Maryland Total Cost of Care Model Evaluation of the First Four Years (2019–2022): Findings at a Glance

During the Maryland Total Cost of Care Model period studied (2019-2022), it reduced hospital admissions by 16.2%, and reduced disparities in several quality measures. From 2019 to 2021, the model reduced total Medicare spending—including non-claims payments—by $689 million. These effects represent the combined effects of all the changes that the Centers for Medicare & Medicaid Services (CMS) and Maryland have made since 2014. Effects were likely driven in large part by hospital responses to global budgets, which reverse traditional fee-for-service incentives and reward hospital efforts to reduce preventable hospital care. Beyond the other model components, the Maryland Primary Care Program (MDPCP) reduced hospital use modestly but strained statewide savings. On average, MDPCP cost CMS about $96 million annually but did not generate any statistically significant savings to offset its costs. The evaluation will continue to examine the model’s impacts on spending, service use, and quality.

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