Maryland

Maryland began a three‐three year pilot study in 2011, the Maryland Multi-Payer Patient-Centered Medical Home Program (MMPP), to test the PCMH model of care, including 52 primary and multi-specialty practices. The practices are comprised of both private and all of the federally‐qualified health centers located across the State. Maryland law SB 855/HB 929 requires the State’s five major carriers of fully insured health benefit products (Aetna, CareFirst, CIGNA, Coventry, and UnitedHealthcare) to participate in the MMPP. The Federal Employees Health Benefit Plan, Maryland State Employees Health Benefit Plan, TRICARE, the health care program serving Uniformed Service members, and plans provided by private employers, such as Maryland hospital systems, have voluntarily elected to offer this program as well.

With the support of a CMS State Innovation grant and participation in the Medicaid Health Homes program, Maryland plans to further strengthen the MMPP through the development of Community-Integrated Medical Home (CIMH) model.  This model of care will integrate patient-centered medical care with community-based resources while enhancing the capacity of local health entities to monitor and improve the health of individuals and their communities as a whole.  

In accordance with Section 31-116 of the Insurance Article of the Annotated Code of Maryland, the Maryland Benchmark Plan sold on the Maryland health insurance Marketplace must include "delivery of benefits through patient centered medical homes for individuals with chronic conditions, serious illnesses or complex health care needs who agree to participate in a patient centered medical home program."
 

CHIPRA: 
Yes
MAPCP: 
No
Dual Eligible: 
No
2703 Health Home: 
Yes
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
Yes
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
5,945,000
Uninsured Population:
10%
Total Medicaid Spending FY 2013: 
$7.8 Billion 
Overweight/Obese Adults:
64.1%
Poor Mental Health among Adults: 
33.0%
Medicaid Expansion: 
Yes 

Mary's Center - Riggs Rd

Practice Type: 
FQHC
Multispecialty practice
Not-for-profit practice
Practice Setting: 
Urban
Practice Address: 
8908 Riggs Rd
Adelphi, MD 20783

Mary's Center - Flower Ave

Practice Type: 
FQHC
Multispecialty practice
Not-for-profit practice
Practice Setting: 
Urban
Practice Address: 
8709 Flower Ave
Silver Spring, MD 20901

CMS Comprehensive Primary Care Plus (CPC+)

Comprehensive Primary Care Plus (CPC+) is a national advanced primary care medical home model that aims to strengthen primary care through a regionally-based multi-payer payment reform and care delivery transformation. CPC+ will include two primary care practice tracks with incrementally advanced care delivery requirements and payment options to meet the diverse needs of primary care practices in the United States (U.S.).

Event To Highlight Successes, Challenges Of Transforming Delivery Of Care For Underserved

on Mon, 2016-04-11 00:00   lisabeth

CareFirst BlueCross BlueShield's (CareFirst) four-year investment in patient-centered medical home (PCMH) programs operated by 11 safety net health centers helped improve care for more than 68,000 low-income and chronically ill patients throughout Maryland, Northern Virginia and Washington, D.C. However, challenges related to staffing, information technology infrastructure and other key areas can adversely affect the implementation of comprehensive PCMH models in safety net settings.

Story Date: 
April 11, 2016
Source Link: 
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Maryland hospitals show cost, quality improvement under revamped payment model

on Thu, 2015-11-12 00:00   lisabeth

Maryland's Medicare patients are among the most costly in the nation and are more likely than those in many states to return to the hospital soon after leaving. That could be changing as Maryland adopts a new payment model under a special agreement with the CMS. 

Story Date: 
November 12, 2015
News Author: 
Melanie Evans
Source Link: 
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In Maryland, A Change In How Hospitals Are Paid Boosts Public Health

on Fri, 2015-10-23 00:00   lisabeth

Think for a moment about what would happen if you upended the whole system of financial incentives for hospitals.

What if you said goodbye to what's known as fee-for-service, where hospitals are paid for each procedure, each visit to the emergency room, each overnight stay? What if, instead, hospitals got a fixed pot of money for the whole year, no matter how many people came through the door?

Story Date: 
October 23, 2015
News Author: 
Audie Cornish
Andrea Hsu
Source Link: 
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Transforming Clinical Practices Initiative (TCPI)

The Transforming Clinical Practice Initiative is designed to help clinicians achieve large-scale health transformation. The initiative is designed to support more than 140,000 clinician practices over the next four years in sharing, adapting and further developing their comprehensive quality improvement strategies. The initiative is one part of a strategy advanced by the Affordable Care Act to strengthen the quality of patient care and spend health care dollars more wisely. It aligns with the criteria for innovative models set forth in the Affordable Care Act:

CareFirst finds savings in 'patient-centered medical home' model

on Thu, 2015-07-30 00:00   lisabeth

A program launched in 2011 by the state's largest health insurer to better coordinate patient care has slowed its overall pace of spending, avoiding millions in costs for the health system and the insured, CareFirst Blue Cross BlueShield reported Thursday.

The idea behind the so-called patient-centered medical home model is to keep people, particularly those with chronic medical conditions, healthy and not in need of expensive interventions. CareFirst was among the early adopters, though many insurers and health systems have launched programs in Maryland and around the country.

Story Date: 
July 30, 2015
News Author: 
Meredith Cohn
Source Link: 
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Quality Remains Strong as Cost Increases Slow Dramatically for Members in Patient-Centered Medical Home Program

on Thu, 2015-07-30 00:00   lisabeth

Baltimore, MD (July 30, 2015) - In its fourth full year of operation, CareFirst BlueCross BlueShield’s (CareFirst) Patient-Centered Medical Home (PCMH) program continues to show dramatic impacts on overall medical spending and key health care quality indicators. Before the program’s inception in 2011, CareFirst experienced overall rates of increase in medical spending that averaged 7.5 percent annually. By 2014, the overall rate of increase slowed to 3.5 percent.

Story Date: 
July 30, 2015
Source Link: 
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Maryland Medicaid To Launch ACO-Like Model For Dual Eligibles

on Mon, 2015-07-06 00:00   lisabeth

The Maryland Department of Health and Mental Hygiene (DHMH) is planning to launch a pilot Accountable Care Organization-like model (ACO) for individuals dually-enrolled in Medicaid and Medicare who live in Baltimore City.  The Dual Eligible ACO will operate on a shared savings model with savings targets and quality of care benchmarks focused on coordination of primary, acute, and long-term care. The goal is to scale the model statewide after the pilot outcomes are analyzed.

Story Date: 
July 6, 2015
Source Link: 
Read More

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