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Progress report on Maryland’s healthcare-transformation program


Tidal marshes on the Chesapeake Bay, Maryland’s most notable natural feature.

Here’s a  update from  Carmela Coyle,  president and CEO of the Maryland Hospital Association, on Maryland’s nationally watched five-year partnership with the Center for Medicare & Medicaid Innovation to see the effectiveness/outcomes from shifting hospitals’ focus toward preventive, community-based care from  acute emergency care, surgeries and inpatient stays. The goal are to control cost growth  and to help people get and stay healthy, before they need a hospital visit.

Ms. Coyle writes:

 “This {program} was a 180-degree turn from the traditional hospital business model and from the way things are done just about everywhere else in the country. No longer would hospitals be paid based on how many patients they treated or services they provided, but rather on making sure that people receive the right care, at the right time, in the right setting.”

Last month the experiment reached its midpoint. Ms. Coyle listed some outcomes so far:

  • “Readmissions rates are decreasing faster than the national rate
  • “Hospital-acquired conditions are down by more than one third
  • “Avoidable hospital visits are down more than 17 percent

“Much of this has been accomplished through innovative, non-traditional hospital activities like the Maryland Faith Health Network, a pilot program that connects hospitals with churches, synagogues, temples and other faith organizations to improve their congregants’ well-being and ability to navigate the system. Other examples:

  • “A free program that connects people who have complex health issues with a health navigator–a registered nurse or licensed social worker who provides one-on-one guidance and care coordination.
  • “Care A Van,” a large RV that transports a social worker and medical staff, who provide free health screenings, help with Medicaid applications, immunizations and more for uninsured children and their families with no regular source of medical care.
  • “Wholesome Wave, which provides a “prescription” for healthy foods for underinsured and uninsured diabetic patients. Vendors at local farmers markets accept these ‘prescriptions’ and provide healthy food at a reduced cost.”

“For the most part, these programs and others like them were conceived and implemented by hospital staff and leaders. While the initiatives have generated strong results, consumers have been largely unaware of these seismic changes, or what they mean for navigating the rapidly changing world of healthcare.’

“Enter a new statewide public engagement campaign, launched in late June, to connect healthcare consumers to this transformation through their local hospitals. The campaign, ‘A Breath of Fresh Care,’ features several health- engagement tools for Marylanders who would like to know more about how healthcare is changing and about how they can partner with healthcare providers to take a more active role in staying healthy before they need care, being empowered during care and remaining healthy after care.”

To read all of her comments, please hit this link.

Md. hospitals launch patient-engagement campaign


The Baltimore Sun reports on how hospitals in Maryland, as in many other places, are changing  how they deliver care, “focusing more on coordinating services and preventing complications.” And they’re launching a campaign to explain the new approach to the public.

“Called ‘A Breath of Fresh Care,’ the campaign’s goal is to get patients to engage in their care by directing them to hospital wellness and chronic-disease management initiatives, as well as information on interacting with providers or even the process of registering a complaint,” the paper reports.

So the Maryland Hospital Association has set up a Web site called with links to individual hospitals’ Web sites. And public-education forums will start in the fall.

“Healthcare in Maryland, is evolving by leaps and bounds; gone are the days when consumers sat on the sidelines, detached from their care,” said Carmela Coyle, association president and CEO. “Healthcare in the 21st Century is about patients; hospitals and other providers are looking to their patients and communities like never before as partners in health. Simply put, to enable Marylanders to lead long, healthy lives, we need their help.”

To read The Sun’s story, please hit this link.

Baltimore hospital chief touts population health


Sinai Hospital in Baltimore.

In an interview with The Baltimore SunSinai Hospital President Amy Perry talks about how she ushered in a new age of population health in that city.

One example she gave was  a patient who would show up often in the emergency room with complications from diabetes. She couldn’t make regular visits to primary-care physician to manage her condition because she couldn’t get out of her apartment.  So Sinai Patient navigators  helped her  find a ground-floor apartment.

“We are working with our patients to solve basic problems,” Perry told the newspaper. “We are trying to be our patients’ advocates way beyond health care.”

“What we have found is that population health has a lot more to do with jobs, violence, prevention, education and other factors than it has to do with traditional medicine,” she said.

The paper noted that “For years, the business model for hospitals meant they made money based on how many patients they saw and how sick they were.”

“Maryland is moving away from this way of doing business faster than any other state because of a special agreement with the federal government that gives it a higher Medicaid reimbursement in exchange for better controlling cost growth. But that means hospitals are given a budget each year to serve their patient population.”

“The changes are good for the hospital industry, Ms. Perry said, but nursing homes, doctors and others outside hospitals need to be similarly regulated.”

Will other states follow Maryland’s hospital-payment reforms?


In 2014, Maryland started to regulate hospital spending after nearly four decades of setting hospital prices for all payers, public and private.

“The state started setting hospital rates for private payers in 1974 and three years later won permission from the federal government to also set rates under Medicare and Medicaid. Maryland policymakers say that move has erased the cost-shifting that most U.S. hospitals rely on to make up for low rates from public payers,” Modern Healthcare reported.

“Although the all-payer model allowed Maryland to significantly reduce its costs per admission, growth in the volume of admissions undermined its broader success in holding down spending.”

“So in 2014, Maryland agreed to set a budget for each hospital for all patients. The budget includes payment from every insurer. The state also promised that the budget would not grow faster than the state economy each year. A commission tracks hospital bills, hospital prices and patient volume. It also makes complex adjustments to account for very sick patients, transfers between hospitals, flu outbreaks and other factors that can increase or decrease demand for hospital services,”  the publication reported.

But do other states have the political will to make such dramatic changes?

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