MHA's Friday Update Messages

MHA Friday Update Weekly Messages

Affordable Coverage = Accessible Care

August 03, 2018 By: Bob Atlas

Since the inception of the All-Payer Model in 2014, Maryland’s hospitals have demonstrated to the nation that it is possible to hold down health care cost growth and improve quality at the same time. Next January, under the new Total Cost of Care Model, Maryland’s bold experiment will expand to encompass not only hospital services but services of non-hospital providers, ranging from physicians to skilled nursing facilities. Of significance, our hospitals will have more potent incentives to work with care partners to mitigate chronic illnesses, like diabetes, for whole communities.

One of the keys to hospitals’ early success, and an essential pillar for the new model, is for people to have good, affordable insurance coverage so they can access care when they need it. If Marylanders can’t get the care they need in the most appropriate settings, then the system begins to break down. People delay care and get sicker until there’s no alternative but a high-cost, acute setting.

This week, MHA testified in person and submitted a letter to the Maryland Insurance Administration weighing in on insurers’ individual market rate increase requests for 2019. The carriers’ requests are in some instances breathtaking and in most cases do not seem reflective of our moderate hospital cost trends. Considering that premiums have been climbing precipitously for several years, there is deep concern that many Marylanders will be left without decent coverage.

In addition to advocating that the savings achieved under the Maryland Model be passed on to consumers, MHA recommended that the administration do three things:

  • ensure that the requests are based on accurate hospital spending and utilization trends
  • conduct an in-depth analysis of enrollee characteristics and insurer programs to manage them
  • explore care management incentives under a state reinsurance program to help drive down insurance costs

These actions could go a long way toward ensuring that all Marylanders have meaningful, affordable coverage.

MHA is also participating in a series of public hearings on the State Reinsurance Program, to further support broad-based coverage. And we have advocated with the federal government to approve our state’s application for waivers under the Affordable Care Act to help fund the reinsurance pool.

The start of the new model is less than five months away and we need a strong foundation for launch. Achieving the model’s core goals of controlling all health care costs and promoting the long-term well-being of all Marylanders demands a united effort from all stakeholders, including payers.