There’s no denying that healthcare costs can stack up, often going far beyond what most people can afford even if they are covered by insurance. But a value-based care approach to patient care delivery can change all of that, saving people on their healthcare costs and providing them with the kind of attention they need to achieve better overall wellness. Studies even show that this is the case here in the state of Maryland, where Care Transformation Organizations (CTOs) are partnering with primary care practices to improve healthcare outcomes for Medicare beneficiaries. This has been a statewide success in Maryland, and soon we hope to see it be a reality all across the country.
The Maryland All-Payer Model (MD-APM)
The Maryland All-Payer Model (MD-APM) evens out payments across private and public payers. If you go to a hospital for total knee replacement surgery, you should be charged the exact same fee that another person would be charged within the same hospital. There would be a standard cost for all care procedures, regardless of the insurance type of the person doing the surgery. While this is the case in Maryland, it’s not the case for other states, and this is how insurance companies make money. But Maryland decided to say, “Let’s negotiate better prices for our patients.” This all-payer model that Maryland instated was able to save the state of Maryland about $1.74 billion in healthcare costs based on a study of the program that ran from 2014 to 2018.
Total Cost of Care
The All-Payer Model focused on a rate-setting system for hospital services that aimed to improve patients’ health and reduce costs. You might ask “What about the primary care sector?” Studies have shown that investing in primary care, prevents the onset or progression of chronic illness and conditions that will require a higher acuity or level of care of hospital services. Maryland has yet again made a pivotal decision to shift to the Total Cost of Care Model. What we are doing innovatively in this area is to make sure that the total cost of care is reduced by doing the right thing.
Total Cost of Care includes our state’s primary care program, and it asks how we’re trying to improve primary care in the state. The driver for much of this has been Medicare, Medicaid, and other programs through the federal government. They have the power to change policy and fund innovation. It’s about seeing how we can better reduce costs by controlling supply and demand.
The Maryland Primary Care Program
In a typical model, you go to your primary care provider as your first stop, and the primary care doctor will diagnose you, prescribe medications that you get from the pharmacy, order labs, and also refer you to a specialist, who then treats you further and may refer you yet again. You can see how the money/cost adds up. The Maryland Primary Care Program aims to create a way we can provide primary care practice with more resources and then hold primary care practices accountable by making sure that all aspects of comprehensive primary care of a patient are under their supervision. This is important because the primary care physician is more engaged with the patient.
Care Transformation Organizations
When you, as a practice, work with a CTO, the CTO is supposed to secure more resources, whether that’s an additional nurse, an additional community health worker, a social worker, an additional analyst, a project manager, or any administrative support. Whatever the case is, the CTO hires an extended care team to help do the work to get the help that’s needed both inside and outside of the doctor’s office. Once you, as the patient, see a doctor, your extended care team is also assigned to support you every step of the way. They will ensure you get your meds, have access to healthy food, and can get education on your chronic condition such as diabetes, or anything else you need to achieve better health and avoid having to prematurely go back to the doctor or hospital in the future. You have a care team who is there to pay attention and support you!
As a leading care transformation organization in the state of Maryland, Medicalincs is on a mission to expand this success nationwide. We leverage our care transformation expertise and successful best practices to also support D.C. and MassHealth Medicaid beneficiaries to improve health care outcomes. We are excited to be forerunners in transforming care delivery nationally, and we stay encouraged to continue the good work.