TRANSFORMING HEALTH IN PRINCE GEORGE’S COUNTY, MARYLAND: A PUBLIC HEALTH IMPACT STUDY UNIVERSITY OF MARYLAND SCHOOL OF PUBLIC HEALTH JULY 2012 Table of Contents SECTION I: SUMMARY INTRODUCTION AND PURPOSE . 1 SNAPSHOT OF FINDINGS . 2 ANSWERS TO FRAMING QUESTIONS . .4 CONCLUSION . .19 RECOMMENDATIONS . 20 VISION . 22. SELECTED REFERENCES . 24 GLOSSARY OF KEY TERMS . 25 STUDY TEAM MEMBERS AND CONTRIBUTORS . 27 ADVISORY COMMITTEE MEMBERS AND PARTICIPANTS . 28 LIST OF TABLES AND FIGURES . Inside back cover SECTION II: TECHNICAL REPORTS This document is available at sph.umd.edu/princegeorgeshealth. Acknowledgements The Study Team benefited from sound advice and input from a variety of individuals. We extend our appreciation to and acknowledge the support of individuals from the following organizations: PRINCE GEORGe’S COUNTY HEALTH DEpaRTMENT AND OTHER GOVERNMENT ENTITIES PRINCE GEORGe’S COUNTY OFFICE OF THE COUNTY EXECUTIVE PRINCE GEORGe’S COUNTY DEpaRTMENT OF PARKS AND RECREATION MARYLAND DEpaRTMENT OF HEALTH AND MENTAL HYGIENE UNIVERSITY OF MARYLAND EXTENSION MARYLAND HEALTH CaRE COMMIssION UNIVERSITY OF MARYLAND MEDICAL SYSTEM CORPORATION Introduction to the Public Health Impact Study of Prince George’s County Prince George’s County, Maryland is poised for changes that will lead to improved health and quality of life for its citizens. Plans for a transformed new regional health care system that focuses on population health are under way through a unique partnership among the County, the state and academic and health care institutions. These plans come at a time of great momentum at the national, state and County levels to advance health care reform and eliminate health disparities. On June 28, 2012, the Supreme Court proactively pursuing strategies to pro- “strategy to transform the system into upheld the constitutionality of the mote health equity, as demonstrated an efficient, effective and financially Patient Protection and Affordable Care by the passage of legislation creating viable healthcare delivery system with Act (ACA) . Under the leadership of the “health enterprise zones” to expand and a regional medical center,” a system O’Malley-Brown administration, the improve access to care in underserved that is “supported by a comprehensive state of Maryland has created a Health areas . Prince George’s County Execu- ambulatory care network, which will Benefit Exchange, designed to expand tive Rushern L . Baker, III has placed improve the health of residents of the health care coverage and fulfill the health as one of his administration’s County and Southern Maryland region provisions of the ACA . The state also is top priorities, and together with the by providing community-based access County Council has taken deliberate to high quality, cost-effective medical steps to enhance the County’s safety care” (from the July 2011 Memoran- net system and to address social and dum of Understanding) . PRINCE GEORGE’S COUNTY environmental determinants of health . An interdisciplinary team of senior AT A GLANCE To inform the design of this new School of Public Health researchers system to improve health and health produced the Public Health Impact The nation’s most affluent County with an care in Prince George’s County, the Study of Prince George’s County by African American majority University of Maryland School of building upon existing relevant reports Public Health was commissioned to and studies, such as the 2009 Rand Maryland’s most diverse County: “minority” assess the proposed system’s potential report, “Assessing Health and Health groups account for more than 80 percent of public health impact and to answer Care in Prince George’s County,” and the population (blacks, whites and Hispanics key questions . The study sponsors are collecting and analyzing a wealth of made up 65 percent, 15 percent and 15 percent Prince George’s County, the Maryland new data . Representatives of the study of the population in 2010, respectively) Department of Health and Mental sponsors served on the advisory com- The second most populous County in the state Hygiene (DHMH), the University mittee that helped guide the study . of Maryland (after Montgomery County) of Maryland Medical System and The study team learned from Dimensions Healthcare System . These resident experiences; listened to policy- Home to the University of Maryland, College parties, plus the University System of makers, County and state leaders and Park; NASA’s Goddard Space Flight Center; Maryland, signed a Memorandum of health care providers; and explored and Joint Base Andrews (previously Andrews Air Understanding in July 2011 to address documented best practices from com- Force Base) and USDA’s Beltsville Agricultural long-standing challenges and gaps in parable