Policy and Advocacy - Testimony

Good morning Chairman Gray and distinguished members of the committee.  My name is Eric Vicks, Associate Director Advocacy and Public Policy for the DC Primary Care Association (DCPCA.) We work to build a healthier DC by strengthening safety net community-based primary care. Our partners in this work include community health centers and FQHCs who serve 1 in 4 District residents in every ward of the District. Today I am here to provide testimony on the budget oversight of the DC Department of Health.

 

Chairman Gray, DCPCA and our partners in the DC PACT (Positive Accountable Community Transformation) have begun the work to build a health network that consistently and systematically identifies and addresses the unmet social needs of patients. DC PACT seeks to maximize resources and collaboration between clinical delivery sites and community service providers to eliminate duplication and close gaps utilizing HIE. Our efforts will expand the capacity of all partners to function as a seamless accountable health community over time and across sites of care through increased cross-sector collaboration. The primary goals of DC PACT are to improve health outcomes and increase health equity.

Director Nesbitt has a track record of supporting innovations which can be studied in practice and then expanded to our larger Medicaid populations. These innovations have included the incorporation of Community Health Workers into its engagement programs. The Joyful Food Markets are also a promising idea for our residents facing food insecurity in Wards 7 and 8. DCPCA recognizes programs that connect clinical care and social services to address social determinants of health (SDOH) have significant impact on the overall wellness on a patient far beyond the impact of health care alone.  We applaud Dr. Nesbitt and her willingness to prioritize the connections between SDOH and clinical care. We would like to see these initiatives scaled for all of D.C.

Recommendation: Increased funding available for the Office of Health Equity to support SDOH: clinical linkages

 

Since the election, the nation has awaited the promised changes to the healthcare landscape including what many believe to be the return to days of a high number of uninsured patients. The District has made a commitment to healthcare for all; in areas of access and quality. The District’s community health centers are the front line of health care for over 200,000 residents; the first choice for many and for some, the providers of last resort.   Continued support of community health centers to ensure that the District’s safety-net system will be ready and able to respond as necessary to meet the District’s needs. Our partnership with DOH has facilitated Technical Assistance and Quality Improvement initiatives across our membership and continues to prepare community health centers for today’s challenges and those to come.

Recommendation: Continue to support DOH programming which facilitates T/A and QI for community health centers and primary care providers.

 

We thank you for the opportunity to testify, and for your work and partnership in building a healthier DC. I am happy to answer any questions now or going forward. 

Good morning Chairperson Gray and distinguished members of the committee.  My name is Patricia Quinn, Director of Policy and External Affairs for the DC Primary Care Association (DCPCA.) DCPCA works toward a health system that helps everyone in the District get and stay well, no matter the color of their skin, the language they speak, where they live, how much money they have, or who they love.  As you know, our partners in this work are community health centers who serve nearly 1 in 4 District residents. We work to build a healthier DC by strengthening safety net community-based primary care. Today I am here to provide testimony on the budget oversight of the DC Department of Behavioral Health.

 

I begin by applauding Director Royster’s efforts to develop a truly integrated Department of Behavioral Health that does not artificially and inefficiently silo substance use disorder treatment from the other aspects of the Department’s work.  Much of our testimony focuses on what it will take to build a 21st century behavioral health system in the District, and we believe Dr. Royster’s realignment can contribute to that evolution.

 

Critical to any 21st century system is the technology infrastructure that supports communication between patients, providers, and payers over time and across sites of care; including both physical health care and behavioral health care.  While the District and its Health Information Exchange (HIE) Policy Board have made significant investment and progress in creating an HIE that links hospital and ambulatory care, DBH clinical data (and that of its network of providers) remains unavailable to the rest of the system of care. While Dr. Royster to some degree inherited the failures of the icams system, we count on her to have a plan for finally linking behavioral health information into the District’s HIE system.

Recommendation: Invest in interoperability of DBH data system to the District’s HIE

 

Another area of investment for which DCPCA has consistently advocated is a Districtwide behavioral health needs assessment that can help us fundamentally answer the question: Does the District have the range and the quality of behavioral health resources we need where we need them?  Absent an answer to this pressing question, policy makers are working in the dark about what and where to invest resources. We do have data that indicates the second most common reason for hospitalization of District residents is mood disorders; the fourth is schizophrenia and other psychotic disorders.  A needs assessment completed in 2012 noted a shortage of behavioral health professionals practicing in Ward 7 and 8, and a pressing need for programs that are culturally and linguistically appropriate.

