September 22, 2019
Increasing Impact
To best support your needs, MHA must constantly balance the demand to address current issues while anticipating opportunities and challenges to come. Last Thursday and Friday, MHA’s Executive Committee of the Board met to ponder the issues shaping health care in Maryland over the next decade.

The group discussed forces affecting health care and how our hospitals and our state health system need to change over the next decade—and what’s needed from MHA to get there. Big picture themes include possibilities for collaboration, ways to disrupt our own industry, and how to think like our competitors. As one CEO said, “We fundamentally want to help communities. We want to change health—individually and at a broader level. The road is hard, but if we don’t do it, who will?”

We heard from the Health Service Cost Review Commission’s Chair Nelson Sabatini and Executive Director Katie Wunderlich, who praised the work that’s been accomplished over the last seven years, while remarking that there’s still much to do. Mr. Sabatini emphasized the commission’s priorities, particularly what they see as excess facility capacity, and Ms. Wunderlich said HSCRC staff aim to increase transparency and simplify methodologies.

We had robust conversations regarding MHA’s role with HSCRC and hospital payment policies and potential redistribution of funding. We also looked at how we demonstrate success to the Center for Medicare & Medicaid Innovation (CMMI). How do you measure quality and care transformation related to population health? While we didn’t fully resolve these questions, we’ll continue to work with you to demonstrate the value of your efforts.

We also looked at how to best approach the 2020 legislative session, particularly where we need to bolster our efforts around issues like billing and collections, governance and liability. We expect to face headwinds in the coming session, so we’re looking at ways to enhance targeted communications.
On behalf of the MHA staff, I’d like to thank our Executive Committee and all of you for your input, guidance and support.
Bob Atlas
President & CEO
MHA Comments on MPA Framework
MHA submitted a comment letter Thursday to the Health Services Cost Review Commission in support of the proposed Medicare Performance Adjustment Savings Component (MPA-SC). MHA also supports the intent of recognizing savings from care transformation initiatives under the MPA Reconciliation Component, but said it is premature to finalize a mechanism to adjust Medicare payments. Read the full letter here .
Performance Measurement Work Group Update
The Health Services Cost Review Commission’s (HSCRC) Performance Measurement Work Group convened September 17 for the first time since June. HSCRC staff informed the field of their plan to finalize by the end of 2019 a framework for a Total Cost of Care statewide integrated health care improvement strategy. The framework will become the basis of a memorandum of understanding between the state and federal government about expectations for quality under the Total Cost of Care model. Measures and goals of this strategic plan would need to be completed by the end of 2020.

Staff spent considerable time outlining the direction and methodology of the Readmissions Reduction Incentive Program (RRIP) for 2020 performance and their proposal to incorporate a social determinants of health perspective into the policy. The work group will provide input to the draft policies over the next few months. Included in the materials is a timeline of the draft and final policy recommendations. The next meeting is October 16.

The materials from the September 17 meeting are here . For questions or additional information, contact Brian Sims .
Cybersecurity Symposium – Save the Date
In collaboration with the Health Services Cost Review Commission, Maryland Health Care Commission and Maryland Chapter of the Healthcare Information and Management Systems Society, your MHA will host a free cybersecurity forum October 23 from 3:30-6 p.m. The event will include networking, followed by presentations, panel discussion with executive leaders and a question-and-answer session. The forum will focus on re-evaluating security, risk and governance to ensure a well-rounded approach to cybersecurity. A more detailed agenda and link for registration is forthcoming. For more information, contact Jennifer Witten or Jane Krienke .
Hospital Care Redesign Program Approved for Commercial Expansion
The Maryland Insurance Administration (MIA) recently reviewed the governing documents submitted by Doctors Community Hospital (DCH) on their Hospital Care Improvement Program (HCIP). The MIA concluded that the HCIP program at DCH does not “constitute the business of insurance.” This will enable DCH to increase physician engagement by expanding the program to their non-Medicare population. The process to expand care redesign programs was authorized by MHA-supported legislation in 2017. Current HCIP participating hospitals should contact Erin Dorrien , to discuss the process for expansion.
Regional Partnership Grant Forum
At the Health Services Cost Review Commission’s (HSCRC) Regional Partnership forum , staff informed current Regional Partnership Transformation grant recipients of the intent to sunset the program as it exists by June 30, 2020. Staff provided an overview of their proposed replacement program, which will be presented to commissioners at their October 16 meeting. The revised Regional Partnership Transformation grant program will offer opportunities under two separate funding streams: diabetes prevention and management programs and behavioral health programs. The proposed program will have additional reporting and return on investment requirements. Staff requested regional partnerships and other stakeholders provide examples of evidence-based behavioral health interventions that HSCRC should consider supporting through grant funds by October 18. MHA will gather feedback from members and consider next steps.

Email grant related questions to hscrc.rfp-implement@maryland.gov .
Maryland Association of Hospital Auxiliaries
Members of your MHA government affairs team presented at a meeting of the Maryland Association of Hospital Auxiliaries September 16. Staff provided an overview of the 2019 legislative session and preview of 2020. The attendees, mostly hospital volunteers, engaged in a discussion on how their roles with hospitals could shift as care delivery under the Maryland model changes.

Maryland Insurance Administration (MIA) Approves 2020 Rates
Last Thursday, the MIA approved individual and small group market premium rates for calendar year 2020. The approved rates reflect an average 10% decrease for individual market plans, and an average 3% increase for small group market plans. The second straight year of decreases in premiums for the individual market is largely due to the creation of the state’s reinsurance program. MHA supported the creation of the reinsurance program in 2018, and this year urged the MIA to look beyond the reinsurance program for ways to ensure market stability and improved health outcomes for enrollees. MHA continues to advocate for a stabilized insurance market with broad-based coverage to ensure success of the Maryland Model.

For more information contact Maansi Raswant .
Maryland Easy Enrollment Health Insurance Program (MEEHP) Advisory Work Group Begins Work
The MEEHP Advisory Work Group held its first meeting September 16 in Baltimore. The group oversees the MEEHP, which was established in 2019. MHA strongly supported the creation of this program to expand health care coverage in the state and will work on its implementation via the work group. At the meeting, the group reviewed its charter and plan to implement the Easy Enrollment process, which will take place in two phases over the next two years. Future topics for the group include reviewing data points collected from the program and whether financial penalties or incentives may increase the number of individuals who enroll in coverage through the program. For additional details, contact Diana Hsu .
MHA Presents at Maryland Organization of Nurse Leaders Meeting
This week's meeting of the Maryland Organization of Nurse Leaders included a presentation by members of your MHA government affairs and policy team. Staff presented on behavioral health throughput, sharing results from two studies Maryland's hospitals participated in to help identify the reasons behavioral health patients become difficult to discharge. Staff also shared the recent collaborative efforts with the Maryland Nurses Association to address workplace violence, including the launch of a steering committee and statewide survey. Staff also provided an overview of 2019 legislative efforts and preview of proposals expected to be introduced during the 2020 session.

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