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Greater Southeast Community Hospital Corporation I
“Washington Alliance for Community Healthcare: DC-WACH Program, Volume I: Technical Proposal”
Response to a Request for Proposal DCFRA #00-R-039
January 30, 2001

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TABLE OF CONTENTS

Cover letter

  1. EXECUTIVE SUMMARY
  2. CORPORATE BACKGROUND / EXPERIENCE
    1. Experience and Potential Partners
    2. Ownership
    3. Financial Ability
  3. KEY ADMINISTRATIVE PERSONNEL & STAFFING PLAN
    1. Organizational Chart
    2. Staffing Plan:
      1. Ambulatory Care
      2. Inpatient Care Services
  4. DC-WACH WORK PLAN
    1. Healthcare Services
      1. DC-WACH Provider Network: Community-Based Primary Care Services
        1. Ambulatory Care Clinics
        2. Neighborhood Outreach Clinics
        3. Private Practice Network
      2. DC-WACH Provider Network: Inpatient Care Services
      3. Emergency Services
      4. Coordination of Care/ Referral Management
      5. School Health Services
      6. Dentistry Care Services
      7. Miscellaneous Healthcare Programs
      8. Mental Health / Substance Abuse
      9. Corrections
      10. Long Term Care /Long Term Rehabilitation
      11. Additional Considerations
    2. Administrative Services
      1. Enrollment and Eligibility
      2. Establishment of Residency Status
      3. Provider Network
      4. Customer / Patient Services
      5. Coordination with Medicaid
      6. Maintenance of Effort
      7. Management Information System
      8. Prior Authorization / Utilization Management
      9. Quality Improvement
      10. Reporting Requirements
      11. Performance Standards
    3. Consideration Of New Acute Care Hospital Facility
    4. Residency Commitment
    5. Cultural and Linguistic Competence
  5. EXHIBITS [not available on-line]
    1. US News and World Report's 1996 Annual Guide to America's Best Hospitals
    2. National Standards for Culturally and Linguistically Appropriate Health Care
    3. Letters of Interest: CCHP, Children's and Hadley Private Practice Physicians
    4. Documentation: Certificate of Non-Collusion, Certificate of Good Standing, Articles of Incorporation, Corporate Bylaws, JACHO Accreditation and Certificate of Licensure
    5. Biographies and Resumes
    6. Greater Southeast Hospital Financial Statements 1998 -1999
    7. Letter of Support: National Century Financial Enterprises
    8. Organizational Charts
    9. Uncompensated Care Policy
    10. Signed received copies of Amendments to RFP 1 - 3
  6. COST PROPOSAL: VOLUME TWO [not available on-line]

January 30, 2001

District of Columbia Financial Responsibility
Management Assistance Authority
441 Fourth Street, NW, Suite 570N
Washington, DC 20001
Attn: Mr. Alex Peacock, Senior Procurement Manager

Greater Southeast Community Hospital Corporation I (GSCH) is pleased to submit the enclosed Proposal in response to the Request for Proposal No. DCFRA 00-R-039 (RFP) issued by the District of Columbia Financial Responsibility and Management Assistance Authority (Authority).

The following person will serve as the primary contact for the Authority's Contracting Officer on behalf of GSCH:

Ana Raley, Chief Executive Officer
Greater Southeast Community Hospital Corporation I
1310 Southern Avenue, SE
Washington, DC 20032
(202) 574-6000
(202) 574-7188 (fax)
araley@ad.gshs.hbocvan.com

In connection with its Proposal, GSCH certifies that it is not currently under suspension or debarment by the District of Columbia or any other state or the federal government and that it will comply with all relevant licensure, certification and registration requirements. GSCH further acknowledges and agrees that it will abide by the procurement rules and procedures, the final contract terms and conditions and all other rights reserved by the Authority as specified in the RFP.

GSCH certifies that the prices in the Proposal have been arrived at independently and without consultation, communication or agreement for the purposes of restricting competition; that the prices quoted in the cost proposal have not been disclosed by GSCH and will not be disclosed prior to the submission date; and that no attempt has been made by GSCH to induce any other person or firm to submit or not submit a proposal for the purpose of restricting competition.

The Proposal includes the use of subcontractors by GSCH. GSCH accepts full responsibility for the performance of any such subcontractors.

The Proposal submitted by GSCH shall remain in full force and effect for at least one hundred eighty (180) days from the date set forth above or through the effective date of the operational contract, which may result from the RFP. Further, the prices contained in the proposal will remain firm six months from the date set forth above.

We appreciate the opportunity to present this Proposal for your consideration and look forward to discussing it with you in the near future.

Sincerely,
Ana Raley
Chief Executive Officer
Greater Southeast Community Hospital

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Washington Alliance for Community Healthcare
DC-WACH Program
Volume I: Technical Proposal

Developed and managed by

Greater Southeast Community Hospital

Developed as a response to a Request for Proposal DCFRA # 00-R-039

"This proposal includes proprietary data that shall not be disclosed outside the Authority and the District of Columbia government and shall not be duplicated, used, or disclosed in whole or in part for any purpose other than to evaluate the proposal. If, however, a contract is awarded to the Offeror as a result of or in connection with the submission of this data, the Authority and the District shall have the right to duplicate, use, or disclose the data to the extent consistent with the Authority and the District needs in the procurement process. The restriction does not limit the Authority's, or the District's right to use, without restriction, information contained in the data if it is obtained from another source. The entire contents of this response in each volume is subject to this restriction."

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I. EXECUTIVE SUMMARY

Greater Southeast Community Hospital Corporation I (GSCH) is pleased to present its response to the DCFRA RFP # 00-R-039. Through a newly created subsidiary corporation to be known as the Community Healthcare Improvement Corporation (CHIC), GSCH as the responsible prime contractor will develop, implement and manage the Washington Alliance for Community Healthcare (DC-WACH Program). The DC-WACH Program is designed exclusively to provide and coordinate healthcare for the uninsured and indigent population of the Distinct of Columbia. GSCH will be responsible for the oversight and implementation of the daily operations of this plan.

