Maryland Health Services Cost Review Commission

This policy draft outlines recommendations for statewide accountability targets under the Achieving Healthcare Efficiency through Accountable Design (AHEAD) Model. The plan focuses on establishing an all-payer Total Cost of Care (TCOC) growth target and an all-payer primary care investment target. It details proposed methodologies, guiding principles, data parameters, and stakeholder engagement processes for both targets, with the aim of improving population health, enhancing quality outcomes, and managing healthcare cost growth.

The Commission addressed various regulatory matters, including the final recommendation for fiscal year 2027 Nurse Support Program competitive grants and adjustments to Care Transformation Initiatives. The Board approved a capital revenue increment for Luminis Health Doctors Community Medical Center and a confidential data request from the Maryland Department of Health. Additionally, the Commission discussed the closure of the Adventist Healthcare Germantown Emergency Center, reviewed performance data for the Medicare Fee-for-Service model, and heard presentations on CRISP HIE funding and the update factor for hospital revenues. New staff members were introduced, and the Commission initiated its eight-year review of agency regulations.

This document outlines Maryland's vision for the AHEAD Model, aiming to empower all Marylanders to achieve optimal health and well-being. It serves as a pathway to improve statewide healthcare quality, health outcomes, and health equity, while controlling cost growth, by bridging health care, population health, and social sectors. The plan focuses on three core strategies: Ensuring High-Value Care, Improving Access to Care, and Promoting Health Equity, all underpinned by accountability and infrastructure investments in workforce, health information technology, and administrative simplification. The State Health Equity Plan is central to this vision, emphasizing community voice and addressing systemic health inequities.

This Multi-Agency Workplan, developed by a regulatory working group for the State of Maryland, outlines key strategies to achieve the goals of the AHEAD Model from 2025 through 2032. The plan prioritizes the development of policies for cost-shifting and Medicare Advantage market stabilization. It further focuses on defining choice and competition options, enhancing workforce development and graduate medical education, addressing post-acute care challenges, and establishing total cost of care and primary care investment targets for 2027-2030. The overarching aim is to promote healthcare quality, access, outcomes, and affordability, while ensuring market stability and meeting significant Medicare savings requirements.

The committee discussed recommendations for methodology selection regarding all-payer total cost of care growth targets under the AHEAD model. Topics included a review of public comments on data parameters, considerations for using economic indicators such as Gross State Product and median household income, and an overview of methodologies used by other states. The committee also examined recommended populations and service inclusions for the model, proposed a counterfactual structure for growth benchmarks, and discussed reporting and monitoring frameworks.