Healthy Ambition

The city’s former health commissioner is battling Parkinson’s. He’s also launching a groundbreaking health care co-op.

Over the course of losing a hard-fought primary to John Sarbanes to represent Maryland’s 3rd congressional district, Dr. Peter Beilenson was faced with the daunting task of writing to everyone who had donated to his campaign. Whether they’d contributed $10 or $2,100, each person would receive a personal thank you. Four thousand-plus handwritten notes.

Asking people for money to run for office in the first place was not the easiest thing he’d ever had to do in public life. “I would not describe it as humbling,” Beilenson says. “It’s humiliating—that’s the word.” As Baltimore City’s Health Commissioner for 13 years, the position he gave up to run for Congress in 2006, he knew exactly how those political contributions—nearly a million dollars on his behalf—could’ve instead helped pay the medical bills or insurance premiums of thousands unable to afford health care. Or funded controversial HIV/AIDS, teen pregnancy, needle-exchange, and drug-treatment programs in Baltimore, which he’d fought for.

While chipping away at the stacks of cards and envelopes, Beilenson, however, began to notice that his handwriting was worsening as the weeks passed, getting smaller, the letters and words crowding together. Not unusual, perhaps. “Initially, I blamed it on cramps,” he says. But when typing, he started to struggle as well, his normally dominate right hand and wrist slowing, unable to keep pace with his left.

Ultimately, it would take 15 months to finish all those thank-you notes.

“I realized that it wasn’t cramps. I self-diagnosed it as Parkinson’s pretty quickly. Eventually I went to a neurologist for a confirmation,” he says.

And then he kept the news of his degenerative disorder private, sharing only with family and close friends for five years—the disease, in his case, progressing slowly. He told his new employer, then-recently elected Howard County Executive Ken Ulman, but kept the diagnosis—the same one famously afflicting Michael J. Fox—out of the media while launching the Healthy Howard plan, an innovative effort aimed at providing universal health care coverage for residents that garnered national attention.

Blunt, outspoken, and always ambitious in terms of public health policy as well as personally—he had run for state delegate and City Council in the early ’90s—Beilenson didn’t reveal his diagnosis until last fall, specifically, the day the Supreme Court upheld Obamacare. “I knew reporters would be calling for a reaction, and I was fed up with Rush Limbaugh and those on right-wing talk radio—who have great health care—bashing legislation that would enable 30 million people to get health insurance,” he says. “The only reason I am doing as well as I am—and I wanted to make this point—is that I have health insurance and can afford to see a doctor and receive treatment.”

In fact, during the two-year legal battle leading to the court’s decision, Beilenson had begun working on a co-op idea—made possible by the Affordable Care Act—that would offer health care to thousands of Marylanders without coverage. Last fall, three months after the high court’s ruling, Beilenson left Howard to launch the potentially groundbreaking Evergreen Health Cooperative—named after the Cold Spring Lane coffee shop where the concept was born. Basically a nonprofit health-insurance company and affiliated provider under one roof—operating four, to start, care centers in Baltimore City, White Marsh, Columbia, and Greenbelt—the biggest challenge of Beilenson’s professional life opens for business January 1.

Optimistic, undaunted by Parkinson’s—a disorder of the central nervous system with no known cause or cure—Beilenson finds a certain irony in the way his career has panned out.

“I’ve been for a single-payer, national health care system my whole life—and that hasn’t changed,” says the man who founded Maryland’s Health Care for All Coalition in 1999. “But here I am,” he laughs in his Falls Road office, “the president and CEO of an
insurance company.”

On a Wednesday afternoon earlier this fall, inside a packed, 110-seat lecture hall at The Johns Hopkins University, Beilenson, casually dressed in a button-down shirt and khakis, welcomes his first class of the semester. It’s an undergraduate course he’s taught for several years, “Baltimore and The Wire: A focus on major urban issues.” The class introduces urban and public-health issues confronting U.S. cities, specifically, the city in which the students are receiving their education, playing off narratives in the iconic HBO drama.

“Who’s familiar with Baltimore’s neighborhoods?” Beilenson asks. “What parts are dangerous?” “What are your impressions of Baltimore?”  Few raise their hands, many not acquainted with the large swaths of the city beyond campus. “It’s not as bad as Detroit,” a student volunteers, generating laughter.