health care systems . The study Research Center the health care delivery system and highlights policy-relevant opportunities, achieve improved health for the County . focuses on improving health outcomes, Bordered by Washington, D.C., and Montgomery, The Public Health Impact Study of provides regional and sub-county Howard, Anne Arundel, Calvert and Charles Prince George’s County comes at an mapping of all categories of primary counties in Maryland early stage in the development of a care providers and assesses County 1 resident-specific recent hospital dis- quality of life in the County, referrals, availability of specialty care charge and readmission data . • address population health broadly, and perceptions of the quality of care This study adds new information not focus just on those seeking at local hospitals . Almost 31 percent of related to: health care, and residents who reported using a hospital • improve the capacity to deliver outside of the County did so because • how residents use and perceive high-quality primary prevention their physician referred them to do health care and health issues in and health and hospital care . so, and 13 percent reported that their the County, insurance coverage dictated their hos- • what works in other model health In the snapshot of our results from pital selection . Addressing these issues care systems that can be applied each study component we highlight will require a multi-pronged effort in Prince George’s County, findings that provide new informa- aimed at County residents, health care • how state and County leaders tion about health care in the County . providers and insurers . and stakeholders perceive what is needed for a new health care system Survey of County Residents Interviews with State, County to succeed, We learned from the Random House- and Local Stakeholders • where there is an inadequate supply hold Survey of 1,001 County residents The study team conducted 40 personal of primary care providers and (referred to throughout as “the survey”) interviews with key stakeholders . They resources, about current use of and attitudes provided input regarding the current • what exists in the public health and toward health care services and gained status of the County’s health care and public sectors to complement the an understanding of the factors that recommendations for the design of a new system, and drive residents’ health care decisions . new health care system . • how residents with key chronic Key findings include: The lack of primary care resources health conditions use hospitals in the and concerns about both the percep- County and region . • While 75 percent of residents have tions of quality and the actual quality a “personal doctor,” 10 percent of the current health care and hos- of these residents go outside the pital system emerged as themes . As A SNAPSHOT OF FINDINGS County to see this provider . one stakeholder put it, “Perception FROM THE PUBLIC HEALTH • Of those who use a doctor outside becomes reality unless otherwise IMPACT STUDY COMPONENTS the County, more than 7 percent challenged and the perception is that indicated that their insurance we don’t have a good hospital system, The study team used multiple novel required them to see a physician and for some parts, they’re right, but and integrated approaches to answer outside the County, and more there are other parts of the hospital the study’s key framing questions and than 7 percent reported being system that ought to be duplicated ”. to inform the design of the new system . unable to get an appointment with Recommendations for the new system The Public Health Impact Study was a specialist inside the County . included the need for an academic guided by the need to: university framework, culturally appro- The frequency with which residents priate health education and prevention, • promote health, prevent disease use hospitals outside the County effective branding and centers of excel- and support wellness, health remains an even greater issue, and is lence among others . equity, health literacy and driven by insurance carriers, provider S MTUDY CO PONENTS Random survey of 1,001 Interviews with 40 Analysis and mapping Analysis of hospital Brief overview of public Interviews with leaders County residents stakeholders of health care workforce discharge and readmis- and private sector from 13 health care in the County sion data resources systems around the U.S. 2 public health impact study C ATEGORIES OF KEY STAKEHOLDERS Policymakers, elected officials Health practitioners Academic administrators Health system, insurance Community leaders and administrators company and hospital administrators Health Care Workforce ideally be managed more effectively sensitive, innovative, team-based Assessment