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Maryland Total Cost of Care Model

Maryland Total Cost of Care Model

Maryland Total Cost of Care ModelThe Maryland Total Cost of Care Model builds on the success of the Maryland All-Payer Model by creating greater incentives for health care providers to coordinate with each other and provide patient-centered care, and by committing the State to a sustainable growth rate in per capita total cost of care spending for Medicare beneficiaries.

The TCOC Model includes three programs:

  1. The Hospital Payment Programtests population-based payments for Maryland hospitals. In Maryland’s Hospital Payment Program, each hospital receives a population-based payment amount to cover all hospital services provided during the course of the year. The Hospital Payment Program creates a financial incentive for hospitals to provide value-based care and to reduce the number of unnecessary hospitalizations, including readmissions.
  2. The Care Redesign Program (CRP)allows hospitals to make incentive payments to nonhospital health care providers who partner and collaborate with the hospital and perform care redesign activities aimed at improving quality of care. A participating hospital may only make incentive payments if it has attained certain savings under its fixed global budget and the total amount of incentive payment made cannot exceed such savings. Thus, the CRP and distribution of incentive payments under the program does not increase overall Medicare expenditures. In order to participate in the CRP, a hospital must enter into a CRP participation agreement with CMS and the State.
  3. The Maryland Primary Care Program (MDPCP) is structured to incentivize primary care providers in Maryland to offer advanced primary care services to their patients. Participating practices will receive an additional per beneficiary per month payment directly from CMS intended to cover care management services. The MDPCP also offers a performance-based incentive payment to health care providers intended to incentivize them to reduce the hospitalization rate and improve the quality of care for their attributed Medicare beneficiaries, among other quality and utilization-focused improvements.