For years, health officials in the United States have sought to improve people’s health while curbing growth in health care costs. One promising approach for fulfilling both objectives is something called hospital global budgeting, a relatively rare health care payment model in the United States that might be on the verge of an expansion under a federal initiative announced late last year.
In most parts of the country, hospitals rely on fee-for-service revenue. The high-level idea with hospital global budgeting is that a hospital gets paid an agreed-upon amount of revenue each year in advance for all anticipated inpatient and hospital outpatient care. If the model works as intended, hospitals should prioritize prevention and community services because they no longer have an incentive to drive up unnecessary health care use.
In 2010, Maryland became the first state to establish a hospital global budgeting program, which expanded to all 46 of the state’s acute care hospitals in 2014. Other states, such as Vermont and Pennsylvania, are adopting versions of hospital global budgets as an alternative payment model. They may soon be joined by other states. Last year, the Centers for Medicare & Medicaid Services announced a funding opportunity for up to eight state agencies to participate in a payment model that would seek to improve the total health of a state population while lowering costs.
This episode of Mathematica’s On the Evidence podcast explores lessons from Maryland, with glimpses into Vermont and Pennsylvania, that could help other states decide whether and how to adopt hospital global budgeting. The guests for this episode are Dr. Joshua Sharfstein, Thomas Mullen, and Dr. Sule Gerovich.
Sharfstein was the secretary of the Maryland Department of Health and Mental Hygiene when the state adopted hospital global budgeting. He is also distinguished professor of the practice in Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.
Mullen recently retired after leading a prominent hospital system in the Baltimore area for about two decades. Aside from his role as president and CEO of Mercy Medical Center and Mercy Health Services, Mullen was a member of the Maryland Health Services Cost Review Commission, which sets hospital rates across the state, a critical component of how the payment model works in Maryland.
Sule is a senior fellow at Mathematica where she focuses on state health policy. She supports Vermont’s implementation of the All-Payer Accountable Care Organization model and Pennsylvania’s Rural Hospital Global Budgets. Before her time at Mathematica, she worked for the Maryland Health Services Cost Review Commission.
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[JOSH SHARFSTEIN]
The key here is that we're not finding a magic way to pay differently that works for everyone doing all the same things today. We're unlocking an opportunity to do things differently, a new line of business, of preventing illness, of figuring out new ways to reduce costs and get rewarded for it. When we were in fee-for-service and I was the health commissioner of the city of Baltimore, we demonstrated that you could go out to the homes of people who were calling 911 all the time and really help them. And we realized, we could try to fund a program like that, but it literally would be taking funds away from hospitals because they wouldn't get paid for the visits. And, you know, if a Martian landed and looked at a system like that, they'd go like, ‘You know, what do -- how does that make sense?’ Right? But then you change the incentives and you see hospitals across Baltimore now talking about their programs to help people in that situation because it's better for the system. And so, you want to unlock that, like, you know, ‘Here’s why we went into medicine,’ . . . ‘Here’s why we went into nursing,’ . . . ‘Here are ways we can help people,’ . . . There’s a lot of innovation and creativity that can come in.
[J.B. WOGAN]
I am J.B. Wogan from Mathematica. And welcome back to "On the Evidence." For years, health officials in the United States have sought to improve people's health while curving the growth in health care costs. One promising approach for fulfilling those dual objectives is something called hospital global budgeting, a relatively rare health care payment model in the U.S. that might be on the verge of an expansion under a federal initiative announced late last year. So, what is hospital global budgeting? Well, in most places, hospitals rely on fee-for-service revenue. Their bottom lines are dependent on the quantity of services provided regardless of their quality or impact on patients' health. The high-level idea with hospital global budgeting is that a hospital gets paid each year in advance an agreed upon amount of revenue for all anticipated inpatient and hospital outpatient care. With no incentive to drive up unnecessary health care use, hospitals should then prioritize prevention and community services.
In 2010, Maryland was the first state to establish a hospital global budgeting program which expanded to all 46 acute care hospitals in the state in 2014. Other states, such as Vermont and Pennsylvania, are implementing versions of hospital global budgeting on a more limited scale. And they may soon be joined by more states. Last year, the Centers for Medicare and Medicaid Services announced a funding opportunity for up to eight state agencies to participate in a payment model that would seek to improve the total health of a state population while lowering costs. On this episode, we'll talk about lessons from Maryland that could help other states decide whether and how to adopt hospital global budgeting. Our guests for this episode are Dr. Josh Sharfstein, Tom Mullen and Dr. Sule Gerovich.
