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District of
Columbia Primary Care Association
Washington,
DC
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Objectives
Goal
1: Increase the number of insured by expanding Medicaid. In
order to get an accurate financial projection of the impact of covering current
and proposed expansions, Communities in Charge (CIC) began a collaborative
effort with the Department of Health's Medical Assistance Administration (MAA)
to develop a plan for analyzing demographic enrollment data on the uninsured.
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Obj.
- Facilitate the implementation of health coverage expansions. To
facilitate implementation of health coverage expansion, CIC has developed
tracking tools of current, pending and proposed waivers for the District of
Columbia. The tool is updated monthly, and includes information such
as current status of each waiver's cost to the District and District
Financing sources.
Goal
2: Increase the number of insured by achieving excellence in
Medicaid outreach and enrollment and retention.
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Obj.
- Conduct a Medicaid Enrollment Survey. CIC conducted a survey
among un-enrolled Medicaid eligible in the District to gain an understanding
of enrollment and retention issues. Results identified two major cause
of "churn;" children aging out and barriers to
re-certification. Results from the survey will be used to improve
Medicaid enrollment and re-certification policy in the District.
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Obj.
- Facilitate Development of a Medicaid Training Institute. CIC is
working with the District's administration responsible for Medicaid
enrollment, and the Department of Health to develop a Medicaid Training
Institute. This institute will provide training to outreach workers,
providers, physicians, social workers, and others who assist people in
applying for Medicaid.
Goal
3: Strengthen the primary care safety net
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Obj.
- Establish a Safety Net Clinic Certification Program. CIC is
facilitating the establishment of the DC Qualified Health Centers Program
(DCQHC). The DCQHC Program is designed to ensure the high quality
primary care is available to all DC residents through its safety net
providers. In collaboration with partners, CIC has developed a
methodology to assure primary care providers for "certification"
and has pilot-tested the assessment with two providers.
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Obj.
- Place and Secure Start Up Fund for a Primary Care Development
Corporation (PCDC). To provide additional needed support to safety
net clinics, CIC is setting the infrastructure for a Primary Care
Development Center Corporation (PCDC) to assist safety net providers in
obtaining capitol funding and financial stability.
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Obj.
- Develop and Implement a Pharmaceutical Resource Center. With the
advice of the Alliance Program, pharmaceuticals were made available for all
non Medicaid DC residents up to 300% of poverty. To help ensure pharmaceuticals
and enough available to meet demand, CIC is developing a Pharmaceutical
Resource Center. The center will allow the District to take advantage
of pharmacy assistance drug programs available through pharmaceutical
manufacturers.
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Obj.
- Support the Successful Implementation of the DC Healthcare Alliance.
The Healthcare Alliance offers District residents under 200% of the
Federal Poverty Level (who are not eligible for Medicaid or other insurance)
"virtual insurance." CIC is working to support the
successful implementation of the Alliance.
Goal
4: Engage Policy Makers and Voters in Health Care Reform
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Obj.
- Conduct Briefings with DC and Congressional Policy Makers. Over
the last year, CIC engaged the City Council, DC's Congressional
Representative, the Mayor's Office and DC voters in healthcare reform
issues. CIC's voter engagement efforts have paid off. The Mayor
announced at his December 2002, Citizen Summit Follow-up that healthcare has
become one of the top issues of concerns for DC residents.
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Obj.
- Produce a Weekly Television Program on DC Healthcare Reform Issues. The
Health Justice Cafe (HJC) weekly television program has been airing to
educate voters on healthcare reform issues and to recruit members for, the
Health Justice League (HJL). The director of the DC Covering Kids
program is the shows host. The activity has been stopped. It was
found that the program had little impact and exhausted numerous resources.
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Obj.
- Educate and inform Policy Makers and Voters through the CIC Website.
CIC web pages have been developed for the DCPCA website. The
website allows policy makers and voters to learn more about the CIC health
reform issues and gives them ways to get involved. Voters sign-up for
the HJL on line, and get current information on the status of reform
issues. See www.dcpca.org
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Program
Design
The
work of CIC is done through the DC Primary Care Association and is guided by a
21 member Task Force. The Task Force is made up of representation from
safety net clinics, hospitals, the city council, the Mayor's policy office, and
other public and private organizations working on healthcare reform in the
District of Columbia. The Task Force is co-chaired by the Director of the
Department of Health, the Chief of Neurosurgery, Howard University Hospital, and
the District of Columbia Council's Chair of the Human Services Committee.
In addition, several members of the Mayor's original Health Care Commission
serve on the CIC Task Force to ensure that Communities in Charge builds the work
of the Commission which included:
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Medicaid
expansion as a tool for decreasing the uninsured
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Development
of a stronger community-based primary care system, including facilities
management, information systems, and technical assistance
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Improvements
in the performance of Medicaid outreach and enrollment
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Better
coordination between prevention, primary care, hospitals, and long-term care
In
2001 drastic changes occurred in the landscape of the District's healthcare
system. Financial and mismanagement prompted the District to close its
public hospital and public health clinics. In it's place, the Mayor
created a public-private partnership to strengthen the healthcare safety-net
system and ensure that all residents up to 200% of poverty receive quality
healthcare services regardless of their ability to pay (the DC Healthcare
Alliance). The birth of a new public health system coupled with the loss
of tobacco settlement monies earmarked to fund healthcare reform, prompted CIC
to modify some of its objectives.
