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forward by Governor Hogan’sadministration.Convene: The Commission is qualified toengage and collaborate with all members ofthe health care community. Each year,MHCC convenes workgroups to study issuesand make recommendations at the requestof the legislature. Currently, MHCC isplaying a leadership role in conveningworkgroups on expanding school-basedtelehealth, integrating clinical and healthpayment records, and reducing AfricanAmerican and rural rates of infant mortality.Measure and aggregate quality data: TheCommission collects and analyzes healthcare cost and quality data for use byconsumers, policy makers, health careproviders, and other entities. The MHCCprovides consumer-facing quality reportcards and maintains a website listinghospital charges and length of stay for awide variety of medical episodes. In 2017,MHCC launched WearTheCost, an initiativeto improve awareness of price variation forMaryland consumers. Data for many of theinitiatives comes from the MarylandMedical Care Data Base, which containsclaims data from plans in the privateinsurance market in Maryland.Assess policy: The Commission can provideobjective policy insight based on data itcollects and knowledge from itscollaboration with multi-disciplinarystakeholders. The MHCC publishes severalreports annually for the legislature andother policy-focused audiences, includingreports on health care cost and utilization,proposed insurance mandates,recommendations from MHCC workgroups,and other topics.Plan for health facility development: TheCommission is charged with planning forhealth facility development via theCertificate of Need (CON) program. Thisfunction includes overseeing the supply anddistribution of regulated health carefacilities and services through the reviewand approval of health facility capitalprojects.The MHCC’s RoleThe MHCC is legislatively mandated to perform the tasks listedbelow:o Report quality and cost informationo Plan and maintain the availability and financialviability of health care facilities and serviceso Reduce costs via wider adoption of informationtechnologyo Promote delivery system reformo Develop an all-payer database to monitor cost,quality, and population healtho Monitor health care expenditureso Protect safety net providerso Monitor disparitiesOther MHCC Resource Demands:o Act as a health policy arm of the General Assemblyo Monitor the health care work forceo Serve as a technical resource to HSCRC for the AllPayer Model and TCOC DemonstrationMHCC VISION & MISSIONOur vision is a state in which informed consumers hold the health care system accountable and have access to affordableand appropriate health care services through programs that serve as national models.The mission of the Maryland Health Care Commission is to plan for health system needs, promote informed decision7making, increase accountability, and improve access in a rapidly changing health care environment by providing timely andaccurate information on availability, cost, and quality of services to policy makers, purchasers, providers and the public.

Everyone’s Challenge:Addressing Social Determinants of Health and Health DisparitiesThe Commission maintains that addressingSDOH and health disparities is critical inorder to achieve Maryland’s health caregoals. While other state agencies lead policydevelopment and research in this area,MHCC will focus on SDOH and disparities ascross-cutting issues that impact all areas ofthe Commission’s work and need sustainedfocus to ensure improvement.residents and achieving Maryland’s TCOCgoals.Reducing health disparities, the differencesin disease burden and health statusbetween populations, is equally importantto achieving Maryland’s health systemgoals. Disparities can be identified based onrace, ethnicity, gender, urban/ruralgeography, income, and other factors.SDOH include housing, employment status,income, education, and food security. Bysome estimates, 40 to 50 percent of healthcare costs are determined by SDOH andgeographic location.7 Thus, addressing theimpact of SDOH will be a key factor inimproving the health of Maryland’sApproximately 50 percent of Maryland’spopulation is non-white or Hispanic andcould be impacted by sizable and persistentracial and ethnic disparities. 8 The infantmortality rate for African American infantsin Maryland is more than two times the ratefor white infants.9 Racial disparities exist forFigure 2. Maryland Life Expectancy at Birth by County, 2014Male Life Expectancy at BirthFemale Life Expectancy at ty-rate-by-race-ethnicity/798