DC-WACH is a unique public / private program designed to coalesce the healthcare resources of the community in an effort to enhance the quality, efficiency and accessibility of healthcare for the uninsured and underserved population of Washington; DC. DC-WACH proposes to bring together some of the most successful and well-known healthcare providers and insurers within Washington, DC to participate in this program. Providers and health maintenance organizations (HMOs) such as Greater Southeast Community Hospital, Hadley Memorial Hospital, Children's National Medical Center, Washington Hospital Center, Providence Hospital, George Washington University Medical Center, Chartered Health Plan, Capital Community Health Plan, Unity Medical Group and the consortium of non-profit healthcare providers have been contacted and have indicated some level of interest in participating.

DC-WACH's goal will be to integrate an array of such providers and one of more HMO insurers into this program under the coordination of DC-WACH. Under the proposal, DC-WACH will provide the following services:

  • Ambulatory, primary and specialty physician care at more than 150 sites
  • Hospital inpatient and outpatient care
  • Emergency and Urgent Care
  • Dental Care
  • School Health Services
  • HIV / AIDS Services
  • WIC and Maternal and Child Health Services

The primary goal of the DC-WACH program is to significantly increase the quality and efficiency of delivery and accessibility of medical services for the underserved and uninsured population of Washington, DC.

GSCH is uniquely qualified to meet the requirements of the RFP and to provide and coordinate primary healthcare, specialty healthcare, in-patient services, emergency / urgent care and public school care. Greater Southeast Community Hospital, a 450-bed, full service hospital, has a long tradition of providing comprehensive, integrated and coordinated healthcare to the residents of Wards 6, 7 and 8 including the indigent and needy. The mission of Greater Southeast Community Hospital is to improve access to quality healthcare services by working closely with the community to identify areas of need and to develop or extend prevention programs.

GSCH has a long and nationally recognized tradition of innovative and effective community outreach as noted in US. News and World Report's 1996 Annual Guide to America's Best Hospitals. (See Exhibit 1). The hospital continues to rely on input from the community and collaborates with private and public organizations to expand access to healthcare in one of the District's most economically challenged areas. GSCH and its sister facility Hadley Memorial Hospital (HMH) participate in a wide range of community outreach efforts including a nationally recognized mall walking program with over 2,000 members, the Komen Breast Cancer Education and Screening Program, a partnership with Fannie Mae for an employee-assisted DC housing initiative, participation in a National Cancer Research Institute study, a shadowing program that exposes elementary school students to healthcare professionals as well as numerous health fairs and screenings at churches, schools and barber shops in the community. By maintaining and extending these community outreach efforts, GSCH will work diligently to ensure that residents in Wards 5, 6, 7 and 8 have access to necessary healthcare services including primary and preventive care.

Greater Southeast Community Hospital also shares the experience of its parent company, Doctors Community Healthcare Corporation (DCHC), which purchased GSCH out of bankruptcy in December 1999. Doctors Community Healthcare Corporation is a family and employee-owned healthcare management company that owns and operates six hospitals: Greater Southeast Community Hospital and Hadley Memorial Hospital in Washington, DC; Michael Reese Hospital in Chicago, Illinois; and Pacifica Hospital of the Valley, Pine Grove Hospital and Brea Community Hospital, all located in greater Los Angeles, California. DCHC's mission is to revitalize, nourish and operate hospitals located primarily in urban areas in order to help them provide high quality healthcare for the poor and medically underserved. The focus of DCHC is to provide community-centered, physician-directed care by keeping healthcare local and responsive to the needs of the people we serve. Doctors Community Healthcare's goal is to provide quality healthcare in the communities where it is most needed, not to dominate a market or a hospital. The DCHC management team works with each hospital to support specific needs and to help such hospitals be more responsive-to the unique communities they serve.

GSCH is not only aware of the economic, ethnic, racial, social, special needs, cultural, linguistic and community climate of the target population, but experienced in identifying healthcare needs and increasing access to care in underserved areas. We understand the considerable challenge of developing measurable, culturally sensitive and cost effective healthcare services, including primary and specialty care, emergency services, healthcare finances and effective community outreach. As will be demonstrated throughout the following proposal, DC-WACH is committed to the cultural and linguistic diversity of the District. In order to meet these important issues with an effective plan, DC-WACH has committed to adopting the National Standards for Culturally and Linguistically Appropriate Health Care.1 These standards are provided for your review as Exhibit. (See Exhibit 2).

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II. CORPORATE BACKGROUND / EXPERIENCE

A. Experience and Potential Partners

Greater Southeast Community Hospital was purchased out of bankruptcy by Doctors Community Healthcare in December 1999. The full service hospital is located east of the Anacostia River in one of the most economically challenged communities in the District of Columbia. Greater Southeast Community Hospital and Hadley Memorial Hospital are the sole providers of acute and sub-acute care services east of the Anacostia River.

Greater Southeast Community Hospital is a 450 bed, full service facility dedicated to delivering healthcare services across the continuum of care. Comprehensive inpatient and outpatient services include 24-hour emergency care, internal medicine, OB/Gyn, pediatrics including Level II infants, oncology, ophthalmology, pain management, urology, mental health, cardiology, dialysis, substance abuse treatment and rehabilitation services among others.

Both hospitals have business office expertise including staff specially trained in capturing funds that are available to uninsured and underinsured patients, including review of qualifications for eligibility to current Medicare, Medicaid and DC-WACH programs and assistance to families in accessing these reimbursement programs. Both hospitals work to educate patients about Medicaid managed care and benefits by enrolling them with local primary care physicians.

