"For the first time I feel like they are really listening to those of us who are on the ground working with clients," Rock said. "They really want to know how to reach these clients and make a difference."

Within the zone, rates of chronic illness such as asthma, diabetes, cardiovascular disease and hypertension are in some instances more than three times that of the state rates. Asthma is five times higher in parts of the zone, cardiovascular disease sickens residents at twice the rate of Maryland.

More than half of emergency room visits are for illnesses that were preventable and could have been treated in a doctor's office.

The state designated four other enterprise zones. They are in Annapolis, Capitol Heights in Prince George's County, Greater Lexington Park in St. Mary's County and Dorchester-Caroline counties.

In St. Mary's County, a coalition plans to build a new community health center, establish a transportatin system to take people to the doctor's office and other medical services, and hire five new primary care physicians, a psychiatrist and two social workers. Nearby MedStar St. Mary's Hospital is leading the nearly $4 million, four-year effort.

The Prince George's County zone will target Capital Heights, which will get five new medical facilities with about a $1 million in funding each year. Dorchester and Caroline Counties aim to attract 18 new health care providers and to establish a mobile mental health crisis team.

Anne Arundel Medical Center in Annapolis will use nearly $200,000 a year in state funding to open a medical center in a senior housing high-rise that accounts for a large number of emergency room visits. About 40 percent of the calls from the center came from nine individuals.

Residents of the senior center, located in the city's Clay Street corridor, don't have cars or regular doctors, so they were calling ambulances for stomach problems and other ailments a doctor could handle, said Dr. Patricia Czapp, chair of clinical integration at Anne Arundel Medical Center.

A free clinic in the building does not have a stable staff, Czapp said. The new facility will have full-time doctors. The hospital will use loan repayment and other incentives to attract the medical staff. The zone's goal is to decrease 911 calls and emergency room visits from the senior center by 30 percent in the first year, she said.

The clinic also will serve the surrounding community, not just the senior center.

"We are spending a lot of health care dollars on crisis prevention, which is so much more expensive than preventive care," Czapp said.

State officials received 19 enterprise zone applications and said they hope to find grant money or other funding sources to establish more. For now the health enterprise zone is a pilot program and the General Assembly must approve the money in the budget each year.

Health secretary Joshua M. Sharfstein said the five zones selected had strong, innovative plans for curbing disparities and brought together diverse coalitions to address the problems.

The state will monitor progress of the programs, Sharfstein said. Each zone must meet stringent goals to ensure full funding each year, he said. If the goals are not met it could jeopardize future funding of the program.

Brown and Sharfstein said curbing health disparities is not just a public good, but it also makes economic sense. African-Americans in Maryland have higher hospital admission rates and more severe illnesses when they do end up in the hospital. In 2010, these higher admissions cost Maryland $820 million dollars, Brown said.

The enterprise zones put the power to change health outcomes in the hands of the community, Sharfstein said.

"It is a very different approach from where the government gets the budget, sets all the rules and then decides how things will be," he said.



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