several other health measures, including lifeexpectancy and self-reported health status(Figure 2). 10,11 Income-based disparities areanother significant challange, theCommonwealth Fund ranked Maryland 31stamong states, well below the nationalaverage. 12such as the Office of Minority Health andHealth Disparities, use their public healthexpertise to raise awareness of SDOH andeliminate health disparities by mobilizingMDH resources. Educational, non-profit,and private sector partners also play keyroles in facilitating change. Moving forward,the Commission intends to utilize itsstrengths as a convener and dataaggregator to impact SDOH and healthdisparities using the following strategies:Addressing SDOH requires a broaderapproach than the health care communityalone can offer. Private investment andpublic policies to promote economic growthand job creation directly contribute toimproved social conditions, as well asprograms to improve educationalopportunities, reduce violence, and ensureaccess to proper nutrition. Similarly, amulti-organization approach is necessary tocomprehensively monitor, analyze, andimprove the current racial and geographicdisparities impacting health in Maryland.Reducing health disparities requires anopen dialogue on race and activeengagement with residents to build trustand provide solutions that fit individualcommunity needs.Consider the impact: The Commission plansto consider the impact each MHCC strategicplan and activity could have on SDOH andhealth disparities, which may includeaugmenting current initiatives and pursuingnew opportunities.Continue the conversation: SDOH andhealth disparities affect all aspects of thehealth care system. The Commission willuse its role as a convener and enabler toensure SDOH and health disparities arealways part of the discussion.Offer support: The MHCC’s collection ofquality and cost data, in addition to theirpolicy expertise, can help other agenciesand organizations fulfill their populationhealth objectives.There are many Maryland organizationswith unique expertise and capabilities thatactively address social issues related toSDOH and health disparities. Units withinthe Maryland Department of Health /sites/default/files/files/county profiles/US/2015/County Report Baltimore County Maryland.pdf10129

The MHCC’sPriorities Educate, inform, and engage the healthcare community Make MHCC the trusted source of qualityand cost information Modernize health planning and theCertificate of Need program Enable providers to participate in valuebased payment models Elevate telehealth10

Educate, Inform, and Engage the Health Care Community Communicating with consumers,businesses, and providers will increaseEngaging stakeholders within the healththe utilization of key MHCC resourcescare community is critical for the success ofrelated to health care cost and quality.each of MHCC’s priorities. While manyCommunity engagement will also helpmembers of the community regularly accessthe Commission understand health careinformation from MHCC’s database andpriorities of the Maryland’s residents.reports, more can be done to improve The MHCC is constantly working toawareness of MHCC’s data, analysis, anddevelop strong relationships with thepolicies. The Commission has identified thepress and recognize the hard work andlack of external awareness of MHCC’s rolestalent of the reporters who reliably andand resources as a factor limiting theaccurately cover the Commission’seffectiveness,regulatoryimpact, andprocesses, andinfluence ofdata analysisObjectivetheEducate, inform, and engage the health careproducts. ThisCommission.community on MHCC activities to elevate thecontinued effortAs thesuccess of the Commissions work in all prioritywill ensureCommissionareas.MHCC news andadvances itsmessaging isstrategic plan,consistentlytheshared through key media outlets.Commission will enhance its focus on Informing legislators about MHCC’seffective communications and marketing topriorities and activities will continue theensure that its work has impact.cooperative relationship betweenThe Commission plans to increase outreachMHCC and the General Assembly.to the media, businesses, lobbyists,legislators, academics, providers, payers,Strategiesand most importantly, consumers.Develop a strategic communications plan: Convening and consulting with otherMHCC will develop and implement ahealth care leaders will encouragestrategic communications plan to supportcollaboration and prevent duplication ofthe strategic priorities identified in thisefforts across the health system.report. This will bring cohesiveness to theImportance11