Josh was the Secretary of the Maryland Department of Health and Mental Hygiene when the state adopted hospital global budgeting. He is also a distinguished professor of the Practice in Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. Tom recently retired after leading a prominent hospital system in the Baltimore area for about two decades. Aside from his role as president and CEO of Mercy Medical Center and Mercy Health Services, Tom was also a member of the Maryland Health Services Cost Review Commission, which sets hospital rates across the state, a critical component of how the payment model works in Maryland.
Sule is a senior fellow at Mathematica where she focuses on state health policy. She is also supporting Vermont's implementation of the All-Payer Accountable Care Organization Model and Pennsylvania's Rural Hospital Global Budgets. Before her time at Mathematica, she worked for the Maryland Health Services Cost Review Commission. Welcome, Josh, Tom and Sule.
Okay. This is probably going to come as no surprise given the title of the show, but I want to start by asking about evidence. Maryland has had hospital global budgeting in some form since 2010. So, what are the results so far? What progress have we made on those dual objectives of improving population health and lowering costs? Josh, do you want to kick us off?
[JOSH SHARFSTEIN]
Sure. And thanks for having me and thanks for your attention to global budgeting. Maryland has had global budget since 2010. Initially, it was a few hospitals as part of a pilot. And then, by 2014, it was statewide. The evidence comes in different categories. Certainly, Maryland has demonstrated cost savings to the Medicare Program. There was an interesting figure in the New England Journal of Medicine paper by CMS that showed Maryland is the most cost-saving model that CMMI has produced so far. And I think it's in the ballpark of a billion dollars for the first, you know, part of the global budget model that started in 2014 compared to a control.
So, it's a pretty robust evaluation that has happened to look at that. And, within that, you can also see that there were significant reductions in preventable admissions, which is something we'd want to see the model produce. And, also, seeing hospital-acquired complications decline and readmissions decline quite a bit. So, I think that there is a lot, that it's fair to say, the model has contributed to. Although it's also fair to say, and I'm sure we'll talk about that, that there is a lot of work still to do in Maryland.
[J.B. WOGAN]
Okay. Perfect. Yeah, I'd love to hear more about what's left to do. Sule, I want to turn to you now. Mathematica has conducted some research on the impacts of hospital global budgeting in Maryland. What have we found?
[SULE GEROVICH]
The best part about the innovation models is that the -- there is a robust evaluation for each model. And Josh kind of summarized the results of those evaluations that was published. And, I guess from the state perspective, we shouldn't forget that this is a voluntary model and Maryland was able to get all the 46 hospitals into this model. So, that's one place where other models are struggling, to be frank, because, as you know, it takes a lot of effort to get providers understand and work on the new models.
The other pieces that the evaluation produces in addition to global budgets, Maryland was able to also coordinate with other sectors, especially with primary care. So, participation in primary care model is also quite robust compared to other models. I believe 60% of the primary care physicians are enrolled in the Maryland model. So, I'm just going to focus on participation side as Josh focused on the results side.
[J.B. WOGAN]
Okay. Perfect. And, Tom, when you were with Mercy Medical Center, how did you see global budgeting affect patient health and cost of care? What results were you tracking?
[TOM MULLEN]
Yeah, we were just tracking the same things that have been mentioned, you know, the unnecessary admissions, low intensity ER visits, that was a big one where they basically disappeared and we saw our emergency room visits drop from close to 70,000 visits to 50. And they were all what we would call Level 1/2 visits that are kind of not appropriate for the ER.
[J.B. WOGAN]
Hm, interesting. Wow. Was that surprising? Did that level of change -- was that what you expected to happen?
[TOM MULLEN]
Well, [audio drop] so fast, but it made sense as -- and, also, you combine that with, you know, the national health plans and the Obamacare coming in giving people more access to physicians, I think we saw, you know, people not needing to go to the ER as much for low intensity stuff. Plus, we saw a lot of growth in the urgent care centers.
[J.B. WOGAN]
Hm. Well, especially if the results that are coming out of Maryland are encouraging, and it sounds like they are, some listeners may be asking, "Why isn't this happening all over the country?" So, let me put that question to you. What has deterred more states from adopting this payment model thus far? And, Tom, let me stick with you for this. What do you think is stopping more states from adopting this model?
