DISTRICT of COLUMBIA PRIMARY CARE
Communities in Charge partnership is stepping onto a moving
train. The Robert Wood Johnson Foundation's Communities in
Charge request for proposals was announced just as the District's
newly elected Mayor Anthony Williams put forth a sweeping plan to
reform the way the District uses its public health dollars.
Mayor Williams suggested redirecting all the Disproportionate Share
and District Subsidies for healthcare services into purchasing
Medicaid insurance. The proposal argued that DC could insure all
but 3% of DC's low-income residents this way. In the midst of
the ensuing vigorous discussion, the DCPCA organized around 70 people
and institutions to develop a response to the Communities in Charge
proposal. The DCPCA wrote the grant using the Mayor's Medicaid
reform numbers because they were the focus of the discussion.
Policy makers and the healthcare community were unprepared to analyze
the sweeping nature of the changes, the Mayor's comprehensive reforms
were not included in the budget. However, the plan put a
spotlight on the inadequacies of our current public health system, and
Medicaid expansions continue as the District debates its overall
strategy for public health reform.
requested that the Council join him in forming a Health Commission
with representatives from the Mayor, the Council, Healthcare and
Community. The Commission has worked for four months to look at
the healthcare status of District residents and is developing
strategies to improve the public health through comprehensive
reform. In the beginning of February the Commission will release
its legislative recommendations for the upcoming budget year.
Five members of
the Commission have been invited to serve on the Task Force to ensure
that the Communities in Charge will build on the work of the
Commission. The Commission, and other efforts underway, will
provide the foundation for CIC. The 21-member Task Force will
meet bi-monthly (with committees meeting in alternate months) for the
first year, with the goal of presenting a legislative agenda in
February of 2001. Three co-chairs will provide Task Force
Walks, Commissioner of the Department of Health, will serve as the
Dennis, Chief of Neurosurgery, Howard University Hospital, will
serve as the Community Chair.
member Sandy Allen will serve or appoint a Co-Chair Council representative.
The Task Force
will serve as the coordinating agent to develop a "community intelligence
quotient" regarding healthcare reform options, develop leadership
and direction to decide among options, and build the political will to
see the decisions implemented.
in Charge Task Force is independent of the DCPCA Board of
Directors. Representative communications open between the Board
and CIC. The Executive Director of the DCPCA will serve as a
Task Force participant and Committee participant, but will not be a
voting member of either. DCPCA will provide staffing that
includes a fulltime staff person to coordinate the project, project
leadership and administrative support. DCPCA will continue to
support the project with grant management, resource development,
communications and other efforts.
There will be
three committees: Financing, Delivery and Accountability.
Staffing will be provided by RWJF funding and other DCPCA funding
efforts. In addition, staff will work with leadership to connect
projects like Kellogg Community Voices and RWJF Covering Kids to
support the committees and develop consumer involvement and voter
expansion will be one tool for decreasing the uninsured.
stronger community based primary care system must be developed, including
facilities, management, information system, and technical assistance.
will likely be interim financing steps needed (for example, a free care
pool) as the system prepares to expand Medicaid roles.
improvements in the performance of Medicaid outreach and enrollment will be
improvements in the oversight of Medicaid will be required.
coordination between prevention, primary care, hospitals, and long-term is
of Health must increase its ability to plan and monitor healthcare systems.
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number of uninsured DC residents
in place a plan that will improve healthcare services and health outcomes
for the medically vulnerable
an accountability strategy
a citywide health policy decision-making capacity by increasing knowledge,
leadership, and skills
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& Outreach Strategy
will use Medicaid expansion as the major vehicle for reform for many
reasons, including the national importance of Medicaid, the structure
is in place for expansion, and District policy makers are comfortable
with Medicaid expansion.
is likely we will also develop a free care pool of some type as an interim
step because Medicaid has many, many internal problems to resolve
before expansion will be effective in improving health
consumer outreach strategy is being developed and funding is reserved
for execution of the plan. The Executive Director of a consumer
Medicaid Advocacy organization will chair the Delivery Committee and
will be responsible for ensuing consumer involvement in the Task
Force. An outreach strategy will be developed as the project
Communities in Charge is as concerned about 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 to the uninsured.
related projects DCPCA is working to secure funding for developing
standards of care for primary care and helping our community providers
meet those standards. We are working with the Department of
Health because they will need to build the capacity to monitor the
providers once standards are in place. 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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The Mayor and
the City Council have a rocky relationship: Both are
relatively new to their emergency roles in a revitalized DC
government. We will work carefully to ensure that both are
included in the process. Constant communication will help
income divisions in the city are real and powerful: We are
an urban center that has an African-American majority (65%-70%) of the
population, a white minority (25%-30%) and a large international
immigrant community (5%-10% most of whom are Latino). This
complicates reform. Strict attention to diversity in leadership
and participation is critical.
are inexperienced: The DCPCA is one of the new emerging
community organizations that have professional advocacy staff.
Healthcare reform, with its complex funding and delivery options is
demanding. In addition to the lack of staff experience,
healthcare leaders are new to reform generally. CIC will be
bringing new voices to the table, like consumers and corporate DC,
which means we will need to help people grasp complex issues quickly.
emerging from many years of little government accountability:
The lack of capacity at the Department of Health, the Income
Maintenance Administration, and the Office of Contracting and
Procurement must be considered when planning implementation.
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Recipients: 120,000 People
Latino and other
immigrants (approximately 10%) Low-income residents of historical
African-American and immigrant neighborhoods.
Current Medicaid Expansion
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District of Columbia Primary Care Association
1411 K Street NW, Suite 400
Washington, DC 20005
Phone: (202) 638-0252
Fax: (202) 638-4557
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