Skip to main content

A unique agreement Maryland reached with federal regulators that affects how much everyone in the state pays for medical care and how they get that care at a hospital or doctor’s office, has been extended until ‘in 2026.

The program aims not only to contain overall health spending, but also to improve health outcomes by ensuring that patients’ chronic conditions are managed and that they avoid unnecessary hospital stays.

The primary care physician portion of the model was added to the longstanding hospital portion in 2019, and both programs are an agreement between Maryland and the US Center for Medicare and Medicaid Innovation.

Under the hospital portion, hospital rates are set and all public and private insurers and self-paying patients pay the same for services, and these payments are tied to the Medicare rate. Medicare pays higher rates in Maryland than elsewhere in return for the state’s medical providers to keep overall health care costs below the national average and keep patients as a whole healthier and out of harm’s way. ‘hospital.

Under the physician portion of the payment system, primary care practices, including federally licensed health centers, receive additional funding and technical support to better coordinate preventive care for patients. The program is voluntary, but 508 primary care practices and more than 2,150 providers now participate, according to the Maryland Department of Health. That’s more than 4 million Maryland patients.

The renewed agreement also comes with new provisions aimed at making the practices more financially responsible and increasing payments to help disadvantaged residents. These payments can be used for health-related support or access to food and nutrition care management services, among other needs.

“The continuation and expansion of [the primary care program] means more Marylanders will have access to comprehensive primary care,” Maryland Secretary of Health Dennis R. Schrader said in a statement. “The amendment also means more support for primary care providers to bolster the state’s efforts to achieve health equity, including funding to meet the social needs of…beneficiaries.”

The program expansion is supported by the state medical society, MedChi, and the Maryland Hospital Association.

Overall, the programs are expected to save Medicare $336 million in 2024, $372 million in 2025, and $408 million in 2026.