The Impact of Maryland's Hospital Global Budgets in Maryland on Utilization, Quality, and Spending

The project team will evaluate health care utilization and spending of Medicare beneficiaries before and after the introduction of Maryland’s hospital global budget program, comparing results with those for a matched control group of beneficiaries selected from similar hospital areas in other states. The team will use Medicare claims data from 2007 to 2015 and data from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) to evaluate changes in inpatient and outpatient utilization and spending and changes in care quality and coordination. They will also seek evidence for any unintended consequences for patient care. In addition, the team will investigate associations between outcomes and patient socio-demographic and hospital characteristics. The evaluation’s first phase, using data from 2007 to 2014, will look at the first eight hospitals involved in the program, allowing for a longer post-implementation period. The second phase, which will incorporate 2015 Medicare data and will cover the remaining hospitals in the program, will encompass larger and more diverse patient populations and hospital settings. This work will help federal and state policymakers, payers, and hospital leaders assess the potential for global budgets as an approach to providing more cost-effective care. It will also reveal how these potential benefits may differ across patient populations and hospital characteristics.