Outpatient services are another vital aspect of healthcare. Greater Southeast Community Hospital currently offers services such as CAT scan, routine radiology, therapeutic radiology, radiation oncology, pharmacy, laboratory, infusion care, rehabilitation services and most therapy modalities. All of these services must be maintained and extended if necessary to meet the demand.

Currently Greater Southeast Community Hospital provides more than 35,000 emergency room visits per year and could easily handle double that number with minimal changes to infrastructure.

Currently, GSCH and HMH along with other DCHC facilities continually emphasize the enrollment of patients into Medicaid and other available insurance programs. In the case of Medicaid, GSCH has dedicated positions to track and process patients through the complicated process of eligibility and verification. Since the GSCH change of ownership in 1999, this program has increased the conversion or enrollment of patients into the DC Medicaid program by as much as 30 percent. It is these types of successful operations that will allow GSCH to improve the conversion of patients from the ranks of the uninsured to the insured.

In addition to the communities served by Greater Southeast Community Hospital and Hadley Memorial Hospital, a target population that closely resembles and overlaps with those currently served by DC General Hospital, DCHC also serves similar populations at Michael Reese Hospital, located on the south side of Chicago. Though our primary service area includes a range of ethnic and socioeconomic backgrounds, many of Michael Reese's patients are uninsured or underinsured African Americans, many of whom are homeless and suffer from mental illness, addiction and a range of disabilities. Additionally, Pacifica Hospital of the Valley, located in Sun Valley, California, primarily serves a largely Hispanic population including many uninsured working poor.

DCHC also has experience with the maintenance of successful residency programs, including Michael Reese Hospital in Chicago, Illinois, which has more than 200 residents and interns. DCHC's own experience shows that many of these programs provide funds for research and other services that are essential for high quality patient care.

GSCH believes that currently a significant number of providers provide important services for the residents of Washington, DC. In developing this proposal, GSCH believes that the more of these providers that participate in the DC-WACH program, the more effective it will be. In preparing this proposal, GSCH entered into discussions with the numerous HMO insurers and healthcare providers. However, since DC-WACH is designed to be a public / private partnership, final selection and subcontracting arrangements were not entered into with any of these parties because GSCH believes that participation by the city in this selection process is very important.

Nevertheless, we have provided information, initial background and the status of discussions or negotiations with each of the following potential partners:

  1. Chartered Health Plan (CHP)
  2. Capital Community Health Plan/United Health Care (CCHP)
  3. Children's National Medical Center (CNMC)
  4. Health Right HMO (HRHMO)
  5. Unity Health Care, Inc. (UHC)
  6. George Washington University (GWU)
  7. Washington Hospital Center (WHC)
  8. Hadley Private Practice Physicians, Inc. (HPPP)

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1. Chartered Health Plan

DC Chartered Health Plan, Inc. (CHP) is a competitive, minority-owned health maintenance organization operating in Washington, DC since 1988. Chartered's network includes over 1,000 community-based physicians and 54 primary care sites. Chartered is committed to serving people in the government-assisted population, those who need special access to primary and preventive health maintenance and treatment services. The unique emphasis of Chartered is reflected in its provider network, which consists of private sector medical groups and physician practices located throughout its service area.

Chartered is a company committed to serving the disadvantaged Medicaid population with dignity and respect by providing quality healthcare services through many outreach and membership retention activities and community events. In addition to creating access to healthcare in urban areas, Chartered works to enhance cost containment, maintain accountability and facilitate economic growth through the employment of minority and diverse populations.

Of the three HMO management services companies that are discussed, GSCH believes that Chartered Health Plan provides GSCH with the best option in providing DC-WACH with HMO management services. Therefore, subject to the provisions of the RFP, approval by the Authority / District and successful negotiations of a contract, GSCH has indicated its intent to invite CHP to become its exclusive provider in the provision of HMO management services. Our proposal details important information about other potential providers of this service for your consideration, should GSCH, DC-WACH and CHP be unable to gain approval by the District or reach a successful agreement.

2. Capital Community Health Plan/United Health Care (see Letter of Interest, Exhibit 3)

Capital Community Health Plan (CCHP) is an HMO owned by five of the leading hospitals in the District of Columbia: Greater Southeast Community Hospital, Children's National Medical Center, Howard University Hospital, Providence Hospital and Washington Hospital Center. These hospitals are all recognized providers in the District's Medicaid Program; together they account for nearly 75 percent of the current Medicaid admissions.

CCHP began operation in June of 1996 and has over 23,000 AFDC/TANF and related Medicaid members who are residents of the District of Columbia. CCHP is committed to providing exceptional quality care and customer service to its members. It offers the city's most complete range of high quality, coordinated healthcare services in convenient locations. CCHP has a well organized provider network with over 1,200 physicians and community-based clinics who have been caring for the Medicaid population for many years.

CCHP has been organized and financed to operate successfully under a risk-based capitated reimbursement system and has contracted with United HealthCare (UH) to provide management and administrative services, including state-of-the-art MIS systems, claims processing, customer service, cost containment and quality assurance systems.

DC WACH has had numerous meetings and discussions with the senior management CCHP regarding the provision of HMO Management Services and the utilization of its private provider network.

3. Children's National Medical Center (see Letter of Interest, see Exhibit 3)

Children's National Medical Center (CNMC) is the only health system in the region dedicated exclusively to the care of infants, children, adolescents and young adults. Children's mission is to be preeminent in providing pediatric healthcare services that enhance the health and well being of children regionally, nationally and internationally.

Children's Hospital, the cornerstone of CNMC, houses 279 inpatient beds, 40 of which are dedicated to its neonatal nursery. A leader in the development of innovative new treatments for childhood illness and injury, Children's nationally and internationally recognized staff of pediatric healthcare professionals delivers care to thousands of families throughout the DC metropolitan area and around the world. The hospital serves as the regional referral center for pediatric emergency trauma cases, as well as cancer, burn, neonatal and critical care.

