HEALTH ENTERPRISE ZONES: Baltimore City Public Forum Department of Health and Mental Hygiene Community Health Resources Commission July 19, 2012

2 Maryland Health Improvement and Disparities Reduction Act The Act emanated from the Maryland Health Quality and Cost Council’s Health Disparities Work Group, established by Lt. Governor Brown and led by Dean E. Albert Reece of the University of Maryland School of Medicine. The Act was the first bill signed into law by the Governor on April 10, 2012 and its implementation is under the leadership of Lt. Governor Brown. The FY 2013 budget provides $4 million in new funding to the Community Health Resources Commission (CHRC) to fund Health Enterprise Zones (HEZ). It is anticipated that this funding will support two to four zones. The Administration appreciates the support of the Maryland General Assembly in approving the Act.

3 Maryland Health Improvement and Disparities Reduction Act The analysis of the Health Disparities Work Group focused on ways to address the root causes of health disparities, as evidenced by higher rates of diseases and illnesses such as: – Asthma – Diabetes The Work Group developed bold recommendations that including the creation of HEZ to saturate underserved communities with primary care providers and other essential health care services. – Hypertension – Other ambulatory care sensitive conditions

4 Main Components of the Act Health Enterprise Zones (HEZ) Promoting Cultural Competency Encouraging Reporting and Analysis of Health Disparities Data

5 Health Enterprise Zones The purpose of establishing HEZs is to target State resources to: – Reduce health disparities among racial and ethnic groups and geographic areas; – Improve health care access and health outcomes in underserved communities; and – Reduce healthcare costs and hospital admissions/readmissions.

6 Health Enterprise Zones Each HEZ will be a contiguous geographic area; Must have documented evidence of health disparities, economic disadvantage and poor health outcomes; and Small enough to allow incentives to have a significant impact but large enough to track data (population of at least 5,000).

7 Eligible HEZ Applicants Non-profit community-based organizations and local government agencies will be eligible to submit an application for HEZ designation on behalf of an area or community. The state is encouraging HEZ applications to reflect inclusion, community participation, collaboration, and support the priorities identified in the Local Health Improvement Process. The application for HEZ designation will be combination of both demonstrated need and intervention strategies to improve health outcomes in the potential Zone.

8 Health Care Practitioners Eligible to Receive HEZ Incentives In order to receive incentives/benefits, health care practitioners must provide services in the HEZ, be licensed/certified, and provide health care in one of the following areas: – Primary care, including OB/GYN, pediatric and geriatric services; – Behavioral health, including mental health and alcohol and substance use services; or – Dental services.

9 Implementation of the HEZs An internal steering committee led by Secretary Sharfstein, comprised of DHMH, Lt. Governor and CHRC staff, has been established to guide implementation of the HEZs with assistance from the Health Disparities Collaborative. There will be three stages in the process to implement HEZs: – Public Comment (June 15 - July 20, 2012) – HEZ Selection Process (September – December 2012) – Implementation & Evaluation Phase (December 2012 – beyond)

10 Public Comment  Feedback was requested on the following: (1) Eligibility Criteria and Data; (2)Proposed Principles for the Review of applications for HEZs; and (3)Potential Incentives and Benefits for the HEZ.  Send public comments to

11 Eligibility Criteria and Data (1)An HEZ must be a community, or a contiguous cluster of communities, defined by zip code boundaries (one or multiple zip codes). (2) An HEZ must have a resident population of at least 5,000 people. (3) An HEZ must demonstrate economic disadvantage: – Medicaid enrollment rate; or – WIC participation rate. (4) An HEZ must demonstrate poor health outcomes: – A lower life expectancy; or – Percentage of low birth weight infants.

12 Eligibility Criteria and Data Based on these criteria DHMH developed dynamic maps with data at the zip-code level.

13 HEZ Selection Principles Purpose: Describe how the proposal will reduce health disparities, including racial/ethnic and geographic health disparities, in Maryland. Description of need: Describe the health needs specific to the community. Core disease targets: Identify specific diseases for improvement. Goals: Propose measurable goals for health improvement in the HEZ by January Strategy: Propose strategies and interventions to meet the goals.

14 HEZ Selection Principles Cultural competence: Explain how the strategies will be implemented in a culturally competent manner and designed to be accessible to the target population. Balance: Strategies should be balanced between community- based approaches with primary care provider based incentives. Coalition: The coalition should include a diverse array of health and community partners, with specific roles and a clear governance structure with a point of accountability. Work-plan: Provide a detailed list of program activities, measurable outputs, timelines, responsible entities and other logistics that enable tracking of effort.

15 HEZ Selection Principles Program Management and Guidance: Include a plan for periodic reporting to the State regarding progress and challenges on implementation of the HEZ work-plan and interim values for the evaluation metrics. Sustainability: Develop a plan for sustainability and acquisition of resources beyond State funding. Evaluation: Propose an evaluation plan which tracks progress in meeting the health goals for the Health Enterprise Zone. Collaboration: Local health departments, hospitals, community organizations, local health improvement coalitions, and other stakeholders are encouraged to collaborate and produce a single plan to reduce health disparities and improve health outcomes in their area.

16 Incentives and Benefits of HEZ Designation Grant funding to implement the actions outlined in the HEZ application to improve health outcomes and reduce health disparities. Specific incentives for individual practitioners or practices that provide primary care, behavioral health services, or dental services in a HEZ: – State income tax credits; – Hiring tax credits; – Loan repayment assistance; – Priority to enter the Patient Centered Medical Home; – Priority for electronic health records funding; and – Grants for capital improvements and medical/dental equipment.

17 Promoting Cultural Competency The Act requires the Maryland Health Care Commission (MHCC) to track efforts by health plans to provide culturally appropriate educational materials for its members. In addition, the Maryland Health Quality and Cost Council (MHQCC) will recommend criteria for health care providers to receive continuing education in multicultural health care, including cultural competency and health literacy training.

18 Encouraging Reporting and Analysis of Health Disparities Data MHCC and HSCRC will develop and incorporate standard measures on racial and ethnic variations in quality and outcomes and track health insurance carriers’ and hospitals’ efforts to combat disparities. MHCC and HSCRC will develop recommendations for criteria and standards to measure the impact of the Maryland Patient Centered Medical Home on eliminating disparities in health care outcomes. State institutions of higher education that train health care professionals are required to report to the Governor and General Assembly on their actions aimed at reducing health disparities.

20 For more information: Send public comments and questions to: