Maryland is the only state with an all-payer medical funding program monitored by the Health Services Cost Review Commission (HSCRC). The system is modernized to improve the quality of care, efficiency, and treatment costs (Centers for Medicare & Medicaid Services, 2022). One program operating under the All-Payer medical program is the Care Redesign Program (CRP). CRP was developed in 2017 to boost the All-Payer medical funding objectives by ensuring care coordination in Maryland (Centers for Medicare & Medicaid Services, 2022). On the other hand, States such as Vermont and Colorado struggle to sustain affordable healthcare alternatives due to their dependence on the single-payer funding system (Centers for Medicare & Medicaid Services, 2022). Unlike the single-payer model, an all-payer program promotes affordable, accessible, and efficient care, supporting equity, coordination, and value in healthcare and justifying the program’s efficacy in improving healthcare quality.
Maryland residents are exempt from the Inpatient Prospective Payment System (IPPS), meaning that charges for all health services are under the all-payer paradigm. Under the waiver, all patients pay the same rate, regardless of healthcare insurance status (Centers for Medicare & Medicaid Services, 2022). The idea is to tame healthcare spending to enhance equity in healthcare delivery by ensuring affordable care for everyone (Centers for Medicare & Medicaid Services, 2022). In single-payer systems such as Vermont and Colorado, patients have limited access to quality care services due to the high rates and limitations of insurance coverage. On the other hand, all-payer models provide a rate setting that consolidates the demand side to ensure that collective bargaining and control of expenditures are achieved. Through such initiatives, healthcare prices drop while service provision intensity increases, promoting health equity.
Another advantage of Maryland’s all-payer model is that it has improved the provider fee determination process, which initially delayed healthcare provision. For instance, the model allows all Medicaid costs to be jointly shared by the state and federal governments (Centers for Medicare & Medicaid Services, 2022). This provision is unlike the single-payer system, whereby private insurance companies, Medicare, or out-of-pocket funding cannot provide sufficient funding in complex situations due to limited coverage (Centers for Medicare & Medicaid Services, 2022). The reimbursement process is also complicated, making processes cumbersome and slow due to issues such as filling claims.
This factor indicates that All-payer’s seamless transition has established better coordination, enhancing community health provision (Centers for Medicare & Medicaid Services, 2022). The reason is that community health focuses on providing care across an entire geographical area rather than a small segment of legible individuals (Centers for Medicare & Medicaid Services, 2022). With government coordination in healthcare service reimbursement, every resident in Maryland can access quality care regardless of their demographic.
The All-Payer Model also promoted quality in healthcare by developing new readmission standards, hospital-acquired infection guidelines, and population health considerations. Maryland achieves these quality targets by designing measures such as The Hospital Care Improvement Program (HCIP) and the Chronic Care Improvement Program (CCIP) to improve care (Centers for Medicare & Medicaid Services, 2022). The Maryland’s all-payer model caters for the HCIP program, which allows hospitals to partner with other specialists to ensure patients receive personalized care (Centers for Medicare & Medicaid Services, 2022). For instance, patients can now access Secondary Care Medical Specialist services through the program at no additional cost to their bill, considering that the federal and state governments coordinate to reimburse such services. This factor indicates that specialized care such as cardiology has become affordable and accessible for all patients needing these services.
The Chronic Care Improvement Program (CCIP) is another CRP track that allows hospitals to collaborate with physicians to improve care delivery. Such programs allow physicians to collaborate to ensure that care management is enhanced by reducing stressors such as burnout that could lead to misdiagnosis. This factor indicates that issues such as readmission and acquired infections reduce considering all causes are sealed (Centers for Medicare & Medicaid Services, 2022). Additionally, the program measures 65 preventable hospital-acquired infections to ensure that all hospitals achieve the aggregate reduction rate before being reimbursed. The provisions of the Maryland All-payer Model required the government to generate millions in savings to enhance quality performance mechanisms. To prove its relevance, Maryland is to generate over $330million every five years in Medicare savings (Centers for Medicare & Medicaid Services, 2022). Such strategies ensure that hospitals commit to delivering quality healthcare that improves population health.
Maryland’s All-payer model has been integral in promoting health equity, coordination and value by enhancing accessibility, affordability, and efficiency. The All-payer Model is a strategy that ensures Medicare funds hospital bills through government and state support. This strategy has enabled many residents to access primary and specialized care at affordable rates regardless of their funding sources. Compared to Vermont or Colorado, Maryland’s All-Payers strategy has enabled the state to reduce the cost of healthcare provision due to reduced competition in the private sector. Policies including HCIP and CCIP have also promoted efficiency in care coordination, and this has improved the quality of service. In return, the state has curbed the high rates of readmissions, cases of hospital-acquired infections, and poor community service, which initially hindered the quality of services.
Reference
Centers for Medicare & Medicaid Services. (2022). Maryland all-payer Model. CMS.Gov. Web.