Lecturers over the semester include Wire creator David Simon, former mayor Kurt Schmoke, former police commissioner Ed Norris, actor Tray Chaney, who portrayed the drug-dealing “Poot,” as well as television and print journalists. Michael K. Williams, aka Omar, and Lawrence Gilliard Jr., who played D’Angelo Barksdale, have visited in past semesters. Former city schools CEO Andrés Alonso and former City State’s Attorney Patricia Jessamy have previously discussed themes from the show’s five seasons, as well.

The course fills two classes each fall, with waiting lists. Teaching the class also led to a well-received book last year, written with journalist Patrick McGuire, Tapping into The Wire: The Real Urban Crisis.

In many ways, after medical school and his master’s in public health from Hopkins, Beilenson’s career started smack in the middle of the years and issues that inspired The Wire. His stint as health commissioner (“the first real job I ever had”) overlapped with Simon’s career, first at The Baltimore Sun, then on Homicide: Life on the Street, The Corner,  and finally, The Wire. The son of former California congressman Tony Beilenson, who took on Big Tobacco decades ago, he came to see public health as the best place to make an impact after interning at the Family Medical Department at the University of Maryland.

Still, Simon says he finds it somewhat surprising that it would be Beilenson teaching The Wire in a class at Hopkins. Although hired by former mayor Kurt Schmoke, Beilenson remained health commissioner for eight years under Martin O’Malley, who famously despised the show’s depiction of Baltimore and “his” administration. Beilenson admits he did not watch the show until leaving the O’Malley Administration—“it was ripped so badly in Monday cabinet meetings, I thought it must be terrible”—and then found it so compelling that he fell into a complete DVD binge-watching jag. Then again, Simon says, “in terms of public health, Baltimore has done a pretty good job. He was a good health commissioner.”

Tall and lanky, Beilenson, 53, is engaging with students. Gesturing with the course outline in his right hand, no one would detect any Parkinson’s symptoms if not aware of his diagnosis. Once or twice, with his hand at his side, the rolled syllabus begins to shake slightly, but Beilenson settles it easily by placing his left hand over his right—never taking his eyes off the students or interrupting his train of thought. Only someone who has known Beilenson might notice a small shift in his gait walking across the room.

“This is not an academic class,” Beilenson continues, discussing field trips to parts of the city, including Middle East, Ashburton, and Pigtown, and assigned policy-oriented papers. Later, he notes, the 20-year disparity in life expectancy in one Baltimore neighborhood versus another a few miles away.

“He’s a hard-charging guy,” Schmoke says of Beilenson, believed to be the youngest big city health commissioner in the country when first tapped. Informed that Beilenson says he’s still not sure why Schmoke choose him, the former mayor chuckles. “He was 32? I was 33 when I was first elected City State’s Attorney, so age wasn’t a factor. I liked what he was doing [as director of city school health services],” Schmoke says. “He was a thinker. He had ideas, but he could also implement those ideas.”

Schmoke also appreciated that Beilenson’s impatience as a young man—which included a tendency to lash out in the face of criticism—could cut two ways. (Beilenson often did not “stand” either, as tradition holds, when the Mayor enters a room, irking some at City Hall, although Schmoke couldn’t have cared less about such formalities.) “It might not have played so well on the campaign trail,” Schmoke says, referring to Beilenson’s brashness and early election defeats. “But in the right job, that passion and desire to change the status quo could well-serve a public official.”

He continues: “With Peter, I’d tell people, ‘Just wait until you hear what he has to say.’”

From the outset, Beilenson didn’t shy from controversial policies. Just months after assuming office, the city began dispensing a long-term contraceptive, Norplant, to teenage girls who requested but could not afford birth control. Some city leaders blasted the initiative as racist, even genocidal. But Schmoke and Beilenson, who possesses a knack for explaining complex health care issues in understandable language, stayed with the effort—later credited with helping reduce teen pregnancy rates. Soon after, Schmoke and Beilenson implemented a needle-exchange program to combat the spread of AIDS, despite public misgivings by then-Gov. William Donald Schaefer.

Then O’Malley took over and although O’Malley didn’t agree with Schmoke on a lot of things, he did want to expand drug treatment and kept Beilenson onboard, praising his dedication and effectiveness.

Later, regrouping after his election loss to Sarbanes—and Parkinson’s diagnosis—Beilenson went to work for Ulman, and
together they formulated a sliding-scale quasi-insurance plan for low-income working individuals and families.

