1. What’s Next for Maryland Hospitals HFMA Maryland Chapter
Michael Robbins
Senior Vice President
Maryland Hospital Association
January 27, 2017

2. All-Payer Model (Waiver)
All-payer system
All pay same price for same service at same hospital
Rate setting system
State commission sets hospital rates
Federal Medicare payment rules had to be “waived”
Brings over $2 billion per year to Maryland
Entered into new demonstration with CMS in 2014; We are in year four of the five-year agreement

3. Maryland Waiver Requirements
Three financial metrics:
Annual hospital spending cap – 3.58 percent per capita
Medicare savings target - $330 million over five years
Growth in Maryland spending (hospital and non-hospital spending) cannot exceed the nation
Two quality metrics:
Reduce 30-day readmissions to national average
Reduce complications by 30 percent in five years
Tells us what to do; not how to do it
Maryland decision: hospital global budgets

4. Maryland Waiver Performance Dashboard Cumulative Performance – Jan 2014 to Most Recent Data Available

5. Annual Medicare All-Provider Spending Growth per Beneficiary Trend
Medicare All Provider Spending Growth Per Beneficiary Trends (Total Cost of Care)
Annual Medicare All-Provider Spending Growth per Beneficiary Trend
Spending Growth per Beneficiary
Source: CMS data, see disclaimer

6. Triple Aim

7. New Incentives
Changes how hospitals are paid to reward the right things
Success under the new rules requires
cost reduction
care for patients in the community
care in lower cost setting
reduce unnecessary care
The key: population health management

8. Population Health Management
“Managing the health outcomes of a group of individuals”
Central role of primary care
Patient activation, involvement and responsibility
Care coordination through wellness, disease and chronic care
management 8

9. Population Health Management
Changes how hospitals think
Do more to earn more  Rewards for efficiency and quality
Care for an individual patient  Care for an entire population
Acute care  Ambulatory care  Community care
Competition  Collaboration
Hospital care  Health care

10. Health is About More Than Clinical Care Family History and Genetics
Health is driven by multiple factors that are intricately linked – of which medical care is one component.
Personal Behaviors
40%
Family History and Genetics
30%
Environmental
and Social
Factors
20%
10%
Medical
Care
Source: Determinants of Health and Their Contribution to Premature Death, JAMA

11. Maryland’s Transformational Change
Maryland at leading edge of innovation
Demo still in its infancy; performance very positive to date
Dramatic and difficult transformation
Transformation underway but not complete
Where from here? Provider alignment
We need:
Partnership and collaboration
Laser-like focus
Flexibility to focus on outcomes
Time to prove success and sustainability
Can’t jeopardize core hospital model

12. Expectations Chasm
Insert Dashboard Here

13. Maryland Demonstration Next Steps
“Care Redesign” amendment to current Maryland All-Payer Model
Hospital Care Improvement Program
Complex and Chronic Care Improvement Program
Primary care model
Primary Care Homes with patient-designated providers (primary care physicians and specialists)
Regional care management entities (ACOs, local care improvement coalitions, regional partnerships, others)
New Medicare Part B funding for care management fees, MACRA bonuses
Dual eligible model
Model progression plan

14. Care Redesign Amendment
HSCRC proposed amendment to the All-Payer Model
Provides access to new tools:
Detailed, patient-identifiable Medicare data
Fraud and abuse waivers under two initial programs:
State can modify programs without CMMI approval
Details to watch for:
“Voluntary” program
Hospital-specific total cost of care guardrail
State oversight functions

15. Primary Care Model Led by Dr. Howard Haft, Deputy Secretary DHMH
Structure:
Standardized, common performance metrics
Details to watch for:
Impact on total cost of care guardrail
Funding source(s)
Interaction with existing care management models
Role of commercial payers

16. How Does Transformation Feel?

17. New Developments
The Affordable Care Act – Repeal and Replace

18. ACA – Repeal and Replace
What we know: lack of clarity
Our message: coverage is paramount
Continue our focus on value: extend our demonstration

19. The Road Ahead

20. What’s Next for Maryland Hospitals HFMA Maryland Chapter
Michael Robbins
Senior Vice President
Maryland Hospital Association
January 27, 2017