Although the Baltimore-Washington area is one of the wealthiest in the nation and has advanced healthcare systems commensurate with such incomes, it's also known for the care and coverage provided to its low-income residents.
For the many physicians who migrate to the region, says Dr. Jesse Pines, director of the Center for Health Care Quality at George Washington University, one of the first things they learn about healthcare in the nation's capital area is the outsized impact of the city's “unity clinics.”
“Because of them, D.C. doesn't have the uninsured problem that a lot of other areas have,” Pines says.
Unity Health Care, which started in 1985 as the primary healthcare provider to homeless residents of the city, expanded in 1996 to become the largest of four community health systems in the city serving the uninsured and working poor.
It has grown to an $80 million program funded primarily by the federal government of more than 850 clinicians that treat more than 82,000 patients annually at 29 federal community health centers throughout the city.
As the seat of a federal government undertaking a cost- and quality-driven overhaul of the nation's healthcare system, Unity's supporters are keenly aware of financial arguments in favor of its approach. As Vincent Keane, president and CEO of Unity, notes, the primary-care services it provides to uninsured and underinsured residents of the city allowed early detection and treatment of potentially serious problems before costly—and uncompensated—hospital care was required.
Sharon Baskerville, CEO of the District of Columbia Primary Care Association, says Unity and its other member organizations have made a large healthcare impact in the city “considering we have a very big chunk of very poor people.”
“That's what makes the difference: getting the needed primary care,” Baskerville says.
Nationally, such health centers provided $24 billion in annual healthcare savings through such preventive care, according to a March report by the National Association of Community Health Centers.
Keane acknowledges that many working poor still prefer using hospital emergency departments for nonemergency care, so the second part of his organization's mission has been to educate the community about the most appropriate places in the city to receive care for various conditions, such as chronic illnesses, regardless of insurance status.
Uninsured residents of the neighboring Baltimore area also have benefitted from an aggressive plan to provide care for them. For the past 11 years, the state of Maryland has offered coverage to residents who were previously denied health insurance because of pre-existing conditions.
The state high-risk insurance pool predated by a decade the federal program established last year through the Patient Protection and Affordable Care Act, which runs or funds such high-risk pools in all 50 states.
In Maryland, the $85 million federally supported high-risk health insurance fund was paired with the state high-risk pool, which had slightly different enrollment criteria, coverage and pay structure.
The Maryland plan, which offers participants access to CareFirst BlueChoice HMO and CareFirst BluePreferred PPO networks, has had a recognizable impact in the state since it was established by the Legislature in 2002.
“By providing this coverage, we were able to lower the uncompensated-care burden that would otherwise have been on our state's hospitals,” says Darrell Gaskin, deputy director of the Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health.
Unlike the federal version of the pre-existing condition insurance program, the Maryland program has had success attracting enrollees, says Gaskin, a member of the program's board of directors.
Gaskin credits the relative success of the Maryland plan to its coordination with private groups to find people who might need the program and its coverage. But the biggest increase in enrollment after its launch came when the state lowered the program's rates to levels comparable with those offered by the individual insurance market in Maryland.
HHS recently announced such a rate-lowering campaign in its year-old program.