IT WAS FUNNY HEARING BEN CARDIN SPEAKING OF HIS REELECTION AND CLEAN CAMPAIGN. HE SAID 'THE PUBLIC HAS TOLD US TO GET DOWN TO WORK AND COMPROMISE WITH REPUBLICANS'......HE IS A REPUBLICAN, MY GOODNESS. EDUCATION REFORM IS REPUBLICAN, DOMESTIC AND FOREIGN POLICY IS REPUBLICAN, CORPORATE TAX AND PUBLIC PRIVATE PARTNERSHIPS ARE REPUBLICAN, AND THIS HEALTH CARE REFORM IS REPUBLICAN......
THE QUESTION IS......WHEN ARE MARYLAND'S POLS GOING TO BE DEMOCRATS!!!!
Whether you look at Enterprise Zones that turn out to look like the Finance Ministry in Brussels as with EBDI, Benefit Corps that give corporations the right to donate money with no transparency unlike the B corps they mimick, and now Health Enterprise Zones that pretend to build healthy community networks for the underserved as they marginalize future care for the poor and elderly.......ALL OF THESE POLICIES ARE AN ASSAULT ON THE MIDDLE/LOWER CLASS TO THE BENEFIT OF THE RICH. BALTIMORE AND MARYLAND IS AWASH WITH THESE POLICIES BECAUSE WE FAIL TO:
VOTE OUR INCUMBENTS OUT OF OFFICE!
Let's be clear that when they say people are covered by health insurance they are failing to say that access will be severely cut. It's like the push for people having college degrees at the same time they are making colleges into 'career-job training' programs. These Maryland pols are lowering the quality of all public services in order to increase profitability. Don't forget, corporations need the tax revenue you and I pay to subsidize their bottom lines.
Those thinking the poor can do without had better know that it is coming to the middle-class, just as these vocational charter schools replacing public education will.
Whether O'Malley, Brown, Rawlings-Blake and all the state and city pols.......they are all working to take your quality of life away so corporations can make more profits! Do you hear them shouting against this usurp of health care?
Coordinating care with the goal of excellence and convenience is a good thing. That is not what is happening.
Medicare recipients to get more coordinated care Federal health law program aims to bring better coordinated care to Medicare recipients
By Meredith Cohn, The Baltimore Sun 3:38 p.m. EDT, July 9, 2012
Four doctor groups across Maryland have been chosen by the federal Department of Health and Human Services for a program that aims to cut health costs and better coordinate care for Medicare recipients.
The program named 89 new groups in 40 states to become Accountable Care Organizations under the federal health care reform law. That brings the total already signed up for the voluntary program to 154, according to federal health officials.
The groups share in savings realized through the more coordinated care. Officials estimate the total savings to the federal Medicare program could be up to $940 million over four years.
There are 33 quality measures developed for the organizations related to care coordination, patient safety, preventive health services, patient experience and care for at-risk populations.
In Maryland, the doctor groups include: Accountable Care Coalition of Maryland LLC, located in Hollywood with 109 physicians; Greater Baltimore Health Alliance Physicians LLC, affiliated with Greater Baltimore Medical Center with 399 physicians; Maryland Accountable Care Organization of Eastern Shore LLC with 15 physicians; and Maryland Accountable Care Organization of Western MD LLC with 23 physicians.
Meredith.cohn@baltsun.com
__________________________________________________
BELOW YOU NOTICE TWO THINGS: MARYLAND HAS ASKED A TEAM OF PRIVATE PRACTICE HEALTH PROFESSIONALS TO FIND SAVINGS IN CARE FOR SENIORS AND IT SPEAKS TO FEE-FOR-SERVICE BENEFICIARIES...THAT YOU AND I. SO, THE FEDERAL AND STATE GOVERNMENTS CUT MEDICARE SPENDING BY HUNDREDS OF BILLIONS AND THESE PROFESSIONALS ARE ASSIGNED TO FIGURE OUT HOW THEY WILL KEEP THEIR PROFITS WITH LESS MONEY COMING TO THEM.
