I have previously written about the Maryland demonstration project called Total Patient Revenue or TPR. The 10 hospitals across Maryland, including WMHS, are paid on a fixed basis regardless of volume or case mix. These hospitals are focused on increased efficiency, reducing cost, reducing avoidable admissions and readmissions in order to achieve financial savings. If the preceding factors aren't well managed, then the hospital bears the risk and the cost. The 10 hospitals have been making progress on increasing value over volume, keeping patients healthier and treating patients in the most appropriate setting, not necessarily in the hospital. The Collaborative is also making great progress in the overall delivery of care and reducing cost of care. These 10 hospitals are doing a wonderful job of learning from each other as they share best practices, improve the patient experience in their respective communities and bend the cost curve. What these 10 hospitals are doing should be modeled across the country in an effort to better address the components of reform.