[{"_1":2,"_100":-5,"_101":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6358085,"mediaKeyId","2212842-dcbc4c245347333a6863922c71d1ade9","parentId",2212842,"title","Maryland outlines AHEAD model to expand primary care; hospitals warn of workforce, capacity and physician‑cost pressures","audioSeconds",995,"startMs",145000,"endMs",1140000,"viewUrl","/Search/View?dp=1&key=2212842-dcbc4c245347333a6863922c71d1ade9&start=145&end=1140","thumbnailUrl","https://assets.pipeline.soar.com/2212842-dcbc4c245347333a6863922c71d1ade9/thumbnail_145000.jpg","articleUrl","/articles/6358085/Maryland/Maryland-outlines-AHEAD-model-to-expand-primary-care-hospitals-warn-of-workforce-capacity-and-physiciancost-pressures","mediaUrl","https://secure.pipeline.soar.com/6358085-28dfadb5f81bed289fbdeffd11179448/orig.mp4?Expires=1771013887&Signature=Lb7wybHQ0imTpcSaq~A0F7QjcbHHi-yBNInXWWadr7O2frLwkezDzT3tIY7Q310Ju~dd0fYdFTkXzUFtQsgGmcKhsSbcZQu1VqI-QsbUf2zAfzi1VEAGzCN65lU7cxw0Nke98pK6tRBpvF2qOslH~t6FH1OsqKcibBoVqUPbu-BAo0eNieC5xiQtQwosDPO-eSEAuPlAnV9i6GPwghB2q6FmiMBxxiV-Fah5xSaW3bJdIiD9u1hFqrqN98NjW80oqAofPTef0YEyKQppNX1S5bJlZa~QDvroZx-rJtebmLGm9L-3DEJsdzb9b6dU24OA5m0V9PvO6l7Ez8b1l2f4yw__&Key-Pair-Id=KUT5TJCACFTXG","author","Maryland General Assembly - Health and Government Operations","date","2025-01-31T00:00:00Z","article","Maryland health officials and the Health Services Cost Review Commission told the House Health and Government Operations Committee on Jan. 31 that the federal AHEAD model will extend the states long-standing total cost of care approach to fund primary care, population health and a statewide health equity plan.

The AHEAD, or All‑Payer Health Equity Advancing Development, model \"is an attempt tomove other states to the work that Maryland has done,\" Laura Herrera Scott, secretary of the Maryland Department of Health, said, adding the model focuses on \"population‑based payments\" and investment targets for primary care.

Maryland created its all‑payer hospital rate setting and then the total cost of care model in order to stabilize hospital financing and curb growth in health spending. John Crum, executive director of the Health Services Cost Review Commission (HSCRC), told the committee participation in the federal model preserves federal flexibilities and payments \"—there's 1,700,000,000.0 in federal payments for Medicare and Medicaid patients,\" that support the state's hospital financing structure.

Why it matters: AHEAD would broaden state payment levers beyond hospitals by linking investments in primary care, data and workforce to health equity goals recommended by the Centers for Medicare & Medicaid Innovation (CMMI). Officials said expanded primary care and population health work could reduce downstream hospital use, but both state staff and hospital leaders warned that workforce shortages, rising physician costs and regional bed distribution could threaten hospital financial stability if policy details are not settled quickly.

What officials told the committee

- \"The goal of the total cost of care model is to ensure [a] world class system of health for all Marylanders,\" Laura Herrera Scott said, adding that the AHEAD model will require data, workforce development and administrative simplification to succeed. She also said the Maryland Commission on Health Equity will serve as the governance body for parts of AHEAD and that the commission's membership was expanded to include hospital, clinician, payer and community representatives.

- John Crum said AHEAD \"does establish a statewide health equity strategy,\" and preserves the state's authority to set hospital global budget policy, while noting that the state agreement with CMMI \"doesn't enumerate solutions to all challenges\" such as physician costs and volume adjustments. He said the HSCRC has already increased hospital rates and provided targeted hardship funds in the past year, including a temporary hardship fund \"of over $80,000,000\" and annual rate adjustments that \"grown hospital rates by over a billion dollars.\"

Hospital concerns and requests for near‑term policy work

- Melanie Griffith, president and CEO of the Maryland Hospital Association, and Tom Kleinhansel, president and CEO of Frederick Health and chair of the MHA board, told the panel they support the models goals but urged faster, concrete policy work before hospitals commit to changes that begin next year.

