We are delighted to present this guest blog by Suzanne Schlattman, Deputy Director for Community Outreach and Development at the Maryland Citizen’s Health Initiative (MCHI)! MCHI is a long-time grantee of Community Catalyst, and in addition to their great work on outreach and enrollment, they are now also working on a health system transformation project. Maryland has long had a unique system for setting hospital payment rates, and MCHI has focused their project on influencing changes to that system that are underway right now. While MCHI’s specific project is grounded in Maryland’s unique hospital payment model, the creative steps that MCHI has taken to engage consumers and partners in their work could be replicated by other states. Read more to find out exactly what MCHI has done!

A New Frontier in Health Advocacy in Maryland

Maryland is implementing innovative changes to how our hospitals are paid (see below for more details).  At MCHI, we believe that consumer involvement will be essential to achieving the goals motivating these changes, which include lower costs and better quality care.  But it is also somewhat uncharted territory for MCHI. Traditionally our coalition has mobilized around expanding coverage and concrete campaigns like raising tobacco and alcohol taxes for public health programs. Mobilizing consumer engagement in a campaign for quality was going to take some retooling—so here’s how we are approaching it:

Focus Groups

  • First, we contracted with OpinionWorks, a research and strategy firm located in Annapolis, MD, to host a series of regional focus groups with consumers, especially consumers enrolled in both the Medicaid and Medicare programs who frequently utilize the hospital. We wanted to learn about their impression of Maryland hospitals and introduce new concepts of how their care might change.  We found that consumers are most interested in practicalities like having their prescriptions filled and in-hand before being discharged. Consumers are also interested in learning more about resources at the hospital and in the community that can facilitate better coordinated care, but they also want control over their privacy.

Public Forums

  • Then, we applied what we learned from the focus groups to develop outreach, education and messaging strategies that we are sharing through a series of public forums that began in January and will continue through this summer. We’ve been reaching out to our current coalition partners and other local coalitions and tagging on to existing meetings where possible. This has resulted in greater participation and allowed us to build relationships with new partners, like Local Health Improvement Coalitions, who are more active at the local level. We’ve sensed some resistance to using our customary regional approach and we’ve responded by adjusting our strategy and planning more local forums—using more of a hospital-by-hospital approach. What we have learned from these forums is that patients, providers and community-based organizations are eager to be engaged and want a clear call to action and follow-up steps for ongoing collaboration.

Faith-based work

  • Meanwhile, our staff looked to models where hospitals have successfully engaged local communities to improve care delivery and coordination. The most impressive model we found was the Congregational Health Network in Memphis, TN where the local hospital entered into a covenant with local faith leaders to organize and align resources in the health care system and the faith community. We think this would be a great model in Maryland and are sharing this as a possible “next step” with local leaders at the public forums. There has been a tremendous response and already significant progress on this front. We hope to support the launch of at least one pilot project at a Maryland hospital by the end of this year.

This is new and exciting territory for our organization. While we are blazing the trail hand-in-hand with local providers, hospitals and advocates, we are also eager to learn from other states that are now approaching these same ideas and challenges!

Background on Maryland’s Unique All-Payer Hospital System

What would your state’s health care system look like if you could tell Medicare—and all other payers—what to pay for each hospital service?

Well, that’s what we have in Maryland. Thanks to a waiver from CMS (the Centers for Medicare and Medicaid Services), this arrangement has been serving us very well for nearly 40 years. Our independent Health Services Cost Review Commission monitors hospital rates and performance and establishes consistent rates used by all hospitals and all payers across the state. Not only has this resulted in better transparency and more consistent quality from hospital to hospital, but our per capita costs have been lower and rising more slowly than the national average since receiving the waiver.

In other words, this waiver has been a major “win” for consumers and hospitals alike. The terms of the new waiver call for some pretty ambitious goals around reducing avoidable hospital admissions and readmissions while also applying some pretty tight financial parameters under global budgeting, which rewards hospitals for improving the health of the population in an area rather than simply paying for a volume of services.  Maryland is blazing a new trail in healthcare, and MCHI has jumped into the fray to make sure that the consumer voice is heard!

Suzanne Schlattman, Deputy Director for Community Outreach and Development,
Maryland Citizen’s Health Initiative