July 13, 2018
A Foundation for Success
It's been a noteworthy week for the Maryland Model, kicking off with a contract signing ceremony on Monday that featured Maryland's top political dignitaries, along with CMS Administrator Seema Verma.
"Transformation can't stop at the hospital walls," Verma said Monday with more than a dozen hospital executives looking on. "The objective is clear: The state will continue to bring all Medicare costs down while improving quality of care."
I was privileged to speak at the event on behalf of Maryland's hospitals and health systems. My message emphasized the importance of having strong collaboration with non-hospital providers, government agencies and others to control the total cost of care.
While the goals may be evident, the precise path to achieve them is less clear. No doubt hospitals will draw on the lessons they learned about reducing hospital utilization under the All-Payer Model in order to hold costs in check in non-hospital settings. There will be no shortage of experimentation in search of the best outcomes.
This is why the care redesign tools that have been developed, and others that will manifest along the way, are so critical.
Already, good progress has been made for hospitals to begin using these tools.
The third performance period of the Care Redesign Program began on July 1, with 42 hospitals signing on to participate in one of the two voluntary, hospital-led programs: the Hospital Care Improvement Program for hospital-based physicians and the Complex and Chronic Care Improvement Program for community-based providers. A third program, the Bundled Payments for Care Improvement in Maryland was approved by the Center for Medicare & Medicaid Innovation on July 5, 2018, one month after submission. This new track, a recommendation of the MHA-convened Stakeholder Innovation Group, is expected to launch January 1, 2019, when an analogous program will be available nationally.
The Maryland Primary Care Program, designed to encourage physicians to deliver value-driven care, is also ramping up. Application deadlines are in July for Care Transformation Organizations and August for primary care practices. CMMI will issue decisions about acceptance in the late summer and fall.
With the pomp and circumstance of the signing ceremony behind us, the hard work now begins. It's clear that that Maryland's health care providers recognize both the enormity of the task laid before them and the promise the new model holds to fundamentally improve the health of all Marylanders.

Bob Atlas
President and CEO

Maryland Model Extension Signed
The Maryland Total Cost of Care Model contract, an extension of the state's unique hospital global budget system, was signed and enacted this week by state and federal leaders. Governor Larry Hogan, Centers for Medicare & Medicaid Services Administrator Seema Verma, MHA President and CEO Bob Atlas, and many hospital CEOs attended the signing ceremony in Annapolis. The new model is expected to save more than $1 billion in health care costs by 2023. The final contract is available on the HSCRC website .
HSCRC Recommends New Executive Director
At this week's Health Services Cost Review Commission meeting, Chairman Nelson Sabatini announced that commissioners had recommended Katie Wunderlich as the next executive director, subject to the approval of the governor. Wunderlich is currently the commission's Director of Engagement and Alignment. Additional details are in this month's edition of Newsbreak .
Webinar on Behavioral Health Capacity Study Available
A webinar this week laid the groundwork for a study to identify the top reasons for discharge delays for behavioral health patients. The study involves a survey to be completed by discharge planners for behavioral patients who experience delays in finding appropriate post-hospital care. A recording of the webinar and the slides are available here . In the coming weeks, hospitals will be asked to sign letters of participation training webinars on data collection will be scheduled. For information on how to participate, contact Erin Dorrien at edorrien@mhaonline.org .
Emotional Intelligence Expert to Speak at MHEI's Annual Conference
MHEI's Annual Leadership Conference has been transformed to make it easier and more convenient for the intended audience - all healthcare leaders and managers in Maryland. Also, the registration fee has been reduced to add even more value for MHEI members. What hasn't changed is the amazing lineup of national and international presenters with expertise in leadership and healthcare:  
  • Daniel Goleman, Ph.D., and author of the best-selling book "Emotional Intelligence and Social Intelligence: The New Science of Human Relationships," will begin the conference by sharing evidence and actions that enable hospitals to more effectively tap into the strengths of their greatest assets: staff!
  • Ryan Donohue from the National Research Corporation will offer insights on the new wave of consumerism in healthcare and how to take advantage of the latest research on patients, families, and their healthcare decision-making. 
  • Author, researcher, and filmmaker Ron Galloway will discuss the entry of Google, CVS, and Amazon into the healthcare marketplace and its implications for hospitals and providers.
  • The day will conclude with Laurie Cameron, author and business leader, and her work helping organizations tap into the great reserves of their staff to be mindful, compassionate, resilient and mentally strong.
Register now for the October 19 conference at the Turf Valley Resort and Conference Center in Ellicott City.
School-Based Telehealth Grant Opportunity Available
The Maryland Health Care Commission this week released two Announcements for Grant Applications - School-Based Teletherapy for Special Education Services and Enhancing School-Based Health Care Services via Telehealth. Some schools struggle with obtaining direct service providers to support students' health care and special service needs due to workforce shortages, particularly in rural areas. Telehealth can complement and expand the capacity of schools to meet students' needs by using technology to connect to providers.  
  • The School-Based Teletherapy for Special Education Services grant aims to increase access to qualified special education and related services providers via teletherapy. The purpose of the grant is to support local education agencies by expanding the availability of services to students eligible for special education in public schools that have a shortage of qualified specialist-related service providers.
  • The Enhancing School-Based Health Care Services via Telehealth project funds the implementation of telehealth to enhance health care services delivered within public schools. The grant is intended to increase access to health care services to improve health quality, academic performance, and decrease absenteeism in the student population. 
Grant applications are due by August 15. The announcements are available here .
Can Physicians Learn To Lead From Other Physicians?
Let's face it! Physicians were never taught how to lead. Those who do it well pretty much learned on their own, through their own successes and failures, and their ability to understand that working with others in an organization where you don't have total control presents challenges that demand a different sort of skill.

Reduce Lighting Energy Costs Up to 50 Percent
Lighting accounts for 30 to 60 percent of annual electric costs for many facilities, and many new advances in lighting technology can help your organization conserve energy and save money.

CMS Releases Proposed Physician Fee Schedule Rule for CY 2019
The Centers for Medicare & Medicaid Services this week proposed to update physician fee schedule rates by 0.25 percent in calendar year 2019, as required under the Medicare Access and CHIP Reauthorization Act of 2015.

Tuesday, July 17
MHA Council on Financial Policy meeting
MHA Medicare Performance Adjustment Work Group meeting
Carroll County Times , By Jon Kelvey, July 6
Cumberland Times-News , By Heather B. Wolford, July 8
The Baltimore Sun , By Andrea K. McDaniels, July 9
WMAR , By Mallory Sofastaii, July 9
The Baltimore Sun , By Jess Nocera, July 10
Home Health Care News , By Tim Mullaney, July 11
Cumberland Times-News , By Heather B. Wolford, July 12