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| Maryland Primary Care Program | |
|---|---|
| Name | Maryland Primary Care Program |
| Established | 2019 |
| Jurisdiction | Maryland |
| Parent agency | Maryland Department of Health |
| Program type | Primary care payment innovation |
Maryland Primary Care Program
The Maryland Primary Care Program is a statewide initiative to transform primary care delivery through prospective payments and enhanced care management across Maryland. It aligns payment reform with statewide efforts such as the All-Payer Model and interacts with institutions like the Centers for Medicare & Medicaid Services and the Maryland Department of Health. The program seeks to coordinate among Johns Hopkins Hospital, MedStar Health, University of Maryland Medical System, and community health centers to shift incentives toward preventive care and population health.
The program provides monthly prospective payments to participating primary care practices, aiming to reduce avoidable utilization at institutions including University of Maryland Medical Center, Baltimore City Health Department, and private systems like Kaiser Permanente. It integrates care management, behavioral health integration, and social determinants interventions with partners such as Community Health Centers and academic centers including Johns Hopkins University, University of Maryland, Baltimore, and Morgan State University. The design references federal programs like Medicare Shared Savings Program, Center for Medicare and Medicaid Innovation, and state initiatives such as the All-Payer Rate Setting framework.
The program emerged after negotiations among stakeholders including the Maryland Health Care Commission, the Maryland Hospital Association, and federal agencies like Centers for Medicare & Medicaid Services following the establishment of the Maryland All-Payer Model and the subsequent Maryland Total Cost of Care Model. Early pilots involved entities such as Baltimore Medical System and community clinics supported by organizations like Robert Wood Johnson Foundation and The Commonwealth Fund. Legislative and regulatory milestones involved the Maryland General Assembly and administrative rulemaking tied to the Maryland Medicaid Program and state waivers negotiated with CMS.
Participating practices receive a population-based prospective payment and provide services including chronic disease management, behavioral health integration with partners such as National Association of Community Health Centers, care coordination with Area Health Education Centers Program, and social needs screening linked to organizations like Maryland Food Bank and Healthcare for the Homeless. Data exchange leverages health information networks including Health Information Exchange platforms and enterprise partners such as Epic Systems Corporation and Cerner Corporation. Quality measurement aligns with metrics used by NCQA, HEDIS, and reporting to the Maryland Health Care Commission.
Eligible entities include qualifying primary care practices, Federally Qualified Health Centers such as Community Clinic, Inc., and independent physician groups affiliated with systems like MedStar Health or Johns Hopkins Medicine. Enrollment processes coordinate with payers including Medicaid Managed Care Organizations, Medicare Advantage plans, and commercial insurers such as CareFirst BlueCross BlueShield. Participation agreements require adherence to program standards linked to the Maryland Department of Health and reporting conventions consistent with CMS waivers.
The reimbursement model combines prospective per-member-per-month (PMPM) payments with performance-based adjustments tied to outcomes used by Centers for Medicare & Medicaid Services and state programs. Funding sources include Maryland Medicaid Program, Medicare payments influenced by the All-Payer Model negotiations, and contributions from commercial payers like UnitedHealth Group and Aetna. The program incorporates risk adjustment methodologies similar to those employed by the Medicare Advantage program and quality incentives consonant with CMS Value-Based Purchasing constructs.
Oversight involves the Maryland Department of Health, the Maryland Health Care Commission, and contractual reporting to Centers for Medicare & Medicaid Services under state waiver agreements. Stakeholder governance structures include advisory groups with representation from Maryland Hospital Association, Medical Society of Maryland, patient advocacy groups such as AARP, and labor organizations including Service Employees International Union. Data governance principles reference standards promulgated by Office of the National Coordinator for Health Information Technology.
Early evaluations report changes in utilization patterns at institutions like University of Maryland Medical Center and clinics in Baltimore, with indicators comparing emergency department visits, hospital admissions, and preventive service uptake measured against baselines used in All-Payer Model assessments. Collaborations with academic evaluators from Johns Hopkins Bloomberg School of Public Health and University of Maryland School of Medicine examine impacts on chronic disease control (e.g., diabetes mellitus, hypertension). Population health outcomes are tracked alongside cost trends monitored by the Maryland Health Care Commission and independent analysts such as Kaiser Family Foundation.
Critics from organizations including segments of the Maryland Medical Society and community advocates have raised concerns about risk adjustment adequacy, potential consolidation effects favoring systems like Johns Hopkins Medicine and University of Maryland Medical System, and the capacity of rural providers in counties such as Garrett County and Dorchester County. Operational challenges cited include interoperability barriers with vendors like Epic Systems Corporation and Cerner Corporation, workforce shortages highlighted by Association of American Medical Colleges, and alignment of incentives across payers including Medicare and commercial insurers.
Category:Health programs in Maryland