Health Enterprise Zones to target disparities in state

Frustrated by Maryland's high rate of health disparities, state leaders are proposing a new attack — one more commonly associated with economic development.

Gov. Martin O'Malley's 2012-2013 budget will include funding to create Health Enterprise Zones, where doctors and community groups in areas with large health disparities, such as Baltimore, could add medical and support services for minorities. Tax credits and other financial incentives would be available to spur interest.

The plan is designed to save lives and healthcare dollars, according to Lt. Gov. Anthony G. Brown, who last summer formed a work group on disparities led by Dr. E. Albert Reece, dean of the University of Maryland School of Medicine.

"Maryland has world-class hospitals, top medical schools and one of the highest rates of primary-care physicians per capita, and yet we continue to see disparities in health care and outcomes among Maryland's racial and ethnic communities. It's clear that a lack of access to primary care in many communities is a significant factor driving these disparities," Brown said, adding that funding is in the governor's budget proposal, which has yet to be released.

According to state and national data, the disparities are many: In Maryland, the infant mortality rate among blacks is almost three times that for whites, the incidence of new HIV infections among blacks is almost 12 times that of whites, and Hispanics are more than four times as likely not to have health insurance as whites.

Moreover, nearly twice as many African-Americans suffer from diabetes as whites, and hospital admission rates were three times higher for blacks with asthma and 41/2 times as high for blacks with hypertension.

Treating such illnesses is costly, according to the work group, which cited data showing nearly $230 billion in direct medical costs could have been saved from 2003 to 2006 if there were no racial and ethnic health disparities.

The proposed program would work something like economic enterprise zones, where businesses receive subsidies to create jobs and activity in certain areas. The health zones program would be a pilot, available in two or three geographic areas.

New and existing primary-care practitioners could receive loan assistance repayment; income, property or hiring tax credits; and assistance in installing health information and other technology. Subsidies would be capped, likely in the tens of thousands of dollars. Local health departments might get involved in recruiting participants.

Brown said he would push to expand the program statewide if it proves successful in a couple of years — not a given, considering the logistical and cultural complexity of the problems. For example, residents of some neighborhoods don't have easy access to grocery stores that sell fresh fruit and vegetables, or don't visit the doctor until there is an emergency.

Reece said many groups have tackled disparities, but the work group wanted to focus its attention on chronic diseases responsible for 80 percent of health costs. They drilled down to a few key maladies that often have "ripple" effects. They include diabetes, hypertension and asthma.

"We decided to identify … areas where we thought we could make an effective impact within a reasonable time frame," he said.

The health enterprise zones approach is unique, he believes. Work group members got the idea from a similar program built around children's needs in the community of Harlem in New York City.

Program applicants are likely to come predominantly from rural and urban area where disparities are most pronounced.

In Baltimore, studies show a 20-year gap in life expectancy between upper-income, predominantly white neighborhoods and poorer, predominantly minority neighborhoods.

Recently, city health department officials began working with community leaders in 55 neighborhoods to identify the most pressing health needs and develop plans to tackle them.

The state's zones would complement these efforts, Reece said. His work group also proposed other elements to promote health and track outcomes.

The group suggested Health Innovation Prizes with small financial rewards and public recognition for individuals and groups that improve health and well-being in their community. The group also recommended tracking disparity data for programs that already exist for primary care physicians and hospitals. Incentives and penalties assessed through these programs could eventually be linked to disparities.

Reece said the prize and the enterprise zones are two things Maryland can do now to help reduce disparities in a few key geographic and health areas.

If legislation to create the zones is passed during the current legislative session, the details will be worked out by the state Department of Health and Mental Hygiene.

Already, Dr. Joshua M. Sharfstein, department secretary, supports the move: "The creation of Health Enterprise Zones will help communities target resources to have the most powerful impact."