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Maryland and CMS advance Total Cost of Care Model and Maryland Primary Care Program with amendment, MOU
Changes will hold primary care practices financially accountable, continue Medicare cost savings and add increased payments to help disadvantaged residents
Baltimore, MD – The Maryland Department of Health (MDH) today announced advancements to the Total Cost of Care Model with the Centers for Medicare and Medicaid Services (CMS) that include further financial accountability for primary care practices, new funding for disadvantaged residents, and continued commitment to reducing Medicare costs and improving the health of Marylanders.
First established in 2019, the Maryland Primary Care Program (MDPCP) is a voluntary program that provides financial and technical support to eligible Maryland primary care practices and Federally Qualified Health Centers (FQHCs) for the delivery of advanced primary care. MDPCP allows primary care providers to play an integral role in the prevention and management of chronic disease and preventing unnecessary hospital utilization. As of May 2022, 508 primary care practice locations and more than 2,150 health care providers are participating in the program, which serves more than 4 million Marylanders.
“The continuation and expansion of MDPCP means more Marylanders will have access to comprehensive primary care,” said MDH Secretary Dennis R. Schrader. “The amendment also means more support to primary care providers to bolster the state’s efforts to address health equity, including funding to address the social needs of MDPCP beneficiaries.”
The changes to the model include an amendment to the state agreement with the Center for Medicare and Medicaid Innovation (CMMI) that creates a third track within MDPCP. In Tracks 1 and 2, CMS offers a performance-based incentive payment to health care providers intended to incentivize them to reduce rates of hospital admissions and to improve the quality of care for their attributed Medicare beneficiaries. Track 3 will commence in 2023 and will meet the request from the CMMI to increase financial accountability for primary care practices and to further align with national priorities. The amendment also includes opportunities for FQHCs to participate in Track 1 and Track 2.
“I applaud the hard work of the Hogan administration with the federal government to get the program approved for a new track that allows for continued participation of Federally Qualified Health Centers, dedicated payments to practices to address health equity, and consistent levels of funding for advanced primary care,” Gene Ransom, CEO of MedChi, said. “Improving and expanding this important program will improve Maryland Medicare patients’ lives and quality of healthcare.”
The amendment also includes the addition of a new Health Equity Advancement Resource and Transformation (HEART) payment to support residents and to promote the state and CMS’ goal of improving the health of all Marylanders. This money can help pay for health-related support or access to food and nutrition care-management services, among other needs for those that qualify.
“We’re pleased to see MDPCP advancing in a way that boosts incentives for primary care practitioners to manage their patients’ care,” said Bob Atlas, president and CEO of the Maryland Hospital Association. “The hospital field fully supports the state’s efforts to evolve the model to improve quality, population health, and equity.”
CMMI and the state have reinforced their mutual support for the Maryland model by executing a memorandum of understanding specifying savings targets under the Total Cost of Care Model for 2024 through 2026, as well as important population health, quality, and health equity goals.
Under the MOU, Maryland will generate savings for Medicare of $336 million in 2024, $372 million in 2025, and $408 million in 2026. The MOU also affirms the state's commitment to continued improvements in hospital quality performance, population health, and health equity in 2023 and 2026 and to the alignment of Medicaid with MDPCP. The state looks forward to working with partners throughout the state, including hospitals and physicians, to continue to improve health care for Marylanders.
“The state is committed to advancing population health, health equity, and improved quality under the TCOC Model, while reducing the cost of care and delivering savings to all payers,” said Katie Wunderlich, Executive Director of the Maryland Health Services Cost Review. “The state and CMMI continue to partner for the success of the model and for improved outcomes for Marylanders."
The amendment and MOU can be found here. More information on MDPCP can be found here.
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