Provider Forum

This workgroup is responsible for identifying barriers to health care access and recommending strategies to improve how Howard County residents navigate and receive primary and preventive care.

• Purpose: Improve how residents access and navigate health services, with a focus on reducing barriers and expanding access to Primary and Preventive Care Services.
• Population: Howard County Residents.
• Scope: Evaluate system-level access gaps, referral and follow-up protocols, and connections between clinical providers and non-clinical partners such as transportation and case management. Based on findings, develop recommendations for the Howard County Executive to improve access pathways and reduce barriers.

This workgroup examines drivers of preventable emergency department use and hospital readmissions and recommends strategies to reduce unnecessary acute care utilization.

• Purpose: Reduce preventable emergency department use and hospital readmissions.
• Population: Individuals receiving inpatient or emergency care.
• Scope: Evaluate root causes of frequent ED use, hospital-to-community coordination processes, mobile health initiatives, and discharge planning effectiveness. Provide evidence-based recommendations to the Howard County Executive for interventions that reduce unnecessary acute care utilization.

This workgroup evaluates behavioral health service capacity and access and recommends strategies to improve coordination and outcomes for individuals with behavioral health conditions.

• Purpose: Optimize behavioral health service provision and improve outcomes.
• Population: Individuals with a diagnosable behavioral health condition.
• Scope: Assess the structure and capacity of behavioral health resources, provider workflows, and access to timely care. Recommend strategies to the Howard County Executive to address service gaps, improve coordination, and expand access.

This workgroup evaluates chronic disease prevention and management efforts and recommends strategies to improve outcomes through coordinated and integrated care.

• Purpose: Improve chronic disease outcomes through coordinated and integrated care.
• Population: Individuals with a diagnosable chronic health condition.
• Scope: Evaluate the availability and effectiveness of screenings for hypertension, diabetes, asthma, and mental health. Review integration of physical and behavioral health services. Recommend actions to the Howard County Executive to strengthen chronic disease prevention and management.

This workgroup identifies social and environmental barriers to health and recommends strategies to improve health equity for Medicaid-insured and uninsured residents.

• Purpose: Address social and environmental factors affecting health, particularly among Medicaid-insured and uninsured residents.
• Population: Medicaid beneficiaries and individuals facing barriers related to social determinants of health.
• Scope: Assess disparities, local social service capacity, and awareness of community resources. Recommend to the Howard County Executive targeted strategies to improve health equity and address identified non-clinical barriers.

This workgroup assesses healthcare workforce capacity and well-being and recommends strategies to strengthen and sustain Howard County’s health workforce.

• Purpose: Ensure Howard County’s healthcare workforce is sufficient, sustainable, and supported.
• Population: Individuals employed in healthcare or related service roles.
• Scope: Evaluate workforce capacity, demand, recruitment, retention, and well-being. Provide recommendations to the Howard County Executive for initiatives that strengthen the health workforce and reduce burnout.

This workgroup monitors health policy developments and evaluates major capacity decisions, including Certificate of Need considerations, to provide timely, evidence-based recommendations to County leadership.

• Purpose: Continuously track and synthesize federal and state policy developments that affect health access, payment, delivery, data, and quality in Howard County, and brief the Forum and County leadership in a timely way. Analyze whether a Certificate of Need should be pursued or supported for new or expanded services or facilities in Howard County and deliver a single recommendation to leadership.
• Population: Cross-cutting audience including providers, county agencies, and residents impacted by policy changes. County residents and healthcare organizations affected by facility and service capacity decisions.
• Scope: Evaluate the potential impact of new or proposed policies, including Medicaid, ACA marketplace, Maryland’s AHEAD model, behavioral health, telehealth, privacy, licensure, and payment programs. Deliver timely recommendations to the Howard County Executive for actions or advocacy strategies in response to policy developments. Review Maryland Health Care Commission criteria, assess current capacity and demand, analyze geographic access and equity, evaluate alternatives to construction, estimate financial and operational implications, gather stakeholder input, and deliver a written recommendation with evidence, timeline, and next steps.

The Howard County Provider Forum is designed to bring together a diverse group of healthcare and human services professionals to examine data, identify system gaps, and develop evidence-based, realistic solutions to improve access and coordination of care in Howard County. Rather than relying on assumptions or quick fixes, the Forum is focused on understanding what the data tells us and using that insight to guide meaningful action. The goal is to reduce ER overcrowding, improve care transitions, expand access to primary and behavioral health care, and create a system that works better for all residents.

No. Every person participating in this forum is volunteering their time and professional expertise. No one is being paid to attend. These individuals and organizations are showing up because they care deeply about the health of Howard County and want to be part of creating solutions.

This is a multidisciplinary effort that includes a wide range of stakeholders: 
Johns Hopkins Howard County Medical Center 
MedStar Health 
Primary care, urgent care, and specialty private practice providers 
The Maryland Hospital Association 
Payers like CareFirst 
Members of the Health Services Cost Review Commission 
Howard County Department of Fire and Rescue Services 
Behavioral health and public health leaders 
State elected officials and others (link to the E.O.) 
Everyone involved understands that the issues are complex and multi-faceted, and shares the goal of improving access, quality, and coordination of care.

The Executive Order that establishes the Howard County Provider Forum specifically calls for evaluating the need for a second hospital. Building a hospital is not something the County can do on its own. First, our county government does not build or operate hospitals, private health systems do. Second, before any new hospital can be developed in Maryland, the state must first issue a Certificate of Need (CON) through the Maryland Health Care Commission. This is a multi-step process that requires significant data, justification, and time. Even if a health system wants to build one, the state must approve it based on need and resource availability. That is exactly why the Provider Forum was created: to evaluate this possibility, gather data, and assess what healthcare infrastructure and services are most urgently needed now and into the future. 

