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Policy Innovation Profile

State Provides Financial and Technical Support to Underserved Communities Designated as Health Enterprise Zones, Leading to Enhancements in Primary Care Capacity

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Maryland's General Assembly passed legislation authorizing the State's Health Enterprise Zones initiative, which is administered jointly by the Maryland Department of Health and Mental Hygiene and the Maryland Community Health Resources Commission. Through a competitive application process, this program has designated five communities as “health enterprise zones,” making them eligible for various forms of financial and technical support, including grants, tax credits, and loan repayment assistance. To date, the program has expanded primary care capacity within the five communities, which in the program’s first 6 months collectively opened or expanded 8 delivery sites, recruited 43 new practitioners (above the first-year goal of 38), and added 87 jobs. It is too early to determine the program’s impact on various health-related outcomes being monitored as part of the initiative, which will be determined in program years 2 through 4.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the number of newly opened or expanded primary care sites, new primary care recruits, and new health care practitioner jobs in the five communities since being designated by the State of Maryland as health enterprise zones.
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Developing Organizations

Maryland Community Health Resources Commission; Maryland Department of Health and Mental Hygiene; Maryland General Assembly; Maryland Health Quality and Cost Council
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Date First Implemented

The authorizing legislation was signed into law in April 2012; program implementation began shortly thereafter.begin pp

Patient Population

Vulnerable Populations > Impoverished; Medically uninsured; Racial minorities; Rural populations; Insurance Status > Uninsured; Vulnerable Populations > Urban populationsend pp

Problem Addressed

As in other States, some Maryland communities lack adequate access to primary, preventive, and specialty health care services, and residents of these areas face an above-average risk of poor health outcomes. The problem affects many racial and ethnic minorities living in economically disadvantaged geographic areas.
  • Inadequate access to routine care: As in other States, many racial and ethnic minorities and low-income individuals who live in Maryland lack access to routine primary and behavioral health care services. For example, before implementation of this program, many of the communities that applied to participate had a significant shortage of primary care physicians and mental health clinics, including all five of the communities designated as health enterprise zones (HEZs).1 In many communities, the shortage of primary care providers is exacerbated by the large number of uninsured individuals in the area; for example, Hispanic residents are five times more likely to be uninsured than White residents.2
  • Disparities in health outcomes: Despite having the highest median household income of any State, strong medical schools, and a relatively robust supply of primary care physicians (PCPs), the State of Maryland ranks relatively poorly in several important health indicators, including infant mortality (41st out of the 50 States), cardiovascular deaths (36th), cancer deaths (29th), and obesity prevalence (29th).3 In addition, these rankings have slipped over the past few years. This relatively poor performance stems in large part from persistent racial and ethnic health disparities that exist for these and other key Maryland health indicators. For example, compared with White residents, African Americans in Maryland are 11 times more likely to die of HIV/AIDS2; American Indian and Alaska Native residents are three times more likely to have end-stage kidney disease2; and Asians and Pacific Islanders are 36 times more likely to develop tuberculosis.4

What They Did

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Description of the Innovative Activity

