New Publications on Maryland’s
Total Cost of Care Model Released

Three new publications from the Milbank Memorial Fund report on recent experience with the Maryland Total Cost of Care (TCOC) Model launched in 2019 and its predecessor, the Maryland All-Payer Model (2014-2018). Under Maryland’s all-payer rate setting system for hospital services, hospitals operate under global budgets, health care providers are incentivized to coordinate care, and the Centers for Medicare & Medicaid Services (CMS) mandates that the state achieve Medicare per capita total cost of care savings targets. Maryland is widely recognized for its efforts to transform care and contain the growth in health care spending.

In a new issue brief, Mark Japinga and Mark McClellan of the Duke-Margolis Center for Health Policy discuss the evaluation of the All-Payer Model commissioned by CMS and explore its implications for other states that want to accelerate the adoption of new payment models.

The Maryland Primary Care Program (MDPCP), a key component of the TCOC Model, supports the delivery of advanced primary care throughout the state. MDPCP encourages primary care providers to play an increased role in prevention, chronic disease management, and preventing unnecessary hospitalizations. An issue brief by MDPCP’s Chad Perman, Robert Patterson, and Howard Haft describes the program’s evolution and core components as well as its potential replicability in other states. Primary care clinicians who voluntarily joined the program serve roughly half of the state’s residents.

A companion article by Sarah Klein and Martha Hostetter examines how Maryland has leveraged the program’s infrastructure during the COVID-19 pandemic. State leaders have been able to effectively communicate with practices about the state’s response and offer clinicians tools to help patients most at risk.

The Hilltop Pre-AH Model^TM employs an event prediction algorithm to identify MDPCP patients at risk for avoidable hospitalization. Hilltop Chief Data Scientist Ian Stockwell, PhD, and his team use the model to produce patient risk stratification scores each month. The Chesapeake Regional Information System for our Patients (CRISP), Maryland’s health information exchange, shares the scores with primary care practices to assist care coordinators in triaging care. Hilltop Senior Data Scientist Fei Han, PhD, was recently awarded funding to further develop the Hilltop Pre-AH Model^TM to estimate individual-level risks of hospitalization due to COVID-19 and other communicable diseases.