[TOM MULLEN]
I think it -- not having a uniform system is a barrier. We had a uniform all-payer system and people were used to operating within that. Outside of Maryland, you -- it's fee-for-service and multiple types of arrangements with commercial insurers. So, you know, getting off of this -- you know, their complicated reimbursement to something that's more simplified is a big hurdle. So, I think it's -- I think it was we had an easier transition because we were all kind of in the same boat.
[J.B. WOGAN]
Interesting. Josh, I'm sure that you talk to officials from other states who are interested in the Maryland experience. Based on those conversations or any other insights you have, what do you think might be holding them back or preventing them from taking the leap into hospital global budgeting?
[JOSH SHARFSTEIN]
Well, I think, you know, it's both the state officials and, frankly, the hospitals, as well as, you know, the state more generally, that have to really be interested in this. And interest is absolutely growing, particularly with the AHEAD Model out there. There are a lot of places looking at this, many calls coming in. I would add to what Tom said and point out that Maryland, you know, since the late 1970s, has had this rate setting system, which is -- has a governance structure, has trust built between regulators and the hospitals, it has the hospitals working together for shared goals.
All those things make this kind of conversation so much easier. You go to a part of the country where the hospitals are feverishly competing for patients, you know, there is a paper that, in those markets, people tend not to share data, you know, let alone let's roll up our sleeves and come up with a new payment model that'll, you know, help us save money and improve population health and, you know, do all these other things.
So, I think that there is the -- just the fact of how Maryland's model was constructed and its relationship with CMS. But then there's the more less -- or the less tangible aspect of a state that knows its job is to work together in health care and then being able to pivot with leadership from hospital leaders, like Tom, to get to global budgeting.
So, my conversation with other state officials is about both things. It's about the policy details and what it actually looks like to put something like this into place, you know, how to think about the cost savings and the population health benefits, but it's also about these less tangible issues, how do you, you know, set up a goal for a state to do better for cost and for patient care, and how do you develop enough consensus and trust that you can start to evolve the payment models to get there.
[J.B. WOGAN]
One contextual question. Is Maryland unique in having that governance structure? Are -- is it the only state to have that? Or are -- like how uncommon is it?
[JOSH SHARFSTEIN]
Yeah, Maryland is the only state left with rate setting. So, there were some other states. But, at this -- at all-payer rate setting, you know, Maryland has that. So, there were other governance structures out there. And there are some that kind of -- you know, councils that talk and have some types of authority. But I don't think any have like the full Maryland.
[J.B. WOGAN]
Okay. Perfect.
[SULE GEROVICH]
I want to add global budgeting is also a tool and the goals are important, as Josh mentioned. So, you could use it for cost control mechanism, you could use it for population health investment. And, in Pennsylvania, they used it for rural health, improving sustainability of the health care resources in their communities. And, in that model, they were able to create a coalition of payers in the hospitals with that goal.
So, it is very difficult to do this in other states because you have to bring a lot of people, including commercial payers, at the table for this model to work because this is a big transformation for a hospital. Right? You want a majority of the patients and services included in a model like this to be effective. So, that's the struggle that other states are having trying to bring those coalitions together and also have a common goal from all perspectives, including commercial payers and hospitals.
[J.B. WOGAN]
Hm. Well, you kind of -- you -- that's a nice transition, a nice segue for the next thing I was going to ask, Sule, because I wanted to hear a little bit more about your experience working with Vermont and Pennsylvania to other states that are implementing some form of global -- hospital global budgeting. So, could you speak a little bit more to that? You just referenced Pennsylvania. What exactly are those states doing? And how is it working so far? What results are we getting in those places?
[SULE GEROVICH]
So, every state has different goals. So, Pennsylvania, as I mentioned, is more about rural hospitals and sustainability. And the challenge there was recruiting hospitals. So, Tom, you know, your perspective here is very important to get them on board on this new model and working through the details of the policy and building trust. It takes years to build trust and a minute to destroy it, as somebody says to me. So, there, I think they did a great job recruiting about 18 hospitals and commercial payers are at the table. And one anecdote, another one, is that the commercial payers said, "We are so happy to have rural hospitals at our table. Because of their size, we tend to not to talk to them."
So, this was also a political improvement from the rural provider perspective. Vermont is dealing with very different issues. They are a rural state with critical access hospitals and they have very important issues around access, wait time. So, in there, they are trying to figure out how to create resources to focus population health. And they are creating also a coalition, but they do have a commission, like Maryland, who can do rate setting or do additional things to coordinate and create that alignment that Tom mentioned. So, they are really focused on creating commonalities across payers to create a global budgeting.