Maryland's General Assembly passed legislation authorizing the State's Health Enterprise Zones (HEZ) initiative, which is administered jointly by the Maryland Department of Health and Mental Hygiene (DHMH) and the Maryland Community Health Resources Commission (CHRC). Through a competitive application process, this program has designated five communities as HEZs, making them eligible for various forms of financial and technical support, including grants, tax credits, and loan repayment assistance. Key elements of this policy-based initiative are detailed below:
  • Authorizing legislation, establishing joint administration: Signed into law in April 2012, the Maryland Health Improvement and Disparities Reduction Act of 2012 created a policy framework for establishing and implementing HEZs in areas of the State facing significant health disparities. The legislation charges DHMH and CHRC with jointly administering the program. The Act authorizes up to $4 million in funding per year for 4 years, with the funds placed in CHRC’s budget through creation of an HEZ reserve fund. (Proposed legislation currently being considered in the Maryland General Assembly would extend the program an additional year.) The Act charges DHMH with applying its public health expertise and authority to ensure that high-quality, safe, and effective health care services are delivered through the HEZs and designates CHRC as the fiscal agent for the program. The Act requires the two organizations to collaborate in implementing many of its provisions. CHRC is responsible for overseeing and administering the reserve fund, DHMH is responsible for provisions related to program administration, and the two agencies collaborate on a number of other provisions.
  • Competitive application process: The Act allowed nonprofit, community-based organizations or local government agencies to apply for their community to be designated as a HEZ. The call for proposals generated 19 applications from 17 jurisdictions, including urban, suburban, and rural areas. Applicants were required to form local advisory committees made up of various health-related stakeholders that took charge of developing proposals describing the community’s plan for targeted investments to improve the health status of residents. An independent panel comprising experts in public health, health care finance and delivery, and health disparities assessed the applications against 13 review principles. The panel paid particular attention to the documented economic disadvantages and health disparities facing the community and to the plan’s potential to have a meaningful, sustained impact in addressing these disparities and improving community health status. With input from CHRC, the DHMH Secretary designated the five HEZs, which included one urban community along with two rural and two suburban areas. Three additional applications were designated as “fundable” if additional resources become available, with the remainder being designated as “not recommended” for funding. The State has applied for additional funding through the Centers for Medicare & Medicaid Services Health Care Innovations Award program. If the application is successful, the State may use these funds to designate additional HEZs.
  • Various forms of financial support: As detailed below, the HEZ initiative features various forms of financial support to the designated communities, including annual operating grants that cover major activities and loan repayment programs and tax credits to attract practitioners to the areas.
    • Annual grants to cover main activities: A coalition of organizations within each winning community receives an annual grant intended to support activities for that year. During the first year, annual budgets ranged from $200,000 to $1.21 million. Coalitions vary in size (ranging from 4 to 16 organizations) and composition, with most being made up of some combination of the following: local health departments, federally qualified health centers, local community hospitals, and various community-based organizations serving the target population. Brief descriptions of the first-year grants and intended first-year activities for the five designated HEZs follow:
      • Suburban HEZ: Coordinated by the Anne Arundel Medical Center, this HEZ received a first-year budget of $200,000 to establish a new primary care health center based in the Morris Blum facility, a public housing complex for senior citizens. Due in part to a lack of available primary care, residents of the complex often call 911, visit the emergency department (ED), and get admitted or readmitted to the hospital. The hope is that this new center can reduce residents' reliance on more expensive sources of care and better manage the many chronic conditions they face, including diabetes and related conditions, smoking-related illnesses, obesity, and cardiovascular disease. If successful, these efforts should lead to a reduction in acute episodes and associated ED visits and hospitalizations.
      • Suburban HEZ: Coordinated by the Prince George's County Health Department, this HEZ is using its first-year budget of $1.1 million to expand access to primary care through the establishment of five patient-centered medical homes that can serve at least 10,000 residents in the Capitol Heights community, an underserved area with high inpatient and ED utilization rates for asthma, diabetes, and hypertension.
