In parts of Maryland, when poverty rates rise, so do healthcare costs — a correlation that’s not uncommon across the country.
In response, the Affordable Care Act carved out a portion of its budget to support communities promoting nutrition and exercise, while reducing obesity and tobacco use. Called the Prevention and Public Health Fund, it aims at not only getting Americans healthier, but also quelling healthcare and hospital costs through preventative measures.

It’s estimated that up to 40 percent of deaths each year from the five leading causes — heart disease, cancer, chronic lower respiratory diseases, stroke and unintentional injuries — are preventable, according to the Centers for Disease Control and Prevention.

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In Maryland, preventative care exploration has been underway since the 1970s, but thanks to the new funding from Obamacare, state officials have revitalized a plan to get its residents healthy.

The western Maryland city of Cumberland has one of the greatest needs for preventative care. The area, with a population of about 20,000, has notched an obesity rate of nearly 29 percent. The surrounding area of Allegany County carries a poverty rate of 16 percent, leading to poor nutrition practices, food insecurity, and often, costly hospital visits.

But Western Maryland Health Systems (WMHS) is tapping into federal funds to transition medical practices out of a traditional fee-for-service model that reimburses doctors and hospitals for each test, treatment, and medication. As critics of fee-for-service have noted, this model can lead to unnecessary treatments or substandard care which prompts further treatment. Instead, WMHS will help doctors cap and stabilize reimbursements through Medicare and Medicaid, encouraging hospitals to use more preventative care methods to keep their patients healthy, according to the American Prospect.

Perhaps the more interesting part of the state’s initiative is the community outreach teams that will visit the homes of patients with conditions like asthma or diabetes to ensure they’re taking medicine and heeding a doctor’s advice.

“If you begin to work on controlling the healthcare spending in an area, you have to be able to confront and understand some of those social determinants of health,” said John M. Colmers, chairman of the state’s Health Services Cost Review Commission and a vice president at Johns Hopkins Medicine.

A variety of organizations across the state are pitching in to help low-income families find better sources of nutrition and increase exercise. The University of Maryland’s extension office for Allegany County has implemented educational programs for families while passing out healthy recipes and helping out at local food banks. Two of its staff, Katheryn Kinsman and Eileen Morgan, have been working with local families for 26 years.

Their biggest challenge, according to Morgan, is getting inside the home.

“There is an extreme amount of pride here, and just forming any kind of rapport here is hard,” Morgan told American Prospect. “Just getting in the door is hard.”

Apart from pride, the poverty rate has directly contributed to the area’s poor health — common afflictions include obesity, asthma, and untreated mental illness. To combat obesity, Morgan and Kinsman use simple methods like teaching how to prepare nutritious meals, learning to chop and stir, and finding sources of fresh fruit and vegetables. The two recalled buying clients a pot and wooden spoon before teaching a class.

“If you’re a mom with very little resources and several kids, and you go into the market and you can get a box of 12 cupcakes for a dollar, while apples are a dollar apiece, which are you going to buy?” Kinsman said.

Even finding an area to exercise poses a problem for Cumberland, which is why the local extension office offers an exercise class at the community center.

But with renewed attention and funds to promote healthy living, state officials are hopeful to turn the tide in Cumberland and Allegany County.