The overwhelming success of Maryland’s All-Payer Model, in which the Maryland Health Services Cost Review Commission sets rates for all payers including private insurance companies, has led to the model’s extension and now expansion to all care settings through the Total Cost of Care Model. The new model leverages improvements stakeholders have made in care coordination, clinical integration, and care quality and places the full risk for the total cost of care of Medicare beneficiaries on the state. Commercial enrollment, while relatively stable thanks to the presence of governmental and large employers, has drifted downward over the past couple years while Medicaid and Medicare Advantage enrollment has risen, giving carriers in those spaces opportunities to gain lives and market share.


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