      • Rural HEZ: Coordinated by the Dorchester and Caroline County Health Departments, this HEZ is using its first-year budget of $755,000 to improve primary and behavioral health care by supporting teams that include peer recovery support specialists, community health outreach workers, mobile health care crisis teams, and school-based wellness programs. The goal is to reduce obesity, behavioral-health–related ED visits, and hypertension-related hospitalizations in an area with a shortage of mental health clinics due to the closing over a decade ago of all but one publicly funded facility.
      • Rural HEZ: Coordinated by MedStar St. Mary’s Hospital, this HEZ is using its first-year budget of $750,000 to expand access to primary and behavioral health services, with the goal of reducing ED and inpatient admissions related to behavioral health conditions and chronic diseases such as hypertension, asthma, pulmonary disease, heart failure, and diabetes. Funds will be used to reduce transportation barriers limiting residents' access to services, support a new community health center, and attract new practitioners to the area. Funds will also help a local primary care practice increase service hours, integrate primary and behavioral health services, participate in cultural competency training, and add services such as case management, nutrition counseling, and chronic disease management.
      • Urban HEZ: Coordinated by Bon Secours Baltimore Health System, this HEZ is using its first-year budget of $1.05 million to recruit additional PCPs, deploy community health workers, and otherwise enhance access to health-related community resources (such as gyms and retailers of healthy foods) in West Baltimore, a chronically underserved part of the city. The goal is to reduce the historically high prevalence and treatment costs of cardiovascular disease, diabetes, obesity, hypertension, and other smoking- and diabetes-related diseases and conditions among area residents.
    • Incentives to attract practitioners, tied to meeting cultural competency requirements: The authorizing legislation specifies that loan repayment assistance and various tax credits be made available to eligible providers in HEZs who serve low-income and Medicaid patients, thus enhancing the ability to attract and retain providers in these areas. The availability of both types of incentives is tied to meeting established criteria related to provider cultural competency and to demonstrating service to low-income and uninsured residents. (The legislation allows DHMH to establish additional requirements as department leaders see fit.) Any organization requesting tax incentives as part of the HEZ program must complete an online cultural competency assessment (the Cultural Competency and Assessment Survey, developed by the Office of Minority Health and Health Disparities within DHMH) and submit the results to DHMH. In addition, any provider seeking either loan repayment or tax incentives through the program must complete six continuing education credits in cultural competency within 12 months of submitting the application and must send proof of completion to DHMH. Details of these incentives follow:
      • Loan repayment assistance: DHMH collaborates with the Maryland Higher Education Commission to offer loan repayment to providers in the HEZs through two existing State programs. (The use of existing programs helps to maximize the resources available to the HEZs, since the funds do not come out of the $4 million annual allocation specified in the legislation). The first program, the Maryland Loan Assistance Repayment Program for Physicians, offers loan repayment to PCPs, while the second, the Janet L. Hoffman Loan Assistance Repayment Program, offers loan repayment to nurses, nurse practitioners, physician assistants, and social workers.
      • Employer tax credits for hiring: The legislation makes State tax credits available to employers in the HEZs that hire primary care practitioners (including physicians, physician assistants, and nurse practitioners), community health workers, social workers, and interpreters. Through these credits, employers can claim a $5,000 annual tax credit per newly hired employee for up to 2 years, with the employer becoming eligible for the credit after the employee has worked for 12 months. In other words, for an employer hiring someone who remains on the job for 2 years, the employer’s State tax liability will be reduced by $5,000 per year ($10,000 in total). If the employer does not owe State taxes, the credit can be issued in the form of a refund. The original statutory language limited the availability of such credits to solo practitioners who hired employees to help them in their practices. After realizing that many of the entities doing the hiring in the HEZs were nonprofit organizations, DHMH leaders submitted a bill to the State legislature to expand eligibility for the hiring credits to these entities. (This legislation is still awaiting final approval.)
