Maryland’s Total Cost of Care Model

Update for P​roviders

Maryland Model Designation as an Advanced Alternative Payment Model

In order to better align incentives and drive provider participation under the Maryland All-Payer Model (Model), the State negotiated an amendment to the current Model with the Centers for Medicare & Medicaid Services (CMS). This amendment makes changes necessary to qualify the Model as an Advanced Alternative Payment Model (AAPM) under CMS’ Quality Payment Program (QPP) established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Providers who participate in Maryland’s Care Redesign Programs are now eligible for an incentive payment from the federal government beginning in 2018.  For more information please consult the CMS QPP website here​, or view the Amendment 2 to the Maryland All-Payer Model Agreement here
Beginning in January 2019, the State will implement its Total Cost of Care Model, which has also been approved by CMS to qualify as an AAPM. Providers who continue to participate in the Care Redesign Program, begin participating in new tracks under the Care Redesign Program or in the Maryland Primary Care Program (MDPCP) will also be eligible for MACRA incentive payments. ​

​TCOC Model Overview​

Improving Marylanders’ Health and Quality of Life

The State of Maryland is committed to ensuring that all Marylanders have access to the nation’s best health care and that our critical health needs are met.  Our priorities:

       Ensure that all Marylanders have access to quality health care by the nation’s best health care providers in every corner of the state – whether rural or urban.

       Address the needs of our senior population, which is expected to increase by 40% over the next ten years.

       Fight the opioid epidemic and other population health improvements such as diabetes prevention and other chronic conditions.

Addressing Health System Limitations

Maryland’s current approach to hospital payment is known as the “Maryland All-Payer Medicare Model Contract,” and runs from January 1, 2014 through December 31, 2018.  The All-Payer Model’s success metrics are based on enhancing quality, improving health outcomes, and constraining the growth of Medicare costs for hospital inpatient and outpatient services. 

Since 2014, Maryland’s hospitals have successfully reduced unnecessary readmissions and hospital-acquired conditions, while decreasing the growth in hospital cost per capita.  However, the current approach focused on hospitals does not sufficiently provide for comprehensive coordination across the entire health care system.  Because of this limitation, the federal government required Maryland to develop a new model that encompasses all of the health care that patients receive, both inside the hospital and the community.  The Progression Plan served as the blueprint for this Model development, known as the “Total Cost of Care Model”.  On July 9, 2018, Maryland and the federal government signed the Total Cost of Care Model State Agreement, which will be effective January 1, 2019.

​​Key Elements of the Total Cost of Care Model
To achieve a patient-centered system, the Total Cost of Care Model includes the following key elements:

    Care will be coordinated across both hospital and non-hospital settings, including mental health and long term care.

    The Model will invest resources in patient-centered care teams and primary care enhancements. 

    Maryland will set a range of quality and care improvement goals.  Providers will be paid more when patient outcomes are better.

    Maryland will set a range of population health goals addressing opioid use and deaths, diabetes, and other chronic conditions.

    State flexibility will facilitate programs centered on the unique needs of Marylanders, the provider community, geographic settings, and other key demographics.  

As part of the federal agreement to put the new Total Cost of Care Model in place, all-payer hospital cost growth will continue to be limited to 3.58% per capita, a limit that was set in 2014 based on long term growth in Maryland’s economy.  As part of this Model, Maryland commits to saving $300 million in annual, total Medicare spending by the end of 2023. The Medicare savings required in the TCOC All-Payer Model will build off of the ongoing work of Maryland stakeholders, which began in 2014. 

Next Steps and Opportunities for Engagement

The State of ​Maryland remains committed to a robust process for input and feedback during the implementation of the TCOC Model.  Maryland stakeholders will continue to provide feedback through participation in workgroups, councils, and provider-led innovation groups. 

 Additional information is available in the following resources and the list of documents below:

    A brief background and summary​ of the Total Cost of Care Model with key requirements;

    Announced Terms of the TCOC Model; ​

    Stakeholder engagement through HSCRC and MDH workgroups​; ​

    All-Payer Model Performance, through 2018 Year-to-Date Results​​​​; and

    Maryland Primary Care Program​

For additional information or to seek clarification on the Total Cost of Care Model, please send an email to the HSCRC staff at hscrc.all-payermodel@maryland.gov​.


 Key Documents