Raising Red Flags
Emerging Montgomery Cares challenges from FY25
by Dr. Veronica X. Vela, Senior Director for Healthcare Access
The FY25 Montgomery Cares Annual Report highlighted key accomplishments, including a 10% annual increase in patient visits for the 24,813 patients served and important improvements to the way we work with our partners.* But the report was not all good news. In addition to program wins, we also flagged emerging threats to the health of our patients and the operation of this safety net system. Here are three areas where we are seeing the impact of challenges, which could worsen if not addressed.
Medication Access
The immigration environment is not just a question of enforcement but one of fear. Namely, no one is sure who—or what—is safe, even in traditionally protected areas. One unexpected way that is playing out for Montgomery Cares participants is in new challenges accessing the 40-plus patient assistance programs offered by pharmaceutical companies. The Primary Care Coalition's (PCC) MedBank program leverages a modest investment in personnel for patient navigation to complete assistance applications into more than $8 million in medications procured for uninsured patients who need them.
During FY25, though, some companies have increased the documentation burden for their programs, just as the political environment is making patients less comfortable providing personal information. If these documentation requests become more frequent and/or strict, fewer patients will be able to access the drugs they need, and our ability to leverage staffing support for medication access will decline.
There are also challenges independent of the political environment. Namely, funding for vaccine purchasing. Just over $210,000 of the Community Pharmacy budget went to vaccine purchasing in FY25—among the top 3 spending categories—but it is insufficient to address the full range of vaccine needs Montgomery Cares patients have. An example is the pneumococcal vaccine, which is recommended for adults 65 and older. Each dose costs $230. With 11% of the Montgomery Cares population over the age of 65, it would cost nearly $630,000 to vaccinate all eligible participants.
Yet vaccines provide high-value, high-return care: preventing the worst outcomes from common reasons for hospitalization, like pneumonia. For instance, a study of older adults hospitalized for pneumonia in South Korea found that pneumococcal vaccination was associated with better survival odds. And unlike the impacts of the political atmosphere, vaccine funding is a solution our community can control.
Cancer Care
Uninsured patients must navigate a patchwork of resources to cover cancer screening, diagnostic, and treatment services in our community—all without the connecting threads of a master quilter. The range of disparate services with limited clinical capacity and patient navigation infrastructure mean an inadequate safety-net cancer care system.
Meanwhile, our service numbers reflect growing cancer care needs: appointments to hematology and oncology, offered through our Project Access program for specialty care, increased five-fold in recent years, highlighting a surge in demand for cancer-related specialty care. When we began routinely applying for Maryland Cancer Fund in FY2020, PCC administered six grants; in FY25, PCC administered 29. The result of growing demand is increased pressure on limited program staff to help patients bridge program offerings. What we need is more comprehensive system investment—both in patient navigation across available cancer services and in frontline prevention tools like access to HPV vaccinations, which reduce the odds of developing cervical cancer.
Workforce Challenges
Several program areas reflect service dips over the year attributed to the inability for PCC and its health center partners to fill workforce vacancies. Some of these are systemic problems, like the challenges recruiting bilingual licensed behavioral health clinicians (already in very short supply nationally) to salaries that cannot compete with other organizations. Others are more idiosyncratic, such as the impact of a key director-level vacancy on the specialty care referral pipeline or a patient navigator vacancy on the volume of medication assistance applications.
We also see a down-stream impact associated with health center staffing shortages. Integrated behavioral health care is a double-edged sword: co-location and warm hand offs from primary care can make behavioral health services more accessible, and behavioral healthcare relies on the primary care visit for service initiation. When a health center sees fewer patients because of primary care provider vacancies, PCC does too—because the pool of primary care patients who might benefit from behavioral healthcare shrinks.
The bigger story these combined gaps tell is of an incredibly lean system with few-to-no redundancies. In good times, that makes for incredibly cost-effective service delivery. In bad times, it becomes something like the ship-on-demand online retail model during COVID, where unanticipated blocks create a chain of delays.
While not all of these challenges are within our local control, some of them are, based largely on the resources we as a community make available. What I hope the FY25 Montgomery Cares Annual Report demonstrates is the value funder dollars unlock. I hope it helps shows that we get what we pay for in the safety net system: where backbone investment yields community dividends and funding failures create cascading gaps.
* We were able to apply human-centered design principles to our system improvement work, co-creating workflows to make sure they actually work for all partners.
This article has not been reviewed or approved by the Montgomery County Department of Health and Human Services.