Maryland Comprehensive Primary Care Model
Overview
Maryland, under agreement with the Centers for Medicare & Medicaid Services (CMS), launched the All-Payer Model in 2014 to transform the health care delivery system. The All-Payer Model is changing the way Maryland hospitals provide care, shifting from a financing system based on volume of services to a system of hospital-specific global revenues and value-based incentives.
Further health transformation in Maryland means transitioning to an All-Payer Model that limits the growth in total cost of care for Medicare beneficiaries in a second term that will begin on January 1, 2019. In the “
Progression Plan”
document, Maryland outlines its proposal to accomplish the expanded system-wide goals and address the State’s goal of including the Medicaid costs for Medicare beneficiaries who are also covered by Medicaid.
A key component of the Progression Plan is system-wide primary care transformation. Primary care is essential for patients with chronic diseases that progress over time, to prevent them from having to seek care in higher acuity care settings. However, many primary care settings lack the resources to meet the full range of needs of the growing number of patients with multiple chronic conditions. Necessary resources include care management, care coordination, and connections to behavioral health and social services.
Maryland, equipped with experience and expertise in primary care transformation, now proposes a Maryland-specific model: The Maryland Comprehensive Primary Care Model. This foundational payment and delivery system reform is designed to transcend the silos that separate the many professionals who are seeing patients, by providing the technical assistance, learning systems and the funding streams to support care delivery transformation.
In December 2016, Maryland submitted a concept paper to the Centers for Medicare and Medicaid Services (CMS):
Maryland is currently negotiating approval of the Maryland Comprehensive Primary Care Model with CMS. Pending approval, here is a timetable for key dates:
|
Activity |
Timeframe |
|
Obtain Approval for Model from CMS |
Summer 2017 |
|
Write legal agreements and applications |
Summer 2017 |
|
Release Applications |
Fall 2017 |
|
Select CTOs and Practices |
Fall 2017 |
|
Launch Program |
Early 2018 |
What does the program do?
- Align community providers with hospitals and specialists to foster collaboration in the care of shared patients in order to reduce potentially avoidable utilization;
- Reduce the pool of high needs and super-utilizing patients through better management of the rising needs population;
- Move care to the safest, most appropriate, and most cost-efficient care setting possible;
- Allow clinicians to step gradually into assuming greater financial responsibility for patient populations, thereby providing a glide path toward sustainability and success for the Maryland CPC Model and All-Payer Model;
- Identify and reduce disparities in care delivery and health outcomes; and
- Foster and implement innovations in health care delivery, including multidisciplinary integration of services.
Where can I learn more?
Questions or comments may be directed to: Chad Perman, MPP, Director, Health Systems Transformation, chad.perman@maryland.gov, 410-767-4557. Primary Care Model comments: dhmh.pcmodel@maryland.gov. For our updated contact information, please refer to the toolbar 'Popular Links' for the 'Staff Directory.'
------------------------------------------
Last updated: 2017 May 3
