THE MARYLAND HEALTH CARE COMMISSION
PRIORITIES & ACCOMPLISHMENTS
2006
Providing a Health Policy Think Tank for Maryland
The Commission plays a key role in developing health policy options, both for the Administration and for the General Assembly.
Reforming the Small Group Market
• Prices for health insurance in the small group market continue to rise faster than inflation and somewhat faster than other markets, posing a challenge to small businesses and their employees.
• The number of insured employees has dropped 10% in 5 years.
• MHCC completed a six month reform process including six community meetings across the state.
• The new Comprehensive Standard Health Benefit Plan – greater flexibility, more choices, lower base price.
o The pharmacy benefit has been completely redesigned:
Pharmacy remains an integral part of the plan - guaranteed issue, guaranteed renewal, and priced using modified community rating;
Employers and employees will have many more pharmacy options; and,
Health plans can offer more creative benefit designs that encourage wise choices.
o An entirely new plan has been introduced – a high deductible HMO plan.
o The price of the base plan will be reduced over 10%.
• One major insurer, Aetna, has re-entered the Maryland Small Group Market.
Making Certificate of Need Work for the Citizens of Maryland
• Maryland hospitals are in the midst of a multi-billion dollar program of construction and renovation, replacing and modernizing aging hospital facilities throughout the state.
o Certificate of Need applications have increased markedly, creating challenges for the Commission staff and Commissioner reviewers.
• The CON Task Force considered ways to streamline the CON process.
o The Task Force recommended, and the Commissioners adopted, a series of changes – in statute, in regulation, and in day to day practice.
o Almost all of these changes are already underway.
• In the controversial area of open heart surgery, the Commission:
o Approved a new CON for a program at Suburban Hospital, following a competitive application process;
o Oversaw and evaluated the C-PORT clinical trial of emergency angioplasty and developed a waiver process to assure access to high-quality emergency angioplasty; and,
o Established a scientific review process to evaluate proposals to study non-emergency angioplasty without back-up on-site open heart surgery.
• The Commission plans to revisit the rationale for Certificate of Need in each major area, bringing health economics expertise to bear on this often controversial area and exploring whether other options would better serve the citizens of Maryland.
Promoting Electronic Health Records and Secure Health Information Exchange
• Health information technology is essential to improve quality, reduce medical errors, and control health care costs by assuring appropriate, high value care.
• MHCC is:
o Staffing the Task Force on the Electronic Health Record, established by the General Assembly and appointed by the Governor;
o Conducting a study to identify barriers to appropriate information exchange in Maryland and to develop strategies to address privacy and security; and,
o Collaborating with the Health Services Cost Review Commission in funding, through a competitive process, several $250,000 projects to plan and then a $10 million project to implement the first phase of a state-wide health information exchange.
Providing Consumers with Better Information to Make Better Choices
• Quality Reporting Using Objective Measures
o MHCC has been a leader in quality reporting for hospitals, nursing homes, and HMOs.
o Quality measures are expanding to include hospital acquired infections.
• Patient and Family Satisfaction Measures
o Objective measures of quality do not capture all that is important to guide our choices.
o HMO report cards include member satisfaction measures.
o MHCC recently launched a nursing home satisfaction survey, for family members regarding their relative’s experiences in the nursing home.
• Price Transparency Project
o Drug prices for common drugs are available through the Attorney General’s web site.
o Hospital prices for specific diagnoses adjusted for case mix are now posted.
o We will soon publish prices for common physician services (both billed amounts and allowed amounts) by county, specialty, and specific service, giving the 25th, 50th, and 75th percentiles.
Reports That Help Guide Policy
• The MHCC conducts research and analysis for policymakers resulting in:
o An annual report on health care expenditures in Maryland;
o An analysis of the problem of the uninsured in Maryland;
o A summary of insurance coverage in the state; and,
o Special studies of importance to policymakers, including prescription drug spending, uncompensated care, and primary care services.