Maryland is well known for a long running, unique system for paying hospitals called the All Payer Hospital Rate Setting system. A Medicare waiver in 2014 allowed the state to implement global budgets for hospitals. An early analysis from the Centers for Medicare and Medicaid Innovation suggested that the program reduces total expenditures without shifting costs to other parts of the healthcare system, but two 2018 analyses offer conflicting results. In 2018, the state received approval to become the first state to assume full risk for the total cost of care for Medicare beneficiaries, called the Total Cost of Care Model, and will extend the global budget system beyond hospitals to nursing homes, mental health facilities and other nonhospital settings.
The state has also made numerous efforts to protect and inform consumers. The Maryland Health Care Commission, which operates the state’s all-payer claims database, launched their Wear the Cost campaign in 2017 enabling residents to find the cost and quality of certain medical procedures at hospitals.
In addition, the state has passed legislation prohibiting pharmacy benefit manager gag clauses and implementing what the Commonwealth Fund refers to as comprehensive protections against surprise medical bills and balance billing. A first-in-the-nation Prescription Drug Affordability Board was implemented in 2019, with the authority to evaluate expensive drugs and recommend methods for addressing high costs, including setting upper-payment limits with approval from a legislative panel.
Maryland ranked 5 out of 47 states plus DC, with a score of 55.1 out of 80 possible points in the Hub's 2021 Healthcare Affordability State Policy Scorecard.
Maryland will now offer coverage for pregnant and postpartum people, regardless of citizenship
status, according to the Baltimore Sun. This is part of the Healthy Babies Initiative, which aims
to reduce the number of maternal deaths in the state. Starting July 1, 2023, pregnant, income-
eligible residents will be able to receive the same benefits available to other pregnant individuals
with Medicaid coverage, including physical and behavioral health care, dental care, prescription
drug coverage without copays, through the CHIP “unborn child” option, plus an additional four
months of postpartum coverage using Health Service Initiative authority.
Maryland has passed a law authorizing the state Prescription Drug Affordability Board (PDAB) to set upper payment limits, according to Arnold Ventures. Upper payment limits determine how much state and local governments will pay for high-cost drugs. SB 202 / HB 279 will empower the Maryland PDAB to make these prescriptions more affordable for governments, and later make recommendations to the General Assembly on how to make drugs more affordable for all state residents.
Maryland’s Prescription Drug Affordability Board released a report detailing price trends and the number of prescription drugs subject to their review, according to State of Reform. The board found that prescription drug prices outpaced inflation by a difference of 31.5 percent to 8.5 percent, and over 800 drugs have increased in price over the last three years.
Beginning on Oct. 1, 2022, Maryland’s state-designated health information exchange (HIE) connecting healthcare providers and the Maryland Department of Health will have authority to operate as a health data utility (HDU), reports Business Wire. This is the first legislation of its kind to be signed in the U.S. As such, the HIE will be required to provide data in real-time to individuals and organizations involved in the treatment and care coordination of patients and to public health officials to support public health goals. The law also required the Maryland Department of Health, nursing homes, electronic health networks and prescription drug dispensers to provide data to the HIE. Experts note that state designation is key for allowing HIEs to clarify, defragment and secure individual health data before sharing it with the state health department – it also allows enhanced partnership with state public health departments to use data to guide, elevate and ultimately enhance outcomes of public health interventions and state-specific health equity goals.
Beginning in September, Maryland residents will have the opportunity to present to the Prescription Drug Affordability Board how they’ve been impacted by the cost of medications, as the board prepares to present their ideas in the coming months, reports Maryland Matters. In 2019, Maryland lawmakers launched an effort to force down the price of prescription drugs by creating a Prescription Drug Affordability Board, making Maryland the first state to do this. However, after three years, the board’s initial mandate remains narrow—to determine which medications cost too much, then to set up a legally defensible method of capping the amount that state and local government health plans can be forced to pay to provide these medications to employees. There is hope, however, now that a funding source has been identified, an executive director hired and a Stakeholder Council put in place to provide community and industry input.
