Maryland Fights Health Disparities Using Health Enterprise Zones

February 26, 2015|3:17 p.m.| ASTHO Staff

Maryland ranks as the state with the highest median household income, has several medical schools, and has the fifth lowest smoking rate. However, health disparities have persisted in the state.

Not everyone has had the same opportunities for good health. Programs were not always reaching the communities with the largest disease burdens. Some modifiable health determinants in these communities included healthcare provider shortages, ineffective patient/provider communication, lack of cultural competency, and the need for economic revitalization.

In 2012, the state enacted the Maryland Health Improvement and Disparities Reduction Act (MHIDR), which provided funding to establish and implement the Maryland Health Enterprise Zones (HEZs) Initiative. HEZs are contiguous geographic areas with poor health outcomes that contribute to racial/ethnic and geographic health disparities, but are small enough for incentives to have a measurable impact.

Under MHIDR, Maryland released a call for proposals for communities seeking HEZ designation. Nineteen applications were received, and through an internal review panel led by then-Maryland Secretary of Health Joshua Sharfstein, five HEZs were designated in January 2013.

Raising Up Communities

The five HEZs Maryland established were nonprofit community-based organizations or local government agencies. They included urban, suburban, and rural communities, were led by hospitals or local health departments, and all included broad community coalitions. Their goals were to "(1) reduce health disparities among racial and ethnic minority populations and among geographic areas; (2) improve healthcare access and health outcomes in underserved communities; and (3) reduce healthcare costs and hospital admissions and re-admissions."

MHIDR provided $4 million per year over the program's four-year duration and created the HEZ Reserve Fund. It also provided HEZs with loan repayment assistance, hiring tax credits, income tax credits, and grant funding. Additionally, the state provided specific technical assistance and program guidance to HEZs in the areas of loan repayment assistance, cultural competency training, chronic disease programs, behavioral health expansion, public health data support, and evaluation guidance.

As a result of the initiative, 14 care delivery sites were opened or expanded as of September 2014 across all five zones. Additionally, the zones had a goal of recruiting 38 new healthcare practitioners in year one. They reported the addition of 43 new practitioners, which included physicians, nurse practitioners, and registered nurses to deliver primary care services and licensed clinical social workers and a psychiatrist to deliver behavioral health services.

The state works with the zones to collect and report patient clinical outcome data. All five zones include a focus on diabetes; other clinical goals include cardiovascular disease, hypertension, obesity, and asthma. The HEZs have also connected with Million Hearts to support their goals.

Learn more about how the Maryland is leveraging HEZs to promote health equity, read the full story from ASTHO's "Have You Shared" story collection. Visit this page to learn more about ASTHO's work in achieving health equity in the United States.