The Center for Community and Pediatric Health promotes healthy communities through clinical care, advocacy, research and education programs. Through a broad scope of services, the Center extends Children's Hospital's presence further into District neighborhoods and establishes it as an integral component of community life. The Center offers a community-based model, which focuses on comprehensive primary care, prevention, diagnosis and treatment of pediatric health conditions prevalent in the Washington, DC community.

DC-WACH has met with the senior management of CNMC and anticipates negotiating a successful partnership for School Health, Children's ambulatory care sites and assistance with specific block grant programs.

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4. Health Right HMO

Health Right (HRHMO) was established by Unity Health Care and Columbia Road Health Resources in 1998. Health Right is a for-profit HMO, the proceeds of which are returned to Unity for expansion of services to the uninsured. It operates as a District of Columbia-based Medicaid managed care health plan.

Health Right focuses on primary care services for all of its members across the life span, with strong emphasis placed on preventive services and health promotion. for the DC Medicaid population. More than 70 percent of Health Right's members are children under the age of 21 years. Therefore, Health Right places particular priority on those children eligible for the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and has developed outreach and case management programs to target these individuals.

5. Unity Health Care, Inc

Unity Health Care, Inc. (UHC) is a non-profit healthcare agency dedicated to providing primary medical care, disease prevention, health promotion, mental health, outreach, HIV and case management services to adults, infants, adolescents, seniors and the indigent of Washington, DC. Unity Health Care's mission is to provide accessible, quality healthcare in a cost effective manner to all people through a coordinated service delivery system. Unity Health Care's primary role is to help empower patients and clients to better their lives regardless of financial circumstances, ethnic background, race, creed or color. In addition, Unity Health Care emphasizes advocacy for social change and resource allocation to help those in our society who have become marginalized.

Unity Health Care's experience spans nearly two decades. In 1984, a small group of committed advocates, health professional and health institutions came together to address the healthcare needs of an ever-increasing homeless population in Washington, DC. Today, Unity's mission has expanded beyond the homeless to include the working poor, the medically undeserved and recently arriving immigrants. Through Unity's network of community-based health centers and shelter-based health clinics, nearly 30,000 medically undeserved patients are served annually. Nearly half of these people are homeless. Unity Health. Care, Inc. is now a vital part of the healthcare safety net for many people in DC who lack access to primary healthcare services.

Unity's circle of care extends throughout many sectors of the city including the East of the River Health Center and the Bethlehem Clinic in Southeast DC with full outpatient services and numerous other clinics throughout DC.

DC-WACH has met with representatives of Unity and anticipates continually meeting to work out a successful relationship for the provision of care at its non-profit sites, as well as potential management of other clinic sites.

6. Hadley Private Practice Physicians, Inc. (see Letter of Interest, Exhibit 3)

In connection with the preparation of this Proposal, GSCH has entered into negotiations with the privately owned primary care clinic at Hadley Memorial Hospital. The Davachi Community Health Center has been providing care upon the Hadley Campus for the last two years. Providing primary adult internal medicine, family practice and OB/Gyn services, the clinic has also agreed to provide extended hours with Urgent Care walk-in appointments. Because of its location within Hadley Memorial Hospital, both laboratory and radiological services are also available.

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7. George Washington Hospital

Senior management of GSCH have also met with and discussed participation points with George Washington University Medical Center. DC-WACH views this facility as a potential provider of high end tertiary and trauma care services.

8. Washington Hospital Center

DC-WACH has also met with the CEO of Washington Hospital Center in order to discuss potential opportunities for participating within this private network. Although facing significant capacity issues of its own, Washington Hospital Center will be happy to meet with DC-WACH again and explore the potential for providing tertiary and trauma care services.

DC-WACH clearly understands the significance and the importance of the selection and completion of this subcontracting partnership. Because GSCH believes that DC-WACH should be a public / private partnership and its desire to seek additional input from the Authority and the District, DC-WACH did not complete any subcontracting process. Upon completion of each contract DC-WACH will submit the required ownership and organization information on each subcontractor.

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B. Ownership

The prime contractor of this proposal will be Greater Southeast Community Hospital Corporation - I (GSCH). This company is 100 percent owned by Doctors Community Healthcare Corporation of Scottsdale, Arizona. GSCH was incorporated in Delaware on November 23, 1999 and became qualified to do business in the District on December 17, 1999. Operations for this company began with the completion of the Greater Southeast Community Hospital acquisition on December 30, 1999. Incorporated within this document are the good standing certificate (see Exhibit 4), articles of incorporation (see Exhibit 4) and corporate bylaws for GSCH (see Exhibit 4). The current members of the board of directors of GSCH are:

Mr. Paul Tuft, CEO, DCHC (see Exhibit 5)
Mr. Mel Redman, President and COO, DCHC (see Exhibit 5)
Mr. Steve Dietlin, Executive Vice President and CFO, DCHC (see Exhibit 5)

Current Officers of the GSCH corporation are:

Mr. Paul Tuft, President and Treasurer
Ms. Susan Engelhard, Secretary

The corporation's Federal Tax ID number is 86-0973343
The corporation's DUNS number is 87-918-5320

GSCH proposes to create an additional corporate entity, as referred to in this proposal, CHIC. This entity will be a Delaware general corporation with good standing in the District of Columbia. GSCH will own no less than 80% of this company and is considering allowing one or more of its key subcontractors to become a co-owner in the entity. GSCH intends to seek the advice of the Authority and District prior to allowing any ownership interest to be held by additional parties.