FEE-FOR-SERVICE WAS IDENTIFIED AS THE MAIN DRIVER OF HEALTH COSTS FOLLOWED BY FRAUD AND WASTE BY ALL GOVERNMENT ACCOUNTABILITY ORGANIZATIONS. REFORMING HEALTH CARE WOULD HAVE BEEN ALL ABOUT ENDING THE PRACTICE OF FEE-FOR-SERVICE. HERE IN MARYLAND, YOUR INCUMBENT HAS SAID 'WHAT? STOP THE INFLATED BILLS THAT MAKE DOCTORS WEALTHY? NO WAY'. WE'LL JUST CUT ACCESS AND INCREASE CO-PAYS AND DEDUCTIBLES!
Greater Baltimore Health Alliance Physicians LLC To Participate As A Medicare Shared Savings Program Accountable Care Organization
Kevin Parker July 9, 2012
Greater Baltimore Health Alliance Physicians, LLC, (GBHA), a subsidiary of GBMC HealthCare (parent company of Greater Baltimore Medical Center), announced it has been selected to participate in the Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organization (ACO), a multifaceted new program sponsored by the Centers for Medicare and Medicaid Services (CMS).
Through the Shared Savings Program, GBHA will work with CMS to provide Medicare fee-for-service beneficiaries with high quality service and care, while reducing the growth in Medicare expenditures through enhanced care coordination.
____________________________________________
I SPOKE WITH EVERYONE OF JUST ONE FRAUD I HAD SOMEONE SHARE WITH ME RECENTLY.....THE PRIMARY CARE DOCTOR THAT HAS ENTITLEMENT PATIENTS COME BACK EVERY 3 MONTHS TO MONITOR VITAMIN D AND CHOLESTEROL. THIS ISN'T AN ISOLATED INCIDENT. THIS WILL BE WIDESPREAD THROUGHOUT PRIVATE PRACTICE AND THESE CHAIN DIET/NUTRITION CLINICS AND IT ALREADY SHOWS YOU THAT THIS REFORM IS NOT ABOUT CONTAINING COSTS AS MUCH AS IT IS ABOUT PROFITS. YOUR ABILITY TO ACCESS MEANINGFUL CARE LIKE HOSPITAL STAYS AND RECOVERY CENTERS WILL BE ERASED BY COST WHILE YOUR MEDICARE COVERS PRIMARY PUBLIC HEALTH CHECKUPS DONE BY NURSES AND MED STUDENTS.
THIS IS BEING DONE BECAUSE THE NUMBERS OF BABY BOOMERS AND THE EXPANSION OF MEDICAID WILL STRESS EXISTING HEALTH STAFFING AND FUNDS. MY QUESTION IS THIS.....THERE WAS ADVOCACY DECADES AGO TO SEND STUDENTS TO MEDICAL SCHOOL FOR FREE.....JUST AS THEY DO ALL OVER THE WORLD......SO THAT THERE WOULD BE ENOUGH TO HANDLE THESE STAFFING PROBLEMS. EVEN IF WE STARTED DOING THAT NOW....WE COULD HAVE A GOOD NUMBER OF DOCTORS IN A DECADE. THAT, AND THE FRAUD/WASTE WOULD SOLVE THE PROBLEM. THEY ARE NOT DOING EITHER. PATIENTS ARE STILL TO BE SENT FOR BLOOD TESTS AND XRAYS ALL THE SAME BECAUSE TECHS DO THAT WORK......THAT IS OFTEN THE WASTE....IT'S JUST THE SURGERY OR TREATMENTS THAT ARE LOOKING TO BE LIMITED. WHY NOT EDUCATE THE DOCTORS FOR FREE? IT IS A HUGE MONEY-MAKER/FREE LABOR FOR HOSPITAL/MEDICAL SCHOOLS.
THIS IS BAD PUBLIC POLICY THAT IS PROFIT OVER PEOPLE! YOUR MARYLAND INCUMBENT LIKES IT THAT WAY!
VOTE YOUR INCUMBENT OUT OF OFFICE!!!
Below our Harvard graduate State Health Commissioner is telling us how all this change is necessary in order to insure the poor. THE POOR HAVE NOTHING TO DO WITH IT. THEY ALREADY GET THIS KIND OF CARE!
