Maryland embarked on an ambitious plan in 2014 to transform its all-payer rate setting system for hospitals under the authority of a new Medicare demonstration. The five-year demonstration will test all-payer global budgets for hospitals while attempting to use hospital payments to shift to population-based payments for most health care services. To learn about this approach, experience to date, and challenges faced, Robert Berenson interviewed John Colmers, chairman of the Maryland Health Services Cost Review Commission (HSCRC), Donna Kinzer, executive director of the HSCRC, and Joshua Sharfstein, former secretary of the Maryland Department of Health and Mental Hygiene.