Continuing To Build A More Rational Health Care System

On Monday, Governor Larry Hogan announced the federal approval of Maryland's Total Cost of Care All-Payer Model, also known as the “Maryland Model.” This long-awaited announcement sets in motion the next phase of Maryland’s move towards a more value-driven healthcare system. Since January of 2014, Maryland has used global hospital budgets as a way to reduce costs and incentivize hospital leaders to improve health outcomes and the patient care experience. This was done to help these leaders build better systems of care and move away from the fragmented model in which they were providing acute care services but bearing little responsibility for how those services fit together to improve the health of the population they serve.

Setting revenue budgets for hospitals can be done in Maryland because we are the only state in the nation where hospitals don’t negotiate rates with individual insurance companies. In our state, the Health Services Cost Review Commission (HSCRC) sets the rates that all payers, including Medicare and Medicaid, will pay a hospital. The rates that are paid can vary from hospital to hospital by up to 60%, so the buyer must beware. Since the HSCRC controls the rates, beginning in 2014, it began to guarantee the total annual revenue for services under its purview to each hospital. If the hospital then reduced hospital utilization by keeping patients healthier, it did not need to worry that its total revenue would go down. This system gave hospital leaders more flexibility to spend money on things that prevent disease or better manage patients who are already sick with a chronic disease, like diabetes.

Maryland’s current model has saved Medicare more than $586 million through 2016, compared to national spending, and the new model is expected to provide an additional $300 million in savings per year by 2023 — a total of $1 billion over five years.

The Maryland Model aims to control the growth in healthcare costs, both at hospitals and community providers such as physician practices and nursing homes. Hospitals will be responsible for reducing the total cost of care for Medicare beneficiaries. Readers of this blog will know that GBMC has been building a system of care capable of improving health outcomes and the care experience while reducing wasteful spending for seven years. To do this, we embraced the concept of the patient-centered medical home. We created teams led by physicians that included nurse care managers, care coordinators, behavioral specialists, addiction specialists, and psychiatrists. We extended our hours of operation, created disease-state registries, and implemented a single medical record (Epic) across our whole system to improve care coordination. We made our specialty care even better than it was and made it easier to communicate between primary and specialty care. Now, there will be even bigger incentives for others in the state to do what we have done.

A piece of the new deal is the Maryland Primary Care Model. This program will financially incentivize primary care physicians to improve patient outcomes and ultimately lower cost by using care managers and others, as GBMC has already done. Since small primary care practices will not be able to afford to hire these new team members, new entities, called Care Transformation Organizations will be set up to provide care management and other services to small practices. GBMC will apply to become a Care Transformation Organization through our existing subsidiary company, Greater Baltimore Health Alliance. 

We are excited about this next phase of redesign in our state. The financial incentives of the Maryland Primary Care Model will make it easier for us to move closer to our vision of being a community healthcare system where every patient, every time, gets the care we would want for our own loved ones! Stay tuned.

Celebrations Galore!
Last week was full of events to celebrate GBMC HealthCare and our people. It started on Monday with the 30th annual GBMC Golf Tournament. Hats off to the entire golf committee, the many employees who helped with the event, and to Jenny Coldiron and the GBMC Philanthropy staff, all of whom worked together for a great event. Approximately 200 golfers supported our efforts and raised more than $195,000 to benefit GBMC. Dr. Bernard McGibbon, posthumously, and Dr. Rob Stoltz were each recognized; the first for having created the event and the second for his many years of service as the Chair of the Golf Tournament committee. 

We also held our annual Donor Recognition Dinner, and again I was honored to spend time with donors, members of the GBMC HealthCare System family, philanthropy committee members, and volunteer auxiliary members. Heidi Kenny-Berman, Chair of the GBMC Philanthropy Committee, was the host of the event, along with her husband, Steve Berman. Heidi and Steve did a fabulous job. The event featured a wine and food pairing that was educational and fun. Thank you to all for everything you do to help us continue to move towards our vision and remain an independent, community-owned and controlled healthcare system.


Lastly, on Friday we had our annual Art of Nursing celebration. We formally celebrated all that our incredible nurses give to GBMC and to our patients and highlighted the winners of the 2018 Art of Nursing Awards. Congratulations to the winners and to all those who were nominated! I also would like to thank everyone who made the Art of Nursing so successful, especially the emcee for the night, Denise Koch, and our GBMC Nursing Ambassador, Matt Stover!