By Mark Jensen

The modernized waiver presents Maryland with an opportunity to do great and innovative things in relation to improving the quality of and access to health care and lowering the cost of healthcare. It also presents huge challenges and possibilities for the opportunity to be lost or squandered.

The modernized waiver lays out laudable high level goals moving Maryland to a population health model. It does not provide anything close to a roadmap for how to get there. This definition and implementation function is left to the HSCRC, which is a little known state agency that sets hospital rates.

As with any public policy, definitions and implementation are critical. Effective implementation will also require transparency in the health insurance industry that has not existed to date. There is no agreement or mechanism linking reductions in health care reimbursements and lower health insurance rates, the later being the cost of which most of us are closely aware.  

Health insurance rate setting is not transparent while the HSCRC sets Hospital rates in public. Insurance companies and the state of Maryland as a Medicaid payor  have vast amounts of data that could exponentially speed up the process to better management of population health, but to date they have been unwilling to share it. Finally, in many important categories the quality of health care in Maryland ranks near the bottom in the nation. The implementation of the new waiver should include transparency of quality and incentives to improve quality.   

For more information, please contact Mark Jensen at Bowie & Jensen, LLC.