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Maryland is in its fifth year of the All-Payer Model, in which the state sets hospital reimbursement rates for all payers, including both private and governmental insurance payers. The model has been extended for another year, now set to end in December 2019, due to the success that hospitals in Maryland--and Baltimore in particular--have had at improving population health, reducing readmissions and hospital-acquired conditions, and facilitating quality improvement and tighter care coordination. Commercial enrollment has continued to trend downward, shedding more than 60,000 lives in the past two years. Meanwhile, enrollment in Medicare Advantage and managed Medicaid is on the rise.