In 2022, two significant new healthcare laws will be taking effect in Maryland, reports the Associated Press. Firstly, Maryland Senate Bill 923 allows low-income individuals who are pregnant to receive healthcare under Medicaid for up to a year after giving birth, a substantial increase from the current coverage limit of 60 days. In addition, the Maryland Medical Debt Protection Act requires hospitals to relax debt collection practices for patients with lower incomes and may no longer charge interest or additional fees on an incurred debt. Hospitals likewise can’t sue patients over unpaid bills until at least 180 days after the initial charge.
A recent study in JAMA Network Open shows that Maryland’s reimbursement model—that sets annual statewide caps for hospital spending—reduces costs and the incidence of avoidable complications, reports Rice University. Maryland’s model holds hospitals to a global budget for total expenditures related to the care of state residents across all sites (inpatient, emergency department and outpatient), and also requires the state to meet spending and savings targets, such as $330 million or more in Medicare savings, as well as quality-of-care-targets. The study also found that in the first three years following the adoption of the all-payer model, Maryland patients undergoing common surgical procedures had significantly fewer avoidable complications and the rate of growth of hospital bills was lower.
In response to increasing health disparities, which cost Maryland more than $1 billion per year in direct medical costs, the Maryland Health Equity Act is allocating $60 million to address health inequities across the state, reports State of Reform. The newly formed Health Equity Resource Community (HERC) Advisory Committee, consisting of state officials and health policy experts from across the state, will decide how best to use these funds. The committee will be meeting throughout August and will begin accepting grant applications for funds as early as October.
Newly passed legislation in Maryland, the Maryland Health Equity Resource Act, will reduce inequality in health, reports Maryland Matters. The bill will fund grants in neighborhoods that have suffered from health disparities and poor health outcomes, offering communities in those neighborhoods funding opportunities for programs to reduce health disparities, improve outcomes, boost access to primary care, prevent illness or reduce hospital use. The neighborhoods eligible for the grants will likely mirror those that qualified for Maryland’s previous Health Enterprise Zone program in 2016.
Maryland’s unique healthcare financing model may have helped providers financially weather the pandemic storm, report experts at a panel held by State of Reform. Maryland’s global budget system for hospitals provided stability and allowed providers to focus on responding to the pandemic, but the payment services system struggled, experts acknowledge. However, the flexibility the financing system in Maryland allowed healthcare systems to focus on social determinants of health and could be implemented elsewhere.
The Maryland House of Delegates has overridden the Governor’s 2020 veto of a Prescription Drug Affordability Board, enabling plans for the Board to proceed, reports STAT+. In January, the Senate also overrode the veto, which the Governor had issued over concerns that the move would raise taxes and fees at a time when the COVID-19 pandemic had already hurt citizens. The Board is designed to function like rate-setting boards that regulate what public utilities can charge residents, with supporters arguing that the board can save consumers money by lowering prescription drug costs. What sets the PDAB apart from other state efforts to rein in costs is that it can, if determined to be in the best interest of the state, make a recommendation to the Maryland General Assembly to pursue upper payment limits to make drugs affordable. If the Board makes this determination, it will first develop a plan of action for review and approval by the Legislative Policy Committee. Maine has also enacted a law creating a board. Although rather than setting upper payment limits for medicines, the board established a spending target for public payers and seeks to leverage public purchasing power to meet its target.
Maryland’s global budget payment model reduced expenditures by more than $20 per month per beneficiary compared to a control group, according to a study Health Affairs. Maryland’s global budget payment model, originally piloted with eight rural hospitals, had no significant differences in service use or spending by Medicare beneficiaries. However, when the state expanded the model to all hospitals, Medicare expenditures decreased by more than $25 per month per beneficiary more than the control group during the first three years of the program, saving Medicare approximately $679 million. Maryland’s global budget payment model can serve as a model for other states considering value-based purchasing models.
The transition from hospital fee-for-service to a population-based revenue system in Maryland is proceeding successfully, according to a Health Affairs Blog. The state’s Medicare savings performance in 2019 was the best since hospital global budgets were implemented in 2014. COVID-19 has provided an unforeseen stress test, which the state responded to with swift collaboration and communication with the Centers for Medicare and Medicaid Innovation, hospitals and other stakeholders, to ensure they could fulfill the promise of guaranteed level of revenue without dramatically increasing prices for payers, employers and consumers. COVID-19 has shown the weaknesses of the fee-for-service payment model, while Maryland’s Total Cost of Care model has allowed hospitals to fare relatively well during the pandemic.
