Payment and Delivery System Reform

The Affordable Care Act created new opportunities to promote a more cost-effective and patient-centered approaches to the delivery of health care.  As advocates, we work to make sure that these work for consumers.

Transforming Health Care in Maryland

Maryland has taken a leadership role by proposing models for reform of the payment and delivery systems that hold the promise to address the “Triple Aim:”

  1. Improve the patient experience of care (including quality and satisfaction);
  2. Improve population health; and
  3. Reduce the per-capita cost of health care.

    All-Payer Hospital System Modernization (Medicare Waiver)

    On January 10, 2014, the Centers for Medicare & Medicaid Services (CMS) announced the approval of Maryland’s proposal to modernize the state’s unique all-payer rate-setting system for hospital services. Maryland operates the nation’s only all-payer hospital rate regulation system.

    Now entering its third year, after the signing of an agreement with the Centers for Medicare and Medicaid Services (CMS), progress is being made.  However, much remains to be done - not least of which is the implementation of the recommendations contained in the Health Services Cost Review Commission's (HSCRC) Consumer Engagement Task Force's Report.

    Even as we are implementing this All-Payer model we are designing phase two with the goal of creating greater alignment across hospitals, payers and providers. To inform its work the HSCRC has reconvened its Advisory Council.  Consumer Health First President, Leni Preston, wass pleased to serve on the Council which submited its preliminary report to the HSCRC and the Department of Health and Mental Hygiene (DHMH) in late March. 

    It is difficult to overstate the value of Maryland's innovative approach to delivery system and payment transformation. David Blumenthal of the Commonwealth Fund and a member of the Advisory Council put it this way, "what you are trying to do is unprecedented."  And he went on to say that in the future "[Maryland] will have a lot to teach..." other states. 

    In addition to HSCRC's work, DHMH is also convening the Duals Care Work Group designed to address care coordination and other needs for those who are dually eligible for both Medicare and Medicaid.

    It should be obvious that there is a lot on the agenda of Maryland's policy makers and that means there is a lot of work for consumer advocates.  We all need to understand the issues to ensure that one of the core principles of this work - a "person-centered" model --is a reality. 

    To learn more about All-Payer Model and the work being done:

    • The All-Payer Model from CMS Center on Innovation here 
    • Maryland's implementation process, including hospitals' transformation grants here
    • The Advisory Council membership and meeting schedule and materials here
    • Meetings of the Duals Care Work Group here 
    • The Baltimore Sun posted an article highlighting the new health care debate in Maryland. Specifically, the fact that the annual hospital rate negotiations have moved from the old fee for service models which rewarded hospitals for volume and complex procedures, and now, rewards them to keep patients healthy and at home in order to conserve their global budgets.  But hospitals are asking for some wiggle room to keep making the investments that this new model requires.. State regulators need to consider the hospitals' request for a higher rate adjustment this year not as the usual jockeying but as a crucial factor that will determine whether Maryland's attempt to chart the way to a better, more affordable health care future will succeed.
    • The Maryland Health Care Commission has a consumer guide site designed to help consumers shop around to see how hospitals compare on costs and quality. They are involved in coordinating these major changes with the rest of the health care system and also have opportunities for public engagement detailed on their site.
    • An interactive tool on the Peterson-Kaiser Health System Tracker allows users to analyze the most up-to-date data on U.S. health spending, then build, display and share the charts they create. 
    • Taking Hospital Community Benefit Policy to the Next LevelAdvancing Community Healthheld on June 15, 2016. Here is the link to the symposium page:

    Get Involved

    The Maryland Health Services Cost Review Commission is overseeing the implementation of the waiver. They are in charge of setting rates and making sure that hospitals continue to deliver the highest quality of care. Visit their site to learn more.

    The Consumer Engagement Task Force released their final report in September 2015. You can read and download it here.

    For more information contact us.

    Additional Reform Initiatives

    • Exciting new Accountably Health Communities initiative: this new "model will test three scalable approaches to addressing health-related social needs and linking clinical and community services - community referral, community service navigation, and community service alignment. Learn more.