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

Members of the Committee on Health

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

Re: Performance Oversight Hearing for DC Department of Health

Date: March 2, 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 strategic focus areas include:

• Value-based reimbursement

• HIT innovation for health centers

• Cross-continuum stakeholder relationships

• Equity-oriented programs and innovations

• Health center infrastructure and operations

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. Health centers are at the nexus of efforts to rewrite DC’s story of health inequity, and we are grateful for the partnership we have forged over decades with the DC Department of Health. That partnership has only strengthened through the crucible of the COVID pandemic. We appreciate the opportunity to provide testimony regarding oversight of DC Health.

Office of Health Equity (OHE)

2018, OHE released a seminal Health Equity Report that directly linked health outcomes to nine drivers of health that impact quality of life and life expectancy for District residents. They followed this report with a Health Equity Summit in 2021, amplifying the roots of the inequity that resulted in such disparate impacts of COVID-19.

OHE focuses on facilitating multi-sector partnerships to identify and solve community health problems related to the social determinants of health. In that capacity, OHE has engaged in DC PACT, a cross-sector collective impact coalition facilitated by DCPCA and focused on building an accountable health community that provides the care and social conditions for racial equity, health equity, and community well-being. OHE is a lead partner in our recent proposal to a Robert Wood Johnson-affiliated foundation focused on the role of data in dismantling racist systems. The project proposes to integrate community-defined well-being measures with health equity and other data to drive cross-sector planning and accountability. Through OHE, DC Health’s commitment is a model for how government can partner with residents to build community power.

Workforce

DCPCA, like other healthcare organizations throughout the District and nationally, is gravely concerned for the state of the healthcare workforce. An informal polling of just three Federally Qualified Health Centers revealed over 170 vacancies. FQHC CEOs have frequently discussed major challenges in recruiting and retaining the behavioral health workforce needed to meet the needs of their patients. In a comparison between 2019 and 2021, every DC health center saw a decline in the number of behavioral health visits. Given what we know about rates of anxiety, depression, and substance use disorder, and the exacerbation of behavioral health conditions during the COVID-19 pandemic, this decline is alarming.

In 2022 and 2023, DC Health convened the Mayor’s Healthcare Workforce Task Force, an “all-hands” call to identify viable pathways to meet health workforce needs in the short and long term. The task force has specific draft recommendations across six critical workforce areas:

• Strengthening recruitment and retention

• Increasing District resident employment in healthcare occupations

• Improving opportunities for advancement in health careers within the District

• Enhancing access to high-quality allied health training programs

• Retention of DC health professional students post-graduation

• Development of a health careers pipeline strategy

Draft recommendations for licensing, payment, reducing provider burdens, building public trust, eliminating barriers to entry, defining career pathways, tuition support, and youth exposure and immersion opportunities should all be adopted if we hope to ensure residents’ access to high quality health care. DC Health has been a valuable partner in strategizing solutions. We look forward to working with DC Health to operationalize the task force recommendations, and we support DC Health investment in innovations that show promise for improving access and outcomes.

Emergency Preparedness

DCPCA receives funding from DC Health HEPRA to support health centers in emergency preparedness efforts. For health centers, DCPCA provides education and facilitates sharing of best practices to improve their capacity to prepare and respond to emergencies via:

• Facilitate Emergency Preparedness Task Force (EPTF) Peer Group of health center staff to share best practices.

• Assess health center preparedness, security, and training against requirements and industry best practices.

• Conduct trainings and exercises, and provide access to supplies. –

• One-on-one coaching/ technical assistance

• Improve coordination and connection with District-wide EP stakeholders, including DC Health and DC HMC, to enhance health center capacity

DC3C: DC Health Colorectal, Breast, and Cervical Cancer Program

The DC3C program strives to increase cancer screening among District residents through a multifaceted, outcomes based-approach that includes evidence-based interventions, professional development, and quality improvement strategies. The program encompasses comprehensive cancer prevention activities to include screening and connection to quality care for colorectal cancer, cervical cancer, breast cancer, and tobacco cessation interventions. In reviewing cancer screening data for 2021, DCPCA notes some reduction in the percent of health center patients that have received appropriate screenings. The decreases are likely related to less frequent visits to health care facilities due to COVID-19 concerns. DCPCA is awaiting 2022 screening data and will share our analysis once available.

Million Hearts

DCPCA has been a partner in DC Health’s DC Million Hearts effort. The District program is part of the national HHS-directed Million Hearts initiative which aims to prevent 1 million heart attacks and strokes. DC Million Hearts is a network made up of multiple public and private organizations, including national and regional organizations, local healthcare systems, academic organizations, and community organizations and programs. Through collaboration with key partners, population-level monitoring, and support for quality improvement, the DC Million Hearts program aims to reduce morbidity and mortality due to heart disease and diabetes in DC.

DC Health plays a critical role in health outcomes for every individual and every community in the District. Investment in public health is essential to our city and its ability to survive and thrive. DCPCA thanks the entire team at DC Health for their unprecedented service to protect the health and safety of those who live and work in the District of Columbia. We are grateful to have the committed partnership of DC Health for the work still ahead.