Paper of the week: 25.07.18

Muir Gray’s paper of the week: Global Budgets in Maryland Assessing Results to Date

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Reference: Sharfstein JM, Stuart EA, Antos J. Global Budgets in MarylandAssessing Results to Date. JAMA.2018;319(24):2475–2476. doi:10.1001/jama.2018.5871

Bottom line, chosen by Muir from the paper

The study also found that efforts to strengthen collaborative relationships with outpatient providers and community organizations are “in early stages and might not have an effect for some time.” Nowhere is this more clear than in the area of behavioral health. Maryland hospitals recognized early that patients with severe mental illness and substance use disorders account for disproportionate amounts of hospital services. Yet challenges in the public and private mental health systems have left hospitals struggling to manage acutely ill patients with mental illness. Indeed, the RTI study found that “most hospitals that we visited reported occasionally having to keep patients with mental health issues in inpatient beds because a safe option for discharge was not available.”

…..As the continued increases in health care costs crowds out other priorities, such as elementary and secondary education, it is reasonable to ask whether global budgets might be part of a broader solution. There is much to learn from the experience of Maryland, which has a diverse population served by rural, suburban, and urban hospitals including 2 major academic health centers. While the state’s reforms are very much still in progress, Maryland’s unique approach merits even greater attention in the months and years to come.

Implications for value improvement

Population healthcare arrives in the USA