Evaluation of the All-Payer Model

December 09, 2019 By: Bob Atlas, President & CEO

Without fanfare, the Center for Medicare and Medicaid Innovation (CMMI) posted the final evaluation of the Maryland All-Payer Model. Overall the findings suggest the Model works. One good sign: CMMI’s project leader for Maryland praised the Model on social media last week, saying, “What I’m most impressed with is the decrease in potentially avoidable hospitalizations.”

The evaluator, RTI International, notes that Maryland reduced hospital costs without shifting costs to other parts of the health care system outside the global budgets. Though it wonders if the Model produced the broad ranging effects that CMMI seeks.

CMMI and our regulator, the Health Services Cost Review Commission, will use the evaluation to press us to improve on areas where we could do better.

There are, in fact, many areas to celebrate including driving down cost and utilization for beneficiaries with multiple chronic conditions and dual eligibles, slowing growth in total cost of care for Medicare beneficiaries and all-payer hospital expenditures, and reduced spending on outpatient hospital services.

The report also reveals opportunities for improvement. RTI found the All-Payer Model did not have an impact on the percentage of Medicare beneficiary or commercial plan member discharges with a follow-up visit within 14 days.

Other areas for renewed focus include patient experience, population health, unplanned readmissions, and ED visits for avoidable conditions.

We’ve prepared a concise summary of the 278-page report. For those inclined to delve deeper, the full report is available on the CMS website .

Just as with our full attainment of the goals of the model contract, this evaluation adds to the case for the Maryland Model to continue. It also invites us to raise our game. Working together, we will do that.
Bob Atlas
President & CEO