Maryland has the only all-payer hospital-rate regulation system in the country under a decades-old Medicare waiver. Since 1977, the state's Health Services Cost Review Commission has set the prices hospitals charge patients, regardless of their insurance coverage.
The state has also been an outlier for another reason: its readmission rates. Historically, they were high compared to the rest of the country. In 2010, when 18.6% of Medicare patients in the U.S. were hospitalized again within 30 days of discharge, Maryland's rate was 2.7 percentage points higher. In 2014, the Maryland commission and the CMS Innovation Center required Maryland hospitals to close that gap by 2018.
At the University of Maryland St. Joseph Medical Center, a 232-bed hospital in Towson, a quarter of high-risk patients were hospitalized again within 30 days. So the hospital began deploying community health workers tasked with helping these patients address pressing nonclinical issues after they leave the hospital.
“You cannot underestimate the importance of addressing the psycho-social needs of patients upon discharge,” said Dr. Gail Cunningham, St. Joseph's chief medical officer. “The best medical plan in the world is going to fail if some of the patient's basic needs aren't met.”
In its first 16 months, readmission rates for patients enrolled in the program dropped by 60%. In May, about 10% of St Joseph's high-risk patients were readmitted within 30 days, compared with 25% when the hospital launched the program in February 2015 in partnership with medical staffing company Maxim Healthcare.