When former Speaker of the House Tip O’Neill coined the phrase “all politics is local,” he knew that successful politicians addressed the everyday “kitchen-table” concerns of voters. Health care policy changes at the national and state levels have dramatically changed how Americans get insurance coverage and how health care is financed and delivered across the country. But for these policy changes to be impactful, local implementation must address kitchen-table issues. As we’re learning in Maryland, “all health care is local,” and philanthropy can play a key role in driving local changes.
Maryland is the only state in the country with an all-payer payment model of hospital services regulated by an independent state commission. Under a recent Medicare waiver renegotiation, Maryland is continuing its all-payer system but with several key changes: the state is moving to a global budget model; capping annual, per capita hospital revenue growth; and guaranteeing $320 million in Medicare savings over five years. Bold moves for a relatively small state.
With Maryland using a global budget to pay hospitals, their financial incentives change from filling beds to ensuring that patients are cared for in the most appropriate setting. Hospitals will need to redefine themselves and refocus on improving community health.
But how are the kitchen-table issues of everyday Marylanders being addressed under this new paradigm? The Horizon Foundation, a health and wellness foundation in Howard County, Maryland (located between Baltimore and Washington, D.C.) recently provided a grant to, and is partnering with, the Maryland Citizens’ Health Initiative and its leader, Vincent DeMarco, to better understand how the historic Medicare waiver would address the everyday concerns of our neighbors.
Focus groups of Marylanders told us that they trusted their local hospital to help them stay well and get care in the most appropriate setting, but they wanted more: help scheduling appointments with their regular doctor upon discharge, help filling their prescriptions before leaving the hospital, and a person to call directly if they had questions or concerns. Marylanders also worry about privacy, and expressed concerns about the confidentiality of their health care data and about having someone from their care team “visiting their home” to help them with care transitions. These are the kitchen-table concerns.
Also, we recently convened the first of many community conversations at a January 22 forum in Howard County to discuss how the new model will truly impact local health. Through our Local Health Improvement Coalition, we brought public health professionals, consumers, community health and social service organizations, labor organizations, health care providers, faith groups, employers, and other community partners together to build a common understanding of Maryland’s new approach, to increase cooperation and trust between local organizations, and to hear ideas about local pilot projects that would engage patients and families in new care models.
In Howard County, our foundation has supported seeding local pilots that achieve the Triple Aim, as well as solve kitchen-table concerns. Our county public health department has piloted care teams of community nurses and community health workers for our “super-high utilizers” of inpatient services. We are currently evaluating the Congregational Health Network developed in Memphis, Tennessee, which partnered with faith organizations that helped congregants transition from the hospital back to their home while attending to their medical, social, and emotional needs. Our local community hospital, Howard County General Hospital, is interested in replicating the model to help improve patient experience, reduce readmissions, and decrease health care spending.
In the midst of all the national and state policy changes that have led to historic health care reforms, we’re reminded in Maryland that all health care is local. We’re also reminded that philanthropy has a catalytic role in ensuring that our neighbors’ kitchen-table concerns are addressed and our state and national health care policy reforms are successful.
