Maryland’s Chronic Disease Benchmarks: Where the Gaps Are and What Physicians Can Do

Maryland's 2026 State Health Improvement Plan sets specific, measurable targets for five priority health areas through 2029. The chronic disease section is the most directly relevant to day-to-day clinical practice, and the numbers reveal some significant gaps worth knowing.

Cancer Screening Is Lagging

Only 49.3% of Maryland adults ages 45-75 have received a recommended colorectal cancer screening, against a state target of 54.6% by 2036. Lung cancer screening is worse: just 16.8% of high-risk patients are currently screened, with a target of 17.6% by 2029. These are modest goals that still require real movement from where things stand today.

Physician action item: Colorectal and lung cancer screening status should be part of every annual visit for eligible patients. If your practice uses an EHR-based care gap tool, flag these as priority closures.

Diabetes Control Remains Poor

67.8% of diabetic patients in Maryland have a hemoglobin A1c above 9.0%. The state's target is 60.3% by 2036, a timeline that reflects how entrenched the problem is. Hypertension is similarly prevalent, with 35.8% of adults carrying a diagnosis and a goal to reduce that to 27.3% by 2029.

Physician action item: Patients who are glycemically uncontrolled often face compounding barriers — cost, food access, health literacy. The SHIP specifically calls out food insecurity (affecting 16.4% of Maryland households) as a root factor. Having a referral pathway to a local food resource or community health worker can make a difference that clinical management alone won't.

Childhood Asthma Disparities Are Stark

Emergency department visits for asthma among children ages 2-17 run at 7.8 per 1,000 statewide, but for Black children, that rate nearly doubles to 14.6 per 1,000. MDH has set a target of reducing the overall rate to 5.3 per 1,000 and the rate for Black children to 6.9 per 1,000 by 2029.

Physician action item: Pediatric and family medicine physicians seeing patients with asthma should assess environmental triggers and ensure families have written asthma action plans. For Black patients with persistent or poorly controlled asthma, a low threshold for specialist referral is consistent with where MDH is trying to move the needle.

What MCMS Is Watching

MCMS will continue tracking how MDH translates these SHIP benchmarks into programs and funding, particularly around chronic disease prevention initiatives affecting Montgomery County physician practices. Members with questions or observations about these gaps are encouraged to reach out to Farhana Arastu at farastu@montgomerymedicine.org.