Healthcare Analytics for Maryland Hospitals and Clinics

Maryland operates approximately 70 acute care hospitals under a regulatory framework that is singular in American healthcare. The Health Services Cost Review Commission (HSCRC) sets uniform rates that all payers — including Medicare and Medicaid, which operate under rate exceptions in all other states — must pay for hospital services. This all-payer model, in place since 1977 and modernized in 2014 under a new TCOC agreement with CMS, means Maryland hospitals cannot pursue traditional payer contracting strategies. Revenue optimization requires instead a deep understanding of HSCRC rate structures, global budget allocations, and population health performance relative to TCOC targets. Johns Hopkins Medicine, with its six-hospital system and global research reputation, anchors Baltimore's academic medical center landscape alongside the University of Maryland Medical System's eleven hospitals. MedStar Health operates ten facilities across the state and into the DC market, while Luminis Health and Adventist HealthCare serve suburban Maryland populations.

Maryland Medicaid operates as HealthChoice, a managed care program covering approximately 1.5 million Marylanders through plans including UnitedHealthcare Community Plan, Aetna Better Health, Amerigroup, and MedStar Family Choice. Unlike other states, HealthChoice MCO payments interact with the HSCRC rate structure in ways that require specialized analytics to model. The state's global budget program for rural and community hospitals means that for those facilities, traditional volume-based revenue logic inverts — reducing unnecessary utilization actually improves financial performance under the global budget allocation. Baltimore City's concentrated poverty and the health disparities present in communities like West Baltimore require analytics tools that can support population health management at the neighborhood level.

Maryland's HSCRC all-payer model operates under a unique CMS waiver that exempts Maryland from standard Medicare and Medicaid payment regulations in exchange for demonstrating per-capita spending growth below national benchmarks. Hospitals submit detailed financial data to HSCRC for rate-setting, and global budget hospitals must demonstrate they are managing their attributed population's total cost of care — tracking quality metrics, utilization patterns, and attribution methodology continuously.

HealthChoice Medicaid managed care organizations impose HEDIS quality reporting requirements on contracted providers, and Maryland's State Health Improvement Process (SHIP) ties state funding to population health performance metrics. Maryland also participates in CMS Advanced Alternative Payment Models, and physician practices navigate MIPS reporting. The state's Maryland Primary Care Program (MDPCP) adds practice-level population health reporting requirements for participating primary care practices.