organization’s communications efforts,which have largely been project-focused.legislators, as well as conductingcommunity outreach with consumers.Redesign the MHCC website and improvesocial media outreach: The MHCC willredesign its core website to increase ease ofuse for all stakeholders and to encourageconsumers to use available resources. Inaddition, the Commission will continue toimprove its social media efforts to reachconsumers better.Improve communication to consumers:The Commission will improve the way itcommunicates with consumers. Marylandresidents have diverse health care needsand want to know how to effectively useMHCC’s resources on health care qualityand health care cost. 13 The Commission willcontinue to work to improve messagingabout available MHCC resources to clarifyhow residents can use these resources intheir everyday lives.Educate legislature on MHCC goals andpurpose: The MHCC will continue to buildrelationships with members of the GeneralAssembly and educate legislators aboutMHCC’s purpose and work, including thestrategic goals contained in this report.Develop other engagement tools andstrategies: Over the next four years, theCommission will develop additionalengagement tools to increase awareness ofMHCC resources. Potential options includeemail updates, new partnerships, astatewide listening tour, holdingCommission meetings outside of Baltimore,and in-person outreach at events.Learn from Maryland residents: For MHCCto best serve the Maryland community, theCommission must understand the prioritiesof Maryland residents. The Commission willcreate opportunities to listen to residentsacross Maryland to learn how differentcommunities interact with the health caresystem.Continued engagement with local mediaoutlets: The MHCC will continue to developrelationships with local press to increasecoverage of MHCC news and activities.Create MHCC issue briefs on timely healthtopics: The MHCC plans to publish issuebriefs with targeted messaging on keytopics related to MHCC’s work andMaryland’s health systems. The issue briefswill provide information and link readers toState resources. These briefs will be keyresources for educating media contacts andMHCC resources for consumers include a pricetransparency website,https://www.wearthecost.org/; consumer guides onlong term care and other x;and quality reports for hospitals, nursing homes, andhealth plans, https://www.marylandqmdc.org/1312

Make MHCC the Trusted Source for Quality and Cost Informationpractices. With this information providerscan confidently focus their qualityimprovement efforts and review theirprogress over time.ImportancePublic sharing of quality and cost data canempower Maryland residents and improvehealth care quality. Equipping consumerswith health care data relevant to their carePolicy makers also have an interest in howneeds will build their confidence whenproviders are performing. Quality datamaking health care decisions. Quality andallows agencies to identify the currentcost data willhealth careinformissues affectingresidents ontheirObjectivethe cliniciansIncrease use of MHCC quality and cost data byconstituentsor hospitalsall members of the state health care system,and adjustbest suited toincluding Maryland residents, to increase pricepayment policytheir needstransparency and reduce use of low-value care.and regulationsand providingaccordingly.high-valueThe MHCCcare. Whencurrently collects, manages, and reportsconsumers demand and utilize high-valuequality and cost data. Moving forward, thecare, they incentivize providers to improveCommission plans to expand its datacare delivery and coordination and securesharing and work to improve how this databetter medical outcomes. Providing privateis communicated to different audiencesand public payers with quality and costwithin the health care community.information has a similar effect. With thisknowledge, payers can create paymentpolicies to encourage consumers to receivecare from high-value providers; once againincentivizing providers to improve care.StrategiesExpand “Wear The Cost”: The MHCC plansto increase consumer understanding ofhealth care cost and cost variability byexpanding the Wear The Cost initiative. TheWear The Cost initiative increases pricetransparency and encourages discussion ofhealth care costs and MHCC resources. TheCommission plans to add additional clinicalSharing quality and cost data with providersdirectly also encourages qualityimprovement. Encouraging providers toreview their performance helps them tounderstand how they compare to other13