Delivery
System
DC
Communities in Charge is as concerned abut delivery as it is about
insurance. Our delivery system is fragmented; prevention, primary care and
home-based services are inadequate both in quality and quantity. A large
amount of uncompensated care is provided in emergency rooms, making it difficult
to secure tertiary and non-emergency hospitalizations for the uninsured.
After
researching various national standards of care models, DC Communities in Charge
worked with community providers to develop performance standards that were
implemented for DC. Recognizing the current status of many of the
providers that make up the District's safety net, performance standards were
developed for "DC Qualified Health Centers" that also incorporated a
technical assistance component.
It
is essential to preserve the medical homes that communities historically rely on
for a number of services. These, mostly small, private non-profits have
historically absorbed about two-thirds of all the uncompensated care in the city
and would now receive assistance from the government as well as become eligible
for Enhanced Medicaid reimbursements for all of the "wrap-around"
services they provide such as social work, transportation services, etc.
Legislation has been developed and the city has committed to fund the program in
the 2002 budget.
DC
Communities in Charge has also worked to develop a pharmaceutical access program
for uninsured patients. It is imperative that once we ensure patients
access to care we also ensure their providers can properly treat patients with
needed medications. A plan has been developed which would take existing
funds used at our public hospital and provide medications to all residents which
currently have no means to access them. Legislation is currently being
developed for this plan. In addition, CIC has a pilot program being
initiated to provide prescription drug access to pharmaceutical companies'
assistance plans for 600 District residents with no-prescription drug coverage.
We
have not yet tackled long-term care problems, which will need to be included
because DC's population is aging. We are using CIC to bring those
communities and others, into the healthcare reform process.
In
addition to the healthcare providers, Medicaid's ability to contract for and/or
provide outreach enrollment and re-certification must be improved if reform is
to succeed.
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Financing
& Outreach Strategies
Financing Strategy
Due to budget crisis funds
were not available in 2002, and $100,000 had been committed in the 2003
budget. Again, the budget crisis led to those funds not being
available. CIC is exploring numerous options for funding in the District's
FY04 budget. We are currently working with the Department of Health
because they will need to build the capacity to monitor the providers once
standards are in place.
Outreach Strategy
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Policy
makers: Meetings, updates, letters, faxes, emails, and reports ensure
understanding reform goals and financing.
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Healthcare
leaders and providers: Meetings, updates, letters, faxes, emails and
reports increase understanding, ensure reform strategies are achievable in
the community.
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Voters:
Web site, data base for email and fax information and distribution health
reform updates increase participation/awareness.
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Community:
Help promote city-wide healthcare summits to influence policy makers.
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Accomplishments
to Date
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Creation
of Alliance Program under Mayor's initiative.
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Creation
of DC Pharmacy Resource Center.
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Completion
of DC Medicaid enrollment survey.
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Completion
of DC demographic survey.
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Continued
to expand the District's primary care network of providers.
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Medicaid
waiver expansions approved for several target populations.
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Challenges
DC
has protected its Medicaid budget and not decreased eligibility criteria despite
a $500 million decrease in revenue funds over the last two years. However,
budget concerns remain a critical challenge to CIC goals. The District
faces a predicted budget shortfall between $300-500 million per year through
2005. Financial stability of Greater Southeast Community Hospital is in
doubt while it undergoes bankruptcy. It remains a major access point for
many of the medically vulnerable citizens of the District and its financial
troubles have absorbed much of the health policy focus from the community.
CIC in collaboration with partners, has conducted a viability study of Greater
Southeast Community Hospital with recommendations to strengthen healthcare
financing.
The
Task Force provided technical assistance to the Department of Health to develop
a program-spending plan for tobacco settlement dollars, which would have funded
all CIC goals, including DCQHC, pharmacy, Medicaid expansions, and the Medicaid
Training Institute. This funding was lost when the DC Congressional
Appropriations Committee ordered all of the money to be put in the reserve
(rainy day) fund.
Transition
to a privatized public health system and closure of inpatient and trauma
services at the city's only public hospital, DC General in 2001 divided the
healthcare community and distracted policymaker and lawmakers attention from any
of the reform efforts underway. The healthcare community recognized the
importance of a strong delivery system of primary care, but many in the
community remain divided about future uses of the DC General site.
Despite
funding challenges, CIC continues to keep the Department of Health, City Council
and the Mayor's office engaged in identifying funding for healthcare reform
issues. CIC regularly consults with the Mayor's budget office, and the
City's Chief Financial Officer, City Administrator and the DOH and City Council
budget offices.
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Contact
Us
Sharon
Baskerville
District of Columbia Primary Care Association
1411 K Street NW, Suite 400
Washington,
DC 20005
Phone: (202) 638-0252
Fax: (202) 638-4557
E-mail: sbaskerville@dcpca.org
Website: http://www.dcpca.org
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