Maryland's Health Enterprise Zones, state-funded initiatives designed to improve healthcare outcomes and prevent unnecessary hospitalizations in underserved communities, were associated with large reductions in inpatient stays, according to a study by researchers at Johns Hopkins Bloomberg School of Public Health.
The study, published today in the October issue of Health Affairs, links the Health Enterprise Zones to a decline of more than 18,000 inpatient stays in the four years of the initiative, and an overall healthcare cost reduction of about $93 million.
The result, said authors, is large cost savings for a relatively small investment.
In 2013, Maryland designated five small areas of the state as Health Enterprise Zones: Annapolis/Morris Blum, Capitol Heights, Caroline and Dorchester counties, Greater Lexington Park and West Baltimore.
Within each, the state recruited primary care physicians and other health workers to improve access and promote healthier behaviors in communities with high rates of Medicaid use, lower than average life expectancy or other indicators of being disadvantaged.
Each zone's initiative was tailored to the specific features of its communities, but the overall goals were to improve health outcomes and reduce unnecessary hospitalizations.
The researchers found that the rate of inpatient stays per 1,000 residents declined in both populations during the study period -- but declined more in the population served by the zones. The analysis linked the zones to relative declines of 13.73 inpatient stays per 1,000 residents in 2013, 18.03 in 2014, 16.76 in 2015 and 17.47 in 2016.
For the four-year study period, there were a total of 18,562 fewer inpatient stays than would otherwise have been expected. Relative declines were even greater for chronic, often lifestyle-related conditions, such as diabetes, hypertension and chronic obstructive pulmonary disorder, that the zones initiative was specifically meant to reduce.
Unexpectedly, the analysis also linked the Zones to a large increase in emergency room visits -- 32.40 per 1,000 in 2013, 41.01 in 2014, 38.78 in 2015 and 31.75 in 2016 -- implying a total of 40,488 extra visits during the study period.
Despite the increase in emergency room visits, the analysis suggests that the zones brought a large net cost savings. The 40,488 extra emergency room visits cost insurers and patients an estimated $59.9 million. The reduction of 18,562 inpatient stays saved an estimated $168.4 million for a net savings of $108.5 million, against the $15.1 million cost of the zones initiative during the same period.
While Maryland's program is fairly unique, there is some precedent when it comes to achieving strong return on investment on efforts to curb unnecessary hospitalization.
Just this year, for instance, Montefiore Health System in the Bronx addressed social determinants of health by investing in housing, which cut down on emergency room visits and unnecessary hospitalizations for an annual 300 percent ROI.