      • Income tax credits for individual practitioners: The legislation makes tax credits available to individual primary care, behavioral health, and dental providers who locate in a designated HEZ. DHMH is responsible for the development of specific regulations related to such credits. With this credit, 100 percent of income earned by an eligible practitioner in the HEZ will be exempt from Maryland income taxes. Once the final regulations are in place, CHRC will make applications and other program materials available to the public. Individual applicants have up to 3 years after filing their taxes to claim the credit against their individual State income tax. Across the five HEZs, first-year budgets call for use of approximately $264,000 in such tax credits; over the full 4 years, roughly $1 million in credits are expected to be claimed. (The reserve fund sets aside money to cover the costs of the credits.)
  • Technical assistance and guidance: CHRC and DHMH take charge of providing technical assistance and consultation to the HEZs. As outlined below, assistance and guidance are available within various domains, with different units within the two agencies taking responsibility for their respective areas of expertise:
    • Cultural competency assessment and training: The Office of Minority Health and Health Disparities within DHMH provides resources and assistance to the HEZs, including dissemination of Web-based information, training sessions, and site visits from department staff with expertise in cultural competency. The office also distributed a train-the-trainer guide and published and distributed a cultural competency primer for academic institutions partnering with HEZs. Cultural competency training programs for the HEZs are being held at various times throughout 2014, including separate sessions for leaders and staff. In addition, on an ongoing basis, department staff respond to disparities-related inquiries from HEZs.
    • Performance monitoring and feedback: The coordinating organization within each HEZ and the State closely monitor HEZ activities and performance, measuring progress against established milestones, goals, and deliverables. (Each HEZ develops annual performance goals, such as the number of PCPs to be hired or the number of community residents to be assisted by community health workers.) State-led monitoring occurs through site visits, conference calls, and the submission of quarterly progress reports by the HEZs, which are required as a condition of receiving public funds. In addition, the Virtual Data Unit within DHMH has access to hospital data by zip code, enabling it to monitor and share data on ED visits and inpatient use (both admissions and readmissions, including breakdowns of preventable and unplanned admissions). The Virtual Data Unit also has access to county-level survey data, allowing the reporting of prevalence data for various diseases and conditions targeted by the HEZs. Beginning in the second year of the program, performance will be assessed against established national standards for clinical outcomes. DHMH and CHRC produce and distribute a quarterly report for each HEZ summarizing its performance on a dashboard of metrics related to established goals for the community. This report, which tracks progress versus key program milestones, is shared with the HEZs and will be made available to the public at some point in 2014.
    • Ongoing and as-needed support in other key areas: As outlined below, various offices within DHMH provide ongoing, topic-specific support related to public health/chronic disease, behavioral health, and delivery reform. In addition, when monitoring activities suggest that an HEZ is facing problems in a particular area, DHMH can mobilize resources to assist, such as sending experts to the community to provide consultation and guidance.
      • Public health and chronic disease: The Prevention and Health Promotion Administration within DHMH provides various resources and assistance related to maternal and child health, cancer, and chronic diseases, including data analysis and training via site visits, conference calls, and best-practice resource guides.
      • Behavioral health: The Behavioral Health and Disabilities Office within DHMH provides a review of behavioral health data and program management activities. In addition, Mid-Shore Mental Health Systems, Inc., plays a significant role in providing technical guidance and support to key stakeholders in the Dorchester/Caroline HEZ.
      • Delivery reform: The Health Systems and Infrastructure Administration within DHMH provides various resources and assistance to HEZs to promote delivery reform, including administering the aforementioned loan assistance repayment program in collaboration with the Maryland Higher Education Commission, supporting and processing tax credits, and helping HEZs develop and submit applications for Federal and State funding designated for the promotion of delivery reform.
    • Support to promote sustainability after funding ends: DHMH and CHRC staff help communities designated as HEZs secure other sources of funding that can allow programs to continue offering services to residents when funding through the State ends in June 2016 (or a year later if the legislature approves the 1-year extension). For example, support is available to help apply for Maryland’s Capacity Building Grants (also administered by CHRC), secure recognition as a patient-centered medical home (which opens up the potential for additional payments from Medicaid and commercial payers), and meet Federal meaningful use requirements and hence qualify for related incentives.

