HEALTH ENTERPRISE ZONES: Western Maryland

1. HEALTH ENTERPRISE ZONES: Western Maryland September 25, 2012 Department of Health and Mental Hygiene Community Health Resources Commission

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 • Hypertension • Other ambulatory care sensitive conditions • 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 include the creation of HEZ to saturate underserved communities with primary care providers and other essential health care services.

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 health care costs and hospital admissions/re-admissions.

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 a 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. Eligibility Criteria and Data • Based on these criteria DHMH developed dynamic maps with data at the zip-code level. 9

10. Eligibility Criteria and Data • 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.

11. HEZ Implementation • 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. Assistance has been provided by 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)

12. Public Comment & Public Forums • Feedback was requested on the following: (1) Eligibility Criteria and Data; (2) Proposed Principles for the Review of Applications for HEZs; (3) Potential Incentives and Benefits for the HEZ. • Public comment on these three areas closed on July 20 and was included in a Joint Chairmen’s Report submitted in mid-August. • Public forums held around the state: • Southern Maryland, Wednesday, July 11 • Baltimore City, Thursday, July 19 • Montgomery County, Thursday, July 26 • Prince George’s County, August 2 • Eastern Shore, September 13 • Western Maryland, September 25

13. HEZ Call for Proposals The public comments received earlier this summer were summarized in a Joint Chairmen’s Report (JCR) submitted to the legislature in mid-August. Following the 45-day legislative review, the CHRC will issue a Call for Proposals in early October. The CHRC and DHMH will host a public conference call in early October, several days after the Call for Proposals is released. Applicants will be given the opportunity to ask questions about the HEZ application process. 13

14. 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 an HEZ: • State income and hiring tax credits; • Grant funding from the CHRC; • 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.

15. HEZ Selection Principles Purpose Description of need Core disease targets Goals Strategies Cultural, linguistic and health literacy competence Balance Contributions from local partners Coalition Work-plan Program management and guidance Sustainability Internal evaluation and progress monitoring 15

17. For more information: http://dhmh.maryland.gov/healthenterprisezones/SitePages/Home.aspx Send questions to:dhmh.hez@maryland.gov