Lessons for Specialty Care Payment Reforms: Insights from Maryland’s GBR Model

 Maryland’s GBR model has been hailed as a game-changer in tackling the rising costs of healthcare. However, it’s crucial to recognize that payment reforms can have varying effects across different types of care. Here are some key takeaways for CMS’s new value-based specialty care strategy.

1️⃣ Tailored Payment Models: Specialty care savings may require specific payment models for different types of care, like cancer surgery. It’s essential to design reforms that cater to the unique needs of each specialty.

2️⃣ Nuanced Quality Measures: Quality assessment in specialty care should go beyond traditional metrics like readmissions and emergency visits. Patient-reported outcomes and person-centered measures should play a more significant role in evaluating care quality.

3️⃣ Health Equity Considerations: Specialty care reforms must address health equity. By separating reimbursement from volume, vulnerable populations can benefit from sustainable financing. The Global Equity Model offers a framework to assess the success of payment reforms based on health outcomes.

4️⃣ Policy Innovation: Replicating the success of Maryland’s GBR model requires policy innovation and alignment. Other states may need to establish cost growth targets or overcome implementation challenges to ensure viability.

5️⃣ Integration of Primary and Specialty Care: Meaningful delivery system changes are crucial to advancing the integration of primary and specialty care. Global budgets provide a foundation for reorganizing how specialty care is delivered and reimbursed.

There is much to learn from Maryland’s experience and drive effective payment reforms in specialty care.