Context of the Innovation

The Maryland General Assembly is Maryland's legislative body, which directly represents the electorate. The State has 47 districts represented by 47 Senators and 141 Delegates. DHMH serves as the main government agency responsible for promoting the physical and mental health of Marylanders. Established by the Maryland legislature as a quasi-independent commission in 2005, CHRC is made up of 11 commissioners who represent diverse health-related interests in the State; its mission is to increase access to care for low-income, underinsured and uninsured Marylanders by supporting community-based health resources through various means, including the awarding of grants.

The impetus for this program was the relatively poor ranking of the State on key health indicators, which stemmed in part from the significant racial, ethnic, and geographic health disparities that exist in Maryland. As noted earlier, in spite of its outstanding medical schools, high median income, and a relatively robust supply of PCPs, Maryland ranked in the lower half of the 50 States on a number of health indicators.

In response to these persistent health disparities, Maryland Lieutenant Governor Anthony G. Brown convened the Maryland Health Quality and Cost Council’s Health Disparities Workgroup. Made up of public health experts, research scholars, and community health leaders, this group took charge of investigating strategies to reduce and eliminate health disparities. The Workgroup was led by Dean E. Albert Reece, MD, PhD, MBA, of the University of Maryland School of Medicine.

Through a series of discussions, the Workgroup identified preventable utilization of health care services, including ED visits and inpatient admissions for ambulatory care-sensitive conditions, as an important health outcome with the potential for meaningful short-term improvement at the local level. The Workgroup also identified modifiable determinants of health at the local level, including provider shortages, poor patient–provider communication (driven in large part by the lack of culturally and linguistically appropriate services), barriers to self-management, and lack of access to healthy foods.

Ultimately, Workgroup members decided that principles from the fields of economic development and revitalization should be applied to public health and health care delivery. To that end, the Workgroup recommended implementing a range of incentives to expand access to care in underserved areas, reduce disparities, and improve outcomes. More specifically, the Workgroup recommended the creation of HEZs, contiguous areas characterized by racial, ethnic, and geographic health disparities that are small enough for incentives to have a measurable impact. The idea for an HEZ came from similar approaches used by States, counties, and cities to stimulate economic development in struggling communities. Under these initiatives, enterprise zones are set up in specific areas that offer incentives to companies and entrepreneurs that invest and develop jobs in the community. The Maryland HEZ Initiative is one of the first to apply this concept to health care and health-related disparities.

Did It Work?

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The HEZ initiative has expanded primary care capacity within the designated HEZs, which in their first 6 months of operation have collectively opened or expanded 8 delivery sites, recruited 43 new practitioners (more than the first-year goal of 38), and added 87 jobs. Data collection and analysis related to the program’s impact on various health-related outcomes has not yet been completed.
  • New and expanded primary care sites: During the program’s first 6 months, eight care delivery sites have been open or expanded within the five HEZs. All five HEZs now provide clinical and other services supported with resources provided under the authorizing legislation.5
  • Above-target practitioner recruitment: Also during the first 6 months of the program, the 5 HEZs added 43 new practitioners, more than meeting the year-one goal of 38 new hires. Overall, four of the five HEZs achieved their full first-year recruitment goals in the first 6 months of the program.5 (As of March 2014, four additional practitioners had been hired, bringing the total to 47.) New hires include physicians, nurse practitioners, and registered nurses who deliver primary care services, along with licensed clinical social workers and a psychiatrist who delivers behavioral health services.
  • Additional jobs: The five HEZs collectively reported adding 87 jobs during their first 6 months in operation. (This figure includes the aforementioned 43 practitioners.) These new positions include clinical practitioners, community health workers, and other staff who deliver care and otherwise support the goals of the HEZs. Among the 87 added positions, 61 were direct hires (jobs supported by HEZ funds or individuals recruited through use of HEZ incentives), while 26 represented “indirect” hires (jobs created by the HEZs for their activities but not supported by HEZ funds or hired through use of HEZ incentives).5
  • To-be-determined impact on disparities, outcomes, costs: In July 2013, DHMH and CHRC issued a call for public comment on how best to evaluate the impact of individual HEZs and the overall initiative in improving the health of the populations living in the designated communities. This analysis will begin in the program's second year and be completed after the program ends in 2016. It will likely include evaluation of the impact on various health outcomes, including admissions, readmissions, and costs. Once selected, the external evaluator will provide interim and annual reports that evaluate performance on key outcomes.

Evidence Rating (What is this?)

Suggestive: The evidence consists of post-implementation data on the number of newly opened or expanded primary care sites, new primary care recruits, and new health care practitioner jobs in the five communities since being designated by the State of Maryland as health enterprise zones.

