To: The Honorable Christina Henderson, Chair, DC Council Committee on Health

Members of the Committee on Health

From: Patricia Quinn, VP of Policy and Partnerships, DC Primary Care Association

Re: Budget Hearing for DC Department of Health

Date: April 10, 2024

The DC Primary Care Association (DCPCA) works to build a healthier DC by sustaining community health centers, transforming care delivery, and advancing racial and health equity. Our strategic focus areas include:

• Value-based reimbursement

• HIT (Health Information Technology) innovation for health centers

• Cross-continuum stakeholder relationships

• Equity-oriented programs and innovations

• Health center infrastructure and operations

Our collaborators in this work include community health centers, serving over 180,000 patients in every ward of the city. Our members serve District residents most impacted by inequity—95% of health center patients are racial or ethnic minority, 88% have incomes below 200% of the federal poverty level, and 37% are best served in a language other than English (1). Health centers are at the nexus of efforts to rewrite DC’s story of health inequity, and we are grateful for the partnership we have forged over decades with the DC Department of Health. We appreciate the opportunity to provide testimony regarding DC Health’s FY25 budget.

DCPCA’s partnership with DC Health spans multiple bureaus across the Community Health Administration (CHA) and includes work with Health Emergency Preparedness and Response Administration (HEPRA) and the Office of Health Equity (OHE). CHA is particularly critical to our shared work to build and sustain the robust primary health care system DC must have to improve health outcomes and increase health equity. DC Health is an important voice and thought partner for DCPCA and for sister health sector agencies in championing exactly the kind of preventative services primary care is designed to deliver.

National research shows greater primary care spending in each state is associated with fewer emergency department visits and hospitalizations (2). Medicare research on regular and continuous primary care shows a $3,000 cost differential yearly per patient (3). Given the difficult fiscal environment, it is more vital than ever to make sure that cost effective, comprehensive primary care is accessible to all District residents to prevent more expensive tertiary and specialist care from becoming necessary.

Instead, the primary care system in the US has deteriorated – nationally, primary care spending as a percentage of overall health spending remains stagnant. Additionally, the number of primary care physicians has declined, and the burden of chronic disease has risen. The result is that fewer providers are treating patients of greater complexity, accelerating burnout and workforce shortages.

Federal officials are increasingly concerned about the lack of investment in primary care and are seeking remedies. The Center for Medicare and Medicaid (CMS) recently launched two new payment models--Making Care Primary (MCP) and Advancing All-Payer Health Equity Approaches and Development (AHEAD)--that center primary care and make needed investments in primary care infrastructure. The 10-year testing phase of these primary care innovations will show the connection between early investments and longer-term outcomes. Additionally, CMS is supporting states to integrate social care and community health workers into standards of care.

As DC Health and the Committee on Health work to finalize the FY25 budget, we urge policymakers to maintain and strengthen investments in primary care to ensure that every patient and provider benefits from a primary care system that prioritizes human caring and connection. We seek to better understand the $1.5 million decrease in the Community Health Services division related to School-based Health Centers. School-based health centers are an important source of primary care imbedded in the school community. We urge DC Health to continue to support community health centers and to be a thought leader with sister health agencies to make primary care the center of DC’s health ecosystem.

1 https://data.hrsa.gov/tools/data-reporting/program-data/state/DC

2 Investing in Primary Care, A State-Level Analysis, Patient-Centered Primary Care Collaborative, Robert Graham Center, Data from 2019

3 Sonmez, D., Adelman, D., & Weyer, G. (2023, August 21). Primary care continuity, frequency, and regularity associated with Medicare savings. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2808555