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Community Benefit Program
The State of Maryland is leading a transformative effort to improve care and reduce the growth in health care spending. Effective January 1, 2014, the State of Maryland and the Centers for Medicare & Medicaid Services (CMS) entered into a new initiative to modernize Maryland’s unique all-payer rate-setting system for hospital services. As the State’s hospital rate-setting authority, the HSCRC plays a vital role in the implementation of this innovative approach to health reform.
This initiative, replacing Maryland’s 36-year-old Medicare waiver, allows Maryland to adopt new and innovative policies aimed at reducing per capita hospital expenditures and improving patient health outcomes. Stated in terms of the “Triple Aim,” Maryland strives to transform its health care system into one that enhances patient care, improves health, and lowers costs.
Success of the All-Payer Model will reduce costs to purchasers of care—businesses, patients, insurers, Medicare, and Medicaid—and improve the quality of the care that patients receive both inside and outside of the hospital. Since 2014, the State, in close partnership with providers, payers, and consumers, has made significant progress toward this modernization effort.
Next Phase: Total
Cost of Care Model Beginning January 2019
In early 2017, the federal government and State officials,
with input from Maryland health care leaders, began negotiations for a new
model beginning January 2019 that builds on the foundation created by the
current All-Payer Model and expands beyond hospitals to address Medicare
patients’ care in the community.
Under the new “Total Cost of Care Model,” Maryland will be
expected to progressively transform care delivery across the health care system
with the objective of improving health and quality of care. At the same time, State growth in Medicare
spending must be maintained lower than the national growth rate. The Total Cost of Care Model will give the
State flexibility to tailor initiatives to the Maryland health care context,
and encourage providers to drive health care innovation. The Total Cost of Care Model encourages
continued Care Redesign, and provides new tools and resources for primary care
providers to better meet the needs of patients with complex and chronic
conditions and help Marylanders achieve better health status overall. Additional
details on the Model can be found on the Modernization tab.
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