Projects
Evaluating Accountability for Statewide Health Cost and Quality Outcomes: The Maryland Total Cost of Care Model
2019-2025
Project Overview
Objective
To determine whether the Maryland Total Cost of Care Model improves quality of care and health outcomes throughout the state while reducing Medicare costs.
Project Motivation
With the Maryland Total Cost of Care Model, the state of Maryland and the Centers for Medicare & Medicaid Services (CMS) are testing whether statewide accountability for cost and quality outcomes—combined with incentives and supports for a wide range of providers to engage in care transformation—can improve health outcomes and reduce Medicare spending. CMS contracted with Mathematica to provide a rigorous, independent assessment of the implementation of the model and its impacts on targeted outcomes.
Prepared For
U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation
The Maryland Total Cost of Care Model is one of the first Center for Medicare and Medicaid Innovation models to hold a state fully accountable for the total cost of care for Medicare beneficiaries and for improving statewide health outcomes. Mathematica is independently evaluating the effectiveness of this model.
In 2018, the Centers for Medicare and Medicaid Services (CMS) and the state of Maryland signed an agreement that established the Maryland Total Cost of Care (MD TCOC) Model. MD TCOC builds on the Maryland All-Payer Model, which ran from 2014 to 2018 and created hospital all-payer global budgets for regulated Maryland hospitals. MD TCOC continues using hospital global budgets and extends that transformation beyond hospital walls by expanding statewide accountability for cost and quality outcomes and broadening the incentives and supports to other providers to transform care.
The goal of the evaluation is to determine whether the MD TCOC Model meets it goals to reduce Medicare spending and improve beneficiary health. This evaluation uses a mixed-methods design to describe model design and implementation, and quasi-experimental design to estimate the impact of the model on key outcomes.
Findings related to the model’s early implementation can be found in the Implementation Report. Quantitative findings from our evaluation of the first three years of the model can be found in the, “Evaluation of the Maryland Total Cost of Care Model: Quantitative Only Report for the Model’s First Three Years (2019 to 2021)."
The goal of the evaluation is to determine whether the MD TCOC Model meets it goals to reduce Medicare spending and improve beneficiary health. This evaluation uses a mixed-methods design to describe model design and implementation, and quasi-experimental design to estimate the impact of the model on key outcomes.
Findings related to the model’s early implementation can be found in the Implementation Report. Quantitative findings from our evaluation of the first three years of the model can be found in the, “Evaluation of the Maryland Total Cost of Care Model: Quantitative Only Report for the Model’s First Three Years (2019 to 2021)."
Evidence & Insights From This Project
Publication
Evaluation of the Maryland Total Cost of Care Model: Quantitative Only Report for the Model’s First Three Years (2019 to 2021)
This report presents impacts from the first three years of the Maryland Total Cost of Care Model (MD TCOC). MD TCOC uses a hospital global budget and expands it to statewide accountability for cost and quality outcomes and broadens the incentives and supports to providers to transform care.
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