LET THESE WALL STREET SUPPLIANTS KNOW THAT WE WILL REVERSE THESE REFORMS AS WE RID OURSELVES OF THESE INCUMBENTS!
Health care reform: Caring about costs, too Expanding health coverage won't be sustainable unless Maryland can reduce expenses by emphasizing primary care
By Joshua M. Sharfstein, Laura Herrera, and Charles Milligan 6:00 a.m. EDT, September 27, 2012
By establishing a health benefit exchange and expanding Medicaid coverage, Maryland is on a path to extend access to affordable health care to hundreds of thousands of individuals, families and small businesses. For our progress to be sustainable, however, the growth in health care spending must be slowed and brought into balance.
According to the Kaiser Family Foundation, health spending in 1999 averaged $3,993 per person in Maryland, about the national average. Over the next decade, however, Maryland's per capita spending rose 88 percent to $7,492 in 2009, outpacing national growth by more than $500 per person.
Greater spending on health care has led to substantial increases in the price of health insurance. A recent Commonwealth Fund study found that between 2003 and 2010, Maryland employers experienced more than a 50 percent increase in insurance premiums for family policies. To cope with rising costs, Maryland employers have shifted a larger share of monthly premiums to employees and increased the use of deductibles and copayments.
Over the last decade, health care spending has grown faster than Maryland's economy as a whole. This means that many families and companies are paying a greater percentage of their income each year for coverage. Rising costs also threaten access to care. As costs go up relative to income, more businesses decide not to offer coverage — and even when insurance is offered, more families elect not to pay the premiums and become uninsured.
Changing this trajectory is essential to Maryland's future. Families need more room to use their savings for education, retirement and other priorities; companies need relief from ever-increasing premiums to invest in such areas as training and research and development. Progress on costs is also critical for the state budget, which includes both Medicaid and the state employees' health care program.
A key root cause of high health care spending in Maryland — and across the country — is a lack of balance in our health care system. The system has provided ample reimbursement for high-tech care for complicated illness while underpaying for the primary and preventive care needed to support people in health and wellness.
Maryland's health care system has become known for providing high-quality care — but very often for conditions that could have been prevented in the first place. The RAND Corp. found that improved access to primary care could have avoided many hospital admissions in our state. The Commonwealth Fund has noted high rates of readmission to Maryland hospitals, indicating that there is considerable room for improvement in keeping patients stable after discharge.
To make progress, we will need to align the delivery and payment of health care to the goal of better outcomes; wherever possible, we must pay for the value of services, not their volume. While this shift has begun in Maryland, it must move further and faster.
A more effective and efficient health care system starts with primary care. Every Marylander should have an attentive primary care clinician who supports prevention and health and has the time and resources to help navigate through complex diagnoses and treatment. Effective primary care can reduce the number of hospital admissions for chronic illness by 25 percent or more. WHAT THEY ARE SAYING IS THIS: SENDING PEOPLE TO PRIMARY CARE IS THE CHEAPEST ROUTE FOR CARE....HOW DO WE MAKE IT SOUND LIKE A GREAT THING? JUST AS TELLING THEM STUDENTS SITTING IN FRONT OF COMPUTERS ALL DAY IS GREAT EDUCATION. SAME THING!
In recent years, primary care has been weakened by reimbursement systems that pay only for brief clinical office visits. Fortunately, new models of primary care called "medical homes" are emerging that support extra time and support for the chronically ill. The models include care teams with different types of health professionals playing important roles. Primary care practices that are medical homes can share in the savings when their patients are healthier at lower cost, with the remaining savings passed to Maryland families, businesses and taxpayers.
Such an approach has been pioneered on behalf of the state by the Maryland Health Care Commission; CareFirst BlueCross BlueShield has also implemented a promising medical home program. We will seek to build on these efforts so that all insurance companies can participate and all primary care clinicians and patients can benefit. To accelerate progress, we will use mapping technology to find "hot spots" of poor outcomes and high cost, allowing for targeting of outreach efforts and coordination with public health coalitions.