A Certificate of Need (CON) is a formal approval required by the Maryland Health Care Commission (MHCC) before a new hospital can be built or an existing one significantly modified, expanded, or relocated.  The purpose of the CON process is to ensure that proposed healthcare projects meet a demonstrated community need, align with the Maryland State Health Plan, and avoid any unnecessary duplication of services.  When evaluating an application, the MHCC considers factors such as population health needs, access to care, financial feasibility, and the impact on existing providers.  The process includes public input and can take several months or longer to complete.  Without a CON, a hospital project cannot legally proceed in Maryland.  The applicant is typically the organization that will own, operate, or finance the proposed facility. 

In Maryland, hospitals and other healthcare facilities are typically built, owned, and operated by private institutions. It is not the responsibility of the County Government to build or expand hospitals. However, any new hospital construction or significant expansion must first be approved by the Maryland Health Care Commission (MHCC) through the state-regulated Certificate of Need (CON) process described above. While the County can support these efforts through planning and advocacy, it does not directly own or operate hospital facilities. 

Hospitals and EMS providers are required by federal law to evaluate and stabilize anyone who presents for care. The Emergency Medical Treatment and Labor Act (EMTALA) prohibits turning patients away based on severity or ability to pay.  Similarly, EMS providers follow MIEMSS (Maryland Institute for Emergency Medical Services Systems) protocols and cannot decide on their own to take someone to urgent care. Instead, the goal is to educate the public about appropriate care settings and to increase availability and access to primary and urgent care so people have alternatives.

No. According to the 2024 Howard County Health Assessment, the percentage of uninsured residents in Howard County is relatively small, the lowest in the State of Maryland, actually. While every patient contributes to the system’s volume, the biggest drivers of ER crowding include lack of primary care access, limited behavioral health resources, and the fact that our overall population is aging.  The forum is focused on addressing these root causes and improving care for all residents. 

In many cases, people use the ER because they don’t know where else to go or cannot access a primary care provider in a timely manner. That is why one of the core goals of the Provider Forum is to help people understand the right care setting and make it easier to access alternatives when an emergency room is not appropriate. Urgent care and primary care providers can often address many common conditions faster, more affordably, and more conveniently than the ER. 

Yes. Howard County has already made major strides: 

Details of prior investments and their corresponding impacts include: 

• Behavioral Health Unit: Howard County invested $2 million to expand the Behavioral Health Unit at HCMC. This $10.3 million project grew the BHU from 1,500 square feet to 7,000 square feet, tripling its capacity from 5 to 24 beds. Since opening in December of 2024, the unit has treated more than 500 behavioral health patients. This has resulted in a length of stay reduction of approximately two hours for these patients. 

• HCMC Behavioral Health Navigators: Since FY20, Howard County has provided approximately $200,000 per year in funding for the HCMC Behavioral Health Navigators. Patients who interact with this program demonstrate lower levels of utilization. 

• HCMC High Utilizers: Since FY20, Howard County has provided approximately $100,000 per year to support multi-visit patients. These are patients who had visited an emergency department more than three times. Since this investment, the Maryland Health Services Cost Review Commission has reported that HCMC has the second-lowest multi-visit rate in the state at 17% of all patients. The statewide average is 27%, and, while broad, this metric suggests that the range of “high utilizer” services at HCMC is effective in reducing re-utilization of the emergency department. 

• Mobile Integrated Community Health (MICH): Between FY21 and FY23, Howard County invested approximately $300,00 for the MICH program. During the three years of this program’s tenure, HCMC and the Howard County Department of Fire and Rescue Services treated more than 800 patients and saw an 85% reduction in 911 calls, 83% decrease in inpatient admissions, and 75% reduction in emergency department visits. 

• Maternal Health: the County has invested $3.2 million between FY23 and FY24 for maternal health initiatives, with funding that went to both HCMC and Chase Brexton. HCMC used the funding to establish a maternal health clinic.  It is estimated that more than 200 people avoided the emergency department as a direct result of the Clinic since opening in 2023. 

• Partnership with the Maryland Hospital Association (MHA): In 2024, Howard County Government and HCMC partnered with MHA to create a discharge hospitality suite. The goal was to help alleviate throughput pressures in HCMC’s inpatient bed and emergency department utilization. Opened in July 2024, this suite has served nearly 3,600 patients, reducing time spent in an inpatient bed by nearly 1,015 hours 

These are meaningful outcomes, but there is still a lot more work to be done. 

Yes. The Provider Forum is also exploring ways to leverage innovation and emerging technology to help residents get to the right care at the right time. New tools that support real-time care navigation, AI-driven recommendations, or more coordinated referral systems are part of the long-term strategy to improve healthcare access in Howard County.

No, it’s not free. While the ER will treat you regardless of your ability to pay and doesn't require payment upfront, there will still be a bill, either to you or your insurance carrier. Emergency care is one of the most expensive types of medical care, and in many cases, the same issue could be addressed more affordably and just as effectively at an urgent care center, through telehealth, or with a primary care provider.

Yes. When hospitals and clinics are short on staff, everything from triage to discharge takes longer. Fewer available doctors, nurses, and support staff can mean longer ER wait times, delays in getting appointments, and less coordinated follow-up care. Staffing challenges also make it harder to manage patients with complex needs, leading to gaps in care.

The Howard County Provider Forum is comprised of eight key focus groups (workgroups), each dedicated to addressing specific healthcare challenges across the county. Their work focuses on identifying gaps, evaluating current systems, and exploring collaborative solutions to strengthen the local healthcare infrastructure.