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 Rivka Friedman Division Director, CMMI

Academy Health Annual Research Meeting June 25-27, 2017 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.

State Innovations Group Center for Medicare & Medicaid Innovation

History of the MD Model

2017:

• Maryland proposes

transition plan for total- cost-of-care model to replace current All-Payer Model

• Maryland and CMS

begin negotiations for eventual TCOC model 1977:

• State of Maryland

receives a waiver allowing the state to implement all-payer rate-setting system

• System predates

DRGs; pays on a per- service-unit basis with a per-case cap.

Evolution of Maryland’s All-Payer Model

Payment per Service Unit

2014:

• Maryland and CMS sign

new agreement creating all-payer global budgets for hospitals

• Maryland quickly

implements global budgets for all hospitals in the state

Hospital Global Budgets Total-Cost-of-Care Accountability

State Innovations Group Center for Medicare & Medicaid Innovation

Global Budgets Encourage Focal Shift

Moving Hospitals Toward Proactive Care Transformation

Payment mechanism rewards service volume growth Inconsistent incentives for successful care management Minimal incentive to coordinate care delivery across providers Single set of rates for hospital IP and OP services across payers Strong incentives to reduce unnecessary hospitalizations Meaningful incentives to focus on reducing readmissions

Payment Per Hospital Service Unit Hospital Global Budgets

State Innovations Group Center for Medicare & Medicaid Innovation

Some Progress, Some Work Still to Come

Better inpatient-outpatient partnerships driving reduced readmissions Focus on data analytics to drive targeted interventions Quality-based programs driving reduced avoidable hospitalizations Despite slowing growth, Maryland still highest-cost state Model is hospital- centric; other sites not yet formally included Hospital-only nature makes savings rate less sustainable without care transformation

CHALLENGES EARLY SUCCESS

Early Successes and Continued Areas of Focus for Maryland Model

State Innovations Group Center for Medicare & Medicaid Innovation

Assessing the Keys to Success

Lessons Learned From Our Work With Maryland

• 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

Expertise, Trust Essential

• Developing policy that both aligns with

existing Medicare statute and advances state goals no easy task

• Extensive discussions about minor

programmatic decisions with big impact

Devil in the Details

• Statewide models align incentives across

payers, potentially generating more interest given broader impact

• Other partnerships can extend federal

incentives (i.e. AAPM bonus) to state programs, boosting participation

State-Federal Alignment Boosts Model Participation

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

negotiations with HSCRC, other State leaders to develop new model, new savings targets

• Anticipate

finalizing terms

• f new model

incorporating total-cost-of- care accountability

• State has

requested a Primary Care program, folding primary care practices into Maryland model; would aim to begin in 2018

• Maryland’s

current waiver and All-Payer Model ends FY2 Annual Report will be released soon, available on our website: https://innovation.cms.gov/Data-and-Reports/index.html

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