Recommendation: Invest in a robust Behavioral Health Needs Assessment

 

As mentioned during previous testimony, DCPCA remains committed to increasing access to behavioral and substance use disorder services within FQHCs, especially those in Wards 7 and 8.  While not strictly a budget issue, we will take this opportunity to urge DBH to support efforts to allow FQHCs to provide substance use disorder treatment within the context of primary care by eliminating current obstacles associated with DBH data and billing requirements.

Recommendation: Eliminate barriers to FQHC provision of substance use disorder treatment

We thank you for the opportunity to testify, and for your work and partnership in building a healthier DC. I am happy to answer any questions now or going forward. 

Good morning, Chairperson Nadeau and distinguished members of the committee; my name is Patricia Quinn, Director of Strategy and External Affairs for the DC Primary Care Association (DCPCA).  DCPCA works to ensure that all residents of Washington, DC have the ability and opportunity to lead healthier lives – through increased health care coverage, expanded access, and high quality care. Our key partners in this effort include community?based safety net primary care providers and other key stakeholders who are committed to our mission of creating a health care system in the District of Columbia that allows for everyone to be covered and everyone to be cared for.  Today I am here to provide testimony on B22-194, the DC Healthcare Alliance Program Recertification Simplification Amendment Act of 2017 and share our recommendations.

First, I would like to thank you for your leadership and taking this powerful first step to address the issues that have long plagued consumers of the DC Healthcare Alliance program. Bill 22-194 addresses a chief obstacle for residents seeking to recertify for the Alliance program, which is that the office of ESA is not properly staffed to provide the language access services to ensure the re-enrollment process is a reasonable one for consumers.  In fact, the process is so onerous that too often; consumers decide to forgo recertification altogether; particularly if they feel they have no urgent medical need. 

 

Critics of this proposal have stated that the issues surrounding Alliance recertification have been addressed by embedding ESA staff at the two health centers with the largest Alliance populations. However, long lines at the ESA office persist, and there is still a significant population which fails to recertify in order to maintain their coverage. Another complaint is that by expanding the recertification authority, non-DC residents will be enrolled into this program. This bill as written only addresses the recertification process. If any non-District resident receives benefits, it would be due to policies not being addressed in this bill. Through the current process consumers face barriers of language and cultural competency which lead to barriers of communication, trust and time; none of these ensures the fidelity of the program for DC residents, nor otherwise increases the quality of the program.

 

Chairwoman Nadeau, as you know community health centers currently provide enrollment services for DC residents for Medicaid and qualified health plans within the DC Health Link portal. When health centers are asked to do their part and are provided the resources to do so, the results have been positive for the people of the District. We are proud of our part in making the District one of the jurisdictions with one of the highest rates of coverage in the nation.

 

To relieve disproportionate burdens on beneficiaries, streamline bureaucratic processes for multiple DC agencies, DCPCA would like to make the following additional recommendations for DC Healthcare Alliance recertification process:

1.Align with the application and recertification process for Medicaid. Meaning CHOs should be permitted to conduct recertification annually.

2.Consumers should have the option of renewing either in person at ESA offices, at community health organizations (CHO) i.e. through enrollment staff certified as in-person assisters), over the phone, or online via DC Health Link.

3.ESA should develop and implement a training program for enrollment agents which will educate them on the District’s desired process as well as all quality standards the state follows. This should include and escalation process to resolve application problems as they arise.

4.Community Health Organizations must be authorized to access appropriate systems/technology to complete the entire enrollment process rather than simply conducting the mandatory interview.

In closing, we want to highlight the role that in-person assisters play in getting residents across the finish line to enrollment in health care services. DCPCA and our health center partners have been privileged to provide support to hundreds of District residents—in times of general need or in crisis. Many people had almost given up hope that they could find any such help. We urge the Council to strongly support B22-194 with our recommendations as an investment in our collective effort to build a healthier DC.

 

We thank you for the opportunity to testify, and for your work and partnership. I am happy to answer any questions now or going forward.