[J.B. WOGAN]
Okay. And you did mention rural hospitals. I was reading a 2017 article that, Sule, you and Josh coauthored for the Commonwealth Fund about hospital global budgeting. And one of the things that came up there was that global -- hospital global budgeting might be especially helpful for rural hospitals. Do you want to say anything more about that, either of you, about why it might be especially appealing for rural hospitals?
[JOSH SHARFSTEIN]
Well, I'm happy to jump in on that. I think that rural hospitals are struggling in many places and they're struggling, you know, financially if their volumes are going down under fee-for-service, but they're also struggling with a rural health crisis. You know, mortality is higher in rural areas, suicide rates are higher, overdose rates are higher. There's a lot of suffering going on. Chronic illness is extremely high. And hospitals, you know, I think in rural areas see pretty clearly that they are pushed to, you know, survive economically under fee-for-service by trying to have services for more, you know, very sick people, whereas a global budget gives them the ability to think about that differently and try to put in place services that actually keep their community healthier.
And there was a paper that came out about higher operative mortality for hip and knee replacements in really small hospitals. And, you know, you really -- I don't know, you know, this is just my projection, but you could imagine sitting there and thinking like, "You know, on the one hand, we may need to do more surgeries like this, you know, in order to stay afloat. But, with a higher mortality, you know, isn't there a better way for us to stay afloat that actually aligns with keeping people healthier instead of maybe, you know, having them more likely to suffer a complication?"
So, I think that there's that. There's, also, I think a technical issue that makes it easier in rural areas which is, typically, a lot of the people in the community will go to that hospital, so it makes a lot of the attributions and, you know, some of the technical aspects of global budgeting easier to do. So, you have both I think a very strong, you know, policy rationale and a strong technical rationale.
[SULE GEROVICH]
And, on the urban settings, the safety net hospitals. Right? So, from their perspective, there are technical issues. But, looking at social drivers of health, again, they are struggling financially, but their population needs more services. So, you could think about the global budget creating that incentive for them and providing additional funding where they can focus more on reductions in need utilization, like Tom mentioned, rather than trying to get more services that they have to compete with other centers in the urban center.
[J.B. WOGAN]
Okay. Well, speaking of hospitals and urban centers, Tom, I want to turn back to you. And I'd like to step back now and talk a little bit about how, even after a state adopts hospital global budgeting, things will likely evolve over time. So, Tom, how did Mercy have to change in response to this payment model? How did it change the way you did business? And how did it affect health outcomes?
[TOM MULLEN]
Yeah, well, we had to rethink what our purpose was. And, you know, prior to this, it was all about, you know, more volume, more volume. And this got us focused on the right volume, you know, the right care in the right setting. So, you know, we saw opportunities to expand access through ambulatory care centers located throughout the Baltimore region. And, so, we now -- we've changed our metric for success to how many patients are in our system that we take care of and we're up to like 280,000 people have received -- different people received care at Mercy. And, in downtown Baltimore, there's maybe 50,000 people.
So, it's really changed our way of operating. And we're not dependent on them coming necessarily into the hospital. We try to create -- to have them to get their care in the right setting. So, we've seen, you know, growth in ambulatory surgery outside of the hospital be one, growth of giving chemo to cancer patients outside of the hospital, because those hospital-added costs for chemo were huge and a big cost driver.
So, we were looking at that. And I think we've been relatively successful with that. And we continue to be that way. And we also have to make sure we're working consistent with how our doctor field care should be done. So, the doctors are really critical in the success here. And your doctors need to know that this isn't about taking their business away. This is about them doing the right things in the right setting. And, so, that's a key driver. So, physician integration was a major, major thing. And we have approximately 250 physicians on our staff now. So, it's pretty large for a medium-sized organization. And they all swim in the same direction.
So, those are things that we did. And we -- and what we did in the hospital -- it didn't mean we weren't doing things in the hospital. But what we did in the hospital, we focused on efficiency and effectiveness. You know, trying to drive late to stay down on orthopedics. You know, now we're almost outpatient on orthopedics, almost everything. And, you know, when we started the global budget, we were 2/3 d -- 2- and 3-day stays. And some of that's technology, but some of it's consistent with where we're headed. And, global budget, it's all about taking care of the patient, not necessarily about driving additional units of service.
