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Keeping Howard Healthy

Photograph by Chris Hartlove

Keeping Howard Healthy (continued)

Healthy Howard isn’t exactly health insurance, but a network of services that includes up to six primary care visits per year at the not-for-profit Chase Brexton Health Services clinic in Columbia, Md., and pro bono services from a bank of 200 specialists in 17 fields. With permission from a state regulatory commission, Howard County General Hospital has agreed to provide free hospitalization to members, forgoing the usual procedure under Maryland’s all-payer system of pursuing collection from uninsured patients. Johns Hopkins Hospital and the Maryland Shock Trauma Center have stepped up too, agreeing to see patients who need care unavailable at Howard County General. The program transfers members requiring very costly treatment to the more inclusive Maryland Health Insurance Program (MHIP) by paying down the required $4,500 deductible. Then they are left to pay the somewhat higher MHIP premium.

There are notable limitations: Healthy Howard provides no coverage outside the area, so members who get sick or injured while traveling are out of luck. Also, it doesn’t cover the county’s undocumented immigrants, who may number in the thousands. But it may be the only public program in the nation to require that enrollees meet periodically with health coaches, who help them set and meet goals such as losing weight or lowering blood sugar through diet and exercise. In this way, the Howard plan is partly an experiment in prevention—an effort to see if the county can offset costs by helping residents forestall ailments that are expensive to treat. “The philosophy is that health care is a human right but also a responsibility, both financially and behaviorally for participants,” says Beilenson.

“The philosophy is that health care is a
human right but also a responsibility, both
financially and behaviorally for participants.”

— Peter Beilenson, Howard County Health Officer

Beilenson has sown seeds of reform since the late 1990s when he founded the Maryland Health Care for All Coalition, a small collection of doctors and health policy experts who agitated for statewide universal health coverage at a time when the momentum nationally seemed to have stalled out (see related story).

That work caught the eye of Howard County Executive Ken Ulman. Two years ago, he tapped Beilenson to become his chief health officer and transform the county into a model public health community. Beilenson’s central challenge: Craft a health care plan for some of the estimated 20,000 residents without insurance.

Its architects drew ideas—if not the precise details—from San Francisco, which covers people making less than 400 percent of poverty but relies on an existing network of public clinics and hospitals. They also looked to Muskegon, Mich., which offers a health access plan that covers a limited number of clinic visits and is funded in equal shares by employers, members and the city.

The Howard County reformers ended up with a homegrown plan that taps the altruism of community specialists and makes use of a clinic, Chase Brexton, with long experience delivering care to uninsured and marginally insured patients. And it requires nothing of local businesses.

 “We’re not obligating businesses that for the most part are doing the right thing, and we didn’t want to compete with those already offering health insurance to their employees,” says Elizabeth Edsall Kromm, PhD ’08, an adjunct professor in HBS at the Bloomberg School, who directs Howard County’s Bureau of Healthy Community Development.

Also, neither the San Francisco program nor the Muskegon program required health coaching, a concept that some insurers have applied to members with chronic illnesses. But Howard County is betting that coaching for everyone, regardless of health status, will pay dividends in the
long run.

“Good health coaching is rooted in the development of a trusting, caring relationship between patient and coach and allowing patients to drive the agenda to a large extent,” says Glenn Schneider, director of health planning and policy for Beilenson. “Long term, our coaching process will hopefully result in healthier patients—ones that have better health outcomes and avoid costly hospital stays.”

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