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Karen M. Dale, Chief Operating Officer, DC Health Care Alliance
Testimony to the Committee on Health and Human Services
June 22, 2001

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Testimony of DC Health Care Alliance
Before the Committee on Human Services
Presented by
Karen M. Dale, RN, MSN, CS
Chief Operating Officer
June 22, 2001

Good morning Chairperson Allen and members of the Human Services Committee. Thank you for this opportunity to discuss the healthcare program for the uninsured persons residing in the District of Columbia. My name is Karen Dale, and I am the Chief Operating Officer for the DC Healthcare Alliance at Chartered Health Plan. With me is Thomas L. Johnson, Director of Government Relations for Chartered.

Chartered's vision is to ensure that the underserved are empowered with knowledge and awareness about achieving good health and maintaining a healthy lifestyle. We are committed to serving the disadvantaged population with dignity and respect. My testimony will cover Chartered's responsibility in the Alliance, the implementation process, and our current status and future plans. The Alliance program has already started. We have been working diligently for weeks on the details of the Program and I am pleased to report that we officially began operations on Friday, June 15 at eight (8) enrollment sites. Additionally, trained member services representatives were available by phone.

Greater Southeast Community Hospital Center has contracted with Chartered to provide specific administrative services. For the past several weeks our implementation team has focused on putting in place the necessary infrastructure to support these functions. We have worked collaboratively with the other Alliance members to ensure that the program will deliver the highest level of member satisfaction and quality health care.

I will briefly discuss some of the administrative functions for which Chartered is responsible. Detailed information has been provided to you in writing.

Eligibility Verification and Enrollment

To promote a seamless process for those members that have traditionally received services at DC General, a letter and information packet was mailed to 43,568 individuals identified as self-pay patients and uninsured, including Medical Charities patients that received services at DC General or one of its community clinics in the past two years. The letter informed the recipients that based on our information they will be presumed eligible under the Alliance program for 30 days. Another letter and information packet was also mailed to 177 persons that had been identified as having insurance. Finally, we ran a cross match with the Medical Assistance Administration database, and 4,803 were deemed Medicaid enrolled or eligible and therefore possibly not eligible for participation in the program. These steps were designed to ensure that a wide net was cast regarding access to the program. In addition to the mailing, as of this morning Enrollment Specialists have enrolled 100 members who have provided appropriate documentation and we have screened those persons that are not eligible for other public programs as appropriate.

Member Services

We are committed to providing accurate and timely public education to ensure that members have information about how to access care. Our Member Services representatives are available Monday through Friday between 8:00 am and 6:00 pm by phone and members may contact our Nurse Advice line 24 hours a day seven days a week with health questions.

Prevention Education and Outreach

An important shift that is an anticipated outcome of managing the care of the uninsured is improved health status for those persons served. One way that this can be achieved is through an investment in primary prevention. Chartered will provide group and individual education to Alliance members and link them to needed services. Our health promotion offerings are aimed at assisting members to stop smoking; develop habits that decrease risk factors for hypertension, manage their weight; manage asthma; prevent diabetes or appropriately manage the disease; reduce risk behaviors associated with sexually transmitted diseases; establish wellness related behaviors; and engage in prenatal care. These education programs specifically address the ambulatory sensitive admissions at DC General Hospital. We will regularly evaluate our efforts based on data and member and provider input.

Utilization Management

Appropriate utilization management can significantly improve care by promoting a delivery system that assures that each patient receives the right care, at the right time, at the right place. The Utilization Management program for the Alliance is responsible for assessment, planning, intervention and evaluation of ambulatory and inpatient healthcare services provided to members of the program and will help to assure appropriate follow-up for patients discharged from the hospital. Our approach is member centered and the member is actively involved in each step of the Care Management process. This type of focused management places the care that Alliance members receive on par with quality of care delivered to members of private employer-based plans.

Quality Management

Our definition of quality is simple - - Each Alliance member has a positive experience. Our Quality Management program will produce this outcome by monitoring, evaluating, and continually improving all clinical and non-clinical services. The Quality Management program is designed to comply with applicable quality standards, including those of the Centers for Medicare and Medicaid Services Quality Improvement System for Managed Care (QISMC) and the requirements of Federal and District authorities that conduct Medicaid oversight.

Provider Relations

Members must have easy access to providers. The network of providers available to members offers 89 primary care providers and 168 specialists in more than 75 locations. In addition, all provider systems have been implemented to support enrollment and verification, utilization management, and claims payment. Provider directories are available to facilitate member selection of a healthcare home. We will conduct ongoing accessibility analyses to refine our network of providers so that the network gives members a choice of providers, encompasses the cultural diversity of our city, and gives access to various specialties.

Data Collection and Reporting

We are looking forward to participating in the data collection process outlined for this program that will ultimately allow for a high level of accountability. Observations as well as formal data will be collected to measure the performance of this healthcare reform initiative. Chartered will track, analyze and report aggregate quantitative and qualitative data. Examples of information that will be collected include the types of encounters by age group, distribution of network providers, number of children receiving well-child services, number of health risk surveys performed, the immunization status of members, information on the utilization of prenatal services, and types of preventive services provided to Alliance members with Diabetes and other chronic conditions. The reporting component will serve as the foundation for ongoing evaluation and modification of the program.

No successful operation functions without qualified and dedicated professionals. Due to the short implementation time frame, we expedited our hiring process in order to have a complement of trained staff available on June 15. We have made every effort to hire DC General employees. We attended each job fair for employees and contacted 227 DC General employees that submitted a data sheet to discuss employment. Our staffing for the Alliance at this time consists of 21 persons (Administrative, clinical, member services, provider relations, enrollment specialists). By the end of the July we will have 39 staff members supporting the Alliance program.

In closing, Chartered is committed and ready to provide accessible, quality services to the uninsured persons in the Alliance Program. The cornerstone of our efforts is member satisfaction. When we are able to provide accessible quality health care and reduce unnecessary and/or potentially preventable emergency room and inpatient use, we will be improving the health status of our city and reshaping the future of care for the uninsured.

Karen M. Dale, Chief Operating Officer, DC Health Care Alliance Testimony to the Committee on Health and Human Services June 22, 2001

Testimony of DC Health Care Alliance Before the Committee on Human Services Presented by Karen M. Dale, RN, MSN, CS Chief Operating Officer June 22, 2001