Payment and Delivery System Reform

Payment and Delivery System Reform

The Affordable Care Act creates new opportunities to promote a more cost-effective and patient-centered approaches to the delivery of health care.  As advocates, we are working to make sure that these work for consumers.

Transforming Health Care in Maryland

Maryland has taken a leadership role by proposing models for reform of the payment and delivery systems that hold the promise to address the “Triple Aim:”

  1. Improve the patient experience of care (including quality and satisfaction);
  2. Improve population health; and
  3. Reduce the per-capita cost of health care.

All-Payer Hospital System Modernization (Medicare Waiver)

On January 10, 2014, the Centers for Medicare & Medicaid Services (CMS) announced the approval of Maryland’s proposal to modernize the state’s unique all-payer rate-setting system for hospital services. Maryland operates the nation’s only all-payer hospital rate regulation system.  This system is made possible, in part, by a 36 year old Medicare waiver that exempts Maryland from certain Medicare reimbursement rules and allows Maryland to set hospital reimbursement rates.  Under the waiver, all third party purchasers pay the same rate.  In recent years, both the incentives created by the waiver and changes in the delivery system have resulted in Maryland having among the highest per capita Medicare hospital costs in the country. 

The Maryland Health Care Commission has a consumer guide site designed to help consumers shop around to see how hospitals compare on costs and quality. They are involved in coordinating these major changes with the rest of the health care system and also have opportunities for public engagement detailed on their site.

The Maryland Hospital Association has information on all of their member hospitals as well as a helpful “Waiver Watch” performance dashboard.

Watch YouTube videos that explain the changes that are underway in hospitals across the state.

Under the new model hospitals are working under global budgets that move them to a values vs. volume approach that should advance the goals of the Triple Aim. 

View a presentation about the project by Steve Ports, Director of Alignment and Engagement.

Get more information on the background of the Model and the Coalition’s position.  

Get Involved

The Maryland Health Services Cost Review Commission is overseeing the implementation of the waiver. They are in charge of setting rates and making sure that hospitals continue to deliver the highest quality of care. Visit their site to learn more.

Attend a public forum on the issue – view details and more information.

Learn more about the Consumer Engagement Task Force, its work and upcoming meetings.  Advocates and others are encouraged to attend. 

For more information contact us.

Additional Reform Initiatives

The Department of Health and Mental Hygiene (DHMH) underwent a restructuring in 2012 and created the Health Systems Infrastructure Administration (HSIA). This office is focused on improving population health by focusing on ensuring that Marylanders have access to high-value coordinated care with greater integration of public health and medicine with a focus on promoting health rather than responding to illness.