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Keeping Howard Healthy

Photograph by Chris Hartlove

Keeping Howard Healthy (continued)

According to Holtgrave, there really is no model for what Healthy Howard is doing, so the county may provide the first data of whether coaching saves costs in the long run. In theory, coaches can hold members accountable for complying with mutually agreed-upon plans and can terminate members for nonadherence. But Maureen Pike, a registered nurse who is one of four coaches with the plan, says she and her colleagues expect to function more as guides than enforcers, and don’t expect to cut many patients loose.

“We’re not telling people what to do,” she says. “The goal is to sit down with people and get to know them. What is it about their health they’d like to work on?” Ultimately, they will look for signs that people are trying, whether or not they achieve hard results.

 So far, coaches have met with Howard County residents who struggle to gain or lose weight and members so overwhelmed by family stresses they can’t begin to think about their health. They have linked patients to social service agencies that can help them pay bills, arrange for the care of an elderly parent, and find cheaper gym memberships.

Not everyone supports the new initiative. Although Howard County Councilman Greg Fox has derided many elements of the plan (including premiums that he says may cost the average healthy resident more than simply paying out of pocket for care), he reserves his harshest criticism for health coaching. Fox, who as the council’s lone Republican cast the only dissenting vote, said he could hardly believe his eyes when he read a handout describing suggestions a health coach could make. “Meet with a dietitian to prepare at least four healthy dinners? Join a gym? You’ve got to be kidding!” Such advice, he says, strikes him as mere common sense, hardly worth the salaries paid to the coaches.

Although they are two of the 48 million Americans
who lack health insurance, Elizabeth and Jay McCarthy
can still see their primary care doctors and specialists
thanks to the Healthy Howard Access Plan.
“It’s peace of mind,” says Jay.

But Elizabeth McCarthy says she could really use a helping hand in meeting personal health goals such as controlling anxiety and losing weight. “I’m having trouble on my own implementing a diet that the whole family can get on board with,” she says. “I don’t think doctors always have time to explain, to help you implement things into a plan.”

When Howard held enrollment sessions in libraries and other venues last fall, about 1,100 people showed up to apply. This was half the first-year goal of 2,200 people, and the health department quickly discovered that most of them qualified for Medicaid and other programs they didn’t know they were eligible for. By early June, the county had enrolled more than 200 people in Healthy Howard and had helped 2,400 others sign up with federal or state programs for which they hadn’t known they were eligible.

Fox cites the relatively small number of people enrolled in Healthy Howard as evidence that the program isn’t worth the $500,000 the county is spending on it in the first year. (The Horizon Foundation has kicked in an additional $500,000 toward the program’s annual budget of about $1.5 million, with remaining revenues expected to come from patient fees.)

But Beilenson argues the county is merely doing the right thing by linking residents to insurance that doesn’t cost the county anything. “It’s really an indictment of the current system,” he says, noting that American health care is so “fragmented” that many people don’t know how it works.

In evaluating the program, Holtgrave will be asking many questions: What are its costs? What health problems do its members have upon entry? Are they receptive to their coaches? What, for instance, has happened to important markers such as blood pressure or body mass index since people entered the program? Healthy Howard isn’t large enough for a randomized trial comparing people inside and outside the program, so he plans a smaller descriptive study of a few dozen patients.

“This is really a pretty interesting proof of concept in Howard County,” Holtgrave says. “It’s an affluent county, and it’s a good test to see if you’re able to construct this provider of last resort. As we look at other counties, the size of the population may be larger and the health needs greater, but it’s good to see if you can prove the concept and then go forward.”

The McCarthys are optimistic that Healthy Howard will work for them. Already, Elizabeth has made an appointment for physical therapy that she hopes will help ease the pain of her arthritic back, and she expects also to see a podiatrist about a foot problem. Her primary care doctor is requesting prior medical records so he can decide how best to treat her anxiety. Jay has learned that his blood pressure and cholesterol levels are normal, and has talked to his doctor about additional tests that could determine if he’s suffered kidney or liver damage from the fumes he inhales at work. And both look forward to their first coaching appointments.

“Knowing that we have a health plan in effect means that if I get hurt, I can go get treated,” says Jay. “It’s peace of mind.”

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