Maryland TCOC
Maryland Total Cost of Care Model
The Maryland Total Cost of Care (TCOC) Model sets a per capita limit on Medicare total cost of care in Maryland. It builds upon the Maryland All-Payer Model to establish pricing of medical services across all payers. The model promotes greater coordination between health care providers and patient-centered care to improve health outcomes and reduce avoidable hospitalizations.
Innovation
The TCOC Model was the first Center for Medicare and Medicaid Innovation model to hold a state fully accountable for risk for the total cost of care for Medicare beneficiaries.
The Problem
In most states, the cost of the same medical procedure can vary widely from hospital to hospital and by payer, and there is little to no coordination between hospital-based health care services and primary care services; these gaps in care can negatively impact both the patient experience and their health outcomes.
The Solution
The model establishes pricing of medical services provided by hospitals, primary care doctors, and specialists across all payers. It holds the state fully accountable for the cost and quality of care for each patient with Medicare, promoting greater coordination and patient-centered care.
Expected Outcomes
Improve the overall health of Marylanders, reduce avoidable hospital readmissions and emergency department visits, and improve the patient experience in health care settings.
Model Goals
- Save Medicare over $1 billion by the end of 2023
- Improve the overall health of Marylanders
- Reduce avoidable hospital readmissions and emergency department visits
- Improve the patient experience in health care settings
Patient Eligibility
Patients with Medicare in Maryland.
- Medicare beneficiary
- Patient in Maryland
Provider Eligibility
Hospitals, primary care practices, FQHCs, and other providers in Maryland.
- Operating in Maryland
- For CRP: Must enter into a CRP participation agreement with CMS and the State
Care Categories
Primary and Preventive Care
CMS Benchmarks & Thresholds
financial
operational
population
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