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Tired of waiting for federal and state governments to solve the nation's health care problem, a Maryland county is taking matters into its own hands. With the planned launch next fall of the Healthy Howard Plan, executives in Howard County, Md., are hoping to bridge the health care gap — at home at least.

Built on a countywide network of partnerships that includes health care providers and programs of all kinds, the innovative health access program promises to bring affordable and comprehensive services to uninsured residents with the goal of keeping them healthy and out of emergency rooms. For a monthly fee of $50 to $85, county residents will gain access to health services, including primary care, discounted prescription drugs, preventive screenings, inpatient and outpatient hospital care, mental health and substance abuse services and an array of specialty care services.

To be eligible for the plan, county residents must make 300 percent of the poverty level or less, have legally resided in the county for at least one year and have been uninsured for at least one year.

The latter stipulation is designed to prevent small businesses from "dumping their employees into our program and giving up insurance," said Howard County Health Officer Peter Beilenson, MD.

Despite its status as the third-richest county in the United States, about 20,000 Howard County residents are uninsured.

"As of now, the federal government is doing nothing new to increase access to care, and there has been only a modest increase in access to care in the state of Maryland...and that is true in most states," Beilenson told The Nation's Health. "So we thought it was incumbent on us that we do something at the local level to help provide access to care for the uninsured."

Importantly, the program is not insurance and is not portable. Most of the participating community partners and providers are located inside the county.

"This is not a panacea...but what we do see ourselves as being is a model for whatever kind of health care reform is proposed at the federal level," said Beilenson, who formerly served as Baltimore's health commissioner.

Among the reasons Howard County Executive Ken Ulman, who helped fast-track the Healthy Howard plan, said he is so vested in the project is because his mother, father and brother are all cancer survivors, "in part because of early detection provided by their health care," Ulman told The Nation's Health.

One of the more innovative aspects of the Healthy Howard Plan is its requirement that every participant have a health action plan and a health coach. The health coach idea is not new, said Glenn Schneider, director of health policy and planning for the Howard County Health Department. Health coaching is being tried by many insurance companies, "but they typically concentrate on chronic disease management," Schneider said.

"The difference here is that everyone in our program, regardless of whether or not they have a chronic disease, will be required to have a health coach and work on a health action plan that will help them overcome any barriers to being healthy," Schneider said.

For example, a grandfather might tell his health coach that he can't get to his yoga program because he has to watch his grandchildren five days a week. The coach will in turn contact a partner gym that provides babysitting and will negotiate a rate that allows the man to overcome that particular barrier.

But because health care is "a right and a responsibility," patients who don't comply with their plan or fail to take the steps necessary to improve their health will eventually lose most of the services offered, except the primary care services for which they paid, Schneider said.

"We aren't asking you to reduce your cholesterol by so much or your blood pressure by so many points," he said. "We are asking you to take steps toward being healthy, and as long as you substantively comply with that you are going to be on the road to better health."

For more information, visit www.co.ho.md.us/health/healthmain/health_news.htm. For more news from The Nation's Health, visit http://www.thenationshealth.org/.