The Maryland Health Department has convened an inter-agency task force aimed at reducing the COVID-19 positivity rate in Hispanic communities, reports WTOP and Maryland Matters. The Hispanic Outreach Task Force will look to provide support to Baltimore City to connect underserved Hispanic communities to social services, prevention tactics, isolation housing, educational materials and contact tracing. The task force will also experiment with an intervention program that would provide financial assistance, medical care, isolation, food and other services for families who have tested positive.
The Governor of Maryland has vetoed a measure to fund the state's fledgling Prescription Drug Affordability Board, reports Maryland Matters. Senate Bill 669 and House Bill 1095 would set up a funding source for the panel, which was created in 2019 and began meeting for the first time in 2020. The board was established by lawmakers to identify ways to reduce the cost of prescription drugs. Though the funding was vetoed, the 2019 legislation that created the board guarantees it will receive state funds in the form of a loan on July 1. The board has until December 31 to identify a way to fund its operations and to repay the loan from the general fund starting next year.
Despite an abbreviated legislative session, the Maryland General Assembly approved permanent funding for the Prescription Drug Affordability Board, reports AARP. The Board has the authority to require that pharmaceutical manufacturers justify large price increases. The Board’s scope will focus on implementing measures to make prescription drugs purchased by state and local government entities and programs more affordable, and to present a plan to the legislature to expand its authority in the future.
When fears of COVID-19 surfaced, the Maryland Health Benefits Exchange opened a special enrollment period so that uninsured people have until June 15 to get coverage, according to Maryland Matters. In March alone, 10,222 people enrolled for coverage through the Maryland Health Connection. For consumers who enroll by April 15, their policies become effective on April 1, meaning it could apply to treatment they already received. The same retroactive provision applies for consumers who sign up between May 1 and May 15.
Hospitals in Maryland have been given permission to temporarily raise rates patients are charged to help pay for emergency care related to COVID-19, reports KIRO7. Normally, the amounts hospitals can charge for surgeries and childbirth are regulated in Maryland, but due to the coronavirus, medical facilities are adding capacity without offsetting costs with other health services.
At least three states are reopening their health insurance exchanges amid the coronavirus outbreak in an effort to boost coverage and expand treatment for the uninsured, reports Roll Call. Maryland, Massachusetts and Washington state all announced special enrollment periods for uninsured individuals this week as the outbreak worsens and governors declare emergencies. Twelve states and the District of Columbia operate their own health insurance exchanges, which give local leaders the authority to reopen enrollment on their own in the face of an emergency like the coronavirus.
Doctors and others who provide mental health and addiction services in Maryland under the Medicaid program have had millions of dollars in bills go unpaid this year because a new state payment system is malfunctioning, according to the Baltimore Sun. The Maryland Health Department, which oversees the payments, notified providers last week that it planned to begin sending estimated payments that total about $32 million a week as it works to fix the system serving more than a quarter-million people. This snafu affects about 2,500 doctors, hospitals, clinics and other facilities that offer behavioral health services in the state.
Western Maryland Health System is now officially UPMC Western Maryland, merging into the UPMC hospital network, according to the Cumberland Times-News. UPMC has committed to make certain capital investments to enhance services and upgrade facilities in the Western Maryland region, to ensure they will continue to provide quality healthcare for residents and remain one of the largest employers in the region. The new affiliation does not affect patients’ insurance coverage, and UPMC Western Maryland has reaffirmed its commitment to work with multiple payers in the future.
Maryland Medicare beneficiaries had 2.8 percent slower growth in total expenditures, relative to a comparison group, largely driven by a 4.1 percent slower growth in total hospital expenditures, reports Healthcare Innovation. The report, prepared by RTI International, examines the first five years of Maryland’s All-Payer annual, global hospital budget Model and finds that slower growth in emergency department expenditures (30.6 percent) and other hospital expenditures (17.2 percent) drove total Medicare hospital savings in Maryland. It's important to note that the model reduced both total expenditures and total hospital expenditures, indicating that costs were not shifted to other parts of the healthcare system outside of the global budgets.