Change must also come to outpatient specialty care. As more patients face larger deductibles and co-payments, it is reasonable to expect that physician practices provide more understandable information about their cost and quality. To support better outcomes at lower costs, specialists should wherever possible be paid for a package of services (such as all care related to a knee replacement) and not individual services (such as each office visit, surgery, and re-operation on the path to a knee replacement). Working with physicians, patients, businesses and others, the Maryland Health Care Commission will explore setting standards for transparency and identify areas for creating packages of services. Maryland's Health Quality and Cost Council is planning to work with experts in the private sector to identify medical interventions that provide an especially high value to Marylanders — and suggest ways to design insurance plans that enhance access to these interventions.
Maryland's unique hospital rate-setting system has taken some important steps toward paying for value in health care. A number of rural hospitals have opted out of traditional payment-by-admission, instead accepting a set budget in advance. This novel payment structure, a "global budget," creates significant incentives to invest in community care and prevention. Many other hospitals in Maryland receive enhanced funding for certain admissions — but no reimbursement if the patient returns with 30 days. These hospitals are developing a much stronger relationship with primary care clinicians, long-term care facilities, community mental health and substance abuse treatment providers, home health agencies, and others to help patients manage their illnesses. An important next step is for these payment innovations to generate significant savings for those paying for care.
There are also opportunities to better align hospital efforts with those of community physicians and with medical homes. As spending on hospital care slows down, hospital systems will naturally expand their efforts in lower cost-settings — further supporting better outcomes at lower cost. Many of our state's hospital systems are well into this transformation. Through a modernization of the rate-setting system, Maryland can generate even more momentum and provide a model for others to follow.
Maryland's strategic initiatives will not just address costs; they will also improve health. With aligned incentives, health care organizations will be able to make the most of our nation-leading health information exchange, which allows critical medical records to be accessible at multiple points of care. We will see more partnerships with schools, local health departments, employers, and others to keep Marylanders active, tobacco-free, eating healthier, and well-immunized. We will see greater collaboration to support the care and independence of individuals with mental illness and substance use disorders. We will also see broad participation in creative approaches such as Health Enterprise Zones, which are expected to employ community health workers and others to address key causes of unacceptable health disparities.
Rebalancing health care is as important as expanding coverage. Both paths lead to the same destination of a healthier Maryland.
Dr. Joshua M. Sharfstein is secretary of the Maryland Department of Health and Mental Hygiene. His email is joshua.sharfstein@maryland.gov. Dr. Laura Herrera is the department's chief medical officer. Charles Milligan is the department's deputy secretary for health care financing at the Maryland Department of Health and Mental Hygiene.
Copyright © 2012, The Baltimore Sun
THE QUESTION IS......WHEN ARE MARYLAND'S POLS GOING TO BE DEMOCRATS!!!!
Whether you look at Enterprise Zones that turn out to look like the Finance Ministry in Brussels as with EBDI, Benefit Corps that give corporations the right to donate money with no transparency unlike the B corps they mimick, and now Health Enterprise Zones that pretend to build healthy community networks for the underserved as they marginalize future care for the poor and elderly.......ALL OF THESE POLICIES ARE AN ASSAULT ON THE MIDDLE/LOWER CLASS TO THE BENEFIT OF THE RICH. BALTIMORE AND MARYLAND IS AWASH WITH THESE POLICIES BECAUSE WE FAIL TO:
VOTE OUR INCUMBENTS OUT OF OFFICE!
Let's be clear that when they say people are covered by health insurance they are failing to say that access will be severely cut. It's like the push for people having college degrees at the same time they are making colleges into 'career-job training' programs. These Maryland pols are lowering the quality of all public services in order to increase profitability. Don't forget, corporations need the tax revenue you and I pay to subsidize their bottom lines.
Those thinking the poor can do without had better know that it is coming to the middle-class, just as these vocational charter schools replacing public education will.
Whether O'Malley, Brown, Rawlings-Blake and all the state and city pols.......they are all working to take your quality of life away so corporations can make more profits! Do you hear them shouting against this usurp of health care?
Coordinating care with the goal of excellence and convenience is a good thing. That is not what is happening.
Medicare recipients to get more coordinated care Federal health law program aims to bring better coordinated care to Medicare recipients
By Meredith Cohn, The Baltimore Sun 3:38 p.m. EDT, July 9, 2012
Four doctor groups across Maryland have been chosen by the federal Department of Health and Human Services for a program that aims to cut health costs and better coordinate care for Medicare recipients.
