January 12, 2020
Success, By the Numbers
Maryland hospitals have delivered wins under the All-Payer Model (2014-18) and the new Total Cost of Care Model contract with the Center for Medicare and Medicaid Innovation (CMMI). In addition to managing spending, we’ve grown savings while decreasing cumulative and year-to-date spending growth for Medicare beneficiaries.

As you know, explaining the Maryland Model—both its features and our performance—is hard to do succinctly. Some of you have suggested what we should highlight and how to better explain the work behind the numbers. In response, we’ve refreshed the Maryland Model Dashboard .

The Dashboard and supplemental presentation offer a quick and easy way to illustrate where we’re improving and identify where we still need some work. Watch also for quarterly updates to help you keep your teams focused on model performance and share our results with your governing boards and other stakeholders.

I’d also like to share a set of slides describing Maryland Model basics that may be useful as you explain the model to other audiences.

Risks and challenges still lie ahead. We’ll work to influence the “statewide integrated health improvement strategy” called for under the MOU just signed by the state and CMMI. We’ll also have to watch the Maryland Primary Care Program (MDPCP) spending; 2019 model results include an estimated $60 million in payments debited just like health care costs. And MDPCP spending by Medicare is forecast to rise, potentially shrinking the savings cushion. We must help ensure MDPCP produces a return on the investment.

We’ll continue to monitor performance and risks and to keep you informed along the way.
Bob Atlas
President & CEO
Join the #Caring4Md Campaign
In partnership with all of our member hospitals, MHA launched the Caring For Maryland campaign January 8—the opening day of the 2020 session of the Maryland General Assembly. The goal is to change the narrative about our hospitals and focus on the mission of care. The topline message is that while Washington politics paralyze health care, Maryland’s hospitals are doing it right. We’re bringing health, hope and healing to every single Marylander.

We invite your organizations to engage with #Caring4Md content on social media and make stories of your own employees and patients a focus of the campaign. We’ll be sharing social media graphics, including some that allow you to add your own images and text. Please visit the Caring For Maryland website and click here for our Week 1 social media graphics .

If you have questions or want to lend your voice to #Caring4Md email us .
Maryland Scores High in Health Care Affordability
A recent Healthcare Affordability State Policy Scorecard from Altarum Healthcare Value Hub found Maryland to be among the nation’s top ranked states in health care affordability outcomes and policy efforts. Our state’s results were favorable overall including the following:

#1 Making Out-Of-Pocket Costs Affordable
We have strong regulations and systems in place to help Marylanders deal with health care costs. However, as we see growth of health plans with a higher percentage of cost sharing, or effectively “no insurance” for larger dollar amounts, consumers continue to be burdened with higher costs.

#1 Policy Efforts to Reduce Low Value Care
Maryland is one of only two states to receive a perfect policy score. Not only do we have strong hospital payment policies that reward high quality and high value service, our unique arrangement with the Centers for Medicare & Medicaid Services spurs hospitals to reduce low value care.

#2 Affordability
Maryland ranks best out of the 42 states, plus Washington, DC, studied for having the lowest percentage of adults facing health care affordability problems. The scorecard does point out that even in high scoring states like ours, one in four adults still report healthcare affordability burdens.

#2 Lowest in Private Payer Prices
Our Maryland Model contract prevents cost shifting for hospital services. As an all-payer state, patients pay out of pocket at the same prices as Medicare, Medicaid and commercial health plans.

Though no state earned a perfect score overall, the scorecard finds that every state has made a degree of progress. The highest ranked state, Massachusetts, still needs to enact stronger protections against surprise medical bills and to reduce the cost of high value care.

Altarum, a nonprofit research and consulting organization that looks at solutions to advance health among vulnerable and publicly insured populations, used a dataset that compiles state-level activity related to both policy and outcome measures across four areas of healthcare affordability:
  • Extending affordable coverage to all residents
  • Ensuring that cost-sharing is affordable and evidence-based
  • Reducing the provision of low- and no-value care
  • Curbing excess healthcare prices
Webinar to Present Final Evaluation of Maryland All-Payer Model
The CMS Innovation Center and RTI International will present the final results of the independent evaluation of the Maryland All-Payer Model in a webinar January 23 at 9 a.m. During the webinar, participants will learn how Maryland performed on the goals of the model in its agreement with CMMI, the impact of the model on payers, as well as hospitals and the patients they serve, and future goals of the Maryland Total Cost of Care Model. To register for the webinar, click here .
MHA Supports HSCRC's Draft Recommendations for MHAC Program
MHA supported the Health Services Cost Review Commission’s (HSCRC) Draft Recommendations for the Maryland Hospital Acquired Conditions (MHAC) Program for Rate Year 2022 in a comment letter sent January 6. Following a major overhaul of the MHAC policy last year, HSCRC proposed minor changes to this year’s policy. After questioning the rise in complication rates for Potentially Preventable Complications that were removed from the payment policy in the calendar year 2019 performance period, HSCRC decided to continue to monitor those complications and not score hospitals for reimbursement on the monitor-only complications. Our message about focusing on the best opportunities for meaningful change resonated with the HSCRC. 
Maryland General Assembly Legislative Session Begins
The 441st session of the Maryland General Assembly began January 8 and will adjourn on April 6. This year’s opening day was historic as two new presiding officers took the helm of the House and Senate for the first time since 1987. Sen. Bill Ferguson became president of the Senate and Del. Adrienne Jones was elected speaker of the House of Delegates, beginning a new era in state government. MHA expects thousands of bills to be introduced in the coming weeks. This week, legislative briefings will be held on hospital financial assistance policies, managed care issues, as well as the Maryland Health Benefit Exchange. MHA will publish a weekly legislative dashboard beginning next week. Advocacy materials can be found here
HSCRC Presents EQIP at MHA’s Technical Work Group
At last Thursday’s MHA Technical Work Group, the Health Services Cost Review Commission (HSCRC) presented on the Episode Quality Improvement Program (EQIP) . Like the Episode Care Improvement Program (ECIP), EQIP creates an episode-based payment program that allows providers to take on risk and receive potential rewards for managing cost and utilization of certain Medicare beneficiaries. EQIP, however, is for non-hospital conveners, including Accountable Care Organizations (ACOs) and Care Transformation Organizations (CTOs), with a focus for these conveners to share risk and rewards with physicians. These ACOs and CTOs can be owned by health systems. HSCRC walked through the high-level components of the program; it aims to release a request for applications sometime this spring. For more information, contact Maansi Raswant .
Grandfathering for Community Health Workers Certification
Beginning April 1, all Maryland Community Health Workers will be required to complete a Maryland Department of Health (MDH) accredited Community Health Worker (CHW) Certification Training Program to be eligible to apply for certification. According to MDH, more than 100 existing CHWs have already taken advantage of the voluntary, grandfathering certification that will remain open until March 31. We encourage your CHWs to consider using this process for certification. The certification is free, and additional details can be found here . For questions or assistance with the certification process, contact the CHW Certification team at 410-767-5971 or via email
Transition to Optum for Medicaid Behavioral Health Services
On January 4, Optum’s online portal went live for the administration of claims and authorizations. Optum is the new administrative services organization for Maryland’s public behavioral health system. To stay informed, providers are encouraged to check Optum’s Provider Alerts page and register for the Provider Alerts listserv by sending an email to MarylandProviderAlerts@optum.com . The subject line should read “Provider Alerts” and the provider’s email address should be in the body of the email. MHA is working with the state to share information about the transition, and address any issues with the Optum system. For additional information or to provide feedback, contact Maansi Raswant.  
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