Improve equitable access to holistic health care that addresses physical, behavioral, emotional, and cognitive health.
Strategies:
Implement the AHEAD model to expand Maryland’s focus on primary care, population health, prevention, and health equity across age groups.
Explore policies that incentivize enhanced care delivery models in the home and community that collaborate with community-based organizations, care navigators, and community health workers, such as the Neighborhood Nursing model.
Overview of Progress Made
- MDOA and the University of Maryland School of Medicine completed the Hospital Transitions Program, a one-year pilot with Maryland Information Network to reduce preventable hospital readmissions among Medicaid- and Medicare-eligible older adults and adults with disabilities.
Key Initiatives
- The Hospital Transitions Program was a one-year pilot program that delivered intensive, person-centered support to 62 participants for 120 days after a hospital discharge to guide them through waiver enrollment, paperwork, insurance navigation, and access to essential services. The program delivered a 23 percent reduction in hospital visits within the first month, and a 5 percent reduction at three months.
Expand access to, and utilization of, community-based behavioral health services that address long-term care needs.
Implement a person-centered, trauma-informed approach across publicly-funded programs to ensure older adults and adults with disabilities can effectively make decisions about their care and wellbeing.
Leverage existing state infrastructure to target shortage areas for health providers and direct support professionals to increase access to care among older adults in underserved communities.
Increase access to technology that will enhance the ability of all Marylanders to pursue their best life as they define it through the Technology First initiative by increasing access to the internet and providing resources for digital literacy education, accessible telecommunications equipment, telehealth, assistive technology, and durable medical equipment.
Explore policy reform opportunities that incentivize small home alternatives to residential nursing institutions.
Identify policy opportunities to incentivize equitable delivery of medical innovations that impact healthy aging.
Outcomes:
Short-Term (1-3 years)
- Launch the AHEAD model
- Identify and promote programs and policies that advance person-centered, trauma-informed care
- Advance awareness of assistive technology and digital access programs
Mid-Term (4-6 Years)
- Improve systemic coordination to address social determinants
of health - Identify opportunities to incentivize enhanced care delivery models across state partners
Long-Term (7-10 years)
-
Enhance holistic health of older adults through coordinated care and long-term services and supports