Under the modernized Medicare waiver, Maryland's hospitals have performed impressively when it comes to holding health care costs in check - 1.47 percent and 2.61 percent growth, respectively, in calendar year 2014 and the coming fiscal year. That's why it raised more than a few eyebrows last month when Maryland's insurers put forth rate request increases of as much as 30 percent for some plans.

Hospitals account for 40 percent of health care spending in Maryland, and there's something that doesn't quite add up when comparing the minuscule cost increases hospitals are seeing with the massive premium increases that insurers are seeking. To address this issue, MHA submitted a letter to the Maryland Insurance Administration asking that insurance regulators reconcile the discrepancy between these two sets of numbers, and testified at a public hearing held by the administration on Wednesday.

One of the primary goals of the waiver, and of the Triple Aim, is to reduce the cost of health care. Insurers that are realizing savings by way of more efficient hospital care ought to be able to pass on at least some of those savings to consumers in the form of reduced premiums. As MHA's letter states, "...it is critical to demonstrate that the significantly lower rates of growth in total per capita hospital spending be translated into significantly lower rates of growth in insurer premiums as well."

Unfortunately, the state's process to determine insurer rate increases is not as transparent as the one to update hospitals' global budgets. Only those who review the administration's website currently have the opportunity to get a sense of any concerns raised regarding the magnitude of the insurers' requests. A more open approach, similar to the one used by HSCRC, would allow for a full airing of the rationale for the increases and any public concerns about them.

Health care, particularly in Maryland under the five-year demonstration agreement, is a highly complex system, with many players. Each of them, however, serves the exact same clients - patients and communities. And because we all have the privilege of working for the same people, it is their interests and needs that should be at the forefront of any regulatory decisions. 

The evolution of health care is happening in real time, and empowered consumers, informed by a transparent system, will dominate the future. Hospitals have transformed quickly to thrive in this new world by focusing on value, rather than volume. That's something everyone involved in health care should be able to get behind.