MD Health Enterprise Zones Seek to Reduce Costs

We hear a lot these days about dysfunctional government, so it's refreshing to hear about proposals to address nagging and persistent issues in community health.

For example, the state of Maryland in January launched a four-year $16 million pilot project that designates five "Health Enterprise Zones" in communities across the state.

Under the HEZ designation, five community coalitions were picked from 19 applicants to receive funding from the pilot after they identified contiguous geographic areas whose residents are poor and suffer from significant levels of chronic illnesses such as asthma, diabetes, and cardiovascular diseases.

If all goes as intended, HEZs might pay for themselves—if they reduce health disparities among the racial and ethnic minority populations within the zones, improve access to cost-effective and coordinated primary care services, and reduce costs through a reduction in hospital admissions, readmissions, and emergency room visits for otherwise non-emergent care.  

Bon Secours Baltimore Health System, through its affiliation with the West Baltimore Primary Care Access Collaborative won HEZ designation with a plan that includes expanding primary care services by adding eight new primary care physicians, 10 other associated primary care providers, and an extensive support and outreach staff.

Gregory Kearns, director of strategic management at Bon Secours, is also the interim project director for the collaborative.

"The collaborative is 16 organizations that came together back in 2010 with the understanding that we are all operating in this community but the community still is having some of the worst health outcomes in the area," Kearns explained in an interview.

"We really needed to assess the primary care capacity. We looked at this from a different level, not just from a healthcare level, but also what are the barriers to care, whether it is transportation or the ability to afford the medication, or to deal with housing modifications you might need."

The health challenges facing the residents of West Baltimore could be applicable in hundreds of socio-economically depressed communities across the nation.

"There is a lot of poverty and much shorter life expectancy, with significant levels of chronic disease, whether it is cardiovascular diseases, asthma, diabetes, HIV/AIDS, etc.," Kearns says.

"We have seen a large reliance on emergency rooms to meet primary care needs with a large percentage of the care in the ER being for illnesses or services that otherwise would be better seen in a primary care setting. A lot of the reason there is there is a lack of healthcare providers in the community, which we are looking to fix with our health enterprise zone application to add and attract new providers into the community."

"Part of it is a cultural issue of thinking the ED is the best or most convenient place to receive care, and part of it is letting chronic diseases escalate to the point where they become an acute illness and need emergency treatment. There are also a lot of social determinants that we are looking to address, whether it is access to healthy food, or access to safe recreational fitness facilities. West Baltimore does not have a lot of assets in this regard at this point and what we want to do is turn the focus on that."

The West Baltimore HEZ will focus on coordinating care through patient-centered medical homes. Outreach and education will be spearheaded by community health workers who will be deployed across the four zip codes in the zone to speak on topics that include disease management, fitness and nutrition, while ensuring that the residents they meet have access to primary care.  

"A big component of this is the strengthening and development of the patient-centered medical home model with a large focus on care coordination across all of our collaborative sites—making sure patients are having handoffs from one entity to the next, from one clinic to a doctor, or community based organization that can help meet social needs," Kearns says.

"That is really the approach we are looking at, which is let's build an infrastructure that allows for care coordination, but also builds that structure that allows for common delivery of education and outreach and then strengthen the existing base so that we are working better together."