​​Maryland's Care Redesign Amendment to the All-Payer Model

In response to Maryland stakeholders' requests for greater provider alignment and transformation tools under the All-Payer Model, the State proposed a Care Redesign Amendment ("Amendment") to the All-Payer Model Agreement.  The Amendment aims to modify the All-Payer Model by supporting:
  • Effective care management and population health activities
  • Improvement in care for high and rising risk populations
  • Efforts to provide high quality, efficient, well-coordinated episodes of care
  • Hospitals and their Care Partners in monitoring and controlling Medicare beneficiaries' Total Cost of Care (TCOC) growth 
  • The next steps toward delivery system transformation

As of January 30, 20​18 eighteen hospitals are participating in Care Redesign Programs.

Hospital Care Improvement Plan (HCIP) Complex and Chronic Care
Improvement Program (CCIP)
Anne Arundel Medical Center
Atlantic General Hospital
Carroll Hospital
Doctors Community Hospital
Frederick Memorial Hospital
Holy Cross Hospital
Holy Cross Hospital - Germantown
Mercy Medical Center
Meritus Medical Center
Northwest Hospital
Peninsula Regional Medical Center
Shady Grove ​Medical Center
Sinai Hospital
Washington Adventist Hospital
Western Maryland Health System
Carroll Hospital
Garrett Regional Medical Center
Greater Baltimore Medical Center (GBMC)
Northwest Hospital
Shady Grove ​Medical Center
Sinai Hospital
St. Agnes Hospital
Washington Adventist Hospital​

Care Redesign Programs
The Amendment proposes two voluntary, hospital-led programs, which align hospitals and their Care Partners through common goals and incentives.  The Hospital Care Improvement Program (HCIP) and Complex and Chronic Care Improvement Program (CCIP).

Key Care Redesign Documents and Information

Hospital Care Improvement Program (HCIP)

The HCIP will be implemented by Participant Hospitals and hospital-based providers.  The HCIP aims to:
  • Improve inpatient medical and surgical care delivery
  • Provide effective transitions of care
  • Ensure an effective delivery of care during acute care events, beyond hospital walls
  • Encourage the effective management of inpatient resources
  • Reduced potentially avoidable utilization with a byproduct of reduced cost per acute care event

Examples of categories of care redesign interventions in the HCIP include:  care coordination, discharge planning, clinical care, patient safety, patient and caregiver experience, population health, and efficiency and cost reduction.  Care Partners who choose to participate may receive incentive payments based on reducing internal costs through a reduction in unnecessary utilization and resources, efficient practice patterns, and improved quality.

Complex and Chronic Care Improvement Program (CCIP)

The CCIP will be implemented by Participant Hospitals and community providers and practitioners.  The CCIP aims to:
  • Strengthen primary care supports for complex and chronic patients in order to reduce avoidable hospital utilization
  • Enhance care management through tools such as effective risk stratification, health risk assessments, and patient-driven care profiles and plans
  • Facilitate overall practice transformation towards person-centered care that produced improved outcomes and meets or exceed quality standards.

Examples of categories of Care Redesign Interventions in the CCIP include: care management, workforce capacity development, and health information technologies. In the CCIP, Participant Hospitals deploy care management resources and technology that align and support community-providers who work with the Participant Hospital. Care Partners who choose to participate will have access to care management tools and resources targeted to high utilizer and rising risk patients that will support implementation of care plans, provide care coordination, and help manage care transitions. Participation in the CCIP is also tailored to leverage the Medicare Chronic Care Management (CCM) fee. Care Partners who choose to participate may receive incentive payments from hospitals based on defined activities that improve quality of care and reduce potentially avoidable utilization of hospitals.​

CCIP Implementation Outline - Provides a step-by-step guide to implementation of CCIP at your hospital.  This user-friendly resource pulls requirements from draft legal documents and the draft program template to help hospitals determine readiness and additional steps needed to implement the CCIP.

CCIP Modeling Tool - Models the financial impacts of assumptions regarding patient enrollment and PAU savings.  To access the tool, click on the CCIP icon from the CRISP Tableau Reporting Portal.  Contact support@crisphealth.org if you do not have portal access.

CCIP Budget Calculator​ - Budget simulator intends to aid hospitals in identifying reasonable estimates of costs associated with implementing the CCIP program.  Costs will vary among hospitals based on the extent to which hospitals have already begun making investments​ in care coordination and care management resources and the scale of the program. 

​Date ​Webinar​​ ​​Materials
10/21/2016 ​All-Payer Model Amendment Webinar 1:  Amendment Overview and Implementation of Care Redesign Webinar 1​
​10/25/2016 ​All-Payer Model Amendment Webinar 2:  Care Partner Approval Process Webinar 2
11/2/2016​ ​All-Payer Model Amendment Webinar 3:  Complex and Chronic Care Improvement Program (CCIP) Webinar 3
11/18/2016​ ​All-Payer Model Amendment Webinar 4:  Hospital Care Improvement Program (HCIP) ​Webinar 4
​11/30/2016 ​All-Payer Model Amendment Webinar 5:  Comprehensive Medicare Data Process and Use Webinar 5
​1/13/2017 ​All-Payer Model Amendment Webinar 6:  Q&A on CCIP and HCIP Program Templates and Implementation Protocols Webinar 6​