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For almost two decades, DCPCA has set the course for high quality, sustainable, accessible primary health care for all in the District of Columbia. More than ever before, primary care is at the heart of the effort to rewrite the District’s health story, and the survival and success of community health centers remains critical to a successful and thriving city.
Over the last ten years, we have seen great success. The District has achieved unprecedented health insurance coverage--94% of residents have health insurance, and 98% of DC’s children are covered. Additionally, we are first in the nation in rates of health insurance for Latino children. But there is more to be done.
DCPCA’s aggressive advocacy agenda identifies legislative, administrative, and budgetary opportunities to support health center sustainability and continued access to comprehensive, integrated primary care - all of which help our residents get and stay strong mentally and physically.
Looking forward, our challenge is to deliver on the implicit promise of coverage and access for all. Working in partnership with health centers, District government, public health advocates, and community members, we intend to match the increase in coverage and access with improvements in health outcomes and quality of life for all residents.
Click below to learn more about our current policy priorities:
- Behavioral Health Integration
- Patient-Centered Medical Homes
- Value Pay Reform
- District Health Information Exchange
- Community Health Workers
- Primary and Specialty Care Need and Capacity Assessment
Current Policy Priorities
Current Focus: Amend the Mental Health Information Act to allow information exchange between behavioral health and medical providers.
DCPCA seeks to align District of Columbia health policy with the goals of integrated care models that address patient needs comprehensively, especially patient behavioral health needs in the context of primary care.
Existing law presents a significant barrier to care coordination. We support Bill 21-7 as an important first step towards allowing primary care teams and behavioral health providers to share information, coordinate healthcare services, and improve outcomes for their patients.
In a population of 100,000 Medicaid patients, the 40,000 with mental health morbidity contribute $82 million in excess medical services costs in comparison to those without mental health needs.
Best practices for successful integration of medical and behavioral health indicate that treatment begins in primary care with a “refer up” system that maximizes capacity for quality behavioral health care. Patients in need of more intensive services must also be connected to primary care providers who can effectively coordinate and communicate with behavioral health services.
For more information, please see: Page 176 of Integration of Mental Health/Substance Abuse and Primary Care.
Current Focus: Ensure that every District resident has access to high-quality primary care through a health home.
The medical home model promises to improve health care by transforming primary care organization and delivery. A medical home delivers the core functions of primary health care incorporating five key attributes:
1. Comprehensive Integrated Care
2. Patient-Centered Care
3. Coordinated Care
4. Accessible Services
5. Quality Care
PCMH designation signals quality standards across all five key areas. Resourcing and promoting PCMH will encourage more of the District’s primary care providers to adopt this model of excellence.
Six of ten peer reviewed studies found PCMHs reduced healthcare costs, and 12 out of 13 reports on utilization found improvements, such as reduced ED visits and inpatient hospitalizations. Meanwhile, of seven state government PCMH reports, 100% indicated cost reductions and 86 percent found utilization improvements.
- For more information, please see: The Patient-Centered Medical Home’s Impact on Cost and Quality (Nielsen, 2014)
Current Focus: Reform our payment system to prioritize getting and keeping patients healthy.
The Affordable Care Act focuses on primary care as the key strategy for improving care and decreasing utilization of the most expensive care settings.
Transformation of our health system will require deeper investment in primary care, with flexibility for primary care providers to utilize care teams that best support patient health, particularly for those with chronic disease.
DCPCA is working with our health center and government partners to design a payment system which resources primary care teams and incentivizes providers to achieve improved health outcomes for patients. The focus is on increasing value for patients and an improved return-on-investment for the District.
For more information, please see:
Current Focus: Develop a data system that tracks patient health across sites of care including primary, specialty, behavioral, and hospital care.
Driving population health improvements and supporting implementation of new care delivery models requires a data system that can integrate across sites of care.
The care management, coordination, and quality improvement efforts necessary to transform health outcomes and contain costs cannot be achieved without access to meaningful data.
The District must invest in a robust Health Information Exchange if it hopes to maximize investment in health care access.
A study tracking emergency room HIE use indicated HIE access reduced overall costs by $1.07 million, or nearly $2000 per patient.
For more information, please see: The Financial Impact of Health Information Exchange on Emergency Department Care.
Enable reimbursement of Community Health Workers as members of the primary care team.
In the District, many providers utilize Community Health Workers (CHWs) to augment their care teams as a proven way to better engage patients, ensure adherence to prescribed treatment, and direct patients to the right care at the right place at the right time.
In January 2014 CMS released a rule change which permits states to allow for the payment of preventative services provided by CHWs.
DCPCA has been providing leadership to a coalition of stakeholders to make a recommendation to the Department of Health Care Finance to create a State Plan Amendment to allow CHWs to be reimbursed in the District.
The use of CHWs to provide individualized asthma education during home visits reduced symptom frequency by 35% and urgent-health resource utilization by 75% between pre- and post-intervention periods, resulting in an estimated cost saving from more than $5 to $1 spent on the intervention.
- For more information, please see: Outcome Effectiveness of Community Health Workers: An Integrative Literature Review
Current Focus: Determine if the District has areas in need of new primary care, behavioral health, and specialty care providers and facilities.
DCPCA recommends that funds be dedicated to an assessment of current primary and specialty care needs and the development of an integrated state health plan.
The data currently in use to identify high-need areas does not take into consideration the Medical Homes projects or any of the additional health services facilities which have been added to the landscape.
This assessment of the primary care network is an integral part of an aggressive strategy for improving health outcomes in which the District needs to invest.
For more information, please see: Development and Importance of Health Needs Assessment
Policy and Advocacy
For More Information
Director of Policy and External Affairs
About the Department
The Department of Policy and Advocacy seeks to develop and sustain an effective, integrated health care system in the District of Columbia that guarantees access to primary health care and eliminates disparities in health outcomes. As a recognized and respected leader in health care reform, DCPCA heads an influential network of organizations and individuals that advocate and encourage the DC government to make responsible decisions to ensure that fully funded, high quality health care services are accessible to low-income and underserved DC residents.