmission Reduction Incentive Program
Quality Based Reimbursement
Maryland Patient Safety Center
GBR-PAU Efficiency Adjustment
PAU Savings Policy
Archived Quality Initiatives
GBR Agreements and Addendums
Annual Update to Unit Rates
Accounting and Budget Manual
Policy Clarifications & Regulation Updates
Approved Hospital Unit Rate Reports
Clinical Data Submission and Requirements
Clinical Public Use Data Requests
Financial Data Submission Tool
Maryland Hospital Audited Financial Statements
Nurse Support Programs I & II
Outpatient Services Survey Results
Hospital IRS 990 Forms
Community Benefit Program
Marylanders’ Health and Quality of Life
of Maryland is committed to ensuring that all Marylanders have access to the
nation’s best health care and that our critical health needs are met. Our priorities:
that all Marylanders have access to quality health care by the nation’s best
health care providers in every corner of the state – whether rural or urban.
the needs of our senior population, which is expected to increase by 40% over
the next ten years.
Fight the opioid epidemic and other population
health improvements such as diabetes prevention and other chronic conditions.
To advance these priorities, Maryland outlined
a “Progression Plan” in the fall and winter of
2016 to improve
care and outcomes for all Marylanders.
The Progression Plan is the State’s vision for the continued evolution
of the All-Payer Model and is designed to achieve person-centered care, foster
clinical innovation and excellence in care, improve population health, and
moderate the growth in the total cost of care for Medicare beneficiaries. The Progression Plan reflects input from
stakeholders and the general public invited through a public comment period
prior to Maryland’s filing of the plan with the federal government in December
2016. Negotiations with the federal
government for continuation of the All-Payer Model were based on the care
transformation vision outlined by the Progression Plan.
Health System Limitations
Maryland’s current approach to hospital payment is known as
the “Maryland All-Payer Medicare Model Contract,” and runs from January 1, 2014
through December 31, 2018. The All-Payer
Model’s success metrics are based on enhancing quality, improving health
outcomes, and constraining the growth of Medicare costs for hospital inpatient
and outpatient services.
Since 2014, Maryland’s hospitals have successfully reduced
unnecessary readmissions and hospital-acquired conditions, while decreasing the
growth in hospital cost per capita.
However, the current approach focused on hospitals does not sufficiently
provide for comprehensive coordination across the entire health care
system. Because of this limitation, the
federal government required Maryland to develop a new model that encompasses
all of the health care that patients receive, both inside the hospital and the
community. The Progression Plan served
as the blueprint for this Model development, known as the “Total Cost of Care
Model”. In May 2018, Maryland and the
federal government announced successful negotiations of the new Model, which
will begin on January 1, 2019.
Key Elements of the Total Cost
of Care Model
To achieve a patient-centered
system, the Total Cost of Care Model includes the following key elements:
Care will be coordinated across both hospital
and non-hospital settings, including mental health and long term care.
The Model will invest resources in
patient-centered care teams and primary care enhancements.
Maryland will set a range of quality and care
improvement goals. Providers will be
paid more when patient outcomes are better.
Maryland will set a range of population health
goals addressing opioid use and deaths, diabetes, and other chronic conditions.
State flexibility will facilitate programs
centered on the unique needs of Marylanders, the provider community, geographic
settings, and other key demographics.
As part of the federal agreement to put the new Total Cost
of Care Model in place, all-payer hospital cost growth will continue to be
limited to 3.58% per capita, a limit that was set in 2014 based on long term
growth in Maryland’s economy. As part of
this Model, Maryland commits to saving $300 million in annual, total Medicare
spending by the end of 2023. The Medicare savings required in the TCOC
All-Payer Model will build off of the ongoing work of Maryland stakeholders,
which began in 2014.
Next Steps and Opportunities
The State of Maryland remains
committed to a robust process for input and feedback on the development and
implementation of the new model. Maryland
stakeholders will continue the process of planning and preparation for the new
Total Cost of Care Model prior to the new model’s start through participation
in workgroups, councils, and provider-led innovation groups.
Additional information is available in the following
The Updated Progression Plan submitted by the Governor
to the federal government in December 2016 laying out the vision for the Total
Cost of Care Model;
A brief background and summary of the Total Cost
of Care Model with key requirements; and
Opportunities to engage in model development
through workgroups and/or document review.
● All-Payer Model
● All-Payer Model Performance, through
2017 Year-to-Date Results
Primary Care Model Concept Paper
For additional information or to seek clarification on the
proposed Total Cost of Care Model, please send an email to the HSCRC staff at firstname.lastname@example.org.
Thank you for all of your support and input into this important planning for Maryland. We appreciate your input and look forward to continuing to work with you.
- Maryland Department of Health (MDH) and Health Services Cost Review Commission (HSCRC)
4160 Patterson Avenue | Baltimore, Maryland 21215 Toll Free: 888-287-3229
Phone: 410.764.2605 | Fax: 410.358.6217