[J.B. WOGAN]
You mentioned physicians and how they felt about global budgeting. I'd love to hear a little bit more about that. Did they see -- did -- was it hard to get buy-in? Did they like the idea of investing more in preventative services? Were they worried? It sounds like they were -- there was some concern about it being bad for business in a sense. So, what -- tell me a little bit more about that.
[TOM MULLEN]
I think their initial fear is it's about you're going to -- you know, "We're the end of the -- we're the end -- we're the ones who are going to get hit the worst in this." And we said, "No, you're not. You're the ones who take care of people. We just want you taking care of the people who need to be taken care of." And, so, that was kind of the view. And the primary care doctors were dying for this, you know, because the primary care doctors are the beginning of the food chain in terms of how people work their way through the system. And now even in primary care, Josh would know this, we're running out of the ability to find primary care doctors because the need is so great and we're moving to nurse practitioners and other kind of alternate providers.
So, the doctors understand that. But we also -- the specialists are the ones that have the crosshairs on them and they're concerned about. But you don't want me to do these cases. You know, we -- you know, that's the whole idea is for me not to do the cases. And we say, "No, that's not the case. We want you to do the right ones, the ones that need to be done." And we kind of view it as sustainable volume, volume that you know you've got to give, and not unnecessary type procedures. So, that's been the focus. Doctors have accepted it and believe in it. And we've done relatively well. Our doctors are fairly successful and they're well known in the Baltimore community.
[J.B. WOGAN]
Josh, I'd like to turn to you. We just heard from Tom about some of the journey that Mercy Medical Center went through with global budgeting and the experience of hospitals and doctors. What lessons can other states draw from Maryland's experience with global budgeting?
[JOSH SHARFSTEIN]
Well, I think there are a few. We, certainly, have talked about a lot of the promise, and I think the promises both on the cost side, which matters to a lot of people, and on the health side, you know, which is incredibly important, particularly in a country where we have massive life expectancy gaps and we're falling further behind, you know, other countries around the world. But, in terms of actually implementing it, I think there are few lessons. And I think, you know, Tom really touched on a bunch of them. One of them is the need for time for a model like this to develop and for people to become comfortable with it. You know, when we switched to global budgets, there were people writing papers like "Maryland fails, six-month evaluation shows no difference." You know? And, here, we're really trying to fundamentally change some of the incentives in health care. And you really do need to be committed to it and, you know, work with health care systems, doctors, others to try to get it to work.
You know, I think doing business as usual under a new payment system can be frustrating, but seeing the opportunity of a payment system to allow you to do things differently in a better way is really where you want to get people, like Tom is saying. And, so, I do think that some degree of patience is important. A really important thing is a transparent and engaging governance process. And I think Maryland has done that well. You know, Tom served on that governance process. He played a really important role in both informing the overall system about the needs of hospitals and talking to hospitals about the opportunity of a new model.
So, you know, you can see, you know, every policy put out for public comment, all of these different, you know, strategies that Maryland's system does to be engaged and transparent, all those things I think really do matter. And then, you know, I guess, I think if you ask me for a third lesson, I would say that to be innovative. You know, like the key here is that we're not finding a magic way to pay differently that works for everyone doing all the same things today. We're unlocking an opportunity to do things differently, a new line of business I used to say I think, what, back in 2014 that like there's a new line of business of preventing illness, of figuring out new ways to reduce costs and get rewarded for it. In, you know, the fee-for-service world, you know, there are certain great things that actually cost everyone money so people are much less likely to do them. You know?
And I remember at one point, for example, we -- back in -- when we were in fee-for-service and I was the health commissioner of the city of Baltimore, we demonstrated that you could go out to the homes of people who were calling 911 all the time and really help them. You know? And not just reduce the expense in 911 in the emergency departments, but like make sure they're on the right dose of insulin or they have, you know, their social isolation addressed. And you could really, really help them. And we realized, you know, we could try to fund a program like that, but it literally would be taking funds away from hospitals because they wouldn't get paid for the visits. And, you know, if a Martian landed and looked at a system like that, they'd go like, "You know, what do -- how does that make sense?" Right?
But then you change the incentives and you see hospitals across Baltimore now talking about their programs to help people in that situation because it's both good for them and it is better for the system. And, so, you want to unlock that like, you know, here's why we went into medicine and here's why we went into nursing, here are ways that we can help people. There's a lot of innovation and creativity that can come in. And, so, I think that's also a third lesson.
