Dataset Information

Health Care Leaders’ Perspectives on the Maryland All-Payer Model

ABSTRACT: Key Points

Question

What lessons can be extrapolated from the implementation of hospital global budgets in the Maryland All-Payer Model that apply to other communities, payers, and hospitals seeking to adopt value-based payment systems?

Findings

This qualitative study of Maryland health care leaders revealed key themes regarding hospital global budgets, including setting achievable expectations for health care transformation, protecting hospital autonomy, ensuring close communication between stakeholders, using actionable data to inform decisions, carefully calibrating budgets, and harnessing a shared commitment to change.

Meaning

The findings of this study suggest that the experience of implementing hospital global budgets in Maryland can inform the development of future payment models that seek to constrain cost growth, improve patient outcomes, and preserve access to health care. This qualitative study examines perspectives on the Maryland All-Payer Model among health care leaders who participated in its design and implementation and identifies themes that may be generalized to other settings.

Importance

Since 2014, all hospitals in Maryland have operated under an all-payer global budget system. Hospital global budgets have gained renewed attention as a strategy for constraining cost growth, improving patient outcomes, and preserving health care access in rural and underserved communities. Lessons from the implementation of the Maryland All-Payer Model (MDAPM) may have implications for policy makers, payers, and hospitals in other settings seeking to adopt global budgets or other value-based payment models.

Objective

To examine perspectives on the implementation of the MDAPM among health care leaders who participated in its design and execution.

Design, Setting, and Participants

This qualitative study with semistructured telephone interviews was conducted from November 1, 2019, to February 11, 2020. The purposive sample of Maryland health care leaders represents diverse stakeholder groups, including hospitals, state government and regulatory agencies, the federal government, and payers.

Main Outcomes and Measures

Key high-level themes were extracted from interviews using qualitative content analysis, with barriers and facilitators to implementation specified within each theme.

Results

A total of 20 interviews were conducted with hospital leaders (n = 6), state regulators (n = 4), federal regulators (n = 4), payer representatives (n = 3), and state leaders (n = 3). Key themes were labeled as (1) expectations (setting bold yet achievable goals), (2) autonomy (allowing hospitals to follow individual strategies within MDAPM parameters), (3) communication (encouraging early and ongoing communication between stakeholders), (4) actionable data (sharing useful hospital and patient-level data between stakeholders), (5) global budget calibration (anticipating technical challenges when negotiating budgets for individual hospitals), and (6) shared commitment to change (harnessing collective motivation for system change). Together, these themes suggest that implementing the payment model followed an evolving and collaborative process that requires stakeholder communication, data to guide decisions, and commitment to operating within the new payment system.

Conclusions and Relevance

The implementation of hospital global budgets in the state of Maryland offers generalizable lessons that can inform the evolution and expansion of this approach to value-based payment in other states and settings.

SUBMITTER: Kilaru A

PROVIDER: S-EPMC8903109 | biostudies-literature |

REPOSITORIES: biostudies-literature

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