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C. Financial Ability

Please see the attached unaudited balance sheets and income statements for the fiscal years ended December 31, 1998, 1999 and 2000 (see Exhibit 6). The 1999 balance sheet was not available for inclusion, as the purchase/sale due to bankruptcy in 1999 inhibited its production. As shown, the earnings before taxes (EBT) has improved from a $48.1 million loss in 1998 and 1999 combined under previous ownership to a profit of $1.6 million in 2000 under current management.

GSCH has had the continuing support of National Century Financial Enterprises (NCFE) since the time NCFE provided DCHC with the funding necessary to purchase GSCH out of bankruptcy in December 1999. NCFE has provided over $300 million in funding to DCHC since 1993 and holds 11.5 percent ownership interest in DCHC's common stock. Please see Exhibit 7 for a letter of support for this proposal from NCFE's chairman, Lance K. Poulsen. NCFE has stated that it is prepared to provide working capital and other funding necessary for the implementation of this proposal.

The $49.7 million turnaround in EBT demonstrated in fiscal 2000 compared with fiscal years 1998 and 1999 combined in conjunction with NCFE's continued commitment to GSCH provides a solid foundation for the implementation of this proposal.

An outline and a proposal with regard to start up and initial capital costs is provided for review and discussion in Volume II: The Cost Proposal.

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III. KEY ADMINISTRATIVE POSITIONS AND STAFFING PLAN

A. Organizational Chart

DC-WACH plans to commit a great deal of experienced and local human resources to this endeavor. The Chief Executive Officer of Greater Southeast Community Hospital, Ms. Ana Raley, will be the CEO of CHIC (see resume, Exhibit E). In addition, Mr. K. Singh Taneja will act as the company's Chief Operating Officer and Chief Financial Officer (see resume, Exhibit 5). DC-WACH proposes to create an advisory board that will act as a "think tank," which will continually review the performance of DC-WACH with regard to the requirements described and agreed to within the RFP. This group of individuals will be expected to provide direction and recommend solutions. Potential advisory board members could include individuals from selected key subcontractors; community members, members of the DC City Council and members of the senior staff of the District's Department of Health. The advisory board will also have the benefit of GSCH's parent organization, Doctors Community Healthcare Corporation, and its team of healthcare management specialists to this project. Specialists in the field of quality assurance, medical management, customer service, accounting, finance, healthcare operations and contract operations will be accessible by the local management team. It is envisioned that DC-WACH will also have an executive director position in which the daily operations of this coalition will be overseen.

DC-WACH also proposes to establish a Physician Advisory Committee (PAC). The chair of this committee will also hold a position on the executive advisory board and the management team. The physician advisory committee will consist of the medical directors of each selected subcontractor (i.e. CCHP, Chartered, Unity, Children's), a representative physician from the District's DOH, the Quality Assurance and ethics director and one or two project medical directors. The following positions or individuals have been selected for service on this committee:

Medical / Clinical Director(s): Elected during first PAC meeting
Subcontractor's medical directors: 4 - 5 MD's
Quality Assurance and Ethics: Dr. Margaret Moon (see Exhibit 5)

Other significant parties who will be involved in this transaction are Mr. Erich Mounce, DCHC's Executive Vice President of Development and Ms. Susan Engelhard, DCHC's General Counsel. Ms. Engelhard will have ultimate responsibility in connection with the negotiation and completion of the contract between GSCH and the Authority / District. In addition, GSCH intends to select the outside local counsel of Epstein Becker and Green to assist in the contracting process. Mr. Mounce and Ms. Engelhard can be contacted as follows:

Erich Mounce
Executive Vice President, Development
DCHC
6730 N. Scottsdale Road, Suite 200
Scottsdale, Arizona 85253
(480) 348-9800
erich.mounce@doctorscommunity.com
Susan Engelhard, Esquire
General Counsel
DCHC
6730 N. Scottsdale Road, Suite 200
Scottsdale, Arizona 85253
(480) 348-9800
Susan.engelhard@doctorscommunity.com

Incorporated into this document as Exhibit 9 is the current GSCH organizational chart. The proposed organizational chart representing the structure and proposed future key administrative positions of DC-WACH is incorporated as Exhibit 9. The DC-WACH CEO will have complete local control over all required decisions making with regard to daily operations.

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B. Staffing Plan

The staffing and selection of employees will be the responsibility of DC-WACH. DC-WACH views the staffing responsibilities as significant and has given a great deal of thought to approaching these issues. To better illustrate the staffing responsibilities, the proposal is broken into equally important categories.

1. Staffing Plan: Outpatient Ambulatory Care Clinics and Dentistry Clinics

DC General Ambulatory Care Clinic Site

The employees of this clinic will be selected and employed by GSCH. It is anticipated for the implementation of this proposal that there will be physician, dentistry, nursing and nonprofessional employee needs with regard to staffing a large ambulatory care clinic. All employees that are current PBC employees will be encouraged to apply. Preference will be given to those qualified PBC employees who apply based solely on the fact that they are current PBC employees. Each employee will be a newly hired employee and will become eligible, according to current GSCH policies, to all GSCH employee benefits as currently structured for similar GSCH employees. The clerical and professional positions required will be submitted to the PBC / District within 30 days of notification of award and or activation of this contract. As this clinic site will be operating under the hospital license of GSCH, DC-WACH will be required to utilize the staffing policies as recommended by the Joint Commission on Accreditation for Hospitals (JCAHO).

Greater Southeast Community Hospital Site

This site will be operated under the terms required by the GSCH license. Therefore, JCAHO minimum requirements for physician and ancillary staffing will be adhered to. Again, this site will provide specific requirements for positions 30 days from notification of award and or activation of this contract. GSCH will give preference to those qualified PBC employees who apply for work at this site based solely on the fact that they are current PBC employees. Each employee will be a newly hired employee and will become eligible, according to current GSCH policies, to all GSCH employee benefits as currently structured for similar GSCH employees.

