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Maryland's Innovative Health Disparities Initiatives Highlighted in JAMA Viewpoint Co-Authored by Dean Reece

Thursday, July 18, 2013

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Maryland’s innovative health disparities initiatives are highlighted in a new Viewpoint article published this week in the Journal of the American Medical Association (JAMA), co-authored by University of Maryland School of Medicine Dean E. Albert Reece, M.D., Ph.D., M.B.A.; Lieutenant Governor Anthony G. Brown, J.D.; and Secretary of the Maryland Department of Health and Mental Hygiene Joshua M. Sharfstein, M.D.

The authors describe the significant steps that Maryland has taken toward finding solutions for disparities in health care and access to care that negatively impact minorities and lower-income residents. Maryland’s recent effort to address health disparities in the state began in 2011 when Lt. Gov. Brown convened a Health Disparities Workgroup to develop proposals to reduce health disparities using incentive-based initiatives. The workgroup was led by Dean Reece, who is also Vice President for Medical Affairs at the University of Maryland and John Z. and Akiko K. Bowers Distinguished Professor at the School of Medicine.

Maryland’s leaders hope that its initiatives will be a model for other states as well, inspiring others to take action against health inequities that leave minorities and low-income Americans vulnerable. “Efforts to move health care forward must not leave behind communities with longstanding disadvantages in health,” write Dean Reece, Lt. Gov. Brown and Secretary Sharfstein in their JAMA Viewpoint. “Incentives can create the environment in which innovation and creativity forge new paths to progress.”

The workgroup’s recommendations were written into law as a result of the Maryland Health Improvement and Disparities Reduction Act of 2012. The highlight of group’s plan was the creation of Health Enterprise Zones similar to the economic enterprise zones that the U.S. Department of Housing and Urban Development designed to bolster disadvantaged communities. The state designated the first five Health Enterprise Zones in January 2013. In each zone, a community coalition leverages support and partnerships to revitalize areas with high rates of chronic disease, health disparities and a lack of access to primary care.

Qualified stakeholders in the zones receive access to incentives, including up to $25,000 per year in loan assistance repayment programs, tax credits against state income and hiring taxes, priority for support for electronic medical record assistance in primary care, funding for medical or dental equipment and grants to support community health. Each zone has a sustainability plan for long term funding and savings based in large part on emerging incentives in the health care system. The workgroup also has recommended monetary prizes — perhaps established through public-private partnership — to reward outstanding innovations that address health disparities. Maryland is measuring the program’s success in its first four year’s by regularly assessing key quality and cost outcomes, such as the number of preventable hospital admissions and readmissions.

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