Maryland legislators announced that the Health Education and Advocacy Unit within the Consumer Protection Division of the Office of the Attorney General closed 1,974 cases in Fiscal Year 2019 and assisted consumers in saving or recovering almost $2.5 million. The Annual Report on the Health Insurance Carrier Appeals and Grievances Process estimates that when consumers seek assistance from the Health Education and Advocacy Unit, carrier denials are overturned or modified over 50 percent of the time.
Nexus Montgomery, a collaboration between six competing Maryland hospitals, has created a cross-continuum of care partnership that includes skilled nursing facilities, according to Home Health Care News. The goal of this pilot is to leverage non-medical home care to help consumers live safely and independently in their homes. As hospitals are subject to financial penalties for high readmission rates, especially within Maryland’s global budget system, pilots such as this one may help keep people healthier and out of the hospital.
For the second year in a row, Marylanders will see cheaper premiums for Affordable Care Act policies purchased on Maryland's health insurance exchange, according to the Washington Post. State officials announced that over 190,000 people will experience lower premium costs, with an average decline of 10.3 percent for individual plan prices. Insurance regulators attribute the decline to the healthcare reinsurance plan that state officials created in 2018, paid for by a tax on insurance companies. However, the cost for around 269,000 small-group plans in the state will increase by 3 percent, significantly less than what insurance companies had proposed.
The Chesapeake Regional Health Information System for our Patients (CRISP), a health information exchange covering Maryland and Washington DC, announced plans to expand technical integration of its advance care planning solution, according to EHR Intelligence. CRISP will use advance care planning provider ADVault to try to give providers access to meaningful patient health information during patient encounters. It's hoped the data will help improve clinical efficiency during patient encounters to improve patient health outcomes across the state.
The University of Maryland School of Medicine will receive $750,000 in federal funds from the U.S. Health Resources and Services Administration to train more doctors for posts in rural areas, according to The Baltimore Sun. The residency program will send doctors-in-training to the University of Maryland Shore Regional Health and the Choptank Community Health System, which are in the Eastern Shore region facing significant provider shortages, an aging population, and high levels of chronic diseases.
A group of 10 Baltimore hospitals have pledged $2 million over two years towards a program that provides housing and medical services for people experiencing homelessness, according to the Baltimore Fishbowl. Funds from the partnership will provide homes and aid for 200 individuals and families, with medical organizations providing medical care and other services to break the cycle of homelessness. The program is designed to show that homeless individuals who receive treatment in permanent housing will ultimately see a reduction in healthcare costs.
LifeBridge and Johns Hopkins are among the local health systems partnering with ride-hailing service firms to provide on-demand transportation to patients in need and reduce overall care costs, according to the Baltimore Business Journal. The program targets specific patient populations who demonstrate the most need, and do not have easy access to reliable transportation options, namely patients residing in areas of West Baltimore who need access to services at LifeBridge's Sinai and Levindale Hebrew hospitals. The goal is to ensure community members are able to get to preventative care appointments more easily, reducing the costs associated with missed healthcare appointments and helping community members remain healthy.
A first-in-the-nation measure in Maryland to create a prescription drug affordability board will become law without the Governor’s signature, according to The Associated Press. The law creates an independent board with the authority to evaluate expensive drugs and recommend methods for addressing high costs. The measure was scaled back significantly from an initial proposal. For one thing, it will only apply to state and local governments, not all Maryland residents. Also, the board could only set upper-payment limits with approval from a legislative panel beginning in 2022.
Johns Hopkins Hospital has filed more than 2,400 lawsuits in Maryland courts since 2009 against patients with unpaid bills. According to The Baltimore Sun, patients being sued include many residents from distressed neighborhoods surrounding the East Baltimore medical campus. A report from the Coalition for a Humane Hopkins, National Nurses United, and AFL-CIO reveals that the number of cases has been increasing, from 20 in 2009 to a peak of 535 in 2016.
Maryland’s Governor is expected to sign the Maryland Easy Enrollment Health Insurance Program (MEEHP), which will use income tax filing as an immediate onramp to health coverage. An uninsured tax filer will be able to check a box on their state income tax return asking the Maryland health insurance exchange to determine their eligibility for free or low-cost insurance and have relevant information from their tax return sent to the exchange, according to Health Affairs. It is expected that this new enrollment system will go into effect in January 2020, when returns are filed for tax year 2019, but implementation may be delayed to January 2021 if the state tax agency finds the original timeline infeasible.
