Solving the state's health disparities
Nearly 10,000 people in West Baltimore are diagnosed each year with new cases of diabetes, hypertension and other treatable, chronic health conditions — enough to fill 24 jumbo jets.
These illnesses will kill many of them and complications will disable others who may end up in wheelchairs or have limbs amputated because they didn't get the proper medical care.
This is the evidence the West Baltimore Primary Care Access Collaborative, a coalition of 16 hospitals and nonprofit organizations, gave state health officials as they sought to join a state program that provides financial incentives in an effort to curb health disparities in the state through the creation of special zones.
The argument was convincing. The coalition, made up of organizations that encompass some of the city's most impoverished neighborhoods, was one of five groups chosen by the state last month to create a health enterprise zone.
Maryland officials plan to allocate $4 million annually over the next four years to fund the zones. Each zone gets a pot of money that they can use to attract doctors, build clinics, buy buses to transport residents to the doctor and come up with other ways to better treat people with health problems.
The idea for the zones comes from a tool economic development officials have used for years to attract businesses by offering tax incentives for those that open in a certain area. The health zones can use the money to provide incentives such as loan repayment to doctors and income tax credits to lure medical talent.
Lt. Gov. Anthony Brown, who has led the charge for the initiative, said that studies and statistics have documented health disparities in the state and that the zones, like health care reform, are an attempt to address the problem.
"This is part and parcel of a much larger effort to create a healthier Maryland," Brown said.
The coalition in West Baltimore plans to use the roughly $5 million it expects to receive over four years to curb health problems in four zip codes — 21216, 21217, 21223 and 21229 — that include some of the state's poorest neighborhoods.
Many residents in these neighborhoods don't have insurance, or are on Medicaid or Medicare. They often wait until they are very sick to seek care and end up in the emergency room, where it is costlier to treat them. A dearth of primary care workers in the community also makes it difficult for residents to access basic care.
Bon Secours spokeswoman Judith Carmichael described a current case that is exactly what the coalition hopes to prevent. Two weeks after the hospital first treated a transient man for ulcers on his feet, he showed back up in the emergency room, she said. Now he may face surgery. The condition should have been better managed, the spokeswoman said, but it's not clear what happened after he was discharged the first time.
Under the state program, the West Baltimore coalition hopes to reduce the number of preventable emergency room visits by 15 percent, cut the number of preventable hospitalizations by 10 percent and reduce the costs of caring for residents with cardiovascular disease by 10 percent.
"We want to get people the care they need so we can keep them out of the hospital," said Gregory Kearns, director of strategic management at Bon Secours Hospital in Southwest Baltimore. The hospital is leading the coordination of the enterprise zone for the coalition.
The coalition plans to use the state money to attract 48 primary care doctors and nurse practitioners to the zone by offering $25,000 toward repaying student loans. It also will hire 11 community workers and offer community grants to help put fitness equipment in churches.
"We need to make sure opportunities for fitness are accessible throughout the community," Kearns said.
The West Baltimore Primary Care coalition grew out of a crisis faced by Bon Secours several years ago when the cost of caring for the poor weighed down its finances and closure seemed a real risk. The hospital eventually turned itself around after management changes and with financial help from the state, but its problems focused attention on the lack of health care in the area.
The coalition organized to address that issue and plans to use the enterprise zone money to help fund some of the initiatives it devised.
"This is an area in Baltimore City that has not seen the type of attention it has needed for decades," said Sen. Verna Jones-Rodwell, who helped organize the coalition. "Now we can bring to reality some of the things that we put down on paper and address disparities that are sickening people."
Debbie Rock helps provide services to women and children who live in poverty or have HIV or substance abuse problems in West Baltimore. The executive director of Light Health and Wellness Comprehensive Services said the money from the enterprise zone will help address problems at the grassroots level. Intensive outreach is often the only way to reach troubled communities, she said.
"For the first time I feel like they are really listening to those of us who are on the ground working with clients," Rock said. "They really want to know how to reach these clients and make a difference."
Within the zone, rates of chronic illness such as asthma, diabetes, cardiovascular disease and hypertension are in some instances more than three times that of the state rates. Asthma is five times higher in parts of the zone, cardiovascular disease sickens residents at twice the rate of Maryland.
More than half of emergency room visits are for illnesses that were preventable and could have been treated in a doctor's office.
The state designated four other enterprise zones. They are in Annapolis, Capitol Heights in Prince George's County, Greater Lexington Park in St. Mary's County and Dorchester-Caroline counties.
In St. Mary's County, a coalition plans to build a new community health center, establish a transportatin system to take people to the doctor's office and other medical services, and hire five new primary care physicians, a psychiatrist and two social workers. Nearby MedStar St. Mary's Hospital is leading the nearly $4 million, four-year effort.
The Prince George's County zone will target Capital Heights, which will get five new medical facilities with about a $1 million in funding each year. Dorchester and Caroline Counties aim to attract 18 new health care providers and to establish a mobile mental health crisis team.
Anne Arundel Medical Center in Annapolis will use nearly $200,000 a year in state funding to open a medical center in a senior housing high-rise that accounts for a large number of emergency room visits. About 40 percent of the calls from the center came from nine individuals.
Residents of the senior center, located in the city's Clay Street corridor, don't have cars or regular doctors, so they were calling ambulances for stomach problems and other ailments a doctor could handle, said Dr. Patricia Czapp, chair of clinical integration at Anne Arundel Medical Center.
A free clinic in the building does not have a stable staff, Czapp said. The new facility will have full-time doctors. The hospital will use loan repayment and other incentives to attract the medical staff. The zone's goal is to decrease 911 calls and emergency room visits from the senior center by 30 percent in the first year, she said.
The clinic also will serve the surrounding community, not just the senior center.
"We are spending a lot of health care dollars on crisis prevention, which is so much more expensive than preventive care," Czapp said.
State officials received 19 enterprise zone applications and said they hope to find grant money or other funding sources to establish more. For now the health enterprise zone is a pilot program and the General Assembly must approve the money in the budget each year.
Health secretary Joshua M. Sharfstein said the five zones selected had strong, innovative plans for curbing disparities and brought together diverse coalitions to address the problems.
The state will monitor progress of the programs, Sharfstein said. Each zone must meet stringent goals to ensure full funding each year, he said. If the goals are not met it could jeopardize future funding of the program.
Brown and Sharfstein said curbing health disparities is not just a public good, but it also makes economic sense. African-Americans in Maryland have higher hospital admission rates and more severe illnesses when they do end up in the hospital. In 2010, these higher admissions cost Maryland $820 million dollars, Brown said.
The enterprise zones put the power to change health outcomes in the hands of the community, Sharfstein said.
"It is a very different approach from where the government gets the budget, sets all the rules and then decides how things will be," he said.
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