- Kleinhansel described ongoing financial strain: \"We had 200 days cash in our bank savings account before COVID. We now have 145 days. So we've spent down 65 days of cash. That's because we've had a negative operating margin.\" He told the committee he wants regulatory clarifications on market share, capital funding and growth policy \"in short order\" so hospital boards can plan for the transition.

- Hospital leaders repeatedly raised physician compensation as a major unregulated cost that is increasing far faster than hospital facility costs and said HSCRC and the department should move quickly to collect better data and consider policy options.

State actions and timelines

- Officials said Maryland will continue to develop HSCRC global budget policies and will launch stakeholder processes to refine volume, capital and market‑share policies before AHEAD's full implementation. The department said the primary care elements of AHEAD are expected to begin in 2026 and that the state has already disbursed approximately $20 million to develop new primary care access sites across underserved areas of the state.

- The Maryland Commission on Health Equity will produce a State Health Equity Plan aligned to five CMMI core domains plus an optional domain; officials reported they selected maternal health outcomes as the optional domain and will focus on reducing disparities for Black women in maternal mortality and morbidity.

Discussion vs. decision

- Discussion: Committee members and agency staff discussed model goals, gaps in authority (physician costs sit outside HSCRC regulated facility costs), workforce shortages and regional differences in utilization and bed needs.

- Direction: Officials said they will continue stakeholder work at HSCRC and MDH, expand data‑collection and convene technical work groups (including a data advisory committee) to support the health equity plan.

- Decision: No formal vote or legislative action occurred during the hearing; agencies described plans and requested ongoing engagement.

Context and clarifying details

- Federal payments: HSCRC staff referenced \"1,700,000,000.0\" in federal payments cited in the briefing as a key fiscal element of the states arrangement with the federal government.

- Recent state adjustments: HSCRC representatives said they created an $80,000,000 temporary hardship fund, made a permanent midyear staffing adjustment, modified capital funding for a new Easton hospital project, and introduced a high‑cost drug policy in the past year.

- Primary care investment target: Officials said Maryland is moving primary care investment from about \"4½–5½ cents on the dollar\" toward approximately \"8–9 cents on the dollar\" under the new model's primary care commitments.

- Governance: The Maryland Commission on Health Equity was named the governing structure for components of AHEAD; the commission's membership now includes hospital, MCO, clinician, tribal and patient representatives.

What comes next

Officials asked lawmakers and stakeholders for sustained engagement during 2025 policy work and urged quicker resolution of a short list of HSCRC policies that hospitals say they need clarified before the AHEAD primary care payments begin in 2026.

Sources and attribution: Committee chair Jocelyn Pena Melnick presided; the presentation was led by Laura Herrera Scott, secretary of the Maryland Department of Health; John Crum, executive director, HSCRC; and speakers representing the Maryland Hospital Association and multiple hospital systems.

Ending: Committee members said they will continue oversight and asked for periodic reports on data collection, primary care rollout and any short‑term rate adjustments as AHEAD implementation proceeds.","mediaType","Video","parentTitle","HGO Committee Session, 1/31/2025 #1","oneSentenceSummary","Maryland health officials and HSCRC staff told the House Health and Government Operations Committee on Jan. 31 that the federal AHEAD model will extend the states total cost of care approach to population‑based payments and primary care investment, while hospital leaders warned workforce shortages, rising physician costs and regional capacity gaps require rapid policy fixes before full implementation.","taxTitle","Health and Government Operations Committee, HOUSE OF REPRESENTATIVES, Committees, Legislative, Maryland","taxId",15061,"location","Maryland","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6358076,"UMB Center for Violence Prevention and LifeBridge—s Center for Hope describe hospital‑linked prevention and intervention efforts",886,12385000,13271000,"/Search/View?dp=1&key=2212842-dcbc4c245347333a6863922c71d1ade9&start=12385&end=13271","https://assets.pipeline.soar.com/2212842-dcbc4c245347333a6863922c71d1ade9/thumbnail_12385000.jpg","/articles/6358076/Maryland/UMB-Center-for-Violence-Prevention-and-LifeBridges-Center-for-Hope-describe-hospitallinked-prevention-and-intervention-efforts","https://secure.pipeline.soar.com/6358076-078c7e0d359d185c293fe412415b74fc/orig.mp4?Expires=1771013887&Signature=TaUdGFzZwQekfD9bz31jJj4AWFgRM3f08NELKWga5NDsYkvHg5-5g9IWu0WAyMe~mmhKXyrPgOAawhrqw1yXUQnAQIDCtGXqZjWy~u-ZJmbc5t1LgO6gHTwPUzFmXfFGJpGhFa5k~28W-2DOzidOYcbqdlvk-u-L0WfAr6UyAf5uZhNVFnfEBilPFy8J0GfQ2tnRm4m0eABTs2Wa9F65Goz6cCAl24r7B8qhuVE0NV-e42DnplzMbn24SkbLW1U3Xtv5hxclwzyVYXTn8CENqthmh42c1PRrqydlezlnLB55yqFTdYh8WZyrAarMrhRK30d7~P-CrFbbsIU1SaphFg__&Key-Pair-Id=KUT5TJCACFTXG","The University of Maryland Baltimores Center for Violence Prevention and LifeBridge Healths Center for Hope briefed the House Health and Government Operations Committee on Jan. 31 about clinical, research and community interventions designed to prevent and respond to community violence.