The Maryland General Assembly passed a slate of related measures to make health coverage easier to secure for uninsured Marylanders and prescription drugs cheaper for government workers, reports The Baltimore Sun. One law would require uninsured people to check a box on their state tax returns to report whether they’re interested in obtaining health coverage through the state. Another would establish a board to study the controversial idea of capping prescription costs for state and municipal employees. The legislature also enacted a patient’s bill of rights and approved sustained funding for a reinsurance program that helps insurers offset costs for the biggest healthcare users. Collectively, these measures are expected to make a significantly improve healthcare access and affordability for consumers.
In 2010 Maryland, for some rural hospitals, replaced fee-for-service payment with a global budget approach called Total Patient Revenue (TPR) to incentivize hospitals to manage resources more efficiently. A study in Health Affairs found evidence consistent with both the incentive to provide care more efficiently and the incentive to provide less care during the 2010-2013 study period. For TPR hospitals, service use fell sharply – ED admissions declined 12 percent, direct (non-ED) admissions fell 23 percent, ambulatory surgery center visits fell 45 percent and outpatient clinic visits/services fell 40 percent. The authors conclude that most of the drop in inpatient admissions at TPR hospitals was offset by higher admissions at Maryland hospitals outside the global budget or moved to neighboring states. Since hospital revenues are maintained under TPR, if care that is no longer provided within budget moves off budget, total healthcare costs could rise. The authors found evidence of higher overall healthcare spending for the FFS Medicare population. Unfortunately, no published studies have examined the effect of TPR on population health or on overall healthcare costs. In 2014, Maryland replaced the limited TPR program with Global Budget Revenue (GBR) for all Maryland Hospitals. The authors conclude that capitation models require strong oversight to ensure that hospitals do not respond by shifting costs to other providers.
The state of Maryland and CMS signed an agreement to implement the Maryland Total Cost of Care Model, which marks the first time CMS will hold a state accountable for total cost of care incurred by resident Medicare fee-for-service beneficiaries, according to JAMA. This 8-year model began on Jan. 1, 2019, and will test whether accountability for Medicare spending will spur statewide healthcare delivery transformation, potentially reducing expenditures, preserving or enhancing quality for beneficiaries and improving individual and population level outcomes. This model builds on Maryland’s All-Payer Model, providing incentives for hospitals to increase high-value care for patients seeking care from their institutions and their community services by centering improved population health as the foundation for the model to achieve savings.
Women leave the correctional system a lot heavier than when they arrived, reports the Washington Post. In an effort to stem weight gains and improve chronic health conditions like heart disease and diabetes that disproportionately affect people who are incarcerated, the Warden of the Maryland Correctional Institution for Women worked with a dietitian to retool meals for women by cutting around 1,000 calories a day (previously a 3,200 calorie menu). The warden expects this initiative will show savings on healthcare costs, including medications, which is the biggest line item in the budget. And, women in the facility already report greater satisfaction with the healthier meals, changing their actions by eating in the dining hall rather than eating unhealthy food from the commissary. This has improved morale in prison, which could translate to heightened safety. Significant challenges remain including a lack of funding: an increase is unlikely even if there are the potentials for saving money down the road.
Maryland implemented the Health Enterprise Zone Initiative in 2013 to improve access to healthcare and health outcomes in undeserved communities, by attempting to reduce healthcare costs and avoidable hospital admissions and readmission, according to a report in Health Affairs. In each community, the Health Enterprise Zone was a collaboration between the local health department or hospital and community based organizations, designed to attract primary care providers to undeserved communities and help support community efforts to improve health behaviors. This initiative was associated with a reduction of nearly 20,000 inpatient stays and an increase of around 40,000 emergency department visits between the study period of 2013-2016. The net cost savings of the reduction in inpatient stays greatly outweighed the initiative's costs to the states. This initiative could be modeled in other communities as a way to reduce healthcare costs.
