A Healthy Approach in Howard

By Ken Ulman and Peter Beilenson,
Ellicott City
Sunday, June 28, 2009

In January we launched the Healthy Howard Health Plan, the health and wellness plan we developed for the uninsured. We have learned several lessons that we believe can inform the national debate over health-care reform.

Lesson No. 1: You can build a better system.

With our development of a health and wellness model based on primary and preventive care, along with face-to-face personal health and wellness coaching, our participants are achieving significant gains. Our program has saved lives because of easy access to our network of specialists and participating hospitals.

In one instance, a plan member who had been without insurance for years was having chest pains. She said it was the type of pain she would have tolerated before, but now that she has coverage, she went to the emergency room. She was immediately admitted and quickly had triple-bypass surgery; she has since fully recovered.

By using evidence-based formulas and by taking advantage of pharmacy assistance programs that few patients know about, we have been able to provide many participants with affordable medications.

Lesson No. 2: Just because you build it doesn't mean they will come.

Although our program seems to be meeting the needs of participants, only 225 of the approximately 10,000 county residents eligible for the program have signed up, with another 300 in the pipeline.

Because Healthy Howard is based on the premise that health care is a right but also a personal responsibility, participation is not free. The monthly fee of $50 to $85, based on income, might be an obstacle for some. More likely is that not enough people in our target demographic -- primarily low- to middle-income people -- know about the program. We have recently started outreach that we hope will increase enrollment.

We also know that close to one-third of the uninsured in both Howard County and the nation are "young invincibles" -- 25- to 40-year-olds who don't think they will get sick or injured and who end up using the emergency room if something does happen.

If universal coverage is a goal, national health-care reform has to include individual and employer mandates as well as governmental subsidies to those with lower incomes to ensure that the risk pool is broad enough and that health coverage is affordable for all.

Lesson No. 3: There's a lot of low-hanging fruit.

One of the greatest successes of our Healthy Howard effort has been the number of applicants to our program who didn't know they were eligible for other programs, primarily Medicaid and the State Children's Health Insurance Program. We are enrolling or have enrolled more than 2,500 applicants and have reduced the number of uninsured county residents dramatically in just a few months. It's estimated that one-quarter to one-third of uninsured Americans -- perhaps 15 million people -- are eligible and could benefit from these programs if government reached out to them.

Lesson No. 4: Everyone needs to have skin in the game.

We don't know the form that final health-care reform legislation will take, but we do know that everyone must participate: government, businesses, health-care providers and patients. We were able to get our program started because of the realization that there would benefits for everyone, from less-crowded emergency rooms to more time for doctors to spend with patients to lower premiums. The result: a healthier community. There's a lesson there for Washington.

Ken Ulman is the Howard County executive. Peter Beilenson is the county's health officer.

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