Value Based Program Design

Background
The State of Maryland's Health Services Cost Review Commission (HSCRC) is seeking a contractor to assist in researching, designing, and refining methodologies for defining and measuring care transformation programs with a focus on episode-based models. The HSCRC is an independent state agency responsible for setting the rates Maryland’s hospitals may charge for healthcare services. Since 2014, the State has used its rate setting authority to set a global budget, whereby each hospital receives a fixed amount of revenue, regardless of utilization. However, under an agreement with the Centers for Medicare and Medicaid Services, the State of Maryland is responsible for managing not just the hospital costs but also the total cost of care.

Work Details
The project will include three required tasks: Technical Input, Program Design, and Episode Development.
The Technical Input task involves conducting literature reviews of potential care transformation models published in peer-reviewed papers, think tank white papers, or gray literature, Centers for Medicare & Medicaid Services (CMS) and CMS Innovation Center released models, and model summaries for the Physician-Focused Payment Model Technical Advisory Committee (PTAC), or other sources recommended by the contractor. Additionally, it includes writing up summaries of care transformation and/or episode-based models that have proven successful in other markets and identifying and contracting with physicians and other experts to provide input on episode design.
The Program Design task involves developing financial models of different shared savings arrangements, creating algorithms to assign patients to physicians based on claims data, and creating and assessing different risk adjustment methodologies using alternative payment models.
The Episode Development task includes assessing clinical services that are most amenable to inclusion in a value-based payment model, constructing groupings of clinical services into a single episode of care, creating and assessing different quality measures relevant for the clinical episodes, and producing program documents that describe the episode for potential participants.

Period of Performance
The contract will last three years. The HSCRC staff anticipates meeting with the Contractor on a weekly basis for the duration of the contract, starting immediately following the award of the contract. The HSCRC anticipates developing 2-3 new episodes per year with constant evaluation and modification to existing design features as appropriate. The contractor’s workload is not expected to exceed 2,650 hours in a year.