The Baltimore market is through the first year of Maryland’s new Total Cost of Care Model program, which puts the state at financial risk for the care of its Medicare beneficiaries. The program is an extension of the Maryland’s All Payer Model. As a result, insurers in markets like Baltimore have been forced to utilize other cost-control measures, and their financial success is largely measured by their ability to keep members out of the hospital and to develop plan designs and physician networks that are attractive in the group plan sector. Carriers in Baltimore also compete with large, well-regarded health systems, such as Johns Hopkins Medicine and MedStar Health, that employ broad physician groups and own popular health plans. Health systems, for their part, are pushing aggressive expansion strategies while seeking partnerships or affiliations with other stakeholders in the market to better coordinate care, in light of both the new TCOC Model and the broader trend towards consolidation in the healthcare industry.


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