Transcript Transforming Maryland’s Health Care & Engaging Communities Charles County Forum on Maryland’s All Payer System Transformation Carmela Coyle President & CEO.

Transforming Maryland’s Health Care & Engaging Communities
Charles County Forum on Maryland’s All Payer
System Transformation
Carmela Coyle
President & CEO
Reform Objectives
Opportunity
for Maryland
to be a
NATIONAL
LEADER
in health care
CHANGE
BUILD
the way we
pay for and
provide
health care
on the great
system we have
and make it
even better:
• More affordable
• Safer
• A healthier
Maryland
2
History
• MARYLAND − only state where hospitals
don’t decide how much to charge for care
payment
• “All-Payer” system of hospital payment
• A 40-year agreement with Medicare
• Allows Maryland to “waive” Medicare
payment rules, set rates hospitals charge
• Can keep as long as we meet waiver “test”
o Growth in Medicare spending per
hospital stay less than the nation
3
History
But 40-year-old waiver “test” was out of date
OLD
NEW
Inpatient care
All hospital care
Medicare only
All payers
Cost of care per
hospital stay
Cost of care per
person overall
4 4
Starts with Hospital Care
• Work together to slow growth in
spending for hospital care
• Continue Maryland’s unique way
of setting hospital prices
• Change how hospitals are paid, to
reward the right things – global
budgets
5
Lower Cost
Annual
hospital
SPENDING
CAP −
3.58% per
capita
Medicare
SAVINGS
TARGET −
$330 million
over 5 years
GROWTH in
Maryland
spending
per capita
cannot
exceed
nation
6
6
Safer
REDUCE READMISSIONS: patients who return
to the hospital within 30 days of discharge
Maryland
ranks poorly
(almost last)
– 49 of 51
states and
D.C.
Bring
Maryland
readmission
rates to
NATIONAL
AVERAGE in
5 years
Better,
SAFER care
7
7
Safer
REDUCE INFECTIONS AND COMPLICATIONS:
patients who get sicker while in the hospital
Maryland
rates of
infection
HIGHER
than nation
REDUCE
infections and
complications
by 30% in
5 years
Better,
SAFER care
8
8
New Incentives
Changes how hospitals are paid to
reward the right things
•Success under the new rules requires
–
–
–
–
cost reduction
care for patients in the community
care in lower cost setting
reduce unnecessary care
• The key: population health management
9
10
Population Health Management
10
Population Health Management
“Managing the health outcomes of a group of individuals”
• Central role of primary care
• Patient activation, involvement and responsibility
• Care coordination through wellness, disease and chronic
care management
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Population Health Management
Changes How Hospitals and Think
•
•
•
•
•
Do more to earn more  Rewards for efficiency and quality
Care for an individual patient  Care for an entire population
Acute care  Ambulatory care  Community care
Competition  Collaboration
Hospital care  Health care
12
Population Health Management
Requires Different Role for Hospitals
•
•
•
•
•
Supply proactive, preventive and chronic care to all
During and between encounters
Regular contact with patients
Support patient efforts to manage their health
Manage high risk patients to prevent from worsening
13
Health is About More Than Clinical Care
Health is driven by multiple factors that are intricately linked –
of which medical care is one component.
Personal Behaviors
40%
Family History and
Genetics
30%
Environmental
and Social
Factors
20%
Page 14
Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993
10%
Medical
Care
Transforming Maryland’s Health Care & Engaging Communities
Charles County Forum on Maryland’s All Payer
System Transformation
Carmela Coyle
President & CEO