Friday, February 21, 2020

Checking in on the Maryland Waiver

On Wednesday, I participated in a panel discussion sponsored by MedChi, our state medical society, entitled “Cutting the Cost of Health Care - Is Maryland's Health Care Model Working?”

Maryland is the site of two major experiments to drive us towards the Triple Aim of Better Health and Better Care at Lower Cost. The first is our Medicare waiver, also known as the Total Cost of Care Model, and the second is the Maryland Primary Care Program (MDPCP). MDPCP is designed to reward primary care physicians financially for transforming their practices to better manage the health of their patients. State leaders recognize that hospitals cannot manage the health of a population; they are constructed to deliver services to those who are acutely ill. Primary care physicians, supported by nurses, technicians, and social workers can be held accountable for the health of a panel of patients.

It is not financially possible with the current fee-for-service system for small groups of privately practicing primary care providers to deliver the kind of advanced primary care that GBMC has been delivering for almost a decade. So, the MDPCP model has upfront payment built in to support the costs of the added team members. Private practicing primary care physicians can contract with a Care Transformation Organization to get the social work and care management support needed for their patients. GBMC operates a care transformation organization, the Greater Baltimore Health Alliance (GBHA), and we support several private practices in the MDPCP.

There is some inherent tension between physicians and hospitals as we transform the delivery system. Money flows to hospitals through the Health Services Cost Review Commission (HSCRC) and physicians want to be assured that they are benefiting financially as they become more active in redesigning care. This will also become true for community agencies as we build new alliances to deal with the social determinants of health, which play a larger role in population health than the care delivery system itself.

Joining me on the panel were Scott Krugman, MD, Vice Chair of Pediatrics at the Herman & Walter Samuelson Children’s Hospital at Sinai, Chris L. Peterson, MPP, CHFP, Principal Deputy Director for Payment Reform and Provider Alignment at the Health Services Cost Review Commission, and Gene M. Ransom III, CEO, MedChi, The Maryland State Medical Society. The room was full and the conversation was lively. Gene acted as the moderator and he began the session with a brief presentation on how the Total Cost of Care Model works. Chris spoke about how the HSCRC has no direct accountability for physician payment rates but that they were working within the model to find ways to financially incentivize physicians to create better systems. Scott voiced his concern about the lack of focus on the needs of children.

I was honored to be on the panel and I think the sharing of ideas was very powerful.

Councilman Marks Visits GBMC
This past Monday, I had the pleasure of being joined by Baltimore County Councilman, David Marks, on our Lean Daily Management (LDM) walk. I updated Councilman Marks about our progress in building a patient-focused system of care and our recent recognition by the Baldrige Performance Excellence System. He offered high praise for our use of LDM to generate improvement and was impressed with our patient-centered medical homes.

Over the last four years, I’ve had the privilege of hosting visits from many policymakers, on various levels, to our system. The common feedback from these visits is that we should be very proud of our accomplishments and the creation of a system of care that the patient experiences as a whole. I couldn’t agree with them more. I am truly grateful for the fabulous efforts of the entire GBMC HealthCare family and the hard work by all of you in moving us towards our four aims and closer to our vision every day. It is truly amazing, and it’s being recognized by many in our community and beyond. Thank you for all your hard work!

Celebrating Black History Month 
On Wednesday, we hosted our annual celebration in honor of Black History Month. This year’s program, entitled Black History Month Celebration: The Power of Unity, was truly remarkable and was attended by approximately 100 employees.

This event gives us an opportunity to recognize the accomplishments of African Americans whose hard work, commitment, and dedication serve as an inspiration to all people who value the ideals of freedom and democracy.

The ceremony’s guest speaker was the renowned preacher, teacher, and author, Rev. Dr. Ann Lightner Fuller. She told her very moving story about how she went from growing up in a poor household to having an outstanding career as a minister and speaker. She encouraged all of us to remember those less fortunate than ourselves and to try to create opportunities for people to create a better life for themselves and their family.

Other highlights included a moving presentation by Jalisa Monroe from the University of Maryland Baltimore County (UMBC) and entertainment from the Parkville High School Dance Team. Ms. Monroe was a very talented orator and the students from Parkville dazzled the crowd with their talent.

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