[J.B. WOGAN]
Well, I mentioned in my intro that the Centers for Medicare and Medicaid Services is encouraging more states to adopt hospital global budgeting. And states could do it through this new funding mechanism or some other means. Obviously, there are states that are already doing this before the funding mechanism even exists. But, for states that are interested in hospital global budgeting, what's at least one thing they'll need to be successful? And, Tom, I'd like to start with you. What would be one thing you think that states and the hospitals in those states would need to be successful?
[TOM MULLEN]
Well, they need to have a common vision and goal. And, so -- and that leads to cooperation. So, you've got to have cooperation among the various providers in the continuum. If you have folks in the continuum resisting to doing this, it'll be a challenge. So, I would say that's the number one thing, cooperation among the providers and agreeing that this is the goal they want to perceive -- pursue.
[J.B. WOGAN]
Okay. And I said at least one thing, I didn't want to limit you too much. If there's anything else that you want to add to your list, feel free, anything else that you would --
[TOM MULLEN]
Well, I think you've got to be prepared to go after high-cost patients and come up with new ways of delivering care to them. And we know the -- you know, the diabetics, you know, the cancer patients, the orthopedic patients, all those types of patients, heart patients. But we have to develop strategies, but then to continue them to kind of have superior outcomes, but a less costly way to get there.
[J.B. WOGAN]
Josh, I imagine that you have a list and have shared that list with people in other states. But, yeah, what -- if a state official reaches out to you and is interested in hospital global budgeting, what would be your one or two things that you would recommend that they implement to be successful?
[JOSH SHARFSTEIN]
Well, I think it is -- it's really important to have a good dialogue and understanding with the hospital leaders who will actually be running the program. And, so, you know, I -- it would be true that I have recommended at times that Tom Mullen speak to them, you know, because I think, you know, frankly, there are only so many things I can say that, you know, people in the hospital industry will under -- you know, understand and appreciate.
And then, as I start to venture into what it could be for them, it's just so much more powerful to hear from someone who has led in that situation and accomplished great things. So, I do think that, more broadly, this is a approach -- because it's an approach broadly to the health care system, it really does require a lot of cooperation for a public leader. It's not something that can be imposed entirely top-down. But, even for a hospital leader, it's not something that can be done entirely within their walls successfully.
There are certain things that can be done, but you do want to have good community partners. You want to suddenly know about what mental health services are available because, now that we look at our population, we're seeing people with a lot of behavioral health conditions keep coming back to the emergency department, can anything be done to help them. You know? So, it means engaging more with the world around you no matter where you are in the system. And I think that is -- it's an advantage, but it can be hard. And really facilitating that and facilitating that kind of spirit is really important for our success.
[J.B. WOGAN]
Sule, I'll give you the final word here. What is at least one thing that a state will need to be successful if they do indeed go down this path of implementing hospital global budgeting?
[SULE GEROVICH]
So, Tom made the comment around vision, right, common vision. And Josh is talking about coalition and getting the communications right. And I work a lot on the detail with the policy. So, from my perspective, we need to meet where the providers are. So, this is a long-term vision and a long-term change. Right? So, if they are not as comfortable moving into a fixed payment and they have concerns for certain things, we need to hear them. And we need to make sure we can get them gradually to where we want to all go as opposed to having very impatient structures where we expect everything to change overnight. So, that's the lesson learned from working especially with Pennsylvania and Vermont and talking to other states.
[J.B. WOGAN]
Okay. I think that's a perfect note to end on. Tom, Josh, Sule, thank you so much for your time today. I really enjoyed talking with you about hospital global budgeting. And I'm curious to see where states go from here. Thanks to our guests, Tom Mullen, Josh Sharfstein and Sule Gerovich.
And thank you for listening to another episode of "On the Evidence," the Mathematica podcast. If you liked this episode, please consider leaving us a rating and review on your podcast player of choice. And, if you aren't already, please consider subscribing. We are on Apple Podcasts, YouTube, Spotify, Goodpods, as well as many other podcast players. To learn more about the show, find us at mathematica.org/ontheevidence.
Show notes
Read Mathematica’s impact findings from its ongoing evaluation of Maryland’s Total Cost of Care Model.
Read a report co-authored by Sharfstein and Gerovich for the Commonwealth Fund on hospital global budgeting as an emerging approach to payment reform for large safety-net hospitals.
