An Update on Maryland’s All-Payer Approach to Reforming the Delivery of Health Care

Sharfstein, Joshua M.; Kinzer, Donna; Colmers, John M.

doi:10.1001/jamainternmed.2015.1616

Cited by 16 publications

(20 citation statements)

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“…As of 2017, in certain US states such as Maryland, health care financing is substantially moving towards global budgets based on the size and characteristics of the population living in a catchment area, rather than based only on those who present themselves for services 62 . This effort will be the first time that a large component of an entire state's health system's budget is based on a population of people who may not utilize the health system at all.…”

Section: Discussionmentioning

confidence: 99%

Public and Population Health Informatics: The Bridging of Big Data to Benefit Communities

2018

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Both medical care providers and public health agencies are increasingly using informatics and big data tools to create and share digital information. The intent of this "bridging" is to proactively identify, monitor, and improve a range of medical, environmental, and social factors relevant to the health of communities. These efforts show a significant growth in a range of population health-centric information exchange and analytics activities.

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Section: Discussionmentioning

confidence: 99%

Public and Population Health Informatics: The Bridging of Big Data to Benefit Communities

2018

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“…By constraining hospital revenue, policymakers sought to give hospitals a financial incentive to limit unnecessary hospital use, to manage patients’ care in settings not subject to a budget (e.g., community-based primary care practices), and to develop care management programs aimed at reducing potentially avoidable emergency department visits and hospital stays. 8,9,12 (Additional details of Maryland’s program are provided in the Appendix. 21 )…”

Section: Methodsmentioning

confidence: 99%

“…Policymakers also hoped that Maryland’s program would encourage hospitals to develop initiatives aimed at deterring readmissions and returning emergency department visits. 9 To assess changes in these outcomes, we measured the proportion of beneficiaries’ acute hospital visits (inpatient admissions, observation stays, emergency department visits) that were followed by a second acute hospital visit within 30 days (we term these 30-day return acute hospital visits ).…”

Section: Methodsmentioning

confidence: 99%

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Changes In Hospital Utilization Three Years Into Maryland’s Global Budget Program For Rural Hospitals

et al. 2018

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In a substantial shift in payment policy, the State of Maryland implemented a global budget program for acute care hospitals in 2010. Goals of the program include controlling hospital use and spending. Eight rural hospitals entered the program in 2010, while urban and suburban hospitals joined in 2014. Prior analyses, which focused on urban and suburban hospitals, did not find consistent evidence that Maryland's program had contributed to changes in hospital use after two years. However, these studies were limited by short follow-up periods, may have failed to isolate impacts of Maryland's payment change from other state trends, and had limited generalizability to rural settings. To understand the effects of Maryland's global budget program on rural hospitals, we compared changes in hospital use among Medicare beneficiaries served by affected rural hospitals versus an in-state control population from before to after 2010. By 2013-three years after the rural program began-there were no differential changes in acute hospital use or price-standardized hospital spending among beneficiaries served by the affected hospitals, versus the within-state control group. Our results suggest that among Medicare beneficiaries, global budgets in rural Maryland hospitals did not reduce hospital use or price-standardized spending as policy makers had anticipated.

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“…Some states are innovating with supplemental funding through State Innovation Model awards from the Center for Medicare and Medicaid Innovation 30 or state initiative such as the Maryland all-payer rate-setting system. 31,32 Although flexible payment strategies of health system resources are stimulating cross-sector collaboration, the definition and measurement of ''success'' has largely been dictated by health system stakeholders. Whether it is feasible for health system, public health, and social service organizations to formulate a shared vision of community health system success, and how such a vision varies from the Triple Aim paradigm of health care success is not straightforward, although the concept of community engagement has gained traction as a core concept of shared accountability in performance measurement.…”

Section: Discussionmentioning

confidence: 99%

Bridging the Silos of Service Delivery for High-Need, High-Cost Individuals

Sherry

Wolff

Ballreich

et al. 2016

Population Health Management

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Health care reform efforts that emphasize value have increased awareness of the importance of nonmedical factors in achieving better care, better health, and lower costs in the care of high-need, high-cost individuals. Programs that care for socioeconomically disadvantaged, high-need, high-cost individuals have achieved promising results in part by bridging traditional service delivery silos. This study examined 5 innovative community-oriented programs that are successfully coordinating medical and nonmedical services to identify factors that stimulate and sustain community-level collaboration and coordinated care across silos of health care, public health, and social services delivery. The authors constructed a conceptual framework depicting community health systems that highlights 4 foundational factors that facilitate community-oriented collaboration: flexible financing, shared leadership, shared data, and a strong shared vision of commitment toward delivery of person-centered care.

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An Update on Maryland’s All-Payer Approach to Reforming the Delivery of Health Care

Cited by 16 publications

References 1 publication

Public and Population Health Informatics: The Bridging of Big Data to Benefit Communities

Public and Population Health Informatics: The Bridging of Big Data to Benefit Communities

Changes In Hospital Utilization Three Years Into Maryland’s Global Budget Program For Rural Hospitals

Bridging the Silos of Service Delivery for High-Need, High-Cost Individuals

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