Perhaps now more than ever, local health care systems are taking the lead in developing initiatives that reduce costs and improve health outcomes among their populations.  At AcademyHealth, we’re pleased to highlight this important work through a new meeting series focused on delivery system transformation in the region hosting our Annual Research Meeting (ARM).  Following the inaugural meeting of this kind last year in Orlando, a group representing government, academia, industry and advocates met Friday in Baltimore to discuss innovations, lessons learned, and ongoing challenges in the state hosting the 2013 ARM – Maryland. Maryland’s complex population and unique payer system make it a particularly interesting case study.  While Maryland is an affluent state overall, it is home to pockets of significant poverty and wide disparities in health outcomes.  In Baltimore alone, there is a 20-year life expectancy difference based on what zip code you live in.  In addition, Maryland is the only state in the country to set its own hospital inpatient and outpatient reimbursement rates for all payers.  This policy, established by the state legislature in 1971 and carried out by the Maryland Health Services Cost Review Commission, allows Maryland to use innovative tools and incentives not available in other states. Friday’s meeting, held at the University of Maryland, Baltimore County, with support from five sponsors, featured panels on topics including innovations in health information technology (HIT) and Maryland’s use of Health Enterprise Zones to target health care disparities.  While a full meeting summary is forthcoming, the following highlights some of the strategies being used by Maryland providers, policymakers, and members of the public to transform local health care delivery.  Some of these strategies also reflect trends playing out on a national level.

  • Using data wisely.  Maryland, a leader in HIT, is the first state to connect all of its hospitals with electronic health records.  Mechanisms like alerts to clinicians when their patients are hospitalized are helping providers make use of real-time data to improve care.  The state is also using data from its health insurance exchange to identify geographical “hot spots” for hospital visits and target interventions effectively.  This and other types of data will become increasingly available – and valuable – in the future.  As one speaker put it, “Data is the new currency.”
  • Engaging communities.  Through its State Health Improvement Process, the Maryland Department of Health and Mental Hygiene is partnering with 18 local coalitions to strengthen population health and reduce disparities across the state.  Each coalition is comprised of stakeholders who meet to identify local health priorities, such as tobacco cessation, diabetes prevention and improved access to care, and develop related action plans.  This public/private partnership, one of several discussed at the meeting, harnesses the unique capabilities of each sector to work toward better health for all Maryland residents.  It also reflects a growing recognition that effective health care must reach people in the places where they live.
  • Improving clinical quality.  As one participant noted, efforts to improve quality often confuse motion – endless meetings, reports and recommendations – with progress.  Anne Arundel Medical Center is working to cut through the motions to make quality improvement a reality.  The hospital has begun revising its more than 800 order sets, some of which were outdated and included unnecessary tests.  The 30 sets that have been revised to date make up 50-60% of admissions and are now better aligned with the hospital’s electronic health record (EHR) system.  Anne Arundel also linked information from the Choosing Wisely initiative to EHRs and made this information available to personnel in the emergency room.  As information on hospital costs and quality gradually becomes more publicly available, some hospitals are taking it upon themselves to initiative quality improvements now.
Participants at the meeting emphasized that while there are important lessons out of the Maryland experience, what works in that state isn’t necessarily the best fit elsewhere.  Culture is key, and the trick is discovering what policies and interventions work for a particular demographic, political and economic context. A summary of the meeting will be available on the AcademyHealth website in the coming weeks.  AcademyHealth intends to hold a similar meeting on health care in the San Diego area prior to the 2014 ARM in that city.  This post was contributed by AcademyHealth Associate Lauren Radomski.
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