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Overview of the 5 Zones• Maryland Health Improvement and Disparities Reduction

Act of 2012 funded the HEZ program with $4 million per year for four years beginning in 2013

• Call for Proposals, developed October 2012, generated 19 applications from 16 jurisdictions

• Five HEZs were designated in January 2013 from rural, urban, and suburban areas. Three are led by coalitions of hospitals/health systems and two are led by local health departments

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HEZ Incentive Program Year One• HEZ enabling legislation provides a number of incentives

and resources to attract providers to the Zones: – State income tax credits– Hiring tax credits– Grants for equipment purchase or lease– Loan repayment assistance programs

• Practitioners must meet the following criteria to access tax credits: – Cultural competency training– Accept Medicaid and uninsured patients– Letter of support from the Coordinating Organization

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Key Activities of Zones• Initiate Community Health Worker Program:

– Four of the five zones created a program– As of May 2014, 20.5 FTE community health workers have been placed

in the Zones • Launched Cultural Competency Training:

– On site training provided at two sites (Dorchester and Annapolis)– Trainings focus on National CLAS standards, workforce diversity, and

health literacy• Implement Targeted Strategies:

–Mobile crisis teams for mental health– Healthy food options in known food deserts – Health care transportation route

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Chronic Conditions Targeted by Zones• All five Zones target a reduction in the prevalence of

Diabetes.

• Other targeted chronic conditions include cardiovascular disease, obesity, and asthma.

• Specific strategies include the following:

– Community fitness classes– Community care and coordination for high ED utilizers– Patient “wellness plans” (assist in teaching patient to monitor

and control chronic conditions independently)

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Key Accomplishments of Zones • Expanding capacity to deliver healthcare services:

– 10 new or expanded delivery sites– All Zones are providing additional health services

• Meeting first year practitioner recruitment goals– Year one goal to hire 37 new practitioners in the Zone– As of May 2014, 53.4 FTEs have been hired throughout all 5 Zones

• Promoting job creation and retention– As of May 2014, 103.2 FTEs have been added to the Zones– This includes practitioners, community health workers, Zone

programmatic and support staff

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Performance Monitoring in Year One• Zones develop annual performance goals

–Progress towards reaching these goals is tracked on a quarterly and annual basis by the CHRC

•An HEZ “Dashboard” assesses performance on key milestones and deliverables of each Zone

–These dashboards facilitate public reporting, accountability, and fiscal stewardship of public resources. They are available online at:

http://dhmh.maryland.gov/healthenterprisezones/SitePages/HEZ_Eligibility_Data.aspx

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Zone Challenges for Year One• Though the HEZs achieved their overall practitioner

recruitment goals in year one, several of the Zones, especially in rural areas, reported challenges in recruiting primary care providers

• Zones also reported challenges in collecting and reporting clinical outcomes data and aggregating this data across multiple different EMR systems and paper-based systems

• The collection of clinical outcomes data will be a key area of focus during year two of the program

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Key Activities for Year Two • Collectively work with Zones to collect and report clinical

outcome data

• External evaluator contracted to provide analysis

• Create an HEZ Learning Collaborative

• Provide technical assistance to the Zones in the areas:

– Promote workforce recruitment/retention– Identify gaps in the HEZ systems of care– Support long-term financial sustainability of HEZs