Develop an Outpatient SurgeryComparison tool: Outpatient surgery mayrepresent a significant opportunity forMHCC to expand its use of quality and costinformation to improve care. Outpatientsurgeries are subject to significantvariability in cost due to variations in howprocedures are reimbursed in differenthealth care settings. Information on qualityoutcomes that might justify cost differencesis sparse. Disparate data systems acrosscare settings make creating and validatingcost and quality measures challenging.Outpatient surgery is usually planned wellin advance of the service, allowing patientstime to evaluate alternative surgeons andfacilities. A value comparison tool would aidpatients through this process, allowingthem to make informed decisions based onprice, the experience of physicians andfacilities in performing the neededprocedure, and the track record of thefacility concerning serious complications orregulatory compliance issues.episodes to the initiative, with a focus onprocedures of high importance to Marylandresidents. In addition, the Commission plansto expand the current database to includeprovider and prescription drug paymentsusing Medicare data.Reducing waste and low-value care:MHCC will publish opportunities forreducing unnecessary and low-valueservices by using Choosing Wisely’s 14measures and guidelines on wasteful andlow-value care. MHCC will engage providersand other key health care stakeholdergroups in using MHCC data to understandand identify pathways for implementingappropriate Choosing Wisely guidelines.The goal is to generate information to startconversations between providers andpatients about choosing care that isappropriate and necessary and that doesnot cause the patient harm.Choosing Wisely is an initiative of the AmericanBoard of Internal Medicine Foundation thatpromotes patient-physician conversations aboutunnecessary medical tests and procedures.1414

Modernize Health Planning and the Certificate of Need ProgramImportanceThe MHCC is legislatively mandated to planIn 2017, the Senate Finance and Housefor and maintain the availability andGovernment Operations Committees askedfinancial viability of health care facilities andthe Commissioners to evaluate the state’sservices for the State of Maryland. TheCON program. The purpose of the requestpurpose ofwas twofold:State health(1) to assureplanning andthe CONObjectivethe CertificateModernize the Certificate of Need program toprogram alignsminimize administrative burden and support theof Need (CON)withState’s goals under the All-Payer Model.program is toMaryland’sensure newgoals under thehealth careAll-Payerfacilities and services are valuable to theModel, and (2) to reduce the administrativestate, in that they are:burden for applicants. In response, the Needed;MHCC invited a range of stakeholders, High-quality;including Commissioners, representatives of Geographically and financiallythe MDH, physicians, payers, employers,accessible; andconsumers, and members from regulated Financially viable.health care facilities to serve on the CONModernization Task force. In 2018, the TaskMaryland’s health care payment andForce reviewed the current policies anddelivery system policies have changed sincedrafted recommendations for thethe inception of CON regulations.Commissioners. The goals identified by theCommissioners agree the current healthtask force include:plan and CON program no longer meet the Modify CON to complement theneeds of Maryland’s health careobjectives of the TCOC Model.environment and goals. Currently, the CON Provider opportunities forapplication process is overly burdensomeinnovators committed to thefor applicants and the MHCC staff. Indelivery of affordable, safe, andaddition, several Commissioners worry thehigh-quality care to enter thecurrent regulations limit competition andmarket.may negatively impact access, cost, andinnovation.15

Reduce the burden of CONregulatory requirements. Maintain meaningful review criteriaand standards consistent with thelaw and understandable toapplicants, interested parties, andthe public.cannot modernize certain CON reviewcriteria without changing basic programrequirements contained in current statute.The Commission will work with state policymakers and stakeholders to provide greaterflexibility for existing organizations toreplace existing capacity, or to expandservices consistent with the aims of theTCOC Model. The MHCC will seek legislationto allow existing providers to modernizecurrent facilities without CON review. TheMHCC will also seek changes in statute toallow established hospices and drugtreatment facilities to add inpatientcapacity, and for ambulatory surgeryfacilities to expand to two operating roomswithout CON review.In December 2018, the Commissionsubmitted a report containingrecommendations on CON Modernizationto the Maryland General Assembly. Overthe next four years, the Commissioners willfurther

expansion of the Maryland All-Payer Model. 1. The TCOC Model, combined with world-class providers and public health organizations, positions Maryland as a national health care innovator and leader. Despite Maryland's leadership status in delivery system reform, opportunities for improvement in health status and patient safety remain.