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New Md. waiver must encourage medical innovation

Nearly three years ago, Maryland embarked on a noble experiment to simultaneously hold down the cost of health care while improving quality and the patient experience. Building upon Maryland's 40-year history of innovation in health care financing, this new agreement with the federal government has created a platform for hospitals to partner in new ways with each other, with other providers and with the communities they serve.

Although performance in the first two full years operating under this new "waiver" has been positive, challenges remain. As the state and federal governments contemplate the next steps, there are particular concerns facing Maryland's academic health systems that should be addressed.

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Maryland has long been a leader in biomedical research and discovery. Our two academic medical centers are national and international powerhouses, bringing in more than $1 billion in research funding annually. The National Institutes of Health and the explosion in private biopharma activity in Montgomery County and increasingly in Baltimore City are further testament to Maryland's place in this discovery ecosystem. These investments have resulted in breakthrough treatments and fundamental new understandings of basic physiologic processes. As the state pursues the laudable goals of the new waiver and controlling the total cost of care, we must be careful that the effort is designed so as not to disrupt progress in biomedical discovery and innovation.

There is no doubt that our health care system can and must become more efficient. The new waiver has encouraged hospitals to think outside their walls and to partner with other health care providers and the communities they serve to prevent readmissions, improve quality and ultimately to improve the health of the community. Hospital readmission rates have fallen as have health care associated complications. Patients suffering from chronic disease are now more often treated in the community, and patient satisfaction has begun to show improvement. Hospitals plan to strengthen and expand these partnerships with community providers.

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The Global Budget Revenue system, a total cap on spending that was implemented as part of the new waiver, has created very strong incentives for hospitals to achieve these goals. Unfortunately, some have suggested that these same incentives make it more difficult for clinician scientists to advance new cures and therapies.

Examples of these innovations include new approaches to cardiac care, such as minimally invasive surgical procedures that repair heart valves without removing the old damaged ones and surgically implanted pumps to help heart failure patients. This discovery also extends to what is referred to as precision or individualized medicine in which physicians can more accurately diagnosis and treat diseases like cancer or neurological disorders tailored to genetic and other characteristics of each patient. In the short run, these types of innovations are likely to add costs to the system, but in the long run, the return will be in lives saved and costs avoided.

These types of efficiencies include Johns Hopkins' partnership with Anne Arundel Medical Center to propose a new cardiac surgery program where patients already treated there can remain in a lower cost setting closer to home, creating capacity at Johns Hopkins Hospital for the sickest cardiac patients requiring more complex highly specialized care. UMMS has a partnership with Prince George's Regional Medical Center that provides similar benefits for patients in that community. This follows the pattern of many other critical services that are developed and refined at academic centers, then expanded to other delivery sites as they are determined to be safe, cost-effective and in the best interests of patients.

By the end of this year, Maryland must submit a blueprint to the federal government for the next phase of the waiver. Without a doubt, it must include plans to enhance patient care and create mechanisms to improve care coordination for Maryland's sickest patients. At the same time, however, it must be designed so as to permit our academic medical centers to thrive in the global market for innovation. The state health regulatory commissions — the Health Services Cost Review Commission and the Maryland Health Care Commission — and the Maryland Department of Health and Mental Hygiene must act wisely in all of these areas to preserve what is good about the state's health system and at the same time allow it to innovate and evolve.

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John M. Colmers is a senior vice president at Johns Hopkins Medicine and a member of the Health Services Cost Review Commission; his email is jcolmers@jhmi.edu.

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