Maryland: The first state CMS will hold fully at risk for total healthcare costs

CMS' Innovation Center revealed June 8 that Maryland will become the first state fully at risk for the total cost of healthcare for Medicare beneficiaries.

Here are five things to know about the Maryland Total Cost of Care Model:

1. The model sets a per capita limit on the total cost of care Medicare beneficiaries receive in Maryland. It is founded on Maryland's current all-payer model, launched in 2014, which limits the state's per capita hospital expenses.

2, The performance period of the TCOC Model begins Jan. 1, 2019, and runs through Dec. 31, 2026.

3. The Maryland TCOC Model aims to save $1 billion-plus on Medicare beneficiaries' care by the end of 2023, the model's fifth performance year.

4. Three programs will operate under the TCOC Model:

  • The Hospital Payment Program, which will test population-based payments for Maryland hospitals. Each hospital will get a population-based payment to cover all hospital services within a year
  • The Care Redesign Program, which will allow hospitals to make incentive payments to partnering providers outside of the hospital
  • The Maryland Primary Care Program, which aims to incentivize primary care providers to offer advanced primary care services in return for additional monthly per beneficiary payments from CMS

5. Maryland will choose its own measures and targets it wants to hit across six population health areas. The measures require CMS approval.

Find more information on the Maryland TCOC Model here.

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