The program named 89 new groups in 40 states to become Accountable Care Organizations under the federal health care reform law. That brings the total already signed up for the voluntary program to 154, according to federal health officials.
The groups share in savings realized through the more coordinated care. Officials estimate the total savings to the federal Medicare program could be up to $940 million over four years.
There are 33 quality measures developed for the organizations related to care coordination, patient safety, preventive health services, patient experience and care for at-risk populations.
In Maryland, the doctor groups include: Accountable Care Coalition of Maryland LLC, located in Hollywood with 109 physicians; Greater Baltimore Health Alliance Physicians LLC, affiliated with Greater Baltimore Medical Center with 399 physicians; Maryland Accountable Care Organization of Eastern Shore LLC with 15 physicians; and Maryland Accountable Care Organization of Western MD LLC with 23 physicians.
Meredith.cohn@baltsun.com
__________________________________________________
BELOW YOU NOTICE TWO THINGS: MARYLAND HAS ASKED A TEAM OF PRIVATE PRACTICE HEALTH PROFESSIONALS TO FIND SAVINGS IN CARE FOR SENIORS AND IT SPEAKS TO FEE-FOR-SERVICE BENEFICIARIES...THAT YOU AND I. SO, THE FEDERAL AND STATE GOVERNMENTS CUT MEDICARE SPENDING BY HUNDREDS OF BILLIONS AND THESE PROFESSIONALS ARE ASSIGNED TO FIGURE OUT HOW THEY WILL KEEP THEIR PROFITS WITH LESS MONEY COMING TO THEM.
FEE-FOR-SERVICE WAS IDENTIFIED AS THE MAIN DRIVER OF HEALTH COSTS FOLLOWED BY FRAUD AND WASTE BY ALL GOVERNMENT ACCOUNTABILITY ORGANIZATIONS. REFORMING HEALTH CARE WOULD HAVE BEEN ALL ABOUT ENDING THE PRACTICE OF FEE-FOR-SERVICE. HERE IN MARYLAND, YOUR INCUMBENT HAS SAID 'WHAT? STOP THE INFLATED BILLS THAT MAKE DOCTORS WEALTHY? NO WAY'. WE'LL JUST CUT ACCESS AND INCREASE CO-PAYS AND DEDUCTIBLES!
Greater Baltimore Health Alliance Physicians LLC To Participate As A Medicare Shared Savings Program Accountable Care Organization
Kevin Parker July 9, 2012
Greater Baltimore Health Alliance Physicians, LLC, (GBHA), a subsidiary of GBMC HealthCare (parent company of Greater Baltimore Medical Center), announced it has been selected to participate in the Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organization (ACO), a multifaceted new program sponsored by the Centers for Medicare and Medicaid Services (CMS).
Through the Shared Savings Program, GBHA will work with CMS to provide Medicare fee-for-service beneficiaries with high quality service and care, while reducing the growth in Medicare expenditures through enhanced care coordination.
____________________________________________
I SPOKE WITH EVERYONE OF JUST ONE FRAUD I HAD SOMEONE SHARE WITH ME RECENTLY.....THE PRIMARY CARE DOCTOR THAT HAS ENTITLEMENT PATIENTS COME BACK EVERY 3 MONTHS TO MONITOR VITAMIN D AND CHOLESTEROL. THIS ISN'T AN ISOLATED INCIDENT. THIS WILL BE WIDESPREAD THROUGHOUT PRIVATE PRACTICE AND THESE CHAIN DIET/NUTRITION CLINICS AND IT ALREADY SHOWS YOU THAT THIS REFORM IS NOT ABOUT CONTAINING COSTS AS MUCH AS IT IS ABOUT PROFITS. YOUR ABILITY TO ACCESS MEANINGFUL CARE LIKE HOSPITAL STAYS AND RECOVERY CENTERS WILL BE ERASED BY COST WHILE YOUR MEDICARE COVERS PRIMARY PUBLIC HEALTH CHECKUPS DONE BY NURSES AND MED STUDENTS.
