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Maryland's Care Redesign Programs under the All-Payer Model Amendment

Maryland’s Care Redesign Amendment to the All-Payer Model

In response to Maryland stakeholders’ requests for greater provider alignment and transformation tools under the All-Payer Model, the State proposed a Care Redesign Amendment (“Amendment”) to the All-Payer Model Agreement. The Amendment aims to modify the All-Payer Model by supporting:

  • Effective care management and population health activities;
  • Improvement in care for high and rising risk populations;
  • Efforts to provide high quality, efficient, well-coordinated episodes of care;
  • Hospitals and their Care Partners in monitoring and controlling Medicare beneficiaries’ Total Cost of Care (TCOC) growth; and
  • The next steps toward delivery system transformation.

The Amendment gives Maryland hospitals the opportunity to implement Care Redesign Programs, through which they can access comprehensive Medicare data, share resources and offer incentives to Care Partners – including hospital-based and community-based providers. CMS approved the proposed Care Redesign Programs under the Care Redesign Amendment in September 2016.

Care Redesign Programs

The Amendment proposes two voluntary, hospital-led programs, which align hospitals and their Care Partners through common goals and incentives: The Hospital Care Improvement Program (HCIP) and Complex and Chronic Care Improvement Program (CCIP).

Key Care Redesign Documents

Business Associate Agreement (BAA)

New Amendment (Appendix 9)

Participation Agreement

Care Redesign Calendar

Hospital Care Improvement Program (HCIP)

HCIP Implementation Protocol Template

HCIP Sample Implementation Protocol - Updated 2017-05-12

The HCIP will be implemented by Participant Hospitals and hospital-based providers. The HCIP aims to:

  • Improve inpatient medical and surgical care delivery;
  • Provide effective transitions of care;
  • Ensure an effective delivery of care during acute care events, beyond hospital walls;
  • Encourage the effective management of inpatient resources; and
  • Reduce potentially avoidable utilization with a byproduct of reduced cost per acute care event.
Examples of categories of Care Redesign Interventions in the HCIP include: care coordination, discharge planning, clinical care, patient safety, patient and caregiver experience, population health, and efficiency and cost reduction. Care Partners who choose to participate may receive incentive payments based on reducing internal costs through a reduction in unnecessary utilization and resources, efficient practice patterns, and improved quality.

Complex and Chronic Care Improvement Program (CCIP)

CCIP Implementation Protocol Template

CCIP Sample Implementation Protocol

The CCIP will be implemented by Participant Hospitals and community providers and practitioners. The CCIP aims to:

  • Strengthen primary care supports for complex and chronic patients in order to reduce avoidable hospital utilization
  • Enhance care management through tools such as effective risk stratification, health risk assessments, and patient-driven care profiles and plans; and
  • Facilitate overall practice transformation towards person-centered care that produces improved outcomes and meets or exceeds quality standards.
Examples of categories of Care Redesign Interventions in the CCIP include: care management, workforce capacity development, and health information technologies. In the CCIP, Participant Hospitals deploy care management resources and technology that align and support community-providers who work with the Participant Hospital. Care Partners who choose to participate will have access to care management tools and resources targeted to high utilizer and rising risk patients that will support implementation of care plans, provide care coordination, and help manage care transitions. Participation in the CCIP is also tailored to leverage the Medicare Chronic Care Management (CCM) fee. Care Partners who choose to participate may receive incentive payments from hospitals based on defined activities that improve quality of care and reduce potentially avoidable utilization of hospitals.

