by Dr. Veronica X. Vela, Senior Director for Healthcare Access

The Montgomery Cares (MCares) clinical quality report is an annual PCC publication. It’s also a living document that reflects an evolving safety net care network and a changing environment.

To reflect that reality, this year’s report makes three key changes:

• New measures, particularly where low performance reflects resource gaps
• Comparing condition prevalence to statewide benchmarks
• Defining measure gaps in terms of patient risk

The problems identified here aren’t new, but publicly naming them is. Among the five new measures reported for FY24, the report links three of them to existing resource gaps:

• Retinal screening for patients with diabetes has been discussed as a problem for years. PCC even applied for foundation funding in FY19 and FY20 to purchase retinal cameras as a bid to provide a low-cost, on-site screening mechanism within primary care. But the cameras were not funded, and the problem has remained. It is an important health maintenance measure that does not happen because our primary care partners lack a viable routine way to provide it. 

• Foot exams for patients with diabetes are possible in a primary care setting, though they may be hard to include among multiple competing concerns in a single visit. Additional specialty care funding for podiatry visits would help ensure higher exam coverage.



• Pneumococcal vaccine coverage can help prevent serious—possibly fatal—infections, but insufficient funding to purchase and administer these vaccines has led to very uneven vaccine coverage across the MCares partner network.  

The consequences of these gaps are significant, and they cannot be bridged by health centers alone.

Our patients are sicker than the average Marylander, a point of comparison we have called out in this year’s report. For example, ~20% of MCares population had diabetes in FY24—versus 11% for Marylanders overall. The disparity is lower for hypertension diagnoses (39% among MCares patients, 33% among Marylanders) but still present. Cervical cancer rates are noticeably higher among MCares participants (10.6 per 100,000) than among Marylanders generally (6.4 per 100,000). Notably, MCares surpasses the HEDIS benchmarks on measures of diabetes annual HbA1c screening and control, hypertension control, and cervical cancer screening—but that may not be good enough, given the higher burden of these conditions among our patients.

Even an area of good news may actually be a cautionary tale. Rates of colorectal cancer are substantially lower among MCares patients (11.4 per 100,000) than among Marylanders (35.2 per 100,000). But Marylanders generally may have greater access to more sensitive screening tools, like a heavier reliance on colonoscopy screening over FIT testing, that drive up diagnostic rates but ultimately find disease sooner.

While there is much worth celebrating, the report shows that important outcomes are still missing. Blood pressure control among patients with hypertension, is “at a near record high” of 71% according to the report, but that still means 29% of patients have uncontrolled hypertension. For those patients, continued high blood pressure could have real and serious consequences in the form of strokes or heart attacks, sequelae that could certainly be life altering, if not life ending.

But the consequences are not limited to a patient or family; they have real implications for our community, too. Either stroke or heart attack would mean an emergency room visit and likely hospital admission, adding pressure to already long emergency room wait times and uncompensated costs for hospital care—ultimately adding to the wait and cost experienced by everyone in the community.

This list began with resource gaps, and many of the report’s recommendations are about finding ways to meet them, particularly where relatively low-cost investments could significantly improve patient outcomes. For instance, quarterly HbA1c testing would improve opportunities for diabetes control without expensive treatments or devices—simply by adding visits and modest lab fees for MCares patients with diabetes. We could address the cervical cancer gap by offering pap smears and HPV vaccination as free services to MCares patients—in much the same way they are for privately insured patients as essential preventive services.

The “wrong pocket problem” discussed in prior issues is ever-present in resource conversations. Happily, pockets align here. The returns we are most likely to see from quality improvements—lower ER burdens and uncompensated costs, fewer income losses—will benefit our local community, the same community that contributes the core program funding. That makes MCares quality an area where financial value and moral values meet: the ultimate policy win.

​​This article has not been reviewed or approved by the Montgomery County Department of Health and Human Services.