Maryland Program Administration

Overview of Total Cost of Care Model and Maryland Programs

Under the Total Cost of Care (TCOC) Model, Maryland is expected to progressively transform care delivery across the health care system with the objectives of improving health and quality of care. At the same time, state growth in Medicare spending must be maintained lower than the national growth rate. The TCOC Model encourages continued care redesign and provides new tools and resources for providers to better meet the needs of patients and help Marylanders achieve better health status overall. CRISP provides administrative support for hospitals participating in Maryland Programs under the Maryland Department of Health (MDH) and the Health Services Cost Review Commission (HSCRC).

Maryland TCOC Programs

  • Population Health Programs (SIHIS)

CRISP’s Role in Program Administration

Maryland offers hospitals a number of voluntary programs to advance the goals of the TCOC Model.

CRISP provides administrative support for hospitals participating in these Maryland programs as applicable. The core functions of CRISP’s program administrative support are:
  • Review of hospitals’ annual submission of Track Implementation Protocols. CRISP conducts an administrative review of hospitals’ proposed protocols to ensure state and federal requirements are met. The reviews are intended to be supportive and iterative, enabling hospitals to address any potential concerns prior to protocol submission.
  • Collection of hospitals’ Care Partner lists. The providers who hospitals engage through care redesign programs are referred to as “Care Partners.” Hospitals must submit Care Partners through a two-step process. One reason Care Partner certification is important is that it enables clinicians to be considered eligible for MACRA bonuses.
  • Review of hospitals’ semi-annual Reports. Every six months or as required, participating hospitals must report on experience implementing interventions. This includes quantitative results as well as qualitative feedback.
  • Facilitate user groups. CRISP conducts interactive and collaborative user groups to align with Maryland state priorities. User groups focus on teaching and demonstrating CRISP tools/functionality and sharing best practices.

Maryland Programs

ECIP and HCIP

The Care Redesign Program includes the Episode Care Improvement Program (ECIP) and the Hospital Care Improvement Program (HCIP). These initiatives enable hospitals to align incentives with care partners. Hospitals can opt to share incentive payments with providers who meet care redesign goals. ECIP encompasses post-acute care, while HCIP focuses on hospital-based care.

CRISP operates the ECIP Management Interace (click here to Login), a platform for hospitals to receive ECIP notices and submit ECIP deliverables.

Contact care.redesign@crisphealth.org for questions on care redesign.

Source and Additional Information: HSCRC

 

CTIs

Care Transformation Initiatives (CTIs) are initiatives undertaken by a hospital, group of hospitals, or a collaborative partnering with a hospital to reduce the total cost of care of a defined population. Under the CTI program, hospitals choose the eligible Medicare population targeted by the CTI intervention; define how to restrict the population to those most likely to be impacted or enrolled in the intervention; and choose the intervention duration.

CRISP operates the Care Transformation Profiler (CTP) (click here to Login), to enable hospitals to view all CTIs statewide, and to monitor their own CTI progress.

Contact care.redesign@crisphealth.org or hscrc.care-transformation@maryland.gov for questions on CTIs.

Source and Additional Information: HSCRC

 

Regional Partnerships

The ​Regional Partnership Catalyst Grant Program enables hospitals partner with neighboring hospitals and/or diverse community organizations to form Regional Partnerships (RP).  Approved RPs received funding to support the implementation of diabetes prevention and management programs and/or behavioral health crisis services programs.

Source and Additional Information: HSCRC

 

Statewide Integrated Health Improvement Strategy (SIHIS)

SIHIS is designed to engage State agencies and private-sector partners to collaborate and invest in improving health, addressing disparities, and reducing costs for Marylanders. The SIHIS aligns statewide efforts across three domains that are interrelated: 1) Hospital Quality 2) Care and 3) Total Population Health.

Source and Additional Information: HSCRC

 

Maryland Primary Care Program (MDPCP)

MDPCP is a voluntary program open to all qualifying Maryland primary care providers that provides funding and support for the delivery of advanced primary care throughout the state. Practices are evaluated on delivering the five Comprehensive Primary Care Function:

  • Care Management
  • Access and Continuity
  • Planned Care for Health Outcomes
  • Beneficiary and Caregiver Experience
  • Comprehensiveness and Coordination Across the Continuum of Care

Hospitals can track their beneficiaries and monitor their progress via MDPCP Reports in the CRS Portal. 

Source and Additional Information: MD Dept of Health

 

EQIP

EQIP is a voluntary program that will engage non-hospital Medicare providers and for achieving cost and quality targets for one or more Clinical Episodes (“EQIP Tracks”), each of which will incorporate a specified alternative payment arrangement. EQIP is targeted to begin July 2021