February 23, 2016: DCPCA Testimony- The Oversight and Performance of the DC Department of Behavioral Health

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 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 the performance and oversight of the DC Department of Behavioral Health (DBH). 

The links between optimal physical and behavioral health are clear. Patients with serious mental illness die an average of 25 years earlier than the general population. For those suffering from chronic illness, co?occurring mental health conditions can impact patients’ abilities to follow treatment plans and manage their disease. In the District of Columbia, mood and psychotic disorders are the second and fourth most common reasons for hospitalization.  Alcohol?related disorders are the number one reason for emergency department use for both Georgetown and Sibley hospitals. 
 
DCPCA is committed to increasing access to behavioral and substance use disorder (SUD) services within federally?qualified health centers. We have been made aware of problems with payment and access within the DBH?funded programs, and we continue to seek ways to optimize access and quality via Medicaid, to both maximize federal dollars and avoid the obstacles that seem inherent in the DBH system.   

As part of the effort to increase availability of behavioral health services, DCPCA advocated for expansion of the list of licensed behavioral health practitioners who can provide services in the District. The Department of Health Care Finance shared our commitment to that expansion, and subsequently included providers such as certified addictions counselors in their new FQHC payment rule. The next step to operationalizing the new behavioral health components of the rule involves engagement of a workgroup that includes DCPCA, health center partners, DHCF, and DBH.  

We urge DBH to approach the workgroup with a predisposition to increasing access to behavioral health services. Extra certifications of sites, requirements to use multiple DBH data systems—all of which have been implicated in the current payment and access challenges—and any other policy barriers must be addressed with a focus on increasing the number of health centers able to provide behavioral health services. Although an assessment of needs and capacity within the behavioral health system is long overdue, DCPCA maintains that FQHCs offer the best chance to amplify treatment options for those struggling with behavioral illnesses.  We look forward to the opportunity in the near future to inform the Committee on Health of the progress we have made with DBH and DHCF regarding increased access in the District. 

In addition, the technology problems within DBH regarding electronic medical records must be resolved. Although the Council passed legislation 2 years ago to improve the ability for physical health providers to support their patients with cooccurring mental health challenges, we have yet to realize the mprovements in care coordination such legislation was designed to facilitate. Our understanding is that the chosen system, icams, is non?functional in regard to interoperability. 

Lastly, DCPCA advocates that DBH undertake an assessment of behavioral health services capacity and needs. We have advocated for an assessment over the previous two oversight hearings, and it remains essential in order to develop a roadmap for ensuring that the District’s behavioral health services meet the mark as part of a 21st century integrated health system.   

We thank you for the opportunity to testify, and for your work and partnership in 
building a healthier District of Columbia.