Hadley Memorial Hospital Site

The provision of ambulatory care for the target population at this site will be delivered via a subcontract with Davachi Community Health Center. This group of physicians currently provides care at the site for patients of all payor categories. This physician group has agreed to subcontract with DC-WACH in order to provide ambulatory care to the eligible target population. This group will increase its staffing as required by volume. Any subcontract between DC-WACH and this group of physicians will require minimum staffing levels for ancillary and physician staff. This physician group has also agreed that it will look to DC-WACH to assist it in locating additional staff as needed. DC-WACH commits that it will provide this group with candidates that are experienced in the capacity required and that preference will be given by DC-WACH to qualified PBC employees.

Children's Hospital Site

Children's National Medical Center currently operates and manages large scale ambulatory care upon its campus. It is anticipated that under this proposal, CNMC will not require significant increases in its staffing to meet the needs of this proposal. However, CNMC does operate its campus-based clinics under its current hospital license. Therefore, CNMC maintains its minimum ancillary and physician staffing requirements in accordance with JCAHO.

2. Staffing Plan: Inpatient Care Services

Greater Southeast Community Hospital Site

This site will be operated under the terms required by the GSCH license. Therefore, JCAHO minimum requirements for physician and ancillary staffing will be adhered to. Again, this site will provide specific requirements for positions 30 days from notification of award and or activation of this contract. GSCH will give preference to those qualified PBC employees who apply for work at this site based solely on the fact that they are current PBC employees. Each employee will be a newly hired employee and will become eligible, according to current GSCH policies, to all GSCH employee benefits as currently structured for similar GSCH employees.

The structure of DC-WACH revolves around the mission to increase reliance upon community-based primary care and specialty care physicians in ambulatory care sites, clinics and private physician offices. Although DC-WACH provides direct contracts with many hospitals through CCHP and Chartered, a direct relationship with CNMC, DC-WACH believes that the majority of required in- and outpatient surgical complex diagnostic care can be adequately handled by GSCH. Therefore, it is anticipated that the bulk of new staffing requirements will be required at GSCH. It is estimated, utilizing the JCAHO requirements and the projections of increased patient admission provided by the District in the RFP, that the following ancillary and nursing positions for inpatient and outpatient hospital care will be required to meet the needs of this proposal.

40 - 50 RNs
20 - 30 LPNs or equivalent
6 -10 Unit Secretaries
20 - 30 Med / Surg technicians
4-5 Housekeepers
2-3 Sterilization Personnel
4 -5 Transport personnel
3-5 Dietary personnel
4-5 Radiation technologists
1-2 Pharmacy technicians
15-20 Additional support staff for therapies, business office, clerical, admission, medical records, etc

Hadley Memorial Hospital Site

This site will be operated under the terms required by the HMH license. Therefore, JCAHO minimum requirements for physician and ancillary staffing for a hospital of this type will be adhered to. Again, this site will provide specific requirements for positions 30 days from notification of award and or activation of this contract. HMH will give preference to those qualified PBC employees who apply for work at this site based solely on the fact that they are current PBC employees. Each employee will be a newly hired employee and will become eligible, according to current HMH policies, to all HMH employee benefits as currently structured for similar employees.

Children's Hospital Site

Children's National Medical Center currently operates and manages large scale inpatient services upon its campus. It is anticipated that under this proposal, CNMC will not require significant increases in its staffing to meet the needs of this proposal. However, CNMC does operate its inpatient acute care services under its current hospital license. Therefore, CNMC maintains its minimum nursing, ancillary and physician staffing requirements in accordance with JCAHO.

It is important not to underestimate the significance of proposing to staff and manage the proposed ambulatory care sites and inpatient acute care hospital sites described throughout this proposals required by the Joint Commission of Accreditation on Healthcare Organizations (JCAHO). JCAHO requirements are dramatically different in scope. Issues such as staffing, physician credentialing, medical records, patient rights, safety issues are all integral to completing a JCAHO survey. DC-WACH will gladly provide, as reference material, an approximately 300 page guide published by the Joint Commission for your review upon request.2 Incorporated into this proposal are the current JCAHO certification for GSCH and the current hospital licensure for GSCH.

School Health Program

Under this proposal, DC-WACH will be providing for the school health program through a subcontract relationship with CNMC or another party. DC-WACH clearly understands its role in this important service. It is anticipated that there will be almost identical staffing ratios for this program under the nursing requirements identified in the RFP and delineated in the memorandum of understanding between the PBC and the DOH. DC-WACH will require that each current PBC employee interested and now employed under this program apply as a new employee of CNMC. DC-WACH commits that preference will be given to those qualified PBC employees who apply for available work positions within this program based solely on the fact that they are current PBC employees.

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IV. DC - WACH WORKPLAN

The purpose of this proposal is to describe the plan that will enhance the District of Columbia's current provision of services for its uninsured population. This proposal is put forth in an effort to provide the District an alternative to maintaining the full service capability of DC General Hospital (DCGH). The ultimate strength and security for the provision of such services, sometimes referred to as part of the District's healthcare Safety Net, is to combine the resources described in this proposal under the DC-WACH Program. The development of a coalition, such as DC-WACH, of successful and committed healthcare providers, as described above, will be extremely successful in creating a new direction in healthcare for the District's uninsured population. GSCH and its local senior management representatives have clearly recognized the District's need to maintain a healthcare Safety Net for the District's residents. GSCH's plan is to maintain the integrity of that Safety Net by providing the eligible target population with a efficient, easily accessible and well managed healthcare provider network.

DC-WACH's Primary Goals:

  1. Assist the District in maintaining the current Safety Net for care to the city's indigent and underinsured.
  2. Provide immediate access for patients in need of inpatient acute care services, including obstetric, pediatric and tertiary care services.
  3. Provide access to hospital outpatient care services, including outpatient surgery.
  4. Dramatically increase the number of primary care and specialty care physician access sites in the communities of Wards 5, 6 and 7.
  5. Provide for the continued access to Urgent, Emergency and Trauma Care Services.

