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Viewpoint | Health Care Reform

An Update on Maryland’s All-Payer Approach to Reforming the Delivery of Health Care

Joshua M. Sharfstein, MD1; Donna Kinzer, BS2; John M. Colmers, MPH3
[+] Author Affiliations
1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
2Health Services Cost Review Commission, Baltimore, Maryland
3Johns Hopkins Medicine, Health Care Transformation and Strategic Planning, Baltimore, Maryland
JAMA Intern Med. 2015;175(7):1083-1084. doi:10.1001/jamainternmed.2015.1616.
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This Viewpoint discusses Maryland’s shift away from fee-for-service reimbursement models tied to volume and toward alternate structures that cap payments and reward hospitals and physicians for delivering better health and quality outcomes at lower costs.

On January 1, 2014, the State of Maryland embarked on an ambitious voyage. The state’s hospitals, physicians, public health departments, and other health care organizations left behind the comfortable shores of a unique all-payer system for inpatient and outpatient hospital care and moved into the uncharted waters of all-payer global budgeting. Under the old system, an independent commission (the Health Services Cost Review Commission) essentially provided each hospital with a rate card that determined what every payer, public and private, paid. The commission pooled expenses for uncompensated care through an assessment added to every hospital bill, distributed costs of medical education to all payers, and maintained stability for close to 4 decades.

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