Peter Beilenson — doctor and public health visionary, Baltimore health commissioner, Howard County health officer, quick-study scholar and decoder of federal regulations — remains one of our most interesting men.
A person whose leadership has certainly improved the lives of thousands of Marylanders over the last 20 years, from Baltimore heroin addicts to young families in Columbia, Beilenson is now trying to establish a nonprofit health insurance cooperative — that is, Obamacare as progressives envisioned it from the start.
Beilenson left his post in Howard County last fall, having helped establish Healthy Howard, a pre-Obamacare initiative that provided medical care at modest premiums to individuals and working-class families who fell into a gap: They earned too much to be eligible for Medicaid but not enough to be able to afford private insurance. With the support of his boss, Howard County Executive Ken Ulman, Beilenson cobbled together an array of primary-care and specialist services, some of them pro bono, and offered them for modest monthly fees.
During Beilenson's tenure, about 2,000 individuals and families enrolled in Healthy Howard and several thousand more took advantage of the county's effort to introduce people to health benefits — such as subsidies for prescriptions — that they didn't know they could get.
There's a lot of that in health care, Beilenson discovered, and even more with the passage of the voluminous Affordable Care Act and its affirmation by the Supreme Court.
"Section 1322," Beilenson says, when I ask about his next great undertaking: the establishment of Evergreen Health Cooperative. Section 1322 of the ACA, he discovered, provides millions of dollars in financing for the startup of nonprofit cooperatives to compete with for-profit insurance companies. Each state is eligible for up to two such entities. Maryland has one, and it's Evergreen.
The cooperative received a $65 million federal loan in late September, and Beilenson left his post in Howard County to oversee the research, development, regulatory compliance and fundraising that will be needed to get Evergreen up and running by Jan. 1.
The mission of Beilenson's brainchild is along the lines of Healthy Howard: provide health care to thousands of Marylanders in the gap between Medicaid and private insurance, though anyone can apply for membership in the cooperative.
Evergreen's centerpiece is service: primary-care "medical homes" at four locations in Maryland shopping centers or malls (probably in White Marsh, Baltimore, Howard County and Prince George's County); staffs of salaried doctors, nurses, health coaches and social workers; smart use of telemedicine and Skype to consult with specialists, avoid unnecessary procedures and visits to emergency rooms; and emphasis on prevention by getting members to develop healthier lifestyles.
"A lot of this has been done before," Beilenson says. "We're trying to put it all together; that's the difference."
The goal is to bundle the best practices and save money.
"Obamacare does a lot to expand health care coverage," Beilenson says, "but it doesn't do enough to reduce costs."
Of course, profit remains in health care delivery. President Obama pretty much declared a single-payer system modeled after Medicare dead on arrival when he handed off his health care reforms to Congress. But despite all the trade offs and compromises that were made in 2010, Section 1322 of Obamacare remains. In the case of Beilenson's Evergreen, that means millions of dollars of credit to establish his plan's solvency and cover its startup costs.
But he and his board will still have to raise money. None of the Obamacare loan can be used for the marketing of Evergreen to Marylanders. Up against the established insurance providers, that will be take gobs of dough.
So Beilenson is running.
Evergreen has already been presenting ideas to focus groups, he says, sampling opinions of men and women, from 24 to 64 years of age, from the city and from the suburbs. So far, so good, he says. People like the convenience of an insurance plan that has its own teams of health care professionals, and focus group participants have been surprisingly receptive to the use of their smartphones to consult with doctors and nurse practitioners.
Something else: Beilenson, who has Parkinson's disease, doesn't want his new customers — excuse me, fellow members of his cooperative — to encounter what he does when he calls his present insurance company. He's adamant that they not spend a lot of time pushing buttons on a telephone to find help when they need it. Evergreen promises a live human being (in Maryland and not Malaysia) who will answer within 30 seconds when someone calls for help. Imagine that.
"That was the single piece that got the biggest response from the focus group," Beilenson says. "When we described that, people said, 'Yes, absolutely!'"
Evergreen is no doubt a risky venture, with a big loan to repay. Beilenson and his collaborators have to get people to buy into a new plan. But he has confidence he'll find takers, including those who see in Evergreen's promise Obamacare as it should have been done in the first place.