Maryland and the Future of State-Based Models The Lessons of - PowerPoint PPT Presentation

Center for Medicare and Medicaid Innovation Maryland and the Future of State-Based Models The Lessons of Maryland’s All - Payer Model for Developing New APMs in Partnership with States Academy Health Rivka Friedman Annual Research Meeting June 25-27, 2017 Division Director, CMMI New Orleans, LA The contents of this [presentation/poster] are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

History of the MD Model Evolution of Maryland’s All -Payer Model Payment per Service Unit Hospital Global Budgets Total-Cost-of-Care Accountability 1977: 2014: 2017: • • • State of Maryland Maryland and CMS sign Maryland proposes receives a waiver new agreement creating transition plan for total- allowing the state to all-payer global budgets cost-of-care model to implement all-payer for hospitals replace current All-Payer • rate-setting system Maryland quickly Model • • System predates implements global budgets Maryland and CMS DRGs; pays on a per- for all hospitals in the state begin negotiations for service-unit basis with eventual TCOC model a per-case cap. State Innovations Group Center for Medicare & Medicaid Innovation

Global Budgets Encourage Focal Shift Moving Hospitals Toward Proactive Care Transformation Payment Per Hospital Hospital Global Service Unit Budgets Payment mechanism rewards Single set of rates for hospital IP service volume growth and OP services across payers Strong incentives to reduce Inconsistent incentives for successful unnecessary hospitalizations care management Meaningful incentives to focus on Minimal incentive to coordinate care reducing readmissions delivery across providers State Innovations Group Center for Medicare & Medicaid Innovation

Some Progress, Some Work Still to Come Early Successes and Continued Areas of Focus for Maryland Model EARLY SUCCESS Better inpatient-outpatient Focus on data Quality-based programs partnerships driving analytics to drive driving reduced avoidable reduced readmissions targeted interventions hospitalizations CHALLENGES Despite slowing Model is hospital- Hospital-only nature makes growth, Maryland still centric; other sites not savings rate less sustainable highest-cost state yet formally included without care transformation State Innovations Group Center for Medicare & Medicaid Innovation

Assessing the Keys to Success Lessons Learned From Our Work With Maryland State-Federal Alignment Devil in the Details Boosts Model Participation • Statewide models align incentives across • Developing policy that both aligns with payers, potentially generating more interest existing Medicare statute and advances given broader impact state goals no easy task • Other partnerships can extend federal • Extensive discussions about minor incentives (i.e. AAPM bonus) to state programmatic decisions with big impact programs, boosting participation Expertise, Trust Essential • Maryland owes much of its success to the expertise and persistence of program staff • State stakeholders trust Maryland program staff to best represent their interests, craft policy that meets all stakeholders’ needs as much as possible State Innovations Group Center for Medicare & Medicaid Innovation

What’s Next for Maryland? Update on Progress of Negotiations for New Model Spring 2017 Late 2017 2018 2019 • Ongoing • Anticipate • State has • Maryland’s negotiations with finalizing terms requested a current waiver HSCRC, other of new model Primary Care and All-Payer State leaders to incorporating program, folding Model ends develop new total-cost-of- primary care model, new care practices into savings targets accountability Maryland model; would aim to begin in 2018 ! FY2 Annual Report will be released soon, available on our website: https://innovation.cms.gov/Data-and-Reports/index.html State Innovations Group Center for Medicare & Medicaid Innovation