A Journey Together: New Maryland Healthcare Landscape

Baltimore County ForumMaryland Health Services Cost Review Commission

June 2015

Health Reform

March 23, 2010

November 1, 2013Health Reform is much

more than the Exchanges

The Context: Health Care System Challenges

High costs

Aging and sicker population

Workforce shortages

Health care disparities

Fragmentation and variation

Coverage & Access

More Challenges Ahead

Changes in Demographics and Expenditures

Age 65 plus 2010 40 million2020 55 million2030 72 million

Federal Budget & Health Care SpendingMore Entitlements, Fewer Contributors

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United StatesCanadaGermanyFranceAustraliaUnited Kingdom

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United StatesFranceGermanyCanadaUnited KingdomAustralia

* 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.

US spending growth outpaces other developed countries

and spending is a higher portion of GDP

Higher Cost Without Better Outcomes

14% of Medicare Beneficiaries have 6 or more chronic conditions—1/2 of cost

National

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27% of Medicare Beneficiaries Have Diabetes—Even More Prevalent in MD

National Aver-age

State Average

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45% of Medicare Beneficiaries Have High Cholesterol --More Prevalent in MD

State AverageNational Average

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55% of Medicare Beneficiaries Have High Blood Pressure—More Prevalent in MD

National Average State Average

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 mid-1970s– 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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Helped hold down costs relative to elsewhere Funds access to care Transparency Leader in linking quality and payment Local access to regulators

Value of the All Payer System

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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The HSCRC Consumer Engagement Task Force

A Companion to Consumer Outreach

Consumer Engagement is a Journey

HSCRC’s Consumer Outreach & Engagement Initiative

• HSCRC convened two task forces to work to ensure that people using Maryland’s health system:– Understand health system transformation and what it means to them– Have the information and resources to become more actively involved

in their health

• The Consumer Outreach Task Force is:– Hosting forums to educate the public about the new health system

– Finding creative ways to partner with hospitals to improve heath across the state

Role of Consumer Engagement Taskforce

Charge #1 - Provide recommendations for a communication strategy that addresses various consumer segments• Goals:

– Engage people as active participants of their own care – Engage people in health policy, planning, service delivery and

evaluation at service and agency levels

• Strategies– Provide clear information and an opportunity for discussion– Educate people on appropriate ways to access health care– Promote collaboration between the government, hospitals and

consumers to develop policies and programs– Motivate people to actively participate in their own health care

Role of Consumer Engagement Taskforce

• Charge # 2- Make Recommendations to Support Consumer Communications to providers or about the healthcare system

– How consumer awareness can be enhanced about their rights to provide feedback

– How consumers provide input to decision makers, regulators, etc. on the impact of system transformation on individual and/or community health issues

– How the process for consumers providing input at all levels can be simplified and streamlined

CETF Activities

• Complete work on Charges #1 and 2

• Continue collaboration with others in the state doing related work

• Issue a draft report of recommendations/considerations in August 2015

• Issue a final report of recommendations/considerations to HSCRC in September 2015

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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-based Health Centers – Meritus Health– Nursing Home Collaboration

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 !