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What Is DCWatch?
OF THE DISTRICT OF COLUMBIA
Department of Health
Office of the
Capitol Street, N.E., Suite 4400, Washington, D.C. 20002 (202) 442-5999
FAX (202) 442-479
Committee on Human
Council of the District of Columbia
Hearing on the Status of
the DC Healthcare Alliance Transition
Testimony Delivered by Ivan
C.A. Walks, MD
On April 30 2001, the
District began a new era in the delivery of health services to the
District's low income, uninsured residents with the finalization of the DC
Healthcare Alliance contract. Over the past two months the transition has
moved ahead efficiently.
Chief Health Officer and
Director, Department of Health
Status of System
and Services During Transition
transition DC General Hospital, the Ambulatory Care Center, and community
health centers have continued to provide primary and specialty care
services. DC General's emergency room, while it has periodically been
closed to ambulances (a situation also occurring in most other District
the same period) has remained open to walk-ins and is currently open to
ambulance transports. Over the long haul, DC General's ER will continue to
receive EMS transports.
The nearly 2 months
since the contract went into effect, though condensed, have been extremely
productive. Some of the objectives completed during this period include:
- The Healthcare Safety
Net-Administration has been established within the Department of
Health to carry-out contract monitoring and management functions.
- Employee transition support services including job fairs, an
onsite employee assistance center and one-on-one support services
have been provided. The center located at DC General will begin
having evening and weekend hours on Monday, June 25.
- Each of the Alliance partners have expanded their capacity and
have begun to take over functions formerly provided by the PBC.
- Arrangements for maintenance of special programs and services
including inpatient care for Corrections' patients, school health,
the Phoenix center for HIV patients, and prescription coverage are
in place. Greater Southeast is completing construction of a locked
unit for prisoners requiring inpatient care. Until this unit is
complete, GSCH will provide secure care for these patients.
- EMS services have been expanded. Two new ACLS-equipped ambulances,
that are not in the 911 system, are now stationed at DC General.
While these vehicles are available to respond to emergencies in the
immediate area of DC General, their primary function is to transport
patients from the DC General ER, who require more extensive care, to
Greater Southeast Community Hospital,
Children's National Medical Center, George Washington University
Hospital, and other facilities as necessary. At least 3 additional new
ambulances will be stationed at locations throughout the Eastern part
of the District to ensure that enhanced EMS patient stabilization and
transport services will be in place. New protocols have been developed
to guide the operation of the 24-hour emergency room at DC General and
EMS transports. These will take effect within the Alliance system and
District government by Monday, July 2, 2001.
- The DC Alliance
enrollment process has been developed and implemented and materials
have been mailed to 45,000 District residents.
- Also during the
transition, Greater Southeast assumed responsibility for some of the
hospital services historically provided by the PBC. During May, 40
med/surg. patients were transferred to Greater Southeast - 10 of these
patients where uninsured. On May 15, 2001, Greater Southeast also took
over the delivery of mammography services.
Major Milestones in Service Transition have been Achieved
One of the most significant challenges facing the DC General had been
the continued delivery of services that few consumers utilized. The low
utilization not only contributed to the institution's financial
instability but it also jeopardized the quality of care. For this
reason, on May 18, 2001, all pediatric inpatient services were
transferred to Children's National Medical Center and OB delivery care
was transferred to Greater Southeast.
The next major milestone was achieved when on June 15, 2001, with
transfer of inpatient admissions to Greater Southeast and its Alliance
partners. On Monday, June 25, 2001, will the initiation of summer
school, Children's National Medical Center will begin providing school health services. Transfer of DC
General's remaining inpatients will be also be completed by June 25. The
Alliance will assume full responsibility for the delivery of healthcare
safety net services on Monday, July 2, 2001.
These dates reflect an expedited transition timeframe necessitated by
the pending departure of DC General's residents. Dr. Fernando Daniels,
DC EMS Medical Director will provide details on concerns about EMS
transports being delayed in District emergency rooms.
Throughout this transition, DOH and other District agencies have worked
closely with the Alliance partners to ensure that quality and
comprehensive health services continued to be delivered to District
Implementing a System and Infrastructure for Oversight and
As the transition of health services advanced, the Administration, led
by DOH, has put into place the infrastructure necessary to monitor and
management effectively the city's comprehensive health reform efforts.
During this period, DOH has advised the Financial Authority on the
closure of inpatient services at DC General. To ensure access to
services and problem resolution, DOH established a consumer call center.
From mid-April until June 21 the call center received over 370 calls.
Quick response is our goal -- all effort is made to resolve a caller's
issue at the time the first contact is made. In more complicated -
nonurgent clinical -- situations, our commitment is to resolve problems
by the end of the following day. To more expeditiously respond to
consumer requests, the center added two member service coordinators.
DOH will continue to play a critical role after July 2. The Healthcare
Safety Net Administration will: maintain historical patient and hospital operational records; provide contract oversight for
the DC Health Alliance; ensure service quality and effectiveness; make
certain that the system provides early and appropriate access; track
access and utilization of services; assess and report on system
deliverables and health outcomes.
The consumer is the focal point for the Alliance's success and for the
District's achievement of its health status improvement goals. Within
this context, increasing consumer's access to and satisfaction with,
critical health services is our first priority. The Alliance will
provide a mechanism for its members to receive an expedited review on
service grievances. If the member is not satisfied with the Alliance
response, he or she has the right to request a review of their case by
the Health Care Safety Net Administration. DOH and the Alliance partners
also recognize the importance of consumer input for system improvement.
In addition to consumer advisory activities carried out by the Alliance,
DOH will be initiating CHAT (Consumer Health Access Team)
together with community groups including "Use Your Power Parent
Council." The CHAT initiative will train 50 consumers from
medically underserved areas of the city to reach out to fellow
consumers, provide feedback on Alliance services, assist in the
development and coordination of outreach and education efforts, and aid
DOH in monitoring and management of the Alliance contract.
For outcomes of the District's new safety net to be fully assessed, the
plan also includes external review. On June 7, 2001, Mayor Williams
established the Health Services Reform Commission. Comprised of a wide
spectrum of community leaders, health providers and planners, nationally
recognized experts and consumers, the Commission's mandate is to
independently track the Alliance's progress and outcomes and to report
on both achievements and areas for improvement. The Commission's first
meeting is on July 12, 2001.
A Plan that Builds on Success
Mayor William's bold leadership led the District to select a strategy
focused on increasing access to community-based primary care services,
improving health outcomes and decreasing the city's historical
dependence on its emergency rooms. The DC Healthcare Alliance was
selected because it is grounded in the best possible marriage of
resources and skills - the expertise of private sector healthcare
providers and the capabilities of public health. It is a model whose
effectiveness is reflected in the successes of an increasing number of
public health departments across the country that have privatized
service delivery and focused on health promotion and health status
Another lesson learned from other communities transforming their
healthcare safety net -- one system can not meet all needs. While
comprehensive, we recognize that the DC Healthcare Alliance can not
provide free services to all the District's uninsured residents. In
response to concerns voiced by Councilmembers during earlier hearings,
the Alliance system is a blending of free care for those most at risk,
those with the lowest family incomes, and care on a sliding scale for
individuals with family incomes above 200% of poverty. DOH will continue
to pursue opportunities to collaborate with local and national
charitable services and expand Medicaid coverage, to ensure health
services are available to all District residents.
So far this strategy is demonstrating that a partnership between private
providers and public health can work successfully. The Administration
remains committed to ensuring that the DC Alliance truly achieves
measurable improvements in the health of District residents.