1. A Journey Together: New Maryland Healthcare Landscape
Carroll and Frederick Counties Forum
Maryland Health Services Cost Review Commission
February 2015

2. Health Reform is much more than the Exchanges
March 23, 2010
Health Reform is much more than the Exchanges
November 1, 2013

3. The Context: Health Care System Challenges
Fragmentation and variation
High costs
Health care disparities
Workforce shortages
Coverage & Access
Aging and sicker population

4. More Challenges Ahead Changes in Demographics and Expenditures
Federal Budget & Health Care Spending
More Entitlements, Fewer Contributors
Age 65 plus
million
million
million

5. Higher Cost Without Better Outcomes
US spending growth outpaces
other developed countries
and spending is a higher portion of GDP
* PPP=Purchasing Power Parity.
Data: OECD Health Data 2011 (database), Version 6/2011.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2011.

6. 14% of Medicare Beneficiaries have 6 or more chronic conditions—1/2 of cost

8. National Average

9. National Average
State Average

10. New Paradigm Improve the health of the population;
Enhance the patient experience of care;
Reduce the per capita cost of care.

11. In Response, a New Culture for Patient Care is Emerging
Year 1
Shift to consumer-centric model
Improve care transitions
Payment reform
Year 2
Modernize services to match new model
Partner across hospitals, physicians, and other providers and communities to develop new consumer centered approaches
Year 3
Improve care coordination and improve chronic care
Work with people to keep them healthier, financially and clinically
Engage communities 11

12. Implications All this means: Payment moves away from fee-for service
The more you do the more you get paid

13. Implications All this means: CHANGE IS HERE – CHANGE IS EVERYWHERE
Payment moves away from fee-for service
The more you do the more you get paid
The better you do the better you get paid
Providers assume more responsibility for outcomes
Need for integration and collaboration
CHANGE IS HERE – CHANGE IS EVERYWHERE

14. Maryland Hospitals are Paid Differently
Maryland has set hospital rates since the mid-1970s
Health Services Cost Review Commission
Independent 7 member Commission
Public utility model
Provides oversight and regulation of hospitals
Maryland hospitals are waived from Federal Medicare payment methods (the Medicare waiver)
All payers participate
Unique in the country

15. Value of the All Payer System
Helped hold down costs relative to elsewhere
Funds access to care
Transparency
Leader in linking quality and payment
Local access to regulators
john

16. New Federal Agreement 5 year demonstration with Medicare (CMS)
Effective 1/1/14
Focus on holding down costs
More rewards for improving outcomes
Encourages better team work among whole health care system

17. Implications for Patients and their Families
Quality, safety and satisfaction scores can account for a significant and growing amount of revenue
Requires hospitals to become more patient and family centered
Expect greater care coordination
Improved transitions of care between settings
e.g., clear instructions for patients on discharge
Expect more outreach from providers
Particularly true for those with chronic illnesses
Movement of care to the most appropriate setting
Right care, right time, right place, right price

18. Concluding Thoughts New waiver is a call to action
Creates a path for change
Less disruptive than elsewhere
Proactive not reactive
Value is the new gold standard
Quality
Appropriate hospital care
New Partnerships
Cost efficiency
Population health focus

19. Questions?