Transcript A Journey Together: New Maryland Healthcare Landscape Western Maryland Forum Maryland Health Services Cost Review Commission April 2015

A Journey Together: New Maryland
Healthcare Landscape
Western Maryland Forum
Maryland Health Services Cost Review Commission
April 2015
Health Reform
March 23, 2010
Health Reform is much
more than the Exchanges
November 1, 2013
The Context:
Health Care System Challenges
High costs
Workforce
shortages
Coverage &
Access
Fragmentation
and variation
Health care
disparities
Aging and sicker
population
More Challenges Ahead
Changes in Demographics
and Expenditures
Age 65 plus
2010 40 million
2020 55 million
2030 72 million
Federal Budget & Health Care Spending
More Entitlements, Fewer Contributors
Higher Cost Without Better Outcomes
US spending growth outpaces
other developed countries
and spending is a higher portion of GDP
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8,000
United States
Canada
Germany
France
Australia
United Kingdom
7,000
6,000
16
14
12
5,000
10
4,000
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* 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.
2008
2006
2004
1998
1996
1994
1992
1990
1988
1986
1984
1982
1980
2008
2006
2004
2002
2000
1998
1996
1994
1992
1990
0
1988
0
1986
2
1984
1,000
1982
4
1980
2,000
2002
United States
France
Germany
Canada
United Kingdom
Australia
6
2000
3,000
15% of Medicare Beneficiaries have 6 or
more chronic conditions—1/2 of cost
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National
Allegany
Anne Arundel
Baltimore
Baltimore City
Calvert
Caroline
Carroll
Cecil
Charles
Dorchester
Frederick
Garrett
Harford
Howard
Kent
Montgomery
Prince Georges
Queen Annes
Somerset
St. Marys
Talbot
Washington
Wicomico
Worcester
State
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27% of Medicare Beneficiaries Have Diabetes—Even
More Prevalent in MD
National Average
State Average
30
25
20
15
10
5
0
70
National
Allegany
Anne Arundel
Baltimore
Baltimore City
Calvert
Caroline
Carroll
Cecil
Charles
Dorchester
Frederick
Garrett
Harford
Howard
Kent
Montgomery
Prince Georges
Queen Annes
Somerset
St. Marys
Talbot
Washington
Wicomico
Worcester
State
45% of Medicare Beneficiaries Have High Cholesterol
--More Prevalent in MD
National Average
State Average
60
50
40
30
20
10
0
80
National
Allegany
Anne Arundel
Baltimore
Baltimore City
Calvert
Caroline
Carroll
Cecil
Charles
Dorchester
Frederick
Garrett
Harford
Howard
Kent
Montgomery
Prince Georges
Queen Annes
Somerset
St. Marys
Talbot
Washington
Wicomico
Worcester
State
55% of Medicare Beneficiaries Have High Blood Pressure—
More Prevalent in MD
National Average
70
60
50
40
30
20
10
0
New Paradigm
• Improve the health of the population;
• Enhance the patient experience of care;
• Reduce the per capita cost of care.
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
Implications
• All this means:
– Payment moves away from fee-for service
• The more you do the more you get paid
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Implications
• All this means:
– 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
– Pressure to assume more risk
– Need for integration and collaboration
• CHANGE IS HERE – CHANGE IS EVERYWHERE
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Maryland Hospitals are Paid
Differently
• Maryland has set hospital rates since the mid1970s
– 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
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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
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
Implications for Patients and their Families
• Quality safety and satisfaction scores can account for a
significant 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
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Model Has Been Tested Maryland
• Maryland has been testing the Model across
the State for 4 Years:
– Better quality
– Reduced Costs
– Reasonable Profitability
• Examples of Collaboration
– School Health Program Collaboration
– Nursing Home Collaboration
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Concluding Thoughts
• New waiver is a call to action
• HSCRC is a State entity that represents the public
– Ensure rates and costs are reasonable
– Promote the Triple Aim for patients and purchasers of care
• 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
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THANK YOU !
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