Coordinated Health Reform in Maryland

Photography by: Tracey Brown

A Conversation with Carolyn Quattrocki

Coordinating the components of the state’s healthcare reform initiatives is a big job. Fortunately, Carolyn Quattrocki, executive director of the Governor’s Office of Health Care Reform, is up to the task. Maryland Physician spoke with her near the close of the 2013 General Assembly session to learn what her office has accomplished and what is planned.

What is the role of your office and how do you support federal healthcare reform?

In May 2011, the Governor created the Office of Health Care Reform to lead and coordinate Maryland’s implementation of the federal Patient Protection and Affordable Care Act (ACA) of 2010.  Essentially, my office has a coordinating role/oversight function with respect to healthcare reform efforts in the state. Maryland Lieutenant Governor Anthony G. Brown has taken a hands-on leadership role, so we work closely with his office.

It’s a complicated process. In the first year, together with our partners in the General Assembly, we enacted legislation to set up the governance structure and framework of the Maryland Health Benefit Exchange. Maryland has been at the forefront among states in launching the health insurance marketplaces, or exchanges, required by the ACA. This year, in our third and final big legislative push, we are putting in place the last pieces, which include Medicaid expansion, a funding stream for the Exchange, and policies to ensure continuity of care for Marylanders moving between Medicaid and commercial insurance, or between different insurance policies.  We are working closely with a terrific team from the Exchange, the Department of Health and Mental Hygiene, and the Maryland Insurance Administration.

We will have the legislation in place by the end of the session. Marylanders can begin enrolling in qualified health plans starting October 1, 2013, with coverage starting January 1, 2014. The goal is to make health insurance affordable and accessible for all Maryland residents, including the approximately 750,000 who are currently uninsured.  By the end of the decade, we hope to cut this number in half.

How will the Exchange Work?

The Exchange, which will be known as the Maryland Health Connection, will offer insurance to individuals and small businesses. Small businesses purchasing through the Exchange will qualify for a tax credit of up to 50% of their contribution to their employees’ premium. They also will be able to offer employees greater choice among plans tailored to their individual needs and greater insurance portability if they change jobs.  In addition, individuals with incomes below 400% of federal poverty guidelines will receive federal subsidies for coverage.

Establishing the Exchange and building the IT system to support it is an enormous and complicated undertaking.  We have received $157 million in federal grants to fund this development and to support operations through 2014.  A dynamic, nine-person board oversees this effort, and the Exchange now has a terrific staff. We are also developing a robust consumer assistance program that will help enroll and support people in the Exchange.

This education and outreach campaign will be a key to the Exchange’s success in reaching the people who can benefit most. The Maryland Health Connection will divide the state into six regions, with one umbrella “Connector” entity responsible for enrollment in each region.  The Connector entities will hire staff and partner with other community organizations to get the word out to people in every corner of their region. They will need to make special efforts to target specific populations that historically have had cultural, linguistic, or other barriers to obtaining insurance.

All insurance carriers currently doing business in Maryland have expressed their intent to participate in the Exchange, and we are also pleased to have a few new entrants into the market.  The ACA also established Consumer Operated and Oriented Plans (CO-OPs), and at least one, the Evergreen Health Cooperative in Howard County, intends to operate in the Exchange.

Interested parties can visit the following websites for information:

  1. Exchange stakeholders –
  2. Office of Healthcare Reform –
  3. Individuals and small businesses–

What are some of the key challenges you face?

Ongoing challenges remain, the most immediate of which is the sprint from here to October when the Exchange must “turn the lights on.”   As I said, though, we have a great team that is making every day count.

Over the longer term, we need to continue to find ways to decrease the underlying costs of health care.  A subcommittee of the Health Care Reform Coordinating Council is looking at new and promising models for care delivery such as Patient Centered Medical Homes (PCMH) and Accountable Care Organizations (ACO).

What are your goals for this year and beyond?

My immediate goals are to ensure passage of the Maryland Health Progress Act and to help the team at the Exchange be ready to begin operations on October 1st.   Over the longer term, we want to focus on workforce development.  As we get more people into coverage, we need to ensure that we have the right professionals in the right place to meet their health care needs.  In Maryland, we have decent ratios of providers to patients, but we still have problems with access and distribution.

Thus, we are exploring ways to increase access to primary care and to address other shortages, like the lack of behavioral health practitioners on the Eastern Shore. The Health Enterprise Zones, through which communities may seek grants and other financial incentives to attract and retain the allied health professionals necessary to address health disparities, is one promising initiative. (see Maryland Physician’s interview with Lt. Governor Brown from Jan/Feb 2012 Volume 2: Issue 1).

Another exciting initiative is the Governor’s EARN program (HB 227 – Employment Advancement Right Now) legislation passed this year, which provides grant dollars to match Marylanders seeking new or better jobs with the workforce needs of state employers. The program will bring together businesses, government, and educational institutions to create training programs that help prepare people for jobs in high-demand fields.  While not limited to the healthcare sector, this program will help address health workforce needs.

What have been your office’s greatest successes?

While some people have said the ACA is too prescriptive, it actually gives states a lot of tools and discretion to implement reform in a way that works for us.  So I’m proud of involving the full panoply of stakeholders – physicians, insurance carriers, hospitals, consumer advocates, unions, insurance brokers and small businesses – in this process.  We recognized early on that we needed the input and expertise of everyone who would be affected by reform in order to implement it most effectively. Our efforts have been inclusive and collaborative, and I believe this has been key to our success.

This issue celebrates Maryland women in medicine. What unique skills have you brought and what challenges have you faced as a woman in today’s healthcare environment?

My legal background has been helpful in drafting and sheparding bills through the General Assembly, and in negotiating the compromises that are critical to successful legislation. My work in policy development under Joe Curran, Maryland’s former Attorney General, was also important.   Most of all, I’ve been lucky to have had wonderful mentors, several of which were ahead of their time in recognizing the challenges women face and helping me succeed while I was raising four children.  Beginning with Attorney General Curran and his deputies, and now working for the Governor and Lieutenant Governor, I am extremely grateful for the importance they have placed on making women integral and successful members of their team.


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