\"The violence that's plaguing Baltimore City, the state of Maryland, and our country writ large is already a nightmare,\" said Dr. Nadine Finnegan Carr, executive director of the UMB Center for Violence Prevention. The center, she said, aims to \"interrupt and intervene on all incidents of and all forms of violence,\" with goals in research, community partnerships and training.

Programs and capacity

- UMB staff described an established training and technical assistance relationship with Maryland's Department of Human Services and Social Services Administration on child trafficking and mandatory training for social workers under the federal Preventing *** Trafficking and Strengthening Families Act. Dr. Finnegan Carr said the university team rolled out required training to social workers in 2017 and continues as a training provider for Maryland's Regional Navigator Program.

- LifeBridge Health described the Center for Hope, a consolidated hub launched in 2022 that brings child advocacy, hospital violence intervention teams, domestic‑violence services and the city's human trafficking navigation together. Adam Rosenberg, executive director of the Center for Hope, said the center and its network provided about 5,000 interactions last year across 11 sites and that programs include bedside violence‑interruption teams, forensic interviews and trauma‑informed therapy.

Impact and metrics

- Rosenberg said hospital‑linked violence interruption work and community mediations appear associated with reductions in gunshot wound admissions in some service areas: \"[T]here was a 52 percent reduction in gunshot wound admissions since at Sinai Hospital,\" he told the committee, and the system's safe‑streets sites reported low or zero homicides in several neighborhoods for extended periods.

- LifeBridge officials said their programs serve a range of ages and needs, including crisis intervention, forensic medical exams, counseling and legal advocacy; the system also supports family stability by providing transportation and childcare to remove barriers to therapy.

Why officials said the work matters

- Both presenters described violence as a public‑health problem that causes chronic trauma, increases downstream need for hospital and behavioral‑health services, and contributes to recurrent emergency department use. They argued that hospital‑based intervention plus community wraparound services keeps people healthier and reduces future acute care demand.

Discussion vs. decision

- Discussion: Officials reviewed program services, training and evidence from local pilots.

- Direction: The presenters invited legislative oversight and said their centers are available as resources for state agencies and local jurisdictions.

Ending: Committee members thanked the presenters and asked for follow‑up on funding sources and the feasibility of replicating elements of the Center for Hope in other jurisdictions. No legislative action was taken at the hearing.","University of Marylands new Center for Violence Prevention and LifeBridge Healths Center for Hope told the committee about statewide training, trauma‑informed services and hospital violence intervention teams that serve thousands annually and aim to reduce violence and its downstream health impacts.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6358081,"State launches ED Wait Time Reduction Commission; HSCRC and hospitals name capacity, post‑acute gaps and pilot fixes",1887,7083000,8970000,"/Search/View?dp=1&key=2212842-dcbc4c245347333a6863922c71d1ade9&start=7083&end=8970","https://assets.pipeline.soar.com/2212842-dcbc4c245347333a6863922c71d1ade9/thumbnail_7083000.jpg","/articles/6358081/Maryland/State-launches-ED-Wait-Time-Reduction-Commission-HSCRC-and-hospitals-name-capacity-postacute-gaps-and-pilot-fixes","https://secure.pipeline.soar.com/6358081-01000cb7ae1cb551f1bf4db10fc05c00/orig.mp4?Expires=1771013887&Signature=ULm8QE5~830aET~sa-QckQPm4HY8viNWmnjr~3OxUt~aO~~8JV8FXAtB48w2FQQp1~CqXLKkrTNuNn1oZxsy8F5-3-JV6-KueWj6Rn-EWLpdJ3aFCoug8kAJsKuDXrdJSdfQWJ7zG5BuokEtuwzyyJosHQFlfyaDcqOWOAY~1yXjph4-SU26H7EPaAZc--iDexbykU9QUsJ1qfHacjLpPxwRBWkjWXi9txjSuPLlvYtMGZwUIdQTyo-TiH8PLI51y2hMuUFuzlbO9JDJFMzqvn9jc8k-ESVZsNs7JePS-8-VR7UUOC4kj2UCoOqpwnyYGbdvWzFmbrXZO~l-3RP6Pg__&Key-Pair-Id=KUT5TJCACFTXG","Maryland officials, hospital leaders and the states health information exchange briefed the House Health and Government Operations Committee on Jan. 31 about a newly formed ED Wait Time Reduction Commission and a range of operational pilots aimed at shortening how long patients wait in emergency departments.

