Maryland All-Payer Model Performance Results Donna Kinzer, - - PowerPoint PPT Presentation

Maryland All-Payer Model Performance Results

Donna Kinzer, Executive Director Health Services Cost Review Commission

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$116 $135 $287 $538

$0 $200 $400 $600 2014 2015 2016 CUMULATIVE SAVINGS

Millions

Maryland’s All-Payer Model Agreement with CMS: Results to Date

Current Hospital Model Features (2014-2018)

✔ Per capita, value-based payment framework for hospitals ✔ Provider-led efforts to reduce avoidable use, and improve quality and coordination ✔ Savings to Medicare without cost shifting ✔ Sustains rural health care with stable revenue base

Future Model Features (2019 and beyond)

✔ Complex and chronic care improvement, population health ✔ Provider-led innovations in primary care, nursing homes, other care settings, fostering State innovation and flexibility ✔ Limit growth in Medicare Total Cost of Care (A&B) for 800k FFS benes Medicare savings of $500+ million in hospital payments in 3 years, relative to national growth rates Maryland hospital growth contained for all payers 1.47% 2.31% 0.80% 3.58% 3.58% 3.58%

CY 2014 CY 2015 CY 2016

MD Per Capita Revenue Growth MD Per Capita Revenue Ceiling

SOURCE State of Maryland . SOURCE State of Maryland analysis of data from CMS.

Total Cost of Care and Quality Results

✔ Medicare total cost of care $364 million savings ✔ Readmissions (-11%) ✔ Hospital Acquired Conditionss (-48%)

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Maryland’s Strategy for Medicare TCOC Based on Use

Source: Draft methodology presented by MHA to TCOC Work Group, April 26, 2017 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

TCOC payments Beneficiaries

No hospital utilization All encouters out of state No apparent single hosp/system Plurality pmts & visits Majority pmts & plurality visits Same hospital/system

79% 13% 65% 31%

SOURCE State of Maryland analysis of Medicare FFS claims data.