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

The Honorable Vincent Gray, Chair, DC Council Committee on Hospitals and Health Equity

Members of the Committee on Health and the Committee on Hospitals and Health Equity

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

Re: Roundtable on Combatting the Opioid and Fentanyl Crisis in DC

Date: June 28, 2023

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 collaborators in this work include community health centers, serving almost 200,000 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. We appreciate the opportunity to provide testimony and recommendations to address the opioid and fentanyl crisis in DC. We will focus on four main ideas: innovation, harm reduction, workforce, and well-being measurement.

DC needs aggressive new strategies to stem the tide of escalating opioid overdoses and deaths. One strategy with significant potential to drive new interventions and innovative solutions is the Institute for Healthcare Improvement Equity Action Lab model. An Equity Action Lab brings together frontline providers of care and people in the District impacted by inequity in health outcomes to a shared table to identify, prototype and test solutions. Coupled with the tools of human-centered design, the Equity Action Lab centers the authority of community members with direct experience—context experts— along with the content expertise of care providers.  What emerges are new insights, renewed commitment, and promising new ideas to assess for scaling and improving. We have used the model to address inequity in maternal health outcomes, and we believe it should be funded and employed to improve our opioid use disorder system of care.

As the District and its communities, families, and individuals confront the lost potential, lost opportunities, and lost lives sacrificed to opioid addiction we must pursue strategies centered on harm reduction. We must ask and answer the question: How do we best help people stay alive so they can have a chance for recovery? We should explore safe consumption sites for overdose prevention and as a means to deliver other health services. Additionally, we need to provide guidance to family members on how they can effectively provide support while preserving their own well-being. Too often, families have few choices and no guidance for how they might use the tools of harm reduction help keep their loved ones suffering OUD as safe as possible. Professionals need to translate the tools and techniques they employ for lay person use. People who are addicted engage and intersect with family and community members who want to help, but may not know how.

Particularly as the Department of Behavioral Health launches the Office of Opioid Abatement and the Opioid Abatement Advisory Commission, DCPCA recommends consideration of well-being and quality of life metrics. Measures of well-being are a better indicator of the social progress necessary for sustained recovery. Simply being sober is not enough—we need to meet basic human needs for safety, housing, and food, and the very human needs for connection and meaningful participation in families and communities. 

DCPCA has identified a well-being measurement framework based on that developed by the Well-Being in the Nation Network (winmeasures.org) and centered on Cantril’s Ladder. The Cantril Self-Anchoring Scale asks respondents where they would place themselves on the ladder now, and where they expect to be in five years. Using a measure that resides solely in hands of individuals/communities and to which systems are accountable builds community power and promotes cross-sector alignment. Community members experiencing the worst disparities in well-being will define whether and how our systems are successful in supporting individuals and communities to thrive. 

Self-perceived measures of well-being can determine whether high priority populations and/or communities are Suffering (1-4), Striving (5-6) or Thriving (7-10). In 2022, DCPCA supported the Ward 8 Community Economic Development Initiative in provision of a well-being survey that reached 1,000

Ward 8 residents. DCPCA acted as the lead facilitator for the W8CED Data Collection Committee, training 20 Ward 8 residents to conduct the survey. Data collected has been paired with qualitative data from numerous domain-specific subcommittees to drive development of the Ward 8 Community economic Development Plan. W8CED hopes to collect well-being data regularly in Ward 8 to gain deeper insight into community progress overtime and to assess which investments and interventions have the most impact.  Funding to consistently measure well-being in Ward 8 and across the city is a specific investment in accountability for systems of care in the District. 

Key to the success of efforts to improve well-being for District residents confronting OUD is a robust workforce across the continuum of prevention, treatment, and recovery. In particular, community health workers, peer support coaches, navigators, and other patient support personnel need to be reimbursed within the health care financing system. These care providers are a critical, trusted source of care and guidance, bringing people into treatment, supporting them in recovery, and linking them back to family and community.

DCPCA would be remiss if we do not take another opportunity to express concern about the transition of behavioral health services into the Medicaid Managed Care contract. We know firsthand the challenges of the MCOs’ credentialing and claims payment systems. Our FQHC members must expend significant human capital to manage processes, track claims, research systems issues and communicate with MCO partners to get paid. We believe the District must be prepared to aggressively support providers newly required to engage with these complex systems and slow down the transition process should early testing reveal challenges to maintaining cashflow essential for organizations to survive. 

Thank you for the opportunity to share our recommendations. We look forward to partnership and to better outcomes for our family members, friends, and community members fighting opioid addiction.