TCOC Model Overview
Marylanders’ Health and Quality of Life
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:
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.
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.
Health System Limitations
Maryland’s most recent approach to hospital payment was known as
the “Maryland All-Payer Medicare Model Contract,” and ran from January 1, 2014
through December 31, 2018. The All-Payer
Model’s success metrics were based on enhancing quality, improving health
outcomes, and constraining the growth of Medicare costs for hospital inpatient
and outpatient services.
During the All-Payer Model, Maryland’s hospitals successfully reduced
unnecessary readmissions and hospital-acquired conditions, while decreasing the
growth in hospital cost per capita.
However, the approach under the All-Payer Model focused on hospitals and did 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. On July 9, 2018, Maryland and the
federal government signed the Total Cost of Care Model State Agreement, which became effective January 1, 2019.
Key Elements of the Total Cost
of Care ModelTo 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 hospital quality, care transformation, and population health
goals as part of the Statewide Integrated Health Improvement Strategy.
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 continues 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.
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
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 firstname.lastname@example.org.