Announcement: New CCIP Tools Released to Guide Hospital Implementation of the CCIP

Members of the HSCRC Care Redesign Team, CRISP and MHA have collaborated with stakeholders over the past several months to develop the following tools to aid hospitals in implementing the CCIP program. These include:

CCIP Implementation Outline — This document provides a step-by-step guide to implementation of the CCIP at your hospital. This user-friendly resource pulls requirements from draft legal documents and the draft program template to help hospitals determine readiness and additional steps needed to implement the CCIP.
Implementation Outline

CCIP Modeling Tool—This tool guides hospitals in modeling the financial impacts of assumptions regarding patient enrollment and PAU savings. To access the tool, click on the CCIP icon from the CRISP Tableau Hospital Reporting Portal. If you do not have Portal access, please contact support@crisphealth.org
Modeling Tool

CCIP Budget Calculator and Instructions—This budget simulator is intended to aid hospitals in identifying reasonable estimates of costs associated with implementing the CCIP program. Costs will vary among hospitals based on the extent to which hospitals have already begun making investments in care coordination and care management resources and the scale of the program.
Budget Calculator

CCIP Slide Deck (Updated)—A few updates have been made to the CCIP program since the November 2, 2016 webinar. We are attaching an updated slide deck to provide additional background information on the CCIP for participating hospitals.
Slide Deck

Thank you for your support of this important Care Redesign initiative. Please send additional questions to hscrc.care-redesign@maryland.gov.

Both Programs (HCIP & CCIP)

Care Partners: To the extent possible, the Care Redesign Programs will be tailored to support the Medicare Access and CHIP Reauthorization Act (MACRA) requirements, which CMS plans to finalize in November 2016.

Hospitals who choose to participate in HCIP and/or CCIP will: have access to patient identified Medicare claims data; achieve closer alignment with their Care Partners, focus on common goals; enhance their person-centered focus of care; increase quality scores and improve outcomes; and generate greater savings and reductions of potentially avoidable utilization under global budgets.

Webinar Series

The Webinar Series on the All-Payer Model Amendment's Care Redesign Programs, as outlined below, will provide hospitals and stakeholders with critical information on the Care Redesign Programs. A total of seven webinars have been scheduled from October 2016 through January 2017, which will be co-hosted by the Center for Medicare and Medicaid Innovation (CMMI), the Maryland Hospital Association (MHA), and the Chesapeake Regional Information System for our Patients (CRISP) to help prepare hospitals to implement one or both of the proposed Care Redesign Programs under the All-Payer Model Amendment.

During each webinar, participants will have the opportunity to ask questions of the State, CMMI, MHA, and CRISP. We strongly encourage hospital participation in the webinars as information discussed will be critical for successful implementation of the Care Redesign Programs. For those who cannot attend, webinar recordings will be posted below.

Care Redesign Program - Frequently Asked Questions - Updated 12/22/16

Webinar Schedule:

2016 Webinar Dates
(Online Only, EST)
Webinar Communication Calendar for Implementation of Care Redesign Programs Webinar Information
October 21
1:00 - 2:00pm
Friday
Webinar 1: Amendment Overview and Implementation Timeline of Care Redesign Programs Webinar 1 Slides

Webinar 1 Recording
October 25
9:00-10:00am
Tuesday
Webinar 2: Care Partner Approval Process Webinar 2 Slides

Webinar 2 Recording- Starts at 18:15 minute mark
November 2
9:00-10:00am
Wednesday
Webinar 3: Complex and Chronic Care Improvement Program Webinar 3 Slides

Webinar 3 Recording
November 18
9:00-10:00am
Friday
Webinar 4: Hospital Care Improvement Program Webinar 4 Slides

Webinar 4 Recording
November 30
9:00-10:00am
Wednesday
Webinar 5: Comprehensive Medicare Data Process and Use Webinar 5 Slides

Webinar 5 Recording
December 7 Rescheduled to February 3
2017 Webinar Dates
(Online Only, EST)
Webinar Communication Calendar for Implementation of Care Redesign Programs Webinar Information
January 13
9:00-10:00am
Friday
Webinar 6: Q & A on CCIP and HCIP Program Templates and Implementation Protocols Webinar 6 Slides

Webinar 6 Recording
March 30
9:00-10:00am
Thursday
Webinar 7: CMS Overview of Data Provided to Care Redesign Program Participant Hospitals Webinar 7 Slides

Webinar 7 Recording
April 12
9:00-10:00am
Wednesday
Webinar 8: CMS Care Redesign Program Data: Q & A Session Webinar 8 Slides

Webinar 8 Recording