In order to achieve these goals GSCH has developed a plan in which multiple providers and subcontractors participate to ensure a Safety Net. A significant piece of this network consists of GSCH, HMH and CNMC providing all hospital-based inpatient and outpatient care services by replicating all the essential services currently being provided by the PBC. In addition to these inpatient services, DC-WACH proposes to maintain and enhance the operations of the current DC General ambulatory care clinics and the six neighborhood outreach clinics as well as significantly increasing the number of additional sites providing these types of medical services.

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A. Healthcare Services / Access to Care

GSCH believes that one of the major advantages of the DC-WACH proposal is the dramatic increase in physician and ancillary access points provided to the uninsured residents of the District. As a comparison under the current system administered by the PBC, the following physician and ancillary sites are available to the city's uninsured:

1 DC General ambulatory care clinic
6 PBC / neighborhood outreach clinics

Under the proposed DC-WACH plan, healthcare access points increase substantially:

4 Ambulatory care clinic sites with primary, specialty physician care; radiology and laboratory services.
19 Neighborhood outreach clinics (6 current PBC / 13 non-profit)
4 Children outreach community clinics
250 Private primary and specialty care physicians

DC-WACH provides a total of 277. access sites for the eligible uninsured population. The ability for the eligible target population to utilize this network will significantly increase the District's ability to improve the preventive and acute care needs of the poor and uninsured in the District.

DC-WACH's proposed provider network is a combination of several access provider types for the target population. DC-WACH considers primary care providers to be qualified3 physicians and physician extenders in the following specialties:

  • Family Practice
  • Pediatrics
  • General Medicine
  • Internal Medicine
  • Obstetrics and Gynecology

Physicians and physician extenders in each of the above specialties will be utilized as primary care providers within the DC-WACH provider network. The DC-WACH provider network consists of the following:

1. DC-WACH Provider Network: Community-Based Primary Care Services

DC-WACH will include access to 4 full service ambulatory care clinics that provide a range of primary and specialty physician care, urgent care, radiology and laboratory services:

a. Community-Based Primary Care Services: Ambulatory Care Clinics

DC General Site / ACC Building / Ambulatory Care Clinic
Ambulatory Care Center:
1900 Massachusetts Avenue SE, Washington, DC 20003

This site will be maintained and operated as a full service ambulatory care clinic, providing all the current clinic and physician specialty services currently being offered by the PBC. This includes the dentistry, HIV, WIC and Maternal and Child Health.4

This site will also provide 24-hour urgent care, social services and physician referral services to within the DC-WACH provider network.

DC-WACH proposes that this site be housed and operated from the current ACC building at DC General. DC-WACH would enter into a full service lease to occupy this building during the term of the contract. DC-WACH also anticipates that this lease would allow for the utilization of the equipment located in this building, which DC-WACH would have the right to relocate, if necessary, and maintain throughout the term of the lease.

DC-WACH would operate this ambulatory care clinic under the healthcare services license and hospital certification of Greater Southeast Community Hospital or current FQHC requirements. The licensing and certification of this facility as a hospital based ambulatory care clinic will require DC-WACH to maintain all JCAHO quality and operational procedures. In addition, hospital-based ambulatory care clinics required to have specific minimum staffing requirements that would be adhered to during the term of this agreement.

Greater Southeast Community Hospital Site / Ambulatory Care Clinic
1310 Southern Avenue SE, Ward 8, Washington, DC 20032

GSCH proposes to open and operate a full service ambulatory care clinic upon the hospital campus. This clinic will provide for full primary and specialty care services similar to those provided at the DC General site. This would include outpatient cancer therapies, radiation, radiological, pathological and laboratory procedures. Extended hours of walk-in urgent care will also be provided at this site either through a "Fast Track" methodology within the current emergency room or within the new ambulatory care clinic.

DC-WACH would operate this ambulatory care clinic under the healthcare services license and hospital certification of Greater Southeast Community Hospital or the current FQHC requirements. The licensing and certification of this facility as a hospital-based ambulatory care clinic will require DC-WACH to maintain all JCAHO quality and operational procedures. In addition, hospital-based ambulatory care clinics are required to have specific minimum staffing requirements that would be adhered to during the term of this agreement. These specific guidelines require stringent policies and procedures in the performance of patient care and service.

Hadley Memorial Hospital / Ambulatory Care Clinic
4601 Martin Luther King Jr. Avenue SW, Ward 8, Washington, DC 20032

DC-WACH proposes to provide access to the current privately operated full service ambulatory care clinic upon the hospital campus. This clinic will provide for full primary and specialty physician care services consisting of Pediatrics, Internal Medicine, Family Practice, Obstetrics, Gynecology and extended urgent care hours. In addition, routine radiological and laboratory procedures are also accessible.

This site is currently owned and operated by private practice physicians. DC-WACH would subcontract for the services provided at this clinic site through either a direct DC-WACH contract or via a provider contract with Unity Health Care or Capital Community Health Plan.

Children's National Medical Center / Ambulatory Care Clinic
111 Michigan Avenue NW, Washington, DC 20010

DC-WACH proposes to subcontract with Children's National Medical Center to allow access to and operate a full service specialty ambulatory care clinic at Children's National Medical Center. This clinic will provide for full service pediatric primary and specialty care services. This would include access to all outpatient services such as diagnostics, cancer therapies, radiation, radiological, pathological and laboratory procedures. Extended hours for walk-in urgent care will also be provided at this site either through a "Fast Track" methodology within the current emergency room or within ambulatory care clinic.