The Centers for Medicare and Medicaid Services (CMS) approved Maryland's waiver to start a reinsurance pool for the Affordable Care Act exchange, according to Modern Healthcare. The state estimates that the program will cancel out the previously projected 30 percent average rate hike for individuals on the exchange for 2019. Officials estimate this waiver will lower premiums by about 30 percent and raise enrollment by about 6 percent. The executive director of the Maryland Health Benefit Exchange called the program, "The largest of it's kind in the country to bring rate relief... to residents who don't qualify for financial help with monthly premiums."
Maryland signed a contract with the federal government to enact the state’s unique all-payer healthcare model, according the Associated Press. This five-year contract with the Centers for Medicare and Medicaid Services is designed to create incentives to improve care while saving money, to provide greater coordinated care, expanded patient-care delivery and chronic disease management. The model emphasizes quality over quantity, expecting to total $1 billion in savings over the next five years. If successful, this holistic-approach plan could be replicated around the country to help address the financial strain on Medicare.
The Centers for Medicare and Medicaid Services (CMS) approved Maryland’s request to continue and expand its unique all-payer model, according to Modern Healthcare. Under the model, the state is exempt from typical Medicare regulations and has the unique ability to set its own rates for hospitals. Starting Jan. 1. 2019, doctors' offices and nursing homes can voluntarily participate in the program as well. Through this model, Maryland officials aim to coordinate care better across hospital and non-hospital settings, including mental health and long-term care services.
Maryland implemented global budgets to control rural acute care hospitals’ service utilization and spending in 2010. But a study in Health Affairs found that, by 2013, global budgets had not reduced rural hospital use or price-standardized spending among Medicare beneficiaries as anticipated. Despite these findings, the authors noted that programmatic adjustments implemented after 2013 could lead to more positive results. Ongoing evaluation will be important to assess whether or not the model can successfully change how care is delivered.
Maryland's all-payer model is perhaps the most far-reaching attempt in the nation to control the medical costs driving up insurance premiums and government spending, reports Kaiser Health News. By essentially paying hospitals to lower avoidable admissions, global budgets incentivize hospitals to invest in community health improvement activities that keep patients healthy. The program has saved hundreds of millions of dollars for taxpayers, employers and others in just three years.
In February 2016 the Maryland Citizens’ Health Initiative (MCHI), in collaboration with LifeBridge Health System, launched a pilot program with the goal of developing a standardized, proven approach for reducing hospital readmissions through partnerships between the faith community, hospitals and community-based organizations. The Center for Consumer Engagement and Health Innovation reports that through the program, known as the Maryland Faith Health Network, LifeBridge partnered with faith communities to provide spiritual and domestic support to congregants who had been admitted to one of the system’s three hospitals. An evaluation of the pilot program, which ended in October 2017, has now been released. The evaluation found the pilot was successful in establishing an infrastructure to implement and evaluate the impact of scalable population health programs involving partnerships between health care institutions, community-based organizations and faith communities.
The clinic at KIPP Harmony Academy in North Baltimore is the only one in the city run by the Johns Hopkins Children’s Center and it offers comprehensive, in-house medical care to many of the 1,500 students who attend the elementary school, or the Ujima Village Academy middle school, reports the Baltimore Sun. Both schools are located in the same building and operated by KIPP, a national network of public charter schools. The center’s goal is to keep kids in classrooms and out of emergency rooms by promoting healthy living and preventive care for chronic illnesses.
Maryland wants to eliminate a “gag rule” that prevents pharmacists from telling consumers that they can pay less for their prescription drugs, joining a nationwide movement to rein in soaring costs, according to the Washington Examiner. If Maryland succeeds, it would mean that pharmacies would be allowed to inform customers they can pay less for a drug out of pocket than through their insurance. Maryland would join five other states—Connecticut, Maine, Louisiana, North Dakota, and Georgia—that have banned the "gag rule" that some pharmacy benefit managers put in their contracts with pharmacies.
Baltimore paramedic crews make more asthma-related visits per capita in zip code 21223 than anywhere else in the city, according to fire department records. This neighborhood is in the shadow of prestigious medical centers — Johns Hopkins, whose researchers are international experts on asthma prevention, and the University of Maryland Medical Center (UMMC), according to the Washington Post. However, like hospitals across the country, the institutions have done little to address the root causes of asthma. The perverse incentives of the health-care payment system have long made it far more lucrative to treat severe, dangerous asthma attacks than to prevent them.
