A little over a year ago, about the same time the state and federal governments put their final touches on the modernized Medicare waiver, Maryland's health secretary designated five Health Enterprise Zones - areas throughout the state with traditionally poor health outcomes that needed a boost.

The HEZs, slated for a four-year pilot run, are designed to do three things: reduce health disparities among racial and ethnic minority populations and among geographic areas; improve health care access and outcomes in underserved communities; and reduce health care costs and hospital admissions and readmissions.

Every once in a while, when separate but similar initiatives converge, as is the case with the revamped waiver and the HEZs, it confirms that innovators in the field are independently moving toward the same goals. That's an affirmation that Maryland's hospitals are heading in the right direction.

Now, all of Maryland's hospitals are working to develop population health management models to meet the waiver's goals and, if early results are any indication, the HEZs are proving to be effective catalysts in their communities. A brief overview of the five: 

• Annapolis/Morris Blum (Suburban) -This project, led by Anne Arundel Health System and the City of Annapolis, established a primary care health center in the Morris Blum public housing building to reduce diabetes-related and smoking illnesses, obesity and cardiovascular disease.
• Caroline/Dorchester Counties (Rural) -The zone targets primary care and behavioral health issues by supporting health care services teams.
• Prince George's County Health Department/Capitol Heights (Suburban) -This zone expands primary care access by establishing five patient-centered medical homes to combat asthma, diabetes and hypertension.
• St. Mary's County/Greater Lexington Park (Rural) -The project, spearheaded by MedStar St. Mary's Hospital, expands access to primary and behavioral health services to reduce emergency department and hospital admissions.
• West Baltimore Primary Care Collaborative (Urban) -Led by Bon Secours Baltimore Health System, Maryland General Hospital, Saint Agnes Hospital, Sinai Hospital of Baltimore and University of Maryland Medical Center, this project aims to reduce cardiovascular disease through primary care providers, community health workers and access to resources such as gyms and healthy food retailers. 

While each of these programs has had some early challenges, all are reporting progress in meeting the zone's goals. Perhaps more important is that through the process of standing up these initiatives, these organizations are learning more every day about the trials and tribulations of population health management. As each of you forms new relationships and implements new procedures to keep your communities healthy, keep an eye on the progress of the HEZs. We can learn a lot from their work.

The busy week started Wednesday with MHA's testimony in the Senate Finance Committee on priority legislation SB-281 Blue Ribbon Commission to Study Maryland's Behavioral Health System. The cross-file bill HB-650 will be considered in the House Government Operations Committee March 10. 

MHA also offered supportive testimony for SB 569-HB 724 Health Care Provider Malpractice Insurance-Scope of Coverage. This bill would repeal prohibiting coverage for the defense of a health care provider in a disciplinary hearing to be included in or to be offered and priced separately from a policy that insures a health care provider against damages due to medical injury arising from providing or failing to provide health care. This would repeal a prohibition on the inclusion of defense coverage for disciplinary hearings in a medical malpractice healthcare provider insurance policy. Prior to 2004, this type of coverage was included in medical malpractice policies in Maryland.

Wednesday, MHA testified in support of SB 586-HB 1010 Health Insurance-Federal and State Mental Health and Addiction Parity Law, requiring health maintenance organizations, insurers, and nonprofit health service plans that offer specified contracts and health benefit plans to submit to the Maryland Insurance Commissioner a report certifying and outlining how designated contracts and health benefit plans comply with the federal Mental Health Parity and Addiction Equity Act and state mental health and addiction parity laws.

This week MHA testified in support with amendments to SB 57-HB 72 Budget Reconciliation and Financing Act of 2015 in the House Appropriations Committee. The Budget Reconciliation and Financing Act of 2015 (BRFA) seeks to delay until fiscal year 2017 any reduction to Maryland's hospital Medicaid tax through savings that accrue to Medicaid as a result of reduced hospital spending under the state's waiver agreement with Medicare. In fiscal year 2016, $14.5 million was identified for this purpose. The BRFA also seeks to require an additional $16.7 million in hospital Medicaid general fund spending reductions through a series of actions to be taken by the Health Services Cost Review Commission (HSCRC), in addition to the Board of Public Works action to reduce hospital Medicaid general fund spending by $8 million for fiscal year 2015. MHA has offered an amendment to request in fiscal year 2016 that HSCRC enact policies that will achieve general fund savings to the Medicaid program by allowing the commission flexibility to work on a viable solution to the budget cut. 

On Thursday, MHA's Carmela Coyle testified as part of a panel to oppose SB 479-Civil Actions-Noneconomic Damages-Catastrophic Injury, which alters the maximum amount of noneconomic damages that may be recovered in health care malpractice and other civil actions for a catastrophic injury under specified circumstances. This proposal would raise fees for plaintiffs' attorneys and increase malpractice insurance rates (and thus health care costs for everyone). Further, the practice of defensive medicine, encouraged by astronomical jury awards, unnecessarily inflates the cost of providing health care, which threatens hospitals' ability to live within the fiscal constraints of a modernized Medicare waiver.  

Licensed to collect blood in Delaware, Maryland, Pennsylvania and Virginia, BBD maintains five permanent donor centers including Salisbury, and utilizes more than 30 mobile donor sites throughout the Delmarva region. In addition, BBD operates a blood supply depot inside the Prince George's Hospital Center in Cheverly. The depot is a blood distribution center and patient reference laboratory testing facility designed to resolve transfusion related medical problems for Maryland member hospitals. Blood products available include red blood cells, platelets and fresh frozen plasma for transfusion and offers superior value along with quicker response times for delivery to existing and new hospital customers along the I-95 corridor. In 2014, BBD distributed over 100,000 blood products to hospitals, including MHA members.

BBD has positioned itself as an innovative, best in class blood bank committed to ensuring that their hospital partners and their patients are provided with the blood products that specifically fit their specialized needs. In addition to supplying blood products, BBD operates a full-service regional laboratory, now undergoing expansion, with the purpose of providing and expanding testing services for blood collection centers in the region and beyond.

For more information on BBD, visit www.DelmarvaBlood.org or call Joe Yelo, Lead Executive of Business & Community Development at 302-737-8405 ext. 866.