DC-WACH would provide these services to the eligible target population by entering into a contract with Children's on terms yet to be negotiated. However, preliminary discussions with the Medical Center have resulted in significant interest.

b. Community-Based Primary Care Services: Neighborhood Outreach Clinics

DC-WACH proposes to increase the number of community outreach clinics from the current six Neighborhood Health Centers (current PBC Clinics) to 23 community outreach clinics. Each clinic will provide access to the appropriate eligible target population members. These clinics will be managed by Unity Health Care and Children's National Medical Center. The following clinic sites will be made available:

Current Neighborhood Health Centers:

  1. Anacostia Health Center, Ward 6, 1328 W Street SE, Washington, DC 20020
  2. Congress Heights Health Center, 3720 Martin Luther King Jr. Avenue, SE, Washington, DC 20032
  3. Southwest Health Center, Ward 2, 850 Delaware Avenue, SW, Washington, DC 20024
  4. Hunt Place Health Center, Ward 7, 4130 Hunt Place, NE, Washington, DC 20019
  5. Walker - Jones Health Center, Ward 2, 1100 First Street, NW, Washington, DC 20001
  6. Woodridge Health Center, Ward 5, 2146 24th Place, NE, Washington, DC 20002

Additional Community Outreach Clinics Provided by DC-WACH

DC-WACH proposes to enter into a subcontract relationship with Unity Health Care, Inc. or a similar party such as the Non-Profit Consortium in order to provide both additional clinic sites and operational management. DC-WACH also commits to maintain and operate the current six PBC clinics for the first six months of this contract. During the first six months, DC-WACH and its selected subcontractor reserve the right to re-locate, consolidate or discontinue the operation of any of the six current PBC clinics based on facility. condition and eligible target population utilization. In addition, DC-WACH proposes to begin immediately reviewing with Unity the operational status and feasibility of altering the operating status of the PBC's current clinics to FQHC status.

The selection of the Non-Profit Consortium or Unity Health Care Services as a subcontractor will allow DC-WACH to immediately meet the requirement by the District to ensure proper coordination between private and non-profit clinics. DC-WACH would also have the advantage to quickly assure appropriate coordination of patient referrals and patient demographic and care data.

DC-WACH also proposes to enter into full service lease arrangements with the District of Columbia, for the use of the current PBC clinics. However, lease terms and commitments to each site will be dependent upon the ability of DC-WACH and the District to come to terms with the significant need for repairs at each site. DC-WACH is open to developing a working plan with the District in order to minimize overall capital improvement needs by consolidating, relocating or discontinuing clinics where services may become duplicative as a result of the implementation of this proposal and the increased number of access points provided by DC-WACH. However, DC-WACH as a lessee of each PBC clinic site anticipates that the District commits the appropriate funds to capital improvements, as detailed in Volume II: The Cost Proposal for any of these PBC clinics that cannot be duplicated or relocated by this plan.

Following is a list of the additional community outreach clinics proposed to be provided by DC-WACH:

Unity Health Care, Inc. Clinic Sites

  1. Upper Cardozo Health Center, 3020 14th Street, NW, Washington, DCC 20009
  2. East of the River Health Center, 5929 East Capital Street, SE, Washington, DC 20019
  3. Bethlehem Clinic, 2041 Martin Luther King Avenue, SE, Washington, DC 20020
  4. Woodland Terrace Clinic, 2702 1/2 Langston Street, SE, Washington, DC 20020
  5. Federal City Shelter Clinic, 425 Second Street, NW, Washington, DC 20001
  6. BID Clinic, 945 G Street, NW, Washington, DC 20001
  7. Blair Shelter Clinic, 635 I Street, NE, Washington, DC 20002
  8. Central Union Mission Clinic, 1631 14th Street, Washington, DC 20009
  9. Christ House Health Services, 1717 Columbia Road, NW, Washington, DC 20009
  10. Day Center, 1309 Rhode Island Avenue, NE, Washington, DC 20018
  11. Emery Shelter, 1725 Lincoln Drive, NE, Washington, DC 20002
  12. Friendship Place Clinic, 4713 Wisconsin Avenue, NW, Washington, DC 20016
  13. House of Ruth Clinic, 651 10th Street, NE, Washington, DC 20002

Children's National Medical Center: Off Campus Clinic Sites

  1. Children's Health Center, Adams Morgan Ward, Dorchester House, 1630 Euclid Street, NW, Washington, DC 20009
  2. Children's Health Center, Good Hope Road, Ward, 2501 Good Hope Road SE, Washington, DC 20020
  3. Children's Health Center, Martin Luther King, Jr., Ward 8, 4605 Martin Luther King Jr. Avenue, SW, Washington, DC 20032
  4. Children's Health Center, Shaw (Comp) Ward, 2220 11th Street NW, Washington, DC 20001

DC-WACH would provide these services to the eligible target population by entering into a contract with Children's on terms yet to be negotiated. However, preliminary discussions with the Medical Center have resulted in significant interest.

c. Community-Based Primary Care Services: Private Practice Network

DC-WACH's commitment to the District requirement for increasing community access to primary care and specialty services is most evident in our proposal to increase the eligible target population's access to more than 50 private practice primary care physicians and 100 private specialty physicians in Wards 5, 6 and 7 and more than 100 primary care and 250 private practice specialties throughout the District.

DC-WACH proposes to form a subcontract relationship with at least one, if not more of the following Medicaid HMO physician provider networks: CCHP, CHP and HRHMO. As of the date of this response CHP and CCHP have signaled the strongest commitment to develop a subcontracting relationship with DC-WACH to provide access to its entire physician provider network. This subcontracting relationship would place the private practice offices of more than 300 physicians into DC-WACH's dedicated network and commitment to serve the eligible target population.

In addition to these HMO providers, further development of the coalition is currently under negotiation in an effort to provide the eligible target population with additional choices of physician networks. DC-WACH feels strongly that participation by other networks will allow for easier coordination and enrollment with Medicaid.