Budget Oversight for the DC Department of Health (DC Health)
To: The Honorable Vincent Gray, Chair, DC Council Committee on Health
Members of the Committee on Health
From: Patricia Quinn, Director of Policy and External Affairs, DC Primary Care Association
Re: Budget Oversight for the DC Department of Health (DC Health)
Date: April 9, 2018
The DC Primary Care Association (DCPCA) works to build a healthier DC by strengthening safety net primary care, improving care coordination across sites of care, and improving access to health information for better health outcomes. Our partners in this work include community health centers serving 1 in 4 District residents in every ward of the city, District government agencies including DC Health, and other providers in the DC health ecosystem. What follows are DCPCA’s recommendations regarding the fiscal year 2019 budget for DC Health.
Recommendation: Support funding that promotes patient navigation, cross-sector partnership, and prevention in the Cancer and Chronic Disease Bureau.
DCPCA currently partners with DC Health on a promising cancer screening navigation pilot. Direct funding for health system and social supports navigation and care coordination, paired with investments in timely, actionable health information exchange are the District’s best option for impacting persistent inequity in health outcomes for those already fighting cancer and chronic disease. DCPCA provides staffing support and data management to an unprecedented collaboration of seven District Federally Qualified Health Centers (FQHCs) in a clinically integrated network (CIN). The CIN is combining standardized, evidence-based high quality care management at the center level with centralized transitions of care, triage, and data analysis to improve care and reduce utilization of high-cost hospital services. We look forward to reporting on its progress and innovation in the months ahead.
In addition, DCPCA supports investment in efforts such as DC PACT, a coalition of clinical, community support, and government partners focused on reframing the culture of health care delivery to address social needs. Our near-term strategic goals include standardizing social needs screening citywide and leveraging the development of the District’s health information exchange capacity to include bi-directional communication between community supports and clinical care. In conjunction with DC Health’s Office of Health Equity, increased investment in addressing social drivers of health and support for cross-sector partnerships will impact both the prevention and the effective treatment of chronic disease.
Recommendation: Support increased funding for School Health, including resources for school nursing and implementation of a navigation component to better link school and community health.
The Mayor’s proposed budget funds the requirement for full-time nursing at all DC public and public charter schools. DCPCA also recommends a pilot family navigation module focused on leveraging resources within and without the schools to support better health and educational outcomes. Additionally, DCPCA recommends exploring opportunities to integrate school health data into the District’s growing health information exchange.
Recommendation: Support new funding to improve birth outcomes/decrease preterm birth, and continue investment in evidence-based home visiting.
DC Health just released The Perinatal Health and Infant Mortality Report, and the data point to persistent preterm birth challenges and significant disparities in initiation of prenatal care. Our preliminary review of the Perinatal report and of data included in the Medicaid Core Set data notes the following:
Close to HALF (49%) of black women and more than 1 in 3 (35%) Hispanic women are not getting into prenatal care until their 2nd or 3rd trimester or not receiving any care at all. (Perinatal report)[i]
Fewer than half of women in D.C. on Medicaid are receiving the recommended number of prenatal visits: According to Medicaid data from the Child Core Set, only 36% of women in D.C. on Medicaid and CHIP received at least 81 percent of the expected number of prenatal visits. (Medicaid Child Core set)[ii]
Fewer than half of women on Medicaid or CHIP had a postpartum visit in the recommended window after giving birth: According to Medicaid data from the Adult Core set, only 49% of women in D.C. on Medicaid, CHIP, or dual eligible had a postpartum care visit between 21 and 56 days after birth. (Medicaid Adult Core set)[iii]
The percentage of preterm births has not changed in the past ten years—clearly, new strategies are in order (Perinatal report.)[iv]
The closures of the obstetrics units at United Medical Center and Providence Hospital prompted DCPCA to initiate a “human-centered design” project to understand and address the reproductive health needs of women in the District, particularly low income women in Ward 7 and 8. Human-centered design is a three-phase approach to problem solving and “design thinking” commonly used in information technology and private sector product design; however, human-centered design is beginning to spread into social services. DCPCA fellows have completed multiple in-depth interviews with women in communities impacted by the OB closures, and they are nearing completion of the rapid-cycling design phase. We look forward to presenting our findings to DC Health and to the Committee on Health in the near future.
DCPCA applauds DC Health’s report of data critical to understanding where we are failing to address and improve maternal-child health. We must partner with DC Health and with women and families in communities most impacted by persistent inequity to increase awareness of existing supports and services. But while the Department’s view that prenatal services in Wards 7 and 8 are underutilized may be accurate, we also understand from our providers in the District’s east end that consistently connecting their high risk patients to appropriate care is challenging. Given that almost 1 in 3 preterm births in the District were to women with a previous preterm birth, we can and must do better to link women to early, excellent prenatal care.
DCPCA supports the establishment of a perinatal and infant health advisory committee, and we endorse implementation of a demonstration project to increase the use of 17 alpha-hydroxyprogesterone caproate (17P) to prevent preterm births.
Recommendation: Support appropriation for the Health Professional Loan Repayment Program (HPLRP).
The HPLRP is an important tool to support recruitment and retention of primary care, behavioral health, and oral health professionals in the context of safety net health care. DCPCA has just released a survey to our Ward 7 and 8 health centers to understand the physical capacity of the existing health centers, as well as what new staff centers would need to hire in order to realize that capacity. We look forward to sharing the results of the survey with the Mayor’s team engaged in planning for the new hospital, as well as the Committee on Health.
Recommendation: Include funding to implement the legislation that increases the smoking age to 21, and implement the $2 increase of the tobacco tax.
The previously mentioned DC Health Perinatal Health and Infant Mortality Report highlighted a finding that District women who smoke are significantly more likely to experience poor birth outcomes such as prematurity, low birth weight and infant mortality. This is only one reason why increasing the legal age for tobacco to 21 is an important public health effort. The additional tax revenue from tobacco sales is targeted in part to smoking cessation, further decreasing deleterious impacts of smoking on district residents.
Recommendation: Continue funding for innovation and diffusion of care grants.
DC Health plays a critical role in the ability of DC’s health system to respond to emerging or growing challenges, such as the crisis in opioid use disorders in the District, or the testing of behavioral health integration in the FQHC setting. DC Health funding for testing innovation and expanding access to effective interventions provides the necessary scaffolding to initiate new and needed services. Continued investment in this manner ensures that the District can be in the vanguard on emerging public health threats.
DCPCA appreciates the opportunity to share our recommendations on the FY19 DC Health budget. We are grateful for partnership with DC Health, Chairman Gray, and the Committee on Health as we work to build a healthier DC.
[i] https://dchealth.dc.gov/sites/default/files/dc/sites/doh/service_content/attachments/DC%20Health%20Perinatal%20Health%20%26%20Infant%20Mortality%20Report_FINAL.PDF
[ii] https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-core-set/index.html https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/child-core-set/index.html
[iii] https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-core-set/index.html https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/child-core-set/index.html
[iv] https://dchealth.dc.gov/sites/default/files/dc/sites/doh/service_content/attachments/DC%20Health%20Perinatal%20Health%20%26%20Infant%20Mortality%20Report_FINAL.PDF