DCPCA thanks Chairman Gray and the Committee on Health for the opportunity to share our perspective on the District’s Health Services Plan. 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.  Our partners in this work are community health centers who serve nearly 1 in 4 District residents in every ward.

The Health Services Plan produced by the Department of Health is impressively rich in data analysis and information about health status, health care utilization, barriers to care, and recommendations for improving the District’s health system. The report raises questions about the impact of utilization patterns on individual and community health, and highlights some potential challenges that may result from getting primary care further from home. DCPCA looks forward to the deeper dive on some of these issues promised in the coming Primary Care Needs Assessment. We make the following recommendations regarding the challenges and opportunities presented in the HSP:

1. The District should deepen investment in care management within primary care.

The launch of the Department of Health Care Finance My Health GPS program is an important beginning to investment in primary care provider capacity to coordinate across sites of care and effectively manage care for priority populations. Additionally, continued DHCF-DOH collaboration and investment in a robust District health information exchange is critical. The changes necessary in staffing, HIE, data analysis, community supports, and patient engagement to impact population health improvement should not be underestimated. But neither should we settle for anything less than a seamless, accountable health community that works to meet patient and caregiver needs, that supports patients in developing the skills and strengths to take charge of their health, and that fights for equity in health outcomes across every ward in the District.

1. The District should expand policies that support and enhance behavioral health services in primary care.

In the recently approved FQHC payment rule, the Department of Health Care Finance expanded the range of behavioral health providers eligible for reimbursement in the FQHC setting. It can take the next step and allow billing for behavioral health codes that represent early intervention for patients with anxiety, stress, and depression symptoms. The Department of Health has played an important role in supporting access to Medication Assisted Treatment (MAT) for addiction in the context of primary care and should continue to expand opportunities for providers to offer addiction care. DCPCA plans a crosswalk of Department of Behavioral Health certification requirements for substance use treatment facilities with those necessary to become an FQHC. As appropriate, we will urge DBH to waive some or all requirements, with a goal to increase the number of FQHCs that offer substance use disorder treatment.  Lastly, DCPCA urges the District to invest in connecting behavioral health providers to the growing DC Health Information Exchange, including an education campaign regarding the legality of exchanging mental health information.

1. The District should explore evidence-based interventions that educate beneficiaries on the best use of the health care system to achieve optimal health.

Evidence presented in the report confirms painfully high rates of hospital admissions and emergency department use to address ambulatory care sensitive conditions. While cost implications are clear, more importantly, use of these high cost settings has not and will not result in high quality health outcomes for patients. DCPCA is committed to addressing the role primary care providers can play in changing this utilization pattern so prevalent in the District. We are interested in exploring what role residents’ use of neighborhood vs out-of-neighborhood primary care may play in the use of hospital and emergency department care. We welcome the opportunity to work with our government and other health sector partners and community members for an aggressive, comprehensive approach to this challenge.

1. The District should support access to appropriate specialty care within primary care.

The Department of Health Care Finance should apply the same payment rules for FQHC-based primary and specialty care to increase the number of health centers offering high-need specialty care such as podiatry and ophthalmology.

1. The District should support cross-sector coalitions focused on addressing social determinants of health

DCPCA leads a multi-sector coalition focused on maximizing resources and collaboration between clinical services and community supports called DC PACT (Positive Accountable Community Transformation). DC PACT is committed to using a collective impact approach to address social determinants and increase health equity in the District. The stark health disparities in Ward 7 and 8 make this connection between direct health care and the resources to address social factors absolutely critical.

1. The District should identify health workforce needs, particularly in the safety net.

Capacity to serve patients is as much a function of success hiring providers as it is a function of the policies, resources, passion and will to serve them. All of our health center partners compete to hire nurses, psychiatrists, physicians, frontline staff, administrative teams, quality improvement leaders, care managers, community health workers and more. We hope to continue to work with the Department of Health and our health partners at the DC Hospital Association, the DC Behavioral Health Association, and the DC Health Care Association to develop strategies that attract top level talent across all levels of our member organizations.

In closing, DCPCA is committed to staying engaged with the Council, with the government health and human services sector, and with all health system actors to use all means at our collective disposal to fight for health equity and ensure every resident in every ward has a fair shot at a long, full, healthy life. We appreciate the opportunity to testify, and I look forward to working with you to build a healthier DC.