Vincent A. Keane, Chief Executive Officer, Unity Health Care, Inc.
Testimony to the Committee on Health and Human Services
June 22, 2001

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TESTIMONY BEFORE
The Committee on Human Services Of The City Council Of The District of Columbia On

The D.C. Health Care Alliance

Presented by:
Vincent A. Keane, CEO
Unity Health Care, Inc.
June 22, 2001

Introduction

Good morning Chairwoman Allen, and members of the Human Services Committee. Thank you for holding this hearing today on the status of the transition to the D.C. Healthcare Alliance (The Alliance). My name is Vincent A. Keane, I am the CEO of Unity Health Care, Inc., a partner and provider within The Alliance. Unity is honored to be chosen as a partner in The Alliance, and we are totally committed to insuring that this historic change in the public health care delivery system within the District of Columbia, will truly serve the most vulnerable and medically underserved of our citizens.

We are pleased to be partners with our fellow Alliance members, Greater Southeast Community Hospital, D.C. Chartered Health Plan, George Washington University Hospital, Childrens' National Medical Center and the D.C. Department of Health. I personally have nothing but the highest respect and admiration for my colleagues who have worked tirelessly over the past several months in the struggle to bring this vision to reality. I can assure you that I have spent more time with my partners here at this witness table than I have with my wife and family. Our meetings have been tense, and intense. They have been long and demanding but through it all we have stuck together as partners, and all of us want to, and will make this Alliance work.

Unity's Role and Responsibilities

Under the terms of our contract with Greater Southeast, Unity is responsible for providing all of the primary health care services, and other support services as defined in the RFP #D.C.FRA-00-R-039 issued in December, 2000. Specifically Unity will staff and operate six (6) community health centers formerly operated by the PBC, they are:

Anacostia 
Southwest 
Hunt Place
Congress Heights 
Woodridge 
Walker Jones

In addition Unity will staff and operate all the outpatient pharmacy services at these clinics as well as the outpatient pharmacy at D.C. General Hospital. While not specifically defined in the scope of services of The Alliance, or the RFP, Unity under a grant from the Department of Health (DOH) will also operate the WIC program formerly operated by the PBC, and the HIV/Aids Clinic at D.C. General Hospital, known as the Phoenix Center.

Unity will make it possible for patients formerly served at PBC clinics to have access to quality health care services in a health center that will be attentive to the health care needs of that community as a whole. Unity will provide a medical home for these patients.

The primary health care services that Unity will provide insure that the same level of services formerly provided by the PBC will remain. Unity's seventeen (17) year history of providing care to the medically underserved in the District of Columbia allows us to bring a wealth of experience and cultural competency in dealing with the unique health care needs of the medically underserved. Unity started out as Health Care for the Homeless Project, Inc. (HCHP), and today we continue to provide health care to 15,000 homeless persons in D.C., our mission continues to be "to provide quality, compassionate care regardless of ability to pay. " Our staff will bring that same compassion and professional expertise to the new patients we will be privileged to serve in The Alliance. A list of the services we will be providing is attached as Appendix A of this testimony.

The Transition Process

Like all of the partners in The Alliance the biggest challenge facing Unity was to insure that we would have sufficient qualified employees to staff the neighborhood health centers effective July 2nd. This challenge was heightened further by the fact that the transition phase was contracted from 3 to 2 months. This section will deal with the following items relative to the transition:

1. Development of the medical and staffing model appropriate for the health centers.
2. Human Resources/Recruitment.
3. Working with our Alliance partners to insure the integration of primary care into specialty, and tertiary care systems.

A. Development of the medical and staffing model appropriate for the health centers:

In May Unity staff immediately began an assessment of each of the health centers to determine how the same level of services previously provided at the PBC health centers could be provided in a cost effective and quality manner. It must be acknowledged that fiscal limitations within this contract forced us to evaluate every position and every service and determine how Unity could provide these services given the fixed dollars-allowed for these services. The Board of Directors of Unity directed me to move ahead as a partner in the D.C. Health Care Alliance on one condition, namely "that the current mission and financial status of Unity not be compromised."