The Maryland Health Care Commission (MHCC) launched an initiative that will shed light on cost and quality differences among Maryland hospitals—information that, until now, has been largely unavailable, particularly in such a consumer friendly form. The initiative, “Wear the Cost,” aims to begin a statewide conversation about disparities in pricing and quality with the ultimate goal of improving health care affordability for Maryland residents. At the center of this initiative is “WearTheCost.org,” a platform for educating consumers about cost and quality disparities across Maryland, and ultimately enabling them to become more savvy shoppers of health care.
Maryland is seeking federal approval to expand a hospital cost-savings program to include doctors, rehabilitation facilities, skilled-nursing centers and others who treat patients insured by Medicare. According to the Baltimore Sun, the 10-year program, which would take effect in January 2019, aims to provide an incentive for health care providers to work more closely with hospitals to improve quality and reduce Medicare costs. The plan calls for Maryland to save $300 million in annual Medicare costs by the end of 2023.
Under a new Centers for Medicare & Medicaid Services waiver approval, Maryland hospitals and doctors can enter care-coordination partnerships and share savings stemming from more efficient treatment, according to Modern Healthcare. Sixteen hospitals will participate in the Care Redesign Program, and more will be able to join next year. In addition to allowing hospitals and doctors to share in savings, the effort will make it easier for multiple providers to access patient's data, ensuring that all providers responsible for that person's care are aware of all treatments being received.
Drug companies asked a federal judge to throw out Maryland's new prescription drug price gouging law, saying the state's first-in-the-nation measure is both unconstitutional and vague. The law, which takes effect in October, allows the state’s Attorney General to prosecute some manufacturers that impose "unconscionable" price hikes, according to the Baltimore Sun. Passed by the General Assembly with near unanimous support earlier this year, the law only governs off-patent and generic drugs, not branded medications protected by patent laws.
A bill allowing Maryland’s Medicaid administrator to inform the attorney general’s office when it sees patients being charged higher rates for drugs has passed the General Assembly, according to the Baltimore Sun. Advocates hope that the bill will have a ripple effect and move other state legislatures to pass similar laws.
The 2011 Maryland alcohol sales tax increase led to a significant reduction in the rate of all alcohol-related crashes, especially among drivers aged 15–34, according to the American Journal of Preventive Medicine. Increasing alcohol taxes is an important but often neglected intervention to reduce alcohol-impaired driving.
A three year campaign in Howard County, Maryland, aimed at curbing the community’s sweet tooth led to a significant decline in sales of sugary drinks, according to an NPR article highlighting a study published in the Journal of the American Medical Association. Researchers found that the Unsweetened Campaign led to a 20 percent decrease in sales of soda and a 15 percent decline in fruit drink sales between January 2013 and December 2015. This community-led campaign included TV and outdoor advertising as well as a social media campaign, along with targeting healthcare professionals like pediatricians to improve messaging on risks associated with excessive sugar intake, obesity and Type 2 diabetes. The president and CEO of Horizon Foundation, the sponsor of the campaign, noted that the changes to the environment that had the biggest impact to allow people to make healthier decisions.
Maryland is halfway through the five-year pilot program from CMS to control rising healthcare costs, according to The Baltimore Sun. The initiative shifted hospitals’ payment incentives from quantity to quality by ensuring the patient's health. Maryland has until the end of the year to submit a plan on how the state will expand this program.
In light of the recent price increases for Epi-Pen, the Maryland Citizens’ Health Initiative is pushing Maryland lawmakers to addressing the rising cost of drugs. According to the Washington Post, the group wants the legislature to require drug companies to disclose how they come up with their prices, notify the public of price hikes and grant the attorney general authority to take legal action. Maryland would be one of the first states to pass legislation requiring drug companies to disclose information about prices.
A Maryland-based healthcare advocacy group is pushing Maryland lawmakers to address the rising cost of drugs, according to The Washington Post. The Maryland Citizens’ Health Initiative wants the legislature to require drug companies to disclose how they come up with their prices, notify the public of price hikes and grant the Attorney General the authority to take legal action against price gouging. Maryland would be one of the first states to pass legislation requiring drug companies to disclose information about prices.
