Coaching Good Health

Howard County's health officer explains the new approach the county is trying to provide health care to the low-income uninsured

Q&a -- Dr. Peter Beilenson

October 28, 2007|By Larry Carson | Larry Carson,Sun Reporter

In an initiative likely to be closely watched in Maryland and across the nation, Howard County is preparing to launch a program aimed at providing low-cost access to care to an estimated 20,000 county residents who are uninsured.

County officials say their plan might be a model for other communities seeking to provide a health care safety net to low-income residents at a time of significant national concern about the availability of affordable health care.

The plan is to begin operating July 1, with a goal of enrolling around 2,000 adults. The county also hopes to enroll up to 4,000 eligible, but uninsured, children in the State Children's Health Insurance program, a federally funded, state-administered program that provides insurance for children from families with incomes up to 300 percent of the federal povertly level.

County Executive Ken Ulman and Dr. Peter Beilenson, the county health officer, have stressed that the Healthy Howard Plan is not insurance, and that only American citizens who have been county residents for one year and uninsured for one year will be eligible. The care is also not portable.

Participants will pay fees of $50 to $115 a month, depending on income and family size, and the county will use the Chase-Brexton clinic in Columbia and Howard County General Hospital as prime service providers. Ulman said he would include $500,000 in the county budget for the next fiscal year to help pay the estimated $2.8 million first-year costs. Patient fees will provide another $1.6 million and the remainder is to be donations from individuals and organizations.

The program contains a strong element of preventive care, since health counselors will work with every patient to help craft a plan to promote their overall good health, guide them to existing programs they may be eligible for, and, it is hoped, reduce the need for medical treatment over time.

Beilenson, who was formerly Baltimore's health commissioner, has long advocated making quality health care more widely available. He agreed last week to answer some questions about the Howard County plan and the broader challenges of health care. What happens if only a handful of Howard County's 12,000 uninsured adults decides to sign up for the new program?

I think there's very little possibility of this. When Kaiser [Permanente] offered low-cost insurance for 175 Howard families, the county got over 650 [applicants] - almost four times the people we had slots for. ... We've been getting lots of response on our help line eight months in advance. ... We've planned a lot of outreach to business owners, labor pools and areas where we'll likely reach people who are not insured, like through clergy and community leaders. We're pretty confident we'll have a sizable number of individuals apply. What if you are deluged with more applicants than you expected?

That could be a tad of a problem. It's certainly conceivable with our plan not being insurance. Again, the interest that's been generated is pretty sizable. We're opening the program to interested parties before July 1. If by June we have 4,000 people interested, we will clearly have to do a lottery. A deadline date, and then a lottery. My strong suspicion is we'll get 2,000 people the first year, but probably not too many above that. Like Mchip [the Maryland Children's Health Insurance Program], not everyone eligible will apply. I think we'll come in around that comfortable medium. You say that health coaches will work with participants to craft an individual-care plan and that people who refuse to follow the plan could be put on probation after three months and lose health care after six. Specifically, what kinds of failure would lead to the loss of coverage?

One of the luxuries we have by announcing this eight months in advance is we're still refining it. This is where the town hall meetings [Nov. 6, 13 and 14] come into play. We want to hear from what people think about this issue. I don't think we'll get tons of changes on services, but we will get comments on the health coach. What constitutes substantive compliance? We clearly want input from the community on that. It may be somewhat subjective. We don't have one specific definition fully fleshed out yet.

We've got to have some relatively firm definitions [so standards don't vary greatly from one health coach to another]. What's the importance of this health coach?

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