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Encouraging Progress Under the All-Payer Model

April 06, 2018 By: Bob Atlas

Last week’s report from RTI International offered some promising findings about how Maryland’s hospitals have transformed care delivery while controlling costs and improving quality. Among the highlights, which draw data from the first three years under the All-Payer Model:

  • Inpatient admissions dropped significantly – 5 percent for Medicare beneficiaries and 4 percent for commercially insured individuals
  • Medicare spending declined $679 million, a 2.7 percent reduction

From the report: “Hospitals made significant strides in adapting to global budgets … [the] All-Payer Model continued to reduce both total expenditures and total hospital expenditures … without shifting costs to other parts of the health care system outside of the global budgets.”

In other words, the model is working very much as intended, driving efficiency and cooperation across the care continuum, and improving quality while holding costs in check. Still, the report suggests several important opportunities to improve. These include mixed effectiveness of the strategies to reduce avoidable utilization, and a need to improve coordination of care with community providers after discharge.

The assessment from RTI is markedly different from that of Harvard researchers, who published an article this week in Health Affairs. They contend that the All-Payer Model has not generated notable changes in hospital use or hospital activity to reduce avoidable utilization.

That research, however, focused on the years 2011-2013, prior to the implementation of the All-Payer Model in 2014, and just on the seven rural hospitals under Total Patient Revenue. So the findings are not really relevant or helpful.

The RTI findings a testament to the impressive work you’ve done to upend traditional models in favor of a system that prioritizes value over volume – work that will be the linchpin to Maryland’s success at the leading edge of innovation.