Meaningful Value-Based Payment Reform, Part 2:
Expanding The Maryland Model To Other States
Part 1 appeared yesterday on the Health Affairs website.
By Ezekiel J. Emanuel, David W. Johnson, Matthew Guido, Merrill Goozner
Last October, the Center for Medicare and Medicaid Innovation (CMMI) issued a white paper that assessed the performance of its payment models to date and established a framework for implementing future initiatives. There were six “successes” that saved money and/or improved quality. Most were niche changes, such as the non-emergent ambulance transportation program and home health value-based purchasing model, that can never scale to produce substantial improvements and transform the health care system.
As a recent review showed, the important exception was Maryland's "All-Payer" program. It establishes uniform treatment prices within global hospital budgets that encompass total hospital and non-hospital care costs. Part 1 of our article details the history and performance of Maryland's All-Payer model.
Going forward, CMMI wants to streamline and reduce the number of payment models it offers. In doing so, it wants to broaden participation and simplify enrollment. It also wants new models to promote health equity as well as improve quality and reduce costs. These are the right parameters for payment reform. To accomplish its goals, CMMI should design new payment models that are
big—statewide,
mandatory—providers need to participate,
administratively simple—minimize gaming, and
long-term—at least five to seven years.
Moreover, new models should reallocate resources to enhance primary care services and access in low-income communities.
The Maryland All-Payer model with global budgets meets all these criteria. Importantly, it shifts incumbent health care payers and providers into value-based care delivery gradually but inexorably. How can Maryland’s model be extended to other states?
To continue reading Part 2 of Meaningful Value-Based Payment Reform: Expanding The Maryland Model To Other States, click here.