THIS IS BEING DONE BECAUSE THE NUMBERS OF BABY BOOMERS AND THE EXPANSION OF MEDICAID WILL STRESS EXISTING HEALTH STAFFING AND FUNDS. MY QUESTION IS THIS.....THERE WAS ADVOCACY DECADES AGO TO SEND STUDENTS TO MEDICAL SCHOOL FOR FREE.....JUST AS THEY DO ALL OVER THE WORLD......SO THAT THERE WOULD BE ENOUGH TO HANDLE THESE STAFFING PROBLEMS. EVEN IF WE STARTED DOING THAT NOW....WE COULD HAVE A GOOD NUMBER OF DOCTORS IN A DECADE. THAT, AND THE FRAUD/WASTE WOULD SOLVE THE PROBLEM. THEY ARE NOT DOING EITHER. PATIENTS ARE STILL TO BE SENT FOR BLOOD TESTS AND XRAYS ALL THE SAME BECAUSE TECHS DO THAT WORK......THAT IS OFTEN THE WASTE....IT'S JUST THE SURGERY OR TREATMENTS THAT ARE LOOKING TO BE LIMITED. WHY NOT EDUCATE THE DOCTORS FOR FREE? IT IS A HUGE MONEY-MAKER/FREE LABOR FOR HOSPITAL/MEDICAL SCHOOLS.
THIS IS BAD PUBLIC POLICY THAT IS PROFIT OVER PEOPLE! YOUR MARYLAND INCUMBENT LIKES IT THAT WAY!
VOTE YOUR INCUMBENT OUT OF OFFICE!!!
Below our Harvard graduate State Health Commissioner is telling us how all this change is necessary in order to insure the poor. THE POOR HAVE NOTHING TO DO WITH IT. THEY ALREADY GET THIS KIND OF CARE!
LET THESE WALL STREET SUPPLIANTS KNOW THAT WE WILL REVERSE THESE REFORMS AS WE RID OURSELVES OF THESE INCUMBENTS!
Health care reform: Caring about costs, too Expanding health coverage won't be sustainable unless Maryland can reduce expenses by emphasizing primary care
By Joshua M. Sharfstein, Laura Herrera, and Charles Milligan 6:00 a.m. EDT, September 27, 2012
By establishing a health benefit exchange and expanding Medicaid coverage, Maryland is on a path to extend access to affordable health care to hundreds of thousands of individuals, families and small businesses. For our progress to be sustainable, however, the growth in health care spending must be slowed and brought into balance.
According to the Kaiser Family Foundation, health spending in 1999 averaged $3,993 per person in Maryland, about the national average. Over the next decade, however, Maryland's per capita spending rose 88 percent to $7,492 in 2009, outpacing national growth by more than $500 per person.
Greater spending on health care has led to substantial increases in the price of health insurance. A recent Commonwealth Fund study found that between 2003 and 2010, Maryland employers experienced more than a 50 percent increase in insurance premiums for family policies. To cope with rising costs, Maryland employers have shifted a larger share of monthly premiums to employees and increased the use of deductibles and copayments.
Over the last decade, health care spending has grown faster than Maryland's economy as a whole. This means that many families and companies are paying a greater percentage of their income each year for coverage. Rising costs also threaten access to care. As costs go up relative to income, more businesses decide not to offer coverage — and even when insurance is offered, more families elect not to pay the premiums and become uninsured.
Changing this trajectory is essential to Maryland's future. Families need more room to use their savings for education, retirement and other priorities; companies need relief from ever-increasing premiums to invest in such areas as training and research and development. Progress on costs is also critical for the state budget, which includes both Medicaid and the state employees' health care program.
A key root cause of high health care spending in Maryland — and across the country — is a lack of balance in our health care system. The system has provided ample reimbursement for high-tech care for complicated illness while underpaying for the primary and preventive care needed to support people in health and wellness.
Maryland's health care system has become known for providing high-quality care — but very often for conditions that could have been prevented in the first place. The RAND Corp. found that improved access to primary care could have avoided many hospital admissions in our state. The Commonwealth Fund has noted high rates of readmission to Maryland hospitals, indicating that there is considerable room for improvement in keeping patients stable after discharge.
To make progress, we will need to align the delivery and payment of health care to the goal of better outcomes; wherever possible, we must pay for the value of services, not their volume. While this shift has begun in Maryland, it must move further and faster.
