CHRC/CRISP Collaboration to Provide Technical Assistance

CRISP, Maryland’s state-designated Health Information Exchange, and the CHRC are collaborating on a technical assistance project that is providing a number of services​​ to CHRC grantees.  These services include reporting and data analytics; supporting care coordination initiatives; and connecting grantees with other sectors of the Maryland’s health care community.  The purpose of the technical assistance program is to assist CHRC grantees in documenting program impact, to support program evaluation, and to help promote program sustainability.   Below are specific types of reports that CRISP has committed to providing:

• Population Health Reports
• Panel-Based reports
• Pre/Post reports
• Encounter Notification Service (ENS)

The technical assistance program was began in the summer of 2016 and is ongoing. CRISP and CHRC staff held a webinar on August 5, 2016 for grantees to inform them about the types of services offered including.  HealthCare Access Maryland, one of the CHRC grantees, participated in this webinar and shared lessons learned in utilizing CRISP data to document program impact.  

HealthCare Access Maryland, received a three-year grant in 2014 to target individuals who utilize Sinai’s Emergency Department (ED) in high volumes, i.e., three or more visits in a four-month period. The grant ended September 30, 2017, with the program having served 802 individuals. Over a third of these program enrollees comprised the program’s target At-Risk client segment (3-9 visits in a four-month period). Sinai calculated a four-month pre vs four-month post comparison for the at-risk clients and compared this to a cohort of similar patients not enrolled in Access Health. This comparison showed a 26% visit reduction for the at-risk clients enrolled in the program, which Sinai estimated translates into $895,580 in cost avoidance.  Total program savings achieved (all 802 clients) translated into $1.2 million in savings. Taking into account the $800,000 investment from the grant, the program's return on investment (ROI) was 47%.

Past Projects

Rural Health Care Delivery Work Group​

During the 2016 legislative session, Senate Bill 707 Freestanding Medical Facilities- Certificate of Need, Rates and Definition, was approved and signed into law by the Governor on May 10, 2016. The legislation establishes a workgroup on rural health care delivery to oversee a study of healthcare delivery in the Middle Shore region and to develop a plan for meeting the health care needs of the five counties -- Caroline, Dorchester, Kent, Queen Anne’s and Talbot.  The workgroup is staffed by the Maryland Health Care Commission and co-chaired by Joe Ciolota, MD, Health Office and EMS Director, Queen Anne’s County, and Deborah Mizeur, MS, MHA, LDN, Kent County resident.  For more information about the workgroup, click here.

The CHRC was invited to serve as a member of the Workgroup and Mark Luckner, CHRC Executive Director, was asked to serve as Chair of the Vulnerable Populations Advisory Group, one of four Advisory Groups of the Workgroup.  Of the 190 grants awarded by the CHRC, more than half (99) have supported programs in rural areas.  Most projects have emphasized addressing the needs of vulnerable populations and underserved communities.  CHRC grants have expanded access to primary and preventative care services; promoted access to Medication Assisted Treatment; opened school-based health centers; and expanded access to dental services for low-income children and adults.  For more information about CHRC-supported programs in rural areas, click here​​. ​ ​

Hospital-Community Partnership Forums

Transformative initiatives are unde​rway impacting community health and health systems in the State. These developments include advances in our collective health IT infrastructure; the State Health Improvement Process (SHIP); patient-centered medical homes and other enhancements to primary care; and behavioral health integration. To facilitate this collaboration, the Community Health Resources Commission (CHRC), with support from the Maryland Hospital Association, hosted four regional forums during the fall ofthis fall (2014). The purpose of the forums was to highlight a number of promising hospital-community partnerships and innovative intervention strategies, to discuss the lessons learned and challenges confronted during implementation, and to develop strategies through which these programs could be sustained and spread.  Click here for more info: Hospital-Community Partnerships.

