Medicare Waiver Year One

A look at the changes to hospitals and Maryland’s health

care environment

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• Maryland waiver in place since the 1970s• Modernized in January 2014• Formalized shift from volume to value and

is in line with health care’s Triple Aim

Background

The Maryland Health Services

Cost Review Commission

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• Limit hospital per capita spending in Maryland to annual growth of 3.58 percent

• Reduce total Medicare hospital spending in Maryland by $330 million over five years

• Limit growth in total Medicare spending in Maryland to no more than national growth

• Reduce the readmissions rate in Maryland to the national average within five years

• Reduce hospital-acquired conditions by 30 percent within five years

Five key metrics

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• Many statewide policies had to be created (e.g.: transfers, market share, uniform coding, readmissions reduction, etc.)

• 95 percent of hospital revenue under global budgets in six months

Implementation

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• $100 million savings to Medicare• Inpatient use rates and admissions down 4%• Potentially avoidable utilization down 6%

Where we stand (financial)

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• Readmissions rate declining faster than nation• 5,000 fewer readmissions than previous year• Statewide, uniform HAC diagnosis codes

developed; sharing of best practices

Where we stand (quality)

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How things have changed

OLD NEW

Fee-for-service Global budgets

Episodic care Population health

Fragmentation Care coordination

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Examples of change

What does it mean?

Patients Partnerships Population health

Bedside prescription delivery

Close collaboration with SNFs

Wellness initiatives

Health “coaches” Transport to primary care appointments

Predictive data analytics

In-home post-discharge visits

Physician education/partnerships

Mental health/substance abuse clinics

Nurse hotlines Sharing of data Mobile health clinics

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• Global budgets are a powerful incentive• Experiment, experiment, experiment• This is the right thing to do for patients

How are we doing it?

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• Never tested before on statewide scale• No one-size-fits-all solution• Innovation abounds, but jury’s out on best

practices

Challenges

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• Expansion beyond hospitals (physicians, post-acute providers, etc.)

• Shared savings programs• Transparency• Consumer engagement • Building data infrastructure

What’s next?

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Questions