How Maryland’s Innovative Physician VBC Program Saved $20 Million In Its First Year

Effective value-based care cannot occur in a vacuum. It requires careful coordination among care partners, payers, health information exchanges (HIEs) and others to receive the right data at the right time to make decisions that improve outcomes while preserving resources.

In Maryland, the results of a new initiative demonstrate the power of collaborative data sharing and carefully coordinated action among state health agencies, hospital and medical groups and clinicians to advance value. They also point to the benefits of neutral administration of value-based initiatives—in this case, by the state’s HIE.

The program—called the Episode Quality Improvement Program (EQIP)—saved $20 million during its first year. Depending on the participants’ state percentile, physicians can receive up to 80% of their shared savings based on performance metrics, with the remainder going to Medicare.

The EQIP program aligns with national trends and initiatives for improving health outcomes through enhanced data sharing, notably fitting within the Center for Medicare and Medicaid Services (CMS) Advancing Health Equity and Data (AHEAD) model. In Maryland, Chesapeake Regional Information System for our Patients (CRISP), the state-designated HIE, implements the EQIP program.

The Maryland Health Services Cost Review Commission (HSCRC) established EQIP for specialist physicians in 2022, with voluntary participation for practitioners who participate in Medicare. It was developed in collaboration with the Maryland State Medical Society (MedChi), CRISP and the Maryland Hospital Association (MHA) as a track program under Maryland’s Total Cost of Care model, which enables participants to earn a portion of the savings they create by achieving cost and quality targets for one or more clinical episodes.

HSCRC is the state’s hospital rate-setting authority, and commission officials deserve tremendous credit for launching such an ambitious, statewide care program. The learnings from this initiative highlight opportunities for other states to drive collaborative value-based improvement powered by shared data, with neutral administration by an HIE.

State Innovates on Care Models

More than 93 million people are part of a value-based care arrangement, according to the Health Care Payment Learning and Action Network. Today, these models represent 60% of healthcare payments in some form, with widespread adoption among both federal and commercial payers. Half of family practice physician groups participate in some type of value-based payment, a 2022 American Academy of Family Physicians survey reveals, while another 18% are exploring their options in this area.

The 10^th annual Humana report on VBC, published in 2023, compared health data for Medicare Advantage patients in value-based care arrangements with that of Medicare patients who weren’t cared for under these models. Patients in the value-based care populations:

Experienced 30% fewer hospital admissions
Received 15% more preventive screenings
Saved 23% in medical costs

Maryland has a long history with alternative payment methods, including pioneering the nation’s only all-payer hospital rate regulation system since the 1970s. In 2014, Maryland announced a new approach, focusing on overall expenditures for hospital services as well as improving quality of care and population health outcomes. With the introduction of the All-Payer Model, the state received a Medicare waiver that exempted the state from the Inpatient Prospective Payment System (IPPS) and Outpatient Prospective Payment System (OPPS), allowing the state to set rates for these services.

Under Maryland’s All-Payer Model, the state was required to reduce Medicare spending by at least $330 million over five years and achieve certain quality improvements such as reducing hospitals’ 30-day readmission rates and hospital-acquired infections. The program included a limit around per-capita cost growth for hospital care for both inpatient and outpatient services.

The state’s Total Cost of Care Model (TCOC), launched in 2019, builds on the All-Payer Model and allows Maryland to set pricing for medical services provided by hospitals, primary care physicians, and specialists. Under this pilot model with CMS, Maryland is fully accountable for the total cost of and quality of care for its Medicare fee-for-service (FFS) beneficiaries and must achieve $2 billion in savings over eight years.

If Maryland fails to obtain its committed Medicare savings, CMS can revoke the state’s waiver that allows it to set its own rates for reimbursements. High-stake initiatives like these underscore the importance of information exchange, proper data collection and reporting capabilities, and cooperation among providers and facilities to set the stage for success.

The model continues to evolve beyond TCOC. In November 2024, Maryland signed an agreement with CMMI to participate in AHEAD. Planning efforts are underway, and the model official begins in January 2026.

How EQIP Works

Maryland’s EQIP program, under the auspices of TCOC, is voluntary for non-hospital Medicare practitioners and suppliers. In its first year, 1,980 practitioners participated. Since then, interest has grown significantly, with 2,733 participants in 2023 and 3,217 in 2024.

Under the guidance of HSCRC, CRISP administers the program through a custom-engineered portal (EQIP Entity Portal) where providers can enroll, view clinical episode categories and other data, and engage with EQIP entities.

The program’s purpose is to better align practitioners with hospitals under TCOC and increase participation. Specific goals include increasing physician accountability for improving care quality and lowering costs, introducing new care models, improving care coordination and sharing evidence-based knowledge.

One unique feature of the program: Participation involves only upside risk, one of the safer ways for clinicians to explore value-based payments. Clinicians can participate individually or with other care partners in one or more established EQIP clinical episode categories within one specialty area or multiple specialty areas. However, clinicians must meet minimum episode standards to be eligible for remuneration.

CRISP facilitates the EQIP program’s savings calculations in collaboration with HSCRC. Through EQIP, Medicare savings are shared based on performance and calculated across clinical episodes. Participating clinicians earn incentive payments based on meeting certain thresholds and adjusted by quality metrics. Top performers can receive up to 80% of the savings generated.

Partnership Makes It Possible

Initiatives such as EQIP show that better outcomes don’t have to cost more. The key to care coordination starts with an easy way to share data so that clinicians have the information they need to make appropriate care decisions.

As more states are selected to participate in the AHEAD model, partnerships with organizations like CRISP are critical as they provide the level of technology expertise necessary to ensure that the prerequisite technical infrastructure is in place. This lays a foundation for deploying value-based care initiatives like this without putting undue administrative burden on participants or those that oversee these programs. It also helps ensure the technological capacity exists to keep participants informed on their progress, as this level of transparency is vital to sustaining buy-in.

An ambitious effort such as EQIP would not be possible without close cooperation among state health agencies, hospital and medical groups and clinicians sharing data through a common HIE. As CMS seeks to move all Medicare recipients under value-based care arrangements by 2030, models like EQIP offer essential learnings about the power of collaborative data sharing in advancing higher-quality care at reduced cost.