\"This is a challenge that we've faced for many, many years,\" John Crum, executive director of the Health Services Cost Review Commission, told the panel. Crum said the commission is focusing on hospital capacity, bed distribution, staffing and ED volume as the main in‑hospital drivers of prolonged emergency department stays. He added that non‑hospital factors such as skilled nursing facility capacity and behavioral health access also lengthen stays.

Commission structure and data work

- The commission, created by statute, has subcommittees on access to non‑hospital care (primary and post‑acute), hospital best practices, capacity operations and staffing, and a data subcommittee tasked with compiling new data elements and driving regional analysis.

- Tina Simmons, associate director of quality methodologies at HSCRC, said the data work aims to move beyond statewide averages to regional and hospital‑level analysis: \"This is where we're starting to look at levers to move those as well... identifying and recommending improvements in the collection and submission of data.\"

Operational pilots and hospital best practices

- Hospitals described operational pilots already in use or under active study: full‑capacity protocols that move patients into identified inpatient spaces to free ED beds more quickly, discharge lounges that allow clinically ready patients to vacate inpatient rooms while final paperwork and transport are arranged, and targeted triage procedures that separate lower‑acuity patients from those needing admission.

- Andrew Nicholas of the Maryland Hospital Association described a statewide throughput collaborative that compiled more than 50 strategies across three categories—input (EMS handoffs and triage), throughput (bed turnover and capacity management) and output (post‑acute discharges and social services connections).

Non‑hospital solutions

- State and departmental presenters emphasized work to expand community services that can prevent unnecessary ED use: MDH described an expansion of mobile crisis teams and brick‑and‑mortar crisis stabilization funded with approximately $13 million, and an expanded Assistance and Community Integration Services pilot for housing‑related wraparound supports.

- Craig Bamford, representing CRISP, said the health information exchange will be central to measuring outcomes: \"The data will allow us to focus on population initiatives and then also make sure that we are improving health, not just some of these utilization measures.\" He highlighted links between clinical, social and behavioral datasets to drive targeted interventions.

Monitoring and incentives

- HSCRC added ED length of stay measures to its quality incentive program so hospitals have a financial quality signal tied to improvement. Representatives said incentives are one tool among many and not a stand‑alone solution.

Discussion vs. decision

- Discussion: Committee members and agencies discussed contributing drivers, specific pilots and the collection of more granular data.

- Direction: HSCRC, MDH, CRISP and hospitals will continue commission meetings and subcommittee work; agencies plan to publish materials and share best‑practice summaries.

- Decision: No regulatory changes were made at the hearing; HSCRC said it will proceed with the incentive measure and the commission will continue scheduled meetings.

Ending: Officials asked the committee for continued oversight and invited lawmakers to observe pilots; the commission has a calendar of frequent meetings through 2025 to deliver interim findings and recommendations.","A new Maryland ED wait time commission has been formed with subcommittees on access, data, hospital capacity and best practices. HSCRC, hospitals and CRISP said the problem is multi‑factorial and identified pilot interventions such as full‑capacity protocols, discharge lounges and expanded mobile crisis teams as immediate responses.","actionData","errors"]

Article not found

Maryland outlines AHEAD model to expand primary care; hospitals warn of workforce, capacity and physician‑cost pressures

UMB Center for Violence Prevention and LifeBridge—s Center for Hope describe hospital‑linked prevention and intervention efforts

State launches ED Wait Time Reduction Commission; HSCRC and hospitals name capacity, post‑acute gaps and pilot fixes