How They Did It

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Planning and Development Process

Key steps included the following:
  • Introduction and passage of legislation: The recommendations of the Workgroup led to the introduction of Senate Bill 234, the Maryland Health Improvement and Disparities Reduction Act of 2012. Lieutenant Governor Anthony G. Brown championed the bill and advocated for its passage, which occurred during the 2012 session of The Maryland General Assembly. Governor Martin O’Malley signed the bill into law in April 2012.
  • Formation of HEZ implementation team: The Secretary of DHMH and the Chairman of CHRC established an HEZ team charged with implementing the legislation. Led by the DHMH Secretary, the team includes staff from CHRC and leaders from various DHMH departments, including Health Systems Infrastructure Administration, Prevention and Health Promotion Administration, the Office of Minority Health and Health Disparities, Behavioral Health and Disabilities, and the Virtual Data Unit.
  • Team-led planning and implementation: The team met frequently throughout the planning and implementation process, working to establish various guidelines related to implementation, measures to evaluate the program’s impact, reporting requirements, budgeting, and technical assistance. The team adopted a shared management model, with department and unit leaders providing guidance and assistance in their respective areas of expertise, including loan repayment, chronic disease, cultural competency, behavioral health, and performance metrics for evaluation.
  • Solicitation and incorporation of public comment: After passage of the legislation, DHMH and CHRC invited public comment on the selection criteria for the HEZs, potential uses of HEZ funding, and outcome metrics that should be developed and used to monitor implementation and progress. Starting in the summer of 2012, the Secretary of DHMH convened a series of public stakeholder meetings to elicit input on these issues. Summarized in a report submitted to the Maryland General Assembly, these public comments were incorporated into the development of the call for proposals issued by CHRC.

Resources Used and Skills Needed

  • Staffing: DHMH created a new half-time position dedicated to this program. This person works with the Maryland Higher Education Commission to administer the loan repayment programs. In January 2014, CHRC hired one full-time person who serves as project administrator for the HEZ initiative. Other DHMH and CHRC provide "in-kind" support to the HEZ initiative in addition to performing their other job responsibilities.
  • Costs: The authorizing legislation provides up to $4 million in funding each year over the 4-year duration of the program. During the first year, $3.85 million has been spent or set aside to cover the grants and tax credits. This figure does not include the loan repayment assistance programs administered by the Maryland Higher Education Commission or compensation costs for the additional personnel hired, as described above.
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Funding Sources

State of Maryland
Funding for this program comes from the State of Maryland.end fs

Tools and Other Resources

The initial call for proposals that communities used to apply to become an HEZ is available at:
(If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).

Adoption Considerations

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Getting Started with This Innovation

  • Identify key measures and associated data needs: Gauging the program’s impact requires data that can measure relevant racial and ethnic disparities. To that end, these metrics and associated data-collection processes should be defined early in the process. As necessary, program developers should work with State and local stakeholders to determine whether all needed data are available and, if not, how to address the gaps. To the extent possible, it is advisable to use data sources that are collected at a highly granular level, such as census tract or ZIP Code boundaries. Because the selected area of interest should have a population large enough to maintain strong statistical reliability in the data, contiguous census tracts or zip codes can be combined as necessary to form a larger population boundary. (Census tracts do not cross county lines while zip codes often do, which may be a consideration if the selected area must be within one county.) The Virtual Data Unit within DHMH has access to data at the address, census tract, zip code, and county levels.
  • Use Federal cooperative agreement model to work with HEZs: The Federal cooperative agreement model ties grant funding to the achievement of clear performance targets. Under this model, the Federal Government sets up requirements for grantees and regularly interacts with grantee representatives to ensure that programs are implemented as intended and that performance targets are met. The same approach should be used with local HEZ teams, members of which may not be accustomed to working with each other. In many cases, local stakeholders have traditionally operated in "silos"; the HEZ initiative may be the first time they have collaborated in a meaningful way.
  • Incorporate public comment period: As noted, leaders of the Maryland HEZ initiative solicited input from the public throughout the development process. Public input ended up informing many aspects of the program, including development of the call for proposals. It also served to limit any later resistance to the initiative, including complaints from applicants not chosen to be HEZs.

