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State to Award $7.6 Million to Implement Population Health Measures

Silver Spring, MD — The Maryland Health Services Cost Review Commission (HSCRC) has recommended awarding $7.6 million to the Nexus Montgomery Regional Partnership—a collaborative effort among the six hospitals operating in Montgomery County and a network of community based organizations—to implement or expand initiatives that will improve the health status of those most at risk of avoidable hospital use. The target population includes Medicare seniors, the medically frail, those with severe behavioral health conditions, and those without eligibility for health insurance.


Annice Cody, president, Holy Cross Health Network, leads the Holy Cross Health effort to improve services for at-risk populations.

The members of the Nexus Montgomery Regional Partnership are Adventist HealthCare Shady Grove Medical Center, Holy Cross Hospital, Holy Cross Germantown Hospital, MedStar Montgomery Medical Center, Suburban Hospital and Washington Adventist Hospital. In partnership with the hospitals, local nonprofit organizations will implement the majority of the community-based programs. These non-profits include The Coordinating Center, Cornerstone Montgomery, and the Primary Care Coalition (PCC). The PCC will also be the management entity for the Nexus Montgomery Regional Partnership.

“In addition to the core implementation partners, the Regional Partnership is integrating a broad alliance of community partners who will be instrumental in its success,” said Leslie Graham, PCC’s president and CEO. “These include local government, senior housing organizations, physicians and other medical providers, and supportive and social services providers.”

The Nexus Montgomery Regional Partnership formed over the past year in response to newly available data showing that, among individuals with more than one hospitalization in a year, over one-third admit to multiple hospitals. These individuals can benefit from health improvement initiatives that take a coordinated approach to building community capacity to address their needs and reduce health risks.

“The hospitals participating in the Nexus Montgomery Regional Partnership recognized that they face several common challenges,” said Annice Cody, president of the Holy Cross Health Network. “This unified effort to share programs among four separate hospital systems is unprecedented and moves our community into a new era in terms of addressing population health.”

The Nexus Montgomery Regional Partnership will implement and expand programs that reduce health care costs in the region by reaching out to and serving the medically frail and most vulnerable. The partnership’s programs have the goal of reducing unnecessary hospital use by connecting people to services in the community that can help keep them healthy.

The partnership’s programs and initiatives will serve people who live in Maryland and are served by the six Montgomery County hospitals, an area which comprises most of Montgomery County and parts of Prince George’s County, Maryland. This region is aging rapidly compared to Maryland as a whole and is home to the most ethnically diverse population in the state.

The largest program, Wellness and Independence for Seniors at Home (WISH), will stabilize the health of older adults at risk of a health crisis requiring hospitalization. Other undertakings include efforts to improve transitions from hospital-to-home to prevent avoidable readmissions; connect uninsured people to specialty care follow-ups after being discharged from a hospital to reduce likelihood of re-hospitalization; and, invest in community-based resources for people with severe mental illness.

“Hospitals and health providers today are focusing more on keeping people and communities healthy, instead of only treating them when they are sick,” said Patrick Garrett, M.D., senior vice president of Physician Integration/Innovation for Adventist HealthCare. “This focus on wellness and prevention helps treat the whole person in mind, body, and spirit.”

The Maryland HSCRC is expected to fund the Nexus Montgomery Regional Partnership through a rate increase to the six hospitals in Montgomery County. The HSCRC will award funds to regional partnerships throughout the state whose planned initiatives will help the state as a whole contain health care costs, in line with its agreement with the Centers for Medicare and Medicaid Services (CMS). The four programs to be implemented by the Nexus Montgomery Regional Partnership share the aim of improving health and quality of life for individuals while creating savings in the health care system.


Adventist HealthCare, an integrated, health-care delivery organization based in Gaithersburg, Maryland, is one of the largest employers in its state. The mission of Adventist HealthCare is to demonstrate God’s care by improving the health of people and communities through a ministry of physical, mental and spiritual healing. The Adventist HealthCare family of services includes Shady Grove Medical Center, Washington Adventist Hospital, Behavioral Health & Wellness Services, Physical Health & Rehabilitation, Home Care Services and The Lourie Center for Children’s Social & Emotional Wellness.

Cornerstone Montgomery is an independent, nonsectarian, nonprofit 501(c)3 organization with the capacity to serve more than 2,200 adults and transition aged youth. We specialize in the provision of comprehensive, community- and evidence-based mental health and co-occurring mental health and substance use disorder treatments and interventions.

Holy Cross Health, founded in 1963 by the Sisters of the Holy Cross, is a comprehensive Catholic health care delivery system that includes two hospitals and a network of community health centers in Montgomery County, Maryland. Holy Cross Hospital, the largest hospital in Montgomery and Prince George's Counties, is located on the Kevin J. Sexton Campus of Holy Cross Health in Silver Spring. Holy Cross Germantown Hospital is the first hospital in the nation located on the campus of a community college. Holy Cross Health Network provides primary care at health centers located in Silver Spring, Aspen Hill, Gaithersburg, and Germantown and community education throughout Montgomery County.

MedStar Montgomery Medical Center is a 138-bed not-for-profit hospital serving the greater Baltimore and Washington metropolitan areas. A proud member of MedStar Health, MedStar Montgomery is committed to delivering the latest in modern medicine and medical technology.

Suburban Hospital, a member of Johns Hopkins Medicine, has served Montgomery County and the surrounding area for close to 75 years. The hospital is the designated trauma center for Montgomery County and has centers of excellence in cardiac, orthopedic, ENT and neurosurgery, as well as oncology. Suburban also has a research affiliation with the neighboring National Institutes of Health.

The Coordinating Center is a non-profit organization that has 33 years of experience in delivering community-based care coordination to people with disabilities and the most complex medical and social needs in Maryland. Coordinating services for more than 10,000 people across the state through innovative programs, The Center moves people from institutions, nursing facilities and hospitals to homes in the community of their choice while reducing costs to the system and the citizens of Maryland.

The Primary Care Coalition works with clinics, hospitals, health care providers, and other community partners to coordinate health services for low-income, uninsured residents of Montgomery County, Maryland and the National Capital Area. Our vision is a community in which all residents will have the opportunity to live healthy lives. PCC is a 501(c)(3) nonprofit organization.