A more effective and efficient health care system starts with primary care. Every Marylander should have an attentive primary care clinician who supports prevention and health and has the time and resources to help navigate through complex diagnoses and treatment. Effective primary care can reduce the number of hospital admissions for chronic illness by 25 percent or more. WHAT THEY ARE SAYING IS THIS: SENDING PEOPLE TO PRIMARY CARE IS THE CHEAPEST ROUTE FOR CARE....HOW DO WE MAKE IT SOUND LIKE A GREAT THING? JUST AS TELLING THEM STUDENTS SITTING IN FRONT OF COMPUTERS ALL DAY IS GREAT EDUCATION. SAME THING!
In recent years, primary care has been weakened by reimbursement systems that pay only for brief clinical office visits. Fortunately, new models of primary care called "medical homes" are emerging that support extra time and support for the chronically ill. The models include care teams with different types of health professionals playing important roles. Primary care practices that are medical homes can share in the savings when their patients are healthier at lower cost, with the remaining savings passed to Maryland families, businesses and taxpayers.
Such an approach has been pioneered on behalf of the state by the Maryland Health Care Commission; CareFirst BlueCross BlueShield has also implemented a promising medical home program. We will seek to build on these efforts so that all insurance companies can participate and all primary care clinicians and patients can benefit. To accelerate progress, we will use mapping technology to find "hot spots" of poor outcomes and high cost, allowing for targeting of outreach efforts and coordination with public health coalitions.
Change must also come to outpatient specialty care. As more patients face larger deductibles and co-payments, it is reasonable to expect that physician practices provide more understandable information about their cost and quality. To support better outcomes at lower costs, specialists should wherever possible be paid for a package of services (such as all care related to a knee replacement) and not individual services (such as each office visit, surgery, and re-operation on the path to a knee replacement). Working with physicians, patients, businesses and others, the Maryland Health Care Commission will explore setting standards for transparency and identify areas for creating packages of services. Maryland's Health Quality and Cost Council is planning to work with experts in the private sector to identify medical interventions that provide an especially high value to Marylanders — and suggest ways to design insurance plans that enhance access to these interventions.
Maryland's unique hospital rate-setting system has taken some important steps toward paying for value in health care. A number of rural hospitals have opted out of traditional payment-by-admission, instead accepting a set budget in advance. This novel payment structure, a "global budget," creates significant incentives to invest in community care and prevention. Many other hospitals in Maryland receive enhanced funding for certain admissions — but no reimbursement if the patient returns with 30 days. These hospitals are developing a much stronger relationship with primary care clinicians, long-term care facilities, community mental health and substance abuse treatment providers, home health agencies, and others to help patients manage their illnesses. An important next step is for these payment innovations to generate significant savings for those paying for care.
There are also opportunities to better align hospital efforts with those of community physicians and with medical homes. As spending on hospital care slows down, hospital systems will naturally expand their efforts in lower cost-settings — further supporting better outcomes at lower cost. Many of our state's hospital systems are well into this transformation. Through a modernization of the rate-setting system, Maryland can generate even more momentum and provide a model for others to follow.
Maryland's strategic initiatives will not just address costs; they will also improve health. With aligned incentives, health care organizations will be able to make the most of our nation-leading health information exchange, which allows critical medical records to be accessible at multiple points of care. We will see more partnerships with schools, local health departments, employers, and others to keep Marylanders active, tobacco-free, eating healthier, and well-immunized. We will see greater collaboration to support the care and independence of individuals with mental illness and substance use disorders. We will also see broad participation in creative approaches such as Health Enterprise Zones, which are expected to employ community health workers and others to address key causes of unacceptable health disparities.
Rebalancing health care is as important as expanding coverage. Both paths lead to the same destination of a healthier Maryland.
Dr. Joshua M. Sharfstein is secretary of the Maryland Department of Health and Mental Hygiene. His email is joshua.sharfstein@maryland.gov. Dr. Laura Herrera is the department's chief medical officer. Charles Milligan is the department's deputy secretary for health care financing at the Maryland Department of Health and Mental Hygiene.
Copyright © 2012, The Baltimore Sun
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