Sustaining This Innovation

  • Support formation of local coalitions: As part of the call for proposals, the Maryland HEZ program required the creation of local coalitions made up of various stakeholders within the community. However, these coalitions vary significantly with respect to their level of engagement and activity. In an ideal world, a State-level team would travel to each HEZ to assist in building coalitions with expertise in a variety of areas.
  • Collaborate with existing loan programs to streamline requirements: Though the HEZs achieved their first-year goals with respect to practitioner recruitment, several reported challenges in recruiting PCPs, particularly in rural areas. While loan repayment assistance is available to help, requirements surrounding these incentives created difficulties in some areas. For example, one nurse practitioner could not access loan repayment assistance because of current statutory requirements that the applicant attend a Maryland school. To get around this problem, program leaders should collaborate with the leaders of existing programs to streamline and simplify requirements as much as possible.
  • Support HEZs in data collection and analysis across multiple sites: Most of the HEZs involve multiple care delivery sites and practitioners, some with electronic medical record systems and some without. As a result, several HEZs are confronting the challenges associated with collecting and reporting individual patient clinical outcome data and aggregating these data across multiple electronic and paper-based systems. The State plans to provide technical assistance to the HEZs in year 2 to help address these challenges.
  • Monitor performance and support HEZs as needed: Program leaders should continually monitor the quarterly reports and other information to identify challenges HEZs may be facing. They should also regularly communicate with HEZs on a wide range of topics, providing guidance and assistance whenever possible on any challenges identified.
  • Promote HEZ sustainability: As noted, State funding for the Maryland HEZs will end after a defined period. Consequently, much of the technical support and guidance provided to the HEZs during this period focuses on helping them secure sustainable sources of funding and other support that will allow programs to continue offering services after State funding ends. Support in securing additional reimbursement from public and private payers can be particularly useful, since these funding sources are tied to service delivery and hence do not have a defined end date.

More Information

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Contact the Innovator

Carlessia A. Hussein, RN, DrPH
Director, Office of Minority Health and Health Disparities
Maryland Department of Health and Mental Hygiene

Andrea Bankoski
Director, Virtual Data Unit
Maryland Department of Health and Mental Hygiene

Mark Luckner
Executive Director
Maryland Community Health Resources Commission
(410) 260-7046

Innovator Disclosures

Dr. Hussein, Ms. Bankoski, and Mr. Luckner reported having no financial interests or business/professional affiliations relevant to the work described in the profile, other than the funders listed in the Funding Sources section.

References/Related Articles

Hussein CA, Luckner M, Samson R, et al. Working with communities to achieve health equity in Maryland’s five Health Enterprise Zones. J Health Care Poor Underserved. 2014;25(1 Suppl):4-10. [PubMed]

Maryland Department of Health and Mental Hygiene and Community Health Resources Commission. Health Enterprise Zones: 2013 report. January 2014.

Maryland Health Quality and Cost Council. Health Disparities Workgroup final report and recommendations. 2012.


1 Hussein CA, Luckner M, Samson R, et al. Working with communities to achieve health equity in Maryland’s five Health Enterprise Zones. J Health Care Poor Underserved. 2014;25(1 Suppl):4-10. [PubMed]
2 Office of Minority Health and Health Disparities. Maryland chartbook of minority health and minority health disparities data. 3rd ed. Baltimore (MD): Maryland Department of Health and Mental Hygiene; 2012.
3 United Health Foundation. America’s health rankings—2012 edition. St. Paul (MN): United Health Foundation; 2012.
4 Office of Minority Health and Health Disparities. Asians & Pacific Islanders in Maryland: health data and resources. Baltimore (MD): Maryland Department of Health and Mental Hygiene; 2013.
5 Maryland Department of Health and Mental Hygiene and Community Health Resources Commission. Health Enterprise Zones: 2013 report; January 2014.
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Original publication: August 27, 2014.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: August 27, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.