Maryland second in overall health rankings, according to WalletHub. The rankings evaluated 50 states and D.C. across three metrics, including health costs, access and outcomes. Maryland ranked first in health costs.
Maryland’s largest insurance provider, CareFirst, is unjustly doubling the rate increases originally proposed in May, according to this op-ed in the Baltimore Sun. The new rate filing requests a 28 percent jump for its HMO and 37 percent for its PPO business. State advocates question the legality, fairness and validity of the filing that will impact Marylanders who are paying more than the average American, for health insurance already.
According to Modern Healthcare, a court has ruled that the Evergreen Health Cooperative, which serves more than 39,000 patients, must pay its $24 million risk adjustment payment while it continues to challenge the current methodology put in place by the ACA.
According to an article in the Baltimore Sun, Maryland hospitals are changing the way they deliver care. Hospitals are going to begin focusing on a community-based healthcare model that includes service coordination and disease prevention. Many advocacy groups support this change, and Maryland has launched a website that directs consumers to their hospital’s initiatives.
CareFirst BlueCross BlueShield is forcing Evergreen Health Cooperative to pay nearly $22 million dollars in risk adjustment costs. Risk adjustment fees are a provision in the ACA that requires insurers who take on healthier patients to pay insurers who have sicker patients. In the Baltimore Business Journal Peter Beilenson, CEO of Evergreen, stated that with such a rapidly growing population they cannot know what sort of sickness is in the population.
The unanticipated costs of providing healthcare to customers on the state's online exchange has prompted large insurers to seek rate increases of up to 30 percent while one insurer decided not to offer individual plans at all, according to the Baltimore Sun. UnitedHealthcare, the nation's largest insurer but a bit player in Maryland, was not included on a list released Friday by state regulators of companies seeking rate increases for 2017.
The first year of Maryland’s experimental rate setting system in which the state has shifted away from traditional fee-for-service to global budgets has shown encouraging early outcomes, according to AIS Health. Results showed that costs were contained and quality of care improved but utilization of services and per capita spending for Medicare patients was still very high. The next steps include fixing these shortcomings and expanding the all payer payment model beyond only hospitals.
National Public Radio: Results are in from the first year of a bold change to the way hospitals get paid in Maryland, and so far the experiment to rein in healthcare costs seems to be working. Maryland phased out fee-for-service payments to hospitals in favor of a fixed pot of money each year (Global Budgets). A report in the latest New England Journal of Medicine says the experiment saved an estimated $116 million in 2014, the first year it was in operation.
The Baltimore Sun: CareFirst BlueCross BlueShield, the state's largest insurer, is raising rates up to 26 percent on average after absorbing more than $100 million in losses incurred as more older and sicker patients received coverage under federal healthcare reform. The Maryland Insurance Administration announced Friday that it approved new premium rates for CareFirst and four other insurance companies that sell plans to individuals and small businesses on the state's exchange.
The Maryland Citizens’ Health Initiative Education Fund (MCHI) collaborated with local health improvement coalitions, health departments, hospitals, local community and faith leaders, and the Maryland Hospital Association to hold eleven regional public forums over a seven-month period about health system transformation. This MCHI report to the state’s Health Services Cost Review Commission’s Consumer Outreach Task Force provides recommendations for continued and expanded consumer outreach strategies. Click here to download the MCHI report.
Health Affairs Blog: The proposed change of incentives has the potential to positively alter hospital workplace culture by halting the current revenue-based push to do more — an effort that invariably trickles down to doctors. Maryland’s framework has the potential to break these vicious cycles and replace them with virtuous ones leading to greater quality and health.
The three CareFirst carriers in Maryland received approval to increase premium rates by 9.8 percent (CareFirst BlueChoice, Inc.) or 16.2 percent (CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.), on average − substantial reductions from the 22.8 percent and 30.2 percent increases those companies requested for 2015, according to a news release from the Maryland Insurance Administration.
On January 10, 2014, the Centers for Medicare & Medicaid Services (CMS) and the state of Maryland jointly announced a new initiative to modernize Maryland’s unique all-payer rate-setting system for hospital services that will improve patient health and reduce costs.