Program Evaluation with Hilltop - Final Report ​issued November 6, 2018

In May 2016, the CHRC engaged The Hilltop Institute to perform an evaluation of CHRC-funded projects, to help determine whether community-based intervention strategies supported by CHRC funds help generate cost savings via reductions in avoidable hospital utilization.  The four grantees selected for the evaluation (below) involve programs that provide access to substance use treatment services and Medication Assisted Treatment; hospital ED diversion and care coordination programs; supportive recovery housing, and promoting earlier access to prenatal care.  The four projects expand access in rural, suburban, and urban areas of the state. Hilltop issued their final report​ on November 6, 2018 and presented their findings to the Commission on November 27, 2018.  The analysis by Hilltop as described in the executive summary confirms that the four programs evaluated in fact made their objectives of reducing avoidable hospitalization and achieved linkages to community based care.  In two of the programs (Garrett County Health Department and Lower Shore Clinic), Hilltop’s analysis calculated cost savings achieved by the intervention strategies. 

For a summary of these findings, click here​.

Potomac Healthcare Foundation is utilizing funds to establish a 50‐bed residential Recovery Support Center in West Baltimore. The project addresses three of the seven goals of the Governor’s Heroin and Opioid Emergency Task Force by: (1) expanding access to treatment by removing one of the barriers for accessing care, housing; (2) enhancing the quality of treatment via an evidence‐based approach that utilizes residential recovery housing; and (3) boosting overdose prevention efforts, as “stable housing and quality treatment are the bulwarks against overdose.” ​ Hilltop found that:

• 88.3 percent of program participants engaged in alcohol or drug dependence treatment for at least 30 days after program discharge.
  
• Total average Medicaid costs per user increased in the 90-day post-intervention period compared to the 90-day baseline period, but the data suggest a shift from hospital-based care to outpatient services and pharmacy treatment for substance use disorder, an objective of the program.
  
• 20.5 percent of participants relapsed as evidenced by claims or encounters for detoxification, an inpatient admission, or an ED visit with a primary diagnosis of substance disorder.​
  

Garrett County Health Department is utilizing funds to support the use of tele‐health technology to increase access to Medication Assisted Therapy (MAT) in a rural corner of the state. The program involves a collaboration between the Garrett County Health Department and the University of Maryland School of Medicine's Department of Psychiatry. Hilltop found that:

• Total average Medicaid costs per user decreased from $4,725 during baseline to $3,901 in the post-intervention period, or 17 percent.
  
• After discharge from the program, all participants obtained at least one MAT prescription, and 85.7 percent continued to be engaged in alcohol or drug dependence treatment for at least 30 days.
  
• Per user health care costs suggest evidence of a shift from hospital-based care to outpatient services and pharmacy treatment during the immediate 90 days after discharge.​​
  

 Lower Shore Clinic is utilizing funds to support the 'CareLink' program that targets individuals with behavioral health needs who visit the hospital ED (Peninsula Regional Medical Center [PRMC]) in high volumes and provides intensive case management services for these individuals post‐hospital discharge. Hilltop found that:

• Total average Medicaid costs per user decreased 44 percent in the 90-day post-intervention period compared to the 90-day baseline period, and there was evidence of a shift from hospital-based care to outpatient services and pharmacy treatment.
  
• ED visits related to behavioral health-related conditions decreased from 21.4 percent during baseline to 6.5 percent in the post-intervention period.
  
• The percentage of participants with a usual source of care in the post-intervention period nearly doubled from baseline. 
  
• 30-day hospital readmissions was mixed, with 18.2 percent of participants readmitted within 30 days of their most recent hospital stay prior to enrollment in CareLink.​ ​
  

Baltimore City Health Department is utilizing funds to support the continued implementation of the B’More for Healthy Babies (BHB) Initiative. The program employs Pregnancy Engagement Specialists who use aggressive, trauma‐informed strategies to outreach pregnant women who are currently unable to be located though traditional outreach methods or who refuse to talk to care coordinators and direct vulnerable pregnant women and newborns into appropriate obstetric and pediatric homes.​ Hilltop found that :

• 99 percent of enrolled women had at least one prenatal visit during the measurement period and 46.5 percent completed one postpartum visit during the post-intervention period, suggesting that the objective of the intervention, connecting vulnerable pregnant women to the care system, was achieved.
  
