The healthcare landscape is constantly evolving, with a growing emphasis on value-based care and cost containment. One significant initiative in this area is the Maryland Total Cost of Care (TCOC) Model. But What Is Ost Of Care Program in this context? This article delves into the details of the Maryland TCOC Model, explaining its purpose, components, and impact on healthcare delivery.
Background of the Maryland TCOC Model
In many states across the U.S., healthcare costs can vary significantly for the same medical procedure, depending on the hospital and payer. Furthermore, there’s often a lack of coordination between different healthcare services, such as hospitals and primary care providers. These inefficiencies can negatively affect patient experiences and health outcomes.
To address these challenges, the Centers for Medicare & Medicaid Services (CMS) partnered with the state of Maryland to develop and test the Maryland Total Cost of Care (TCOC) Model. This model builds upon the foundation of the earlier Maryland All-Payer Model, which was launched in 2014 and focused on setting global budgets for hospitals to control Medicare expenditures. The All-Payer Model successfully reduced hospital costs and improved care quality in Maryland.
However, the All-Payer Model primarily targeted hospital settings. To achieve more comprehensive and sustainable cost savings and quality improvements, the Maryland TCOC Model was created. It expands the scope beyond hospitals to include a broader range of healthcare providers and aims for better coordination of care across the entire healthcare spectrum.
Maryland Total Cost of Care Model Coverage Map: Illustrating the statewide implementation of the TCOC model in Maryland, aiming to improve healthcare delivery and cost efficiency.
Key Features of the TCOC Model
The Maryland TCOC Model is designed to achieve significant savings for Medicare while enhancing the quality of care for beneficiaries. It sets a per capita limit on the total cost of care for Medicare beneficiaries in Maryland, making the state accountable for managing healthcare expenditures. The model aims to save Medicare over $1 billion by the end of 2023 and encourages participation from various non-hospital healthcare providers.
The TCOC Model operates through three main programs:
1. Hospital Payment Program
This program is central to the TCOC Model and tests population-based payments for Maryland hospitals. Instead of traditional fee-for-service models, each hospital in Maryland receives a predetermined population-based payment to cover all hospital services throughout the year.
This approach creates a strong financial incentive for hospitals to deliver value-based care. Hospitals are encouraged to reduce unnecessary hospitalizations, including readmissions, and to focus on preventive care to manage population health effectively within their allocated budget.
2. Care Redesign Program (CRP)
The Care Redesign Program (CRP) is designed to foster collaboration between hospitals and non-hospital healthcare providers. It allows hospitals to share savings achieved under their global budgets with partnering non-hospital providers who engage in care redesign activities to improve care quality.
Participating hospitals can make incentive payments to these partners, but only if they have realized savings under their global budget. The total incentive payments are capped by these savings, ensuring that the CRP does not increase overall Medicare spending. Hospitals must enter into a CRP participation agreement with CMS and the State to participate.
3. Maryland Primary Care Program (MDPCP)
Recognizing the crucial role of primary care, the Maryland Primary Care Program (MDPCP) incentivizes primary care practices and Federally Qualified Health Centers (FQHCs) in Maryland to offer advanced primary care services.
Participating practices and FQHCs receive a per beneficiary per month payment directly from CMS to support care management services. The MDPCP has evolved through different tracks. Track 3, introduced in January 2023, is a significant step, as it introduces upside and downside financial risk for participating primary care practices based on their performance on cost and quality metrics. This track is modeled after the Primary Care First (PCF) Model. Care Transformation Organizations (CTOs) also receive payments to support practices in meeting care transformation goals.
Outcomes-Based Credits and Model Performance
The TCOC Model also incorporates an Outcomes-Based Credits framework. This allows CMS to reward Maryland for achieving improvements in population health. The state selects population health measures and targets, which are then approved by CMS. Maryland can earn credits based on its performance against these targets, effectively reducing the state’s actual total cost of care when evaluating performance against savings goals.
For example, in 2019, Maryland’s first Outcomes-Based Credit focused on diabetes prevention. These credits are calculated based on the return on investment (ROI) that Medicare anticipates from the state’s progress in these population health areas.
The TCOC Model’s performance period started in January 2019 and extends to December 31, 2026. Looking ahead, CMS and Maryland will decide whether to expand the model, implement a new model, or revert to the national prospective payment systems after the current model period concludes.
For further inquiries about the Maryland Total Cost of Care Model, individuals can contact the dedicated email address: [email protected].
Conclusion
The Maryland Total Cost of Care Model represents a significant effort to transform healthcare delivery by focusing on cost containment, care coordination, and quality improvement. By setting a total cost of care limit and implementing innovative programs like the Hospital Payment Program, CRP, and MDPCP, Maryland is striving to create a more efficient and patient-centered healthcare system. Understanding what is ost of care program through initiatives like the Maryland TCOC Model is crucial for navigating the future of healthcare and ensuring sustainable, high-quality care for all.