In an attempt to maximize resources and enhance patient care, Unity adapted a model of primary care practice that focuses heavily on the role of the family practice physicians. The family practice physician is capable of serving all age groups, children and adults, males and females, and furthermore is qualified to do prenatal care and deliveries. By the time the six (6) community health centers are fully staffed we will have employed twelve (12) family practice physicians whereas previously there was only one. While family practice physicians are skilled in family care and play a diversified function, we also recognize the need for pediatricians, internal medicine physicians and obstetricians. Unity has hired appropriately to ensure that the full complement of services defined in the RFP will be provided.

Not only did Unity conduct on-site assessment of the medical model operative at the PBC clinics, but we also relied heavily on two reports that had been conducted on the PBC/D.C. General operations. These reports were the Cambio Report and a report by the Health Resources Services Administration/Bureau of Primary Care (HRSA/BPHC) entitled "A Primary Care Assessment of the D.C Health and Hospitals Public Benefit Corporation. " The latter conducted in August, 2000 was very helpful in assessing the strengths and weaknesses of the PBC system, making recommendations on how productivity could be increased, and staffing patterns adjusted to more accurately reflect utilization. This report contained a series of recommendations that Unity has incorporated in the development of it's staffing model for the health centers.

B. Human Resources/Recruitment:

As did all Alliance partners, Unity initiated it's staff recruitment by inviting existing PBC staff to apply for positions within Unity. Our staff have been diligently interviewing personnel, assessing qualifications and extending offers to current PBC staff. We have also participated in all the job fairs sponsored by the District Government relative to The Alliance transition.

The following is a summary of Unity's recruitment efforts:

• Originally it was anticipated that Unity would hire approximately 120 staff to support The Alliance. With the addition of WIC, and the Phoenix Center it is now expected that Unity will hire between 140 150 staff to support The Alliance. 
• Approximately 215 contacts were made between Unity and PBC applicants. 
• 125 interviews were conducted. 
• Unity has extended 53 job offers for full-time equivalent (FTE's).
• There are currently 55 job offers pending to full-time or contract work;
• 4 offers were made and rejected by the applicants.
• 12 persons who applied for jobs withdrew their applications or did not follow-up with scheduled interviews.
• 91 applications were rejected because (A) no position was available within Unity; (B) the applicants did not meet the qualifications or (C) Unity's pay scale did not meet the applicants pay requirements.

We should note that we have not yet completed our evaluation and interviewing of all staff at the Phoenix Center.

For those positions not filled by former PBC staff Unity has recruited from a variety of difference sources.

C. Working with our Alliance partners to insure the integration of prima care into specialty, and tertiary care systems:

Because Unity has a long history of providing care to the homeless and medically underserved community of D.C. we are vary aware of the challenges that they face in accessing secondary and tertiary care. In our partnership particularly with D.C. Chartered Health Plan and Greater Southeast we have been able to identify and articulate potential barriers that our patients may experience in the enrollment process, and in their efforts to access specialty care at the D.C. General Hospital clinics. Unity's membership in the Non-Profit Clinic Consortium (NPCC) has enabled us to share with our partners the unique needs and challenges that all of us as non-profits on limited resources face. The overall result I believe is excellent. We have developed through The Alliance an organized system for insuring that patients can be referred for specialty care, and in turn that referring physician will receive a full consult report back from the specialist who performed the evaluation/consult. In addition pharmacy services will be available to patients referred in for speciality care, another significant need experienced by non-profits. We believe that The Alliance will enhance patient care, result in better health care outcomes, and barriers to access will be greatly reduced.

Looking To The Future

Unity's role in delivering primary care services to the members of The Alliance is not just focused on treating sick people. We plan to expand our preventive health care services, and to establish extensive outreach services including community health promoters, similar to the program we now operate at our East of the River Health Center.

Though the Community Advisory Councils at each health center we plan to solicit community input around hours of operation, gaps in services, and other community health care and social needs that are negatively impacting on the health and welfare of our patients. Unity truly sees itself as a partner with the community for better health care.

Conclusion

Unity has a long tradition of services to the most medically vulnerable in D.C. We welcome the challenge of extending our compassion and care to an even wider population. We consider it a privilege to serve those who are most needy in our community.

Thank you and I will be glad to answer any questions.

April 8, 2001

Appendix A

Attachment 2.1.1

PBC Clinics and Level and Scope of Services Provided