An Interview with Maryland's Lt. Gov. Anthony Brown
In April, Maryland’s Gov. Martin O’Malley signed the Health Improvement and Disparities Reduction Act into law. The Act, spearheaded by Lt. Gov. Brown, will designate zones where the greatest health disparities exist. Primary care practitioners, community organizations and health departments in these areas will be offered incentives to expand access to care, improve health, and reduce disparities.
Here Lt. Gov. Brown tells Primary Care Progress about the bill and why primary care is so important to Maryland’s administration.
Watch as Lt. Gov. Brown tells us via Skype why primary care and the patient-centered medical home are keys to lowering health care costs. Then read the rest of our interview with him below.
Tell me about the Health Improvement and Disparities Reduction Act and how it will work?
It’s a long way of saying we’re going to create health enterprise zones in Maryland. It’s just stunning that today we have the kinds of disparities that exist in Maryland. Maryland is a wealthy state. It’s got a lot of resources; some of the finest health institutions – Johns Hopkins, University of Maryland Medical System, outstanding community hospitals – yet there continue to be a lot of health disparities throughout Maryland. For example, infant mortality: a black child is three times more likely to die before her first birthday than a white child. An African American man diagnosed with cancer is 40 percent more likely to die than a similarly diagnosed white person. And disparities don’t just exist along racial lines but also ethnic and geographic. So we are introducing the health enterprise zone where we’re going to provide incentives for providers and community health resources to target communities in Maryland where we see some of the greatest disparities to make a difference, to improve the quality of health, and eliminate these disparities, whether it’s asthma, hypertension, diabetes, or any other health indicator where we see the greatest disparities.
So are these incentives meant to bring more physicians to these areas where there are physician shortages?
That’s part of it. Certainly physicians are a big part of addressing the health needs of Marylanders and reducing disparities, but also non-physician providers whether it’s nurses or other allied health professionals. Either a non-profit or a local government or consortium of the two will come together and design a strategy to address the disparities in the targeted community. Their strategy may include bringing in additional physicians; it may include bringing in additional non-physician providers. And we will offer a variety of incentives to attract physician and non-physician providers and resources into these targeted communities. Those incentives might be income tax credits; property tax credit; loan repayment assistance for physicians; or it could be a grant to provide ancillary services to connect patients to health services to improve the quality of care for that targeted population.
Maryland has released a report announcing a goal to increase the primary care workforce by up to 25% over the next ten years. Can you give me an overview of that plan and tell me why the government is so committed to primary care?
In Maryland, the health care workforce is the second-fastest growing workforce. From 2009 to 2011, we added about 12,000 health care workers. That’s the good news. It’s an expanding industry. It’s stepping up to address the needs of more and more Marylanders who have access now to affordable health care.
The real challenge is that over the course of the next several years, we anticipate that there will be a need for about 11,000 nurses for example. So we have a plan to increase by 25% the health care workforce in Maryland. First we’ll target what those shortages are and where. We know that there are shortages of physicians and most health care providers. We’ll first indentify where the shortages are and then look at ways that we can address it to include, for example, change in the way that we compensate our providers; to provide incentives for more and more people to choose the health professions as a career.
Another part of the strategy is to look at non-traditional pathways to health careers. For example, we have men and women who are coming off of active military duty. They bring with them a lot of training and experience in caring for people, in fact saving lives on the battlefield. Yet, we often have high hurdles for them to cross to provide health services in our local communities. I think that if you can save a life on the battlefield in Afghanistan, you certainly should be able to save a life and treat people in the emergency department in the state of Maryland. So we’re going to look at some non-traditional pathways to these professions. In the 60s JFK used his administrative pulpit to call more people to join the Peace Corps, and it really was quite effective. Does Maryland’s administration see a parallel opportunity to call people into primary care careers?
I think there is a greater understanding and appreciation within the medical community of the importance of primary care, and in fact, we are seeing more and more physicians taking a look at primary care – how important it is to make a difference in the lives of the patients that they see, but I tell you, we can’t simply rely on physicians’ notion of what’s right and wrong – they do what’s right everyday – without providing the tools to deliver primary care. That’s why we offer the patient-centered medical home, so we can match up the reimbursements with doing what’s right in the community and for the community. So I think that most men and women that go into the medical profession do it because they want to make a positive difference in the lives of their patients, but that’s really not a substitute for the need to properly and appropriately reimburse all care providers for the care that they deliver.