The report noted that the model reduces both total and total expenditures for dementia patients, without transferring costs to other parts of the health system outside of global budgets. The reduction in hospital expenditure was due to a reduction in outpatient hospital spending. The emergency department attendance rate (ED) decreased by 2.6% among Maryland trade plan members compared to the comparison group in the first four years of the all-pay model. Ed`s attendance rate also declined among Medicaid recipients in Maryland. In 2014, Maryland and CMS partnered to reduce hospitalization costs and improve the quality of care through a 5-year model agreement. The model uses a payment system that makes hospitals responsible for the total cost of care per capita. In accordance with the agreement, the overall rates for hospital fees for services are regulated by the state. Since its inception, the model had reduced unnecessary remissions and hospitalization conditions, while reducing costs. The path to value-based care is becoming clearer, as many models are available to help organizations move forward. Whatever the model, states deal with similar problems and must develop similar capabilities to succeed. The question now is to make reforms more systematic. Policies at the state level will be decisive in advancing efforts, and it will benefit the most proactive states.
Maryland is demonstrating a way to take effective action and the years ahead will be crucial to establishing a strong database, not only to show what other approaches might work, but also to understand how they all fare once they implement fundamental changes and begin to address even more difficult problems. Supporters fail to articulate the challenges of national implementation, and these challenges are largely due to the imbalance of payments between Maryland and other countries. Despite modest cuts in Medicare subsidies due to recent Maryland system reforms, the all-payer system continues to allow Maryland hospitals to get higher Medicare payments than they would otherwise. Although the exemption has resulted in an estimated $796 million reduction in the grant between 2014 and 2018, Maryland has still received a $1.440 billion grant in 2017. And even if Maryland`s hospitals met the reformed program`s goal of achieving an average of $200 million in savings per year between 2019 and 2023, the state would still receive about $1.24 billion in additional Medicare payments per year. In other words, subsidies from the Medicare Trust Fund, which supports the interest rate-setting program, overshadow the savings sought by the program. Most health systems reported investing in population health efforts, from care coordination to landfill planning to cooperation with social services. Many people have been concerned about their control over the health of high-risk patients, the behaviour of these patients outside the hospital, and the decisions of frequent ED users. Although Maryland has not developed health outcomes for the population to encourage bonuses or other payment adjustments in this model, these results will play a more important role in the total cost of care model, the second phase of the all-paid model that was introduced in 2019.5 “The new Maryland model will expand access to health care and affordable health – and , ultimately, improve the quality of life – for the Marylander.
, especially those suffering from chronic and complex diseases,” Hogan said in the statement.