• The percentage of participants who received care consistently from the same provider for two or more visits increased from 51.8 percent during the baseline period to 70.5 percent in the post-intervention period.
  
• The rate of very low birth weight among the babies delivered by study participants was about 3 percent, consistent with the overall Medicaid population. ​

Local Health Improvement Coalitions​​

DHMH established the StateHealth Improvement Process (SHIP)​​ in 2012, which focuses on improving population health outcomes and measures every jurisdiction on its performance on 39 population health metrics.  These metrics include reducing emergency department visits related to behavioral health; reducing diabetes-related emergency department visits; and reducing the percent of children considered obese. In support of SHIP, the CHRC issued two Calls for Proposals in 2011 and 2012 and awarded 24 grants totaling $1.95 million to assist in the planning and implementation activities of Local Health Improvement Coalitions (LHIC), which are led by local health departments and hospital systems. The bulk of LHIC grant funds were utilized to support the costs of hiring new personnel, including community health workers, program administrators, and community health nurses. Non-personnel costs were utilized by LHICs to support medical equipment in a new patient-centered medical home, purchase of computer equipment, and trainings for new personnel.  Click here​ ​for more information on CHRC LHIC grants.

Access to Care Program

In 2011, the Maryland General Assembly approved legislation (SB 514/HB 450) that directed the CHRC to assist community health resources in their efforts to respond to the implementation of the ACA. The CHRC developed a business plan​ in 2012 that outlined specific recommendations for how the state could promote the readiness of safety net providers and assist in their efforts to build capacity and achieve long-term financial sustainability. As part of these efforts, the state launched the Access to Care Program, an interagency collaboration of the CHRC, DHMH, and the Maryland Health Benefit Exchange. The purpose of the Access to Care Program was to build the capacity of safety net providers to serve more patients as the newly insured individuals access primary, preventive, and specialty care services in higher volumes. The state hosted six forums in June 2013 and invited safety net providers, Medicaid Managed Care Organizations, and Quality Health Plans. These forums were designed to encourage networking opportunities and promote the participation of essential community providers in Medicaid Managed Care Organizations and commercial health insurance networks.

Developmental Disabilities Administration Infrastructure Grants

At the request of DHMH leadership, the CHRC worked with the DHMH Developmental Disabilities Administration (DDA) to issue the DDA Infrastructure Grant Call for Proposals on April 2, 2012. This Call for Proposals generated a total of 121 awards to DDA licensees, totaling $5,997,975 in one-time only infrastructure grants. The grants were supported with funds provided by the DDA (funds were transferred to the CHRC’s budget) and were awarded to support projects in one of the following six categories: (1) New vehicles and other forms of transportation; (2) Adaptation of, or modification to, existing DDA licensee-owned vehicles; (3) Information technology equipment, software, or related services; (4) Adaptations, modifications, repairs, or improvements to existing provider-owned properties/programs that address critical health and safety issues or improve access or quality of life for individuals with developmental disabilities. (Programs include day, vocational, and residential services such as group homes and Assisted Living Units); (5) Start-up funds for or expansion of infrastructure for innovative programs that increase community integration or integrated employment for people with developmental disabilities; and (6) Staff training in areas directly related to working with people with developmental disabilities. Grant funds supported projects that included the purchasing of new vans for programs to provide transportation for clients to and from health care appointments and providing repairs for existing properties which provided DDA services (e.g., window replacements, updating of HVAC units, and new flooring).

DHMH Task Force on Regulatory Efficiency

​At the request of DHMH leadership, the CHRC Executive Director co-chaired the DHMH Task Force on Regulatory Efficiency with the DHMH Chief-of-Staff. The Task Force was tasked with conducting a cross-agency review of DHMH regulations and soliciting public comment to promote greater transparency, efficiency, and effectiveness in regulations. An initial public comment period generated 73 proposals from the public. Following a second public comment period, the Task Force issued its final report in June 2012. Of the 73 proposals received, 42 were supported by DHMH and moved forward for implementation or further review. Proposals that were implemented include such changes as allowing patients to return unused medications to help reduce health care costs at nursing homes by enabling the appropriate re-use of returned medications.