To: The Honorable Vincent Gray, Chair, DC Council Committee on Hospital and Health Equity

Members of the Committee on Hospital and Health Equity

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

Re: Performance Oversight Hearing for DC Department of Health Care Finance

Date: February 17, 2023

The DC Primary Care Association (DCPCA) works to build a healthier DC by sustaining community health centers, transforming DC care delivery, and advancing racial and health equity. Our collaborators in this work include community health centers, serving almost 1 in 4 District residents in every ward of the city; District government agencies including the Department of Health Care Finance (DHCF), DC Department of Behavioral Health and DC Health; as well as other providers in the DC health ecosystem. Thank you for the opportunity to provide testimony regarding the work of the District of Columbia Department of Health Care Finance (DHCF.)

DCPCA’s partnership with DHCF is robust and effective. From our long-standing alliance to develop the DC HIE (health information exchange) and ever-advance its capabilities, to new collaborations to advance health equity and amplify beneficiary voice, DHCF is a committed and transparent partner. Given DCPCA’s central mission, we particularly want to highlight DHCF’s progress and opportunities to advance racial and health equity.

Health inequity in the District is profoundly racialized. The social conditions impacting health are influenced by DC’s legacy of racial and economic segregation, disenfranchisement, and marginalization, and by present-day racism. Health systems that ignore the social needs of individuals and close their eyes to structural inequity risk perpetuating and compounding the structural racism that has resulted in Washington DC’s extraordinary inequity in well-being and life expectancy. Without a doubt, DHCF plays a central role in the District’s push toward health equity. Recognizing this, the agency is leading the nation in leveraging CMS dollars to build capacity for robust social needs screening and community referral.

DHCF should build upon its work regarding screening and referral and lean in to new opportunities offered by CMS to explicitly address health-related social needs via 1115 demonstration waivers or through the use of “in lieu of services” (ILOS) options. Section 1115 waivers allow Medicaid agencies to test new approaches, and generally reflect priorities of the current Administration. ILOS are approved by a Medicaid agency as cost-effective, medically appropriate substitutes to Medicaid benefits and can be considered to develop the medical portion of the MCO capitation rate.

While DCPCA is aware of significant challenges ahead at DHCF in regard to behavioral health integration and the restart of benefit redeterminations for Alliance and Medicaid, DHCF should not miss this opportunity to reorient toward integrated health and social care. We need changes in policy and practice that move health system resources to social supports and structural solutions that work to close the health gap.

Analysis of combined health and social spending shows that countries with overall spending similar to that in the US, but with more significant social investment versus health care, have better health and longer life. Existing public health, health care, and social systems in DC lack the integration, flexibility, and in some cases, incentives to address immediate unmet social needs with the greatest impact on health. Changes in Medicaid policy, in payment models, in community benefit requirements, and in accountability can be leveraged for action on social and structural determinants.

A critical aspect of the District’s health equity drive is the Cedar Hill Regional Medical Center, GW Health. All stakeholders have indicated a desire for development of a comprehensive, integrated system for residents East of the River. The new hospital is necessary, but not sufficient, to create the comprehensive, integrated system residents in Ward 7 and 8 deserve. A true integrated system requires partnership and integration with the existing health care and social service providers in the community.

Integration of hospital specialty/in-patient and primary care is equally important, and both the hospital and the primary care medical home should play a central role in that coordination. DCPCA and our member centers have identified a number of areas that will better meet the needs of patients east of the river and can be accomplished via partnership with Cedar Hill and GW Health:

• Improved and expedited access to specialty care – (podiatry, cardiology, maternal fetal medicine, nephrology, pulmonology, ENT, etc.)

• Direct communication and collaboration between hospital staff and primary care providers,

• Opportunities of health center providers to round and/or provide maternal health services at Cedar Hill hospital alone

• Opportunities for educational training partnerships at CHCs with residents and medical students

• Social rounding (PCPs visit hospitalized patients and communicate with the care team)

• Rapid electronic transfer of discharge forms to primary care

• Collaboration between hospital-based nurses (nurse care manager, nurse discharge advocate, transition coach, nurse coordinator) and the primary medical home to facilitate patient discharge and transitions of care.

These integration ideas require extensive collaboration, communication and the allocation of joint resources. They are key to achieving the health equity goals that led the District to invest in the new hospital.

DCPCA and our members are ready to explore these strategies with the Cedar Hill leadership team, GW MFA and UHS. We have begun these dialogues and urgently need to continue them before critical resource and program allocation decisions are made. Our mutual goal is for collaboration and agreement on the best approach for integrated care delivery for residents in Ward 7 and 8. We hope UHS is ready to meet for robust discussions about partnership, and we welcome the opportunity to share our progress with this committee and the rest of the Council.