Maryland

Maryland began a three‐three year pilot study in 2011, the Maryland Multi-Payer Patient-Centered Medical Home Program (MMPP), to test the PCMH model of care, including 52 primary and multi-specialty practices. The practices are comprised of both private and all of the federally‐qualified health centers located across the State. Maryland law SB 855/HB 929 requires the State’s five major carriers of fully insured health benefit products (Aetna, CareFirst, CIGNA, Coventry, and UnitedHealthcare) to participate in the MMPP. The Federal Employees Health Benefit Plan, Maryland State Employees Health Benefit Plan, TRICARE, the health care program serving Uniformed Service members, and plans provided by private employers, such as Maryland hospital systems, have voluntarily elected to offer this program as well.

With the support of a CMS State Innovation grant and participation in the Medicaid Health Homes program, Maryland plans to further strengthen the MMPP through the development of Community-Integrated Medical Home (CIMH) model.  This model of care will integrate patient-centered medical care with community-based resources while enhancing the capacity of local health entities to monitor and improve the health of individuals and their communities as a whole.  

In accordance with Section 31-116 of the Insurance Article of the Annotated Code of Maryland, the Maryland Benchmark Plan sold on the Maryland health insurance Marketplace must include "delivery of benefits through patient centered medical homes for individuals with chronic conditions, serious illnesses or complex health care needs who agree to participate in a patient centered medical home program."
 

CHIPRA: 
Yes
MAPCP: 
No
Dual Eligible: 
No
2703 Health Home: 
Yes
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
Yes
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
5,945,000
Uninsured Population:
10%
Total Medicaid Spending FY 2013: 
$7.8 Billion 
Overweight/Obese Adults:
64.1%
Poor Mental Health among Adults: 
33.0%
Medicaid Expansion: 
Yes 

CMS Health Care Innovation Award: CareFirst

CareFirst BlueCross/BlueShield is receiving an award to expand its Total Care and Cost Improvement Program (TCCI), a Patient-Centered Medical Home model of care delivery and payment, to 25,000 Medicare beneficiaries in Maryland per year. This approach will move the region toward a new health care financing model that is more accountable for care outcomes and less driven by the volume-inducing aspects of fee-for-service payment.

CMS Health Care Innovation Award: John Hopkins University

The Johns Hopkins School of Nursing is receiving an award for a Medicare/Medicaid dual eligibles program (Community Aging in Place, Advancing Better Living for Elders –“CAPABLE”) that uses a care management team to improve the everyday functioning of complex, frail patients in their own homes. The program will reduce difficulty with activities of daily living and improve medication management, mobility, and health-related quality of life, based on an individualized package of interventions including home visits from occupational therapists and nurses and other services.

Cigna Accountable Care Program - Greater Baltimore Health Alliance

Under the program, Greater Baltimore Health Alliance physicians monitor and coordinate all aspects of an individual's medical care. Patients continue to go to their current physician and automatically receive the benefits of the program. Individuals who are enrolled in a Cigna health plan and later choose to seek care from a doctor in the medical group will also have access to the benefits of the program. There are no changes in any plan requirements regarding referrals to specialists.

ACA Section 2703 Health Homes

The Medicaid Health Home State Plan Option, authorized under the Affordable Care Act (Section 2703), allows states to design health homes to provide comprehensive care coordination for Medicaid beneficiaries with chronic conditions. States will receive enhanced federal funding during the first eight quarters of implementation to support the rollout of this new integrated model of care.

Medicaid Section 1115 Waiver

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that promote the objectives of the Medicaid and CHIP programs.

FQHC Advanced Primary Care Practice

[Ended October 31st, 2014] The Federally Qualified Health Center (FQHC) Advanced Primary Care Practice demonstration will show how the patient-centered medical home model can improve quality of care, promote better health, and lower costs.

CMS Comprehensive Primary Care Initiative

[Ended in December 2016] The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients. 

Multi-Payer Advanced Primary Care Practice (MAPCP)

[Ended in 2016] Under this demonstration, CMS will participate in multi-payer reform initiatives that are currently being conducted by states to make advanced primary care practices more broadly available.

CMS State Innovation Model (SIM)

[Ended] In Round One of the SIM Initiative, nearly $300 million was awarded to 25 states to design or test innovative health care payment and service delivery models in the form of Model Design, Model Pre-Test, and Model Test awards. In Round Two, the SIM initiative is providing over $660 million to 32 awardees (including 28 states, three territories, and the District of Columbia).

CMS Pioneer ACO

[Ended December 31st, 2016] The Pioneer ACO Model (as authorized by  Section 3021 of the Affordable Care Act) is designed specifically for organizations with experience offering coordinated, patient-centered care, and operating in ACO-like arrangements. It allows the selected provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Services Program. 

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