The Maryland Health Care Commission (MHCC) discussed primary care investments, and how they relate to the All-Payer Health Equity Approaches and Development (AHEAD) model during its meeting last week.
Maryland Secretary of Health Laura Herrera Scott said the primary care workforce is not growing fast enough to meet the needs of the population.
“Our primary care physician workforce is an aging workforce, so in the next 10 years, we’re going to see (their numbers) go down significantly,” Scott said. “We do not have enough people in the pipeline, and the training that’s provided; a lot of it is still hospital-based and not community-based.”
Maryland’s voluntary Episode Quality Improvement Program (EQIP) allows practitioners who treat Medicare beneficiaries in care transformation and value-based payment through an episode-based approach. The program aims to hold participants accountable for achieving cost and quality targets for one or more clinical episodes.
The Centers for Medicare and Medicaid Services (CMS) approved a one-time reversal of the Medicare Performance Adjustment (MPA) savings component. The MPA framework allows hospitals to maintain savings they produce from non-hospital related costs via reconciliation payments. Scott said the state set aside the majority of this amount to fund targeted investments in order to improve the reach and effectiveness of primary care in Maryland. The state currently has $19 million for an EQIP primary care program, which will expand the program to address the availability of primary care in underserved areas beginning Jan. 1, 2025.
Between now and 2030, MHCC hopes to increase the state’s overall primary care spending by 10 percent, and plans to include a relative improvement goal of about one percent annually. Targets will be reviewed annually, and will be adjusted as needed to achieve this statewide improvement goal.
“Pharmacy spending and rebates, dental and other supplemental expenditures will be excluded from [conversations about how it] is helping spending per member per month by engaging in primary care early and often, compared to more expensive points of care, like the (emergency room) or other places in the hospital,” Scott said.
The AHEAD model sets statewide accountability targets for Medicare and all-payer cost growths, investments, and equity and population health outcomes through state agreements with CMS. Maryland is seeking to create a primary care program that is aligned between Medicare and Medicaid, and to set similar hospital quality targets.
“The new AHEAD Model will be a key driver for advancing primary care,” Scott said.
Maryland has developed and vetted the concept of a primary care and alternative payment model for Medicaid. Recruitment, however, remains a considerable issue.
“We have over 500 practices and there is considerable overlap [with Medicaid]. We actually took the providers’ tins and ran it through Medicaid just to see how much overlap we had, just so we knew what we were starting out with,” Scott said. “Now, we still have to make sure that those practices have enough Medicaid lives in them to meet the requirements for AHEAD, but we’ve started that process already.”