Maryland's hospitals are among the most heavily regulated and most transparent in the nation. For hospitals to continue to provide the highest quality care to patients and communities, they need both the resources to invest in long-term delivery system transformation and the flexibility to tailor that investment to individual communities. MHA's work in regulatory advocacy reflects a commitment to secure both resources and flexibility while remaining committed to transparent, quality care.
Maryland’s All-Payer System
Maryland is the only state in the country that has an agreement with the Centers for Medicare & Medicaid Services requiring all payers — insurance companies, HMOs, Medicare, Medicaid, uninsured individuals and others — to pay the same rate for the same service at the same hospital. This demonstration, the Total Cost of Care Model, is often referred to as the “Maryland Model,” under which all payers reimburse Maryland’s hospitals according to rates set by the commission.
In January 2019, Maryland began operating under a new demonstration agreement with the Centers for Medicare & Medicaid Services that kept in place the nearly 40-year-old system that provides a level of transparency and accountability unseen in other states.
The Total Cost of Care Model aims to hold all health care costs in check, including hospital spending, as well costs for non-hospital health care providers. Rather than focusing on how hospitals alone can deliver efficient, high-quality care, physicians, skilled-nursing facilities, home health providers, and others, are 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 works to ensure that patients receive the right care, at the right time, in the right setting.