Seeing the Healthy Howard plan in practice, combined with the passage of Obamacare—making loans available for health co-ops—sparked brainstorming sessions at the aforementioned Evergreen Cafe. In September, the cooperative was approved with established carriers CareFirst, UnitedHealthCare, and Kaiser Permanente, among others, for Maryland’s health care exchange.

Maryland has an estimated 800,000 residents without insurance, but expanding coverage isn’t Beilenson’s only goal for Evergreen. He believes more affordable care and better outcomes go hand-in-hand. The model, says medical director Dr. Manisha Sharma, is predicated on principles borrowed from initiatives elsewhere—as well as breakthroughs in technology, such as telemedicine. The four new centers will serve as comprehensive-care facilities, with primary doctor offices for routine examinations, plus services such as pre-natal, mental health, preventive care, and women’s health care, as well as substance abuse, wellness, and family counseling assistance. Same-day appointments are guaranteed to avoid unnecessary emergency-room trips.

During regular visits, patients will meet with either a nurse practitioner or salaried physician—displacing the traditional fee-for-service approach—and a licensed social worker, serving as a personal health “coach,” to address behavioral and environmental health factors. As much as possible, Skype-like conferencing and exams using virtual technology and tools will enable specialists on Evergreen’s plan to be in the “same room” with patients and their primary-care physicians to go over test results and treatment options.

“The focus is on patient-centered care and not volume,” says Sharma. “It’s not about how many people you can see and how quickly, but helping people live healthier lives. The doctors we’re hiring are attracted to that. That’s why they got into medicine.”

Launched with a $65-million federal loan and $5 million in low-interest “program investments” from the Open Society Institute-Baltimore, The Abell Foundation, and The Annie E. Casey Foundation. Both Evergreen’s state-approved individual and small-business group rates are among the lowest in Maryland. To get the word out, Evergreen has been canvassing door-to-door in low- and middle-income neighborhoods where residents may be eligible for premium subsidies, and Beilenson remains confident they’ll sign up enough to make the math work. Beilenson says the co-op can accept about 3,000 members at each care facility.

Ulman doesn’t know if Evergreen will succeed, but believes Beilenson is the right person to take a shot at a new model. “He’s not afraid to take risks,” Ulman says. “They may not always work out exactly as planned, but moving forward requires someone who knows how to design and implement new ideas.”

A certain willfulness is likely in Beilenson’s DNA. For example, accepted to Harvard—his father’s alma mater—for undergraduate school, Beilenson wouldn’t enroll until he was also accepted at Yale on his own. He admits, also, to listening to conservative talk radio during his commute—just to better form his policy arguments.

Inevitably, that tenacity will aid his Parkinson’s battle. And while the disease is irreversible and progressive, he still scores a very low “number” on the symptom-rating scale. His oldest children—there are three from his first marriage in their 20s—understand the nature of Parkinson’s, of course. “I had some very emotional interactions with my older kids, who are all different, and reacted in their own different ways,” Beilenson says.

The youngest of his other two kids, ages 8 and 10, with his second wife, Chris, calls his condition “the shaky thing.” He has coached all of them in sports, from baseball and basketball to lacrosse and soccer. “Thirty-seven seasons,” he says with pride.

Ultimately, along with physical symptoms, there will be mental, behavioral, and mood effects from the disease.

“I didn’t go through the ‘four stages of grief’ or anything like that,” he says. “It’s partly denial. Adult life expectancy doesn’t change much with Parkinson’s. And it’s not the physical things, it’s the other things, dementia, though much less common in early onset cases, that scare me.”

Chris Beilenson says that with her husband’s still relatively minor symptoms, the family often “forgets” about the diagnosis in the everyday hustle and bustle of life. Which is fine, of course. But there are also the occasional reminders of what lies down the road.
“The thing that affects us is seeing another family dealing with a medical issue or tragedy,” Chris Beilenson says. “It makes you realize, ‘Oh yeah, we need to pay more attention to whatever it is we are doing.’ There’s a heightened sense of awareness. A greater sense of urgency maybe. You become more starkly aware that this diagnosis is out there.”

Her husband’s approach, as always, is to press forward. He won’t view the Evergreen initiative, even if it succeeds beyond his wildest dreams, as any type of career capstone. Too early for that.

“It might be 10 years away, but I’ll be doing something else after this,” Beilenson says. “I’ve got one more new challenge left in me.” He pauses and smiles. “I just don’t know what it will be yet.”

Issue date: November, 2013
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