But you know we are merely in the foothills, and that the arduous work of reshaping health care delivery for 6 million Marylanders has just started. 

 

You know firsthand the dramatic change your organization has undergone in the past 18 months - from shifting 95 percent of all hospital revenue to fixed global budgets (the waiver agreement called for 80 percent by year five) to restructuring staff and facilities to build, from the ground up, a population health infrastructure that cares for entire communities.

 

And your hard work is paying off. Inpatient admissions and inpatient use rates are down more than 4 percent and potentially avoidable utilization is down more than 6 percent; readmissions rates have dropped 0.8 percent, faster than the nation as a whole. All this has translated into more than $100 million in savings to Medicare in the first year alone (the agreement calls for $330 million by year five). (MHA marked the advancements in the first year with several articles and resources.)

 

This progress is a testament to your commitment.

 

But we're still climbing. In these 18 months, you've shown that the Triple Aim is attainable- that refocused partnerships, infrastructure, staff, community and culture can really make a difference in the lives of the people you serve.

 

Of course success comes at a cost, and sustaining these early gains will take significant investment. Working with the Health Services Cost Review Commission, MHA helped secure a 3.3 percent average per capita global budget increase (more than $500 million) for the coming fiscal year. That's a good start, but we'll continue to fight for the resources you need to build systems to care for an unknown number of patients with unpredictable care needs within a fixed budget.

 

And, of course, other providers - doctors, post-acute care facilities and others - still operate under a strict fee-for-service model. To truly transform health care, it will take cooperation and buy-in from the entire continuum. This will include physician gainsharing and other initiatives that bring providers in line with the goals of the waiver agreement.

 

Looking back on this first, tumultuous year, it's fair to say that while we're not near the top of the mountain just yet, we are, thanks to your hard work and dedication, climbing steadily upward.