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Meeting Basic Needs First: How Meritus Health Funds Crisis Care on a Scarce Budget

Published
August 31, 2026
Facility
Meritus Health
Region
Western Maryland
Featuring
Dave Lehr, Chief Administrative Officer, Meritus Health

Tagged

  • Western Maryland
  • Linkage to ongoing SUD care
  • Assessment and management of common co-occurring conditions

Inclusion is not an endorsement

The Maryland Department of Health shares this account to highlight practices other facilities may find useful. Appearing in this series is not an endorsement, recommendation, certification, or approval of any hospital, health system, provider, vendor, or program by the Maryland Department of Health or the State of Maryland. Descriptions and figures are provided by the participating facility.

“Build the infrastructure your patients need first, and let the funding argument follow, because in his experience it rarely arrives on its own.”

— Dave Lehr’s advice to other hospitals


Meritus Health has ranked in the top 1.5% of nonprofit hospitals nationwide for community benefit spending, two years in a row, according to the Lown Institute. In the most recent year with published data, Meritus spent $27 million more on charity care and community investment than the value of its tax exemption, a surplus only one in five nonprofit hospitals nationally can claim. For a system running on a 0.5% margin, that ranking is the result of specific, deliberate investments rather than surplus spending.

Before he became Meritus Health's chief administrative officer, Dave Lehr spent years working across the country's health systems as part of Epic, the software company behind much of America's hospital record-keeping. That vantage point, inside dozens of hospitals rather than just one, shapes how he talks about Meritus's mission today. Now, overseeing Meritus's non-hospital business lines, Lehr spends much of his time defending and expanding the programs that keep patients connected to care once they leave the hospital— work that, by his own account, often has no budget at all.

The clearest example is the crisis stabilization program his colleague, Alan Twigg, helped build: a six-bed unit for patients in active addiction, grounded in a “no-wrong-door” philosophy. This is the idea that anyone who walks in asking for help gets it on the spot, rather than a referral for another day. It works: data shows success getting patients linked into treatment, but Lehr is blunt about what it costs Meritus to run. The program operates without the formal state designation as a 24/7 mental health urgent care facility, a status that comes with rigorous requirements, including full-time physician coverage, that Lehr estimates would cost Meritus roughly $1.5 million more a year to meet. Rather than pursue that designation, Meritus built the crisis unit within its existing hospital budget, without any corresponding increase in funding. "Those of us who are providing the care are doing it as part of our community-based mission," Lehr said​​.

Savings Reinvested in Services

That same logic extends outward. When Meritus noticed patients missing appointments due to a lack of transportation, the hospital decided, in Lehr's words, that "no one in Washington County is going to miss an appointment because they can't get a ride," and bought vans and hired drivers to make it true, completing nearly 18,000 patient trips last year (again, with no outside funding). Another program, the food pharmacy, sends patients home with condition-specific groceries and recipes: high-protein meals and produce for a newly diagnosed diabetic or a pregnant patient not eating well, rather than the shelf-stable pantry staples a typical food pantry provides. Both programs are funded substantially through savings from the 340B drug pricing program administered by the Health Resources and Services Administration.​​​​

What other Maryland hospitals can take away

Lehr's advice to other hospitals is less a set of steps than a stance: build the infrastructure your patients need first, and let the funding argument follow, because in his experience it rarely arrives on its own. That stance shows up most evidently in how Meritus talks about the patients hardest to place: people with serious, persistent mental illness who have nowhere else to go once they're medically ready for discharge. Some have stayed in Meritus's mental health beds for over 100 days, cycling between the hospital, the streets, and jail without it. "It's not right," Lehr said, "to send these people to jail, or leave them suffering homeless in the streets." For Meritus, that's reason enough to keep the door open, whether or not the funding to do it ever fully catches up.  ​

By the numbers

  • 20thnationally among nearly 3,000 nonprofit hospitals for community reinvestment, on a 0.5% margin
  • ~18,000patient trips completed last year, with no outside funding
  • $1.5Mestimated additional annual cost to meet 24/7 mental health urgent care requirements

Figures reflect what the interviewee reported and are provided by the participating facility.

What other Maryland hospitals can take away

  • Build the infrastructure first. Lehr’s advice is less a set of steps than a stance: build what your patients need, and let the funding argument follow, because it rarely arrives on its own.
  • Reinvest savings into wraparound care. Transportation and food programs, funded substantially through 340B savings, determine whether treatment can hold.
  • Name the gaps no single hospital can close. Long-term residential placement for serious, persistent mental illness sits outside any one hospital’s control.

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