The Total Cost of Care Model: Uniquely Maryland, Uniquely Successful
Maryland’s Total Cost of Care Model contract with the Center for Medicare & Medicaid Innovation builds on the work of the All-Payer Model and on Maryland’s more than 40-year history of innovation in hospital payment systems. For four decades in Maryland, hospital rates have been regulated by an independent state body, and all payers—private, commercial, Medicare, Medicaid, self-pay—are charged the same rate for the same service at the same hospital. *
Rather than focusing on how hospitals alone can deliver efficient, high-quality care, physicians, skilled-nursing facilities, home health providers, and others, will be incentivized to improve how they coordinate care for patients and on societal health problems such as diabetes, heart disease, and opioid use disorders. In doing so, Maryland’s entire health care system will work to ensure that patients receive the right care, at the right time, in the right setting.
The Maryland Model gets right what other states are getting wrong. The people of Maryland can’t afford to lose it.
* On the same day. Prices may fluctuate throughout the year, subject to the average. Individual out-of-pocket expenses may vary based on health plan design. There is a small differential, required by law, between public and private payers. Outside of Maryland, this differential can be 1.5 to 2 times as much.
The Three Pillars of the Maryland Model
Equity
Marylanders get great health care – no matter where you live, who you are, or your income.
In our hospital payment system, everyone pays the same, sparing Marylanders from cost-shifting and the two-tiered care that burdens patients and worsens outcomes elsewhere. The Maryland Model promotes equitable access and equitable outcomes.
Community
Maryland, under the Total Cost of Care Model, is the only state where hospitals are accountable for the health of their communities. Hospitals invest outside their walls, so people do not have to come in to benefit. Focusing on the health of the community, hospitals collaborate more and use their resources to help their neighbors.
Value
Hospitals in Maryland don’t dictate prices, and they aren’t paid more to do more. In the Maryland Model, hospitals get a set budget to help keep their communities healthy. Your hospitals focus on quality and the value of care.