Transforming Maryland’s Health Care & Engaging Communities

1. Transforming Maryland’s Health Care & Engaging Communities Charles County Forum on Maryland’s All Payer System Transformation Carmela Coyle President & CEO

2. Reform Objectives BUILDon the great system we have and make it even better: • More affordable • Safer • A healthier Maryland Opportunity for Maryland to be a NATIONAL LEADERin health care CHANGEthe way we pay for and provide health care

3. History • MARYLAND − only state where hospitals don’t decide how much to charge for care payment • “All-Payer” system of hospital payment • A 40-year agreement with Medicare • Allows Maryland to “waive” Medicare payment rules, set rates hospitals charge • Can keep as long as we meet waiver “test” • Growth in Medicare spending per hospital stay less than the nation

4. History But 40-year-old waiver “test” was out of date OLD NEW All hospital care Inpatient care Medicare only All payers Cost of care per person overall Cost of care per hospital stay 4

5. Starts with Hospital Care • Work together to slow growth in spending for hospital care • Continue Maryland’s unique way of setting hospital prices • Change how hospitals are paid, to reward the right things – global budgets

6. Lower Cost Medicare SAVINGS TARGET − $330 million over 5 years GROWTHin Maryland spending per capita cannot exceed nation Annual hospital SPENDING CAP − 3.58% per capita 6

7. Safer REDUCE READMISSIONS: patients who return to the hospital within 30 days of discharge Bring Maryland readmission rates to NATIONAL AVERAGE in 5 years Maryland ranks poorly (almost last) – 49 of 51 states and D.C. Better, SAFER care 7

8. Safer REDUCE INFECTIONS AND COMPLICATIONS: patients who get sicker while in the hospital REDUCE infections and complicationsby 30% in 5 years Maryland rates of infection HIGHER than nation Better, SAFER care 8

9. New Incentives Changes how hospitals are paid to reward the right things • Success under the new rules requires • cost reduction • care for patients in the community • care in lower cost setting • reduce unnecessary care • The key: population health management 10

10. Population Health Management

11. Population Health Management “Managing the health outcomes of a group of individuals” • Central role of primary care • Patient activation, involvement and responsibility • Care coordination through wellness, disease and chronic care management

12. Population Health Management Changes How Hospitals and Think • Do more to earn more  Rewards for efficiency and quality • Care for an individual patient  Care for an entire population • Acute care  Ambulatory care  Community care • Competition  Collaboration • Hospital care  Health care

13. Population Health Management Requires Different Role for Hospitals • Supply proactive, preventive and chronic care to all • During and between encounters • Regular contact with patients • Support patient efforts to manage their health • Manage high risk patients to prevent from worsening

14. Health is About More Than Clinical Care Health is driven by multiple factors that are intricately linked – of which medical care is one component. Personal Behaviors 40% Family History and Genetics 30% Environmental and Social Factors 20% 10% Medical Care Source: Determinants of Health and Their Contribution to Premature Death, JAMA 1993

15. Transforming Maryland’s Health Care & Engaging Communities Charles County Forum on Maryland’s All Payer System Transformation Carmela Coyle President & CEO