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Spreading Innovations in Health Care Delivery

This website, endorsed by Maryland’s Stakeholder Innovation Group, offers a glimpse at how many of Maryland’s health care providers and community organizations are working together to improve care delivery.

We urge you to use this site to share innovative programs and practices that improve the health of Maryland’s communities.

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Case Study Form

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Background and Purpose
The Secretary of the Maryland Department of Health (MDH) requested that the Stakeholder Innovation Group (SIG) facilitate the sharing and development of ideas to accelerate health system transformation efforts in support of the Total Cost of Care Model, including the Statewide Integrated Health Improvement Strategy (SIHIS). Fundamental to this work is an inventory of innovative care redesign/payment initiatives and programs related to SIHIS goals.

The inventory will be assessed for possible broader adoption of programs under Maryland's Model. The goal is to create a baseline inventory of current efforts and measure progress toward the state's Model and SIHIS goals.

Guidance on Submitting Your Innovative Programs and SIHIS-Related Initiatives
We are interested in submissions from a wide range of hospitals, health systems, clinicians, local health departments, and their partners. Consider submitting what you see as your most innovative programs focused on improving population health and reducing costs. These programs may be part of national initiatives (e.g., Accountable Care Organizations) or may be "home grown." We are interested in programs that have an associated payment model, as well as those that do not.

We are also interested in programs that align with the SIHIS focus areas: hospital quality and pay-for-performance, care transformation across the system, and total population health (with a particular focus on diabetes, opioid use, maternal morbidity, and childhood asthma).

Program Overview

Improved care coordination
Improved health outcomes
Reductions in health disparities
Reduced readmissions
Increased use of preventive and primary care
Reduced utilization of post-acute care
Reduced transitions from post-acute care/long-term care
Reduced avoidable utilization
Reduced spending
Upstream interventions in community/population health
Other (please specify)
Internal funds/investments
Hospital community benefit
State funding (such as a grant)
Private/non-profit grant
Other (please specify)

Maryland's Total Cost of Care and Statewide Integrated Health Improvement Strategy Goals

  • Effective care management, including reducing readmissions and population health activities.
  • Improvement in care for high and rising risk populations.
  • Providing high quality, efficient, well-coordinated episodes of care.
  • Monitoring and moderating the growth in Medicare beneficiaries Total Cost of Care (TCOC).
  • Limiting all-payer hospital revenue growth per capita.

Yes, Hospital Care Improvement Program (HCIP)
Yes, Complex & Chronic Care Improvement Program (CCIP)
Episode Care Improvement Program (ECIP)
Episode Quality Improvement Program (EQIP)

Information on the Care Redesign Amendment can be found here.

Accountable Care
Episode-based Payment Initiatives
Primary Care Transformation
Initiatives Focused on the Medicaid and CHIP Population
Initiatives Focused on the Medicare-Medicaid Enrollees
Initiatives to Accelerate the Development and Testing of New Payment and Service Delivery Models
Initiatives to Speed the Adoption of Best Practices
Please briefly explain your answer:
Descriptions of the CMMI categories can be found on this page . Click on "Category Descriptions."

Program Design and Implementation

Care coordination/management
Patient assessment tools
Care transitions
Patient education/coaching/self-management
Multidisciplinary care teams
Patient care plans
Advance care plans/advance directives
Community health workers
Interventions to address social determinants of health
Protocols/agreements with care partners
Telehealth/connected patient technologies
Risk stratification
CRISP tools (e.g., Encounter Notification Service)
Population Health Improvement
Other(please specify)
Physicians' office (Specialty)
Physicians' office (Primary care)
Hospital / Health system
Skilled nursing facility
Home health care
Rehabilitation center
Behavioral health provider (e.g., mental health and/or substance abuse)
Non-clinical setting
Other(please specify)
Medicare / Older Adults
Dual Eligibles (Medicare-Medicaid enrollees)
Privately Insured
Individuals with multiple chronic conditions
Individuals with one specific chronic condition
Frail / Disabled
Pregnant and Post-Partum Individuals
Younger Adults
Other(please specify)
Anne Arundel
Baltimore City
Prince George's
Queen Anne's
St. Mary's
Participation also includes non-Maryland residents
BMI reduction
Behavioral health
Cardiovascular disease
Respiratory disorders (e.g COPD)
Substance abuse
Opioid overdose reduction
Severe maternal morbidity
Childhood asthma
Alzheimer's disease and other dementias
Other (please specify)
Cost/utilization measures
Process measures
Participant outcome measures
Participant experience/satisfaction measures
Other(please specify)
Shared savings
Bundled payments
Bonus payments
PMPM payments
Shared resources (e.g., IT Infrastructure)
Other(please specify)
Internal funds (e.g., hospital revenue)
Private health plan
Other (please specify)

Results and Evidence

Yes, expected results were achieved
Results are expected but not yet achieved
Some of the expected results were achieved
No, expected results were not achieved

Yes, expected results were achieved
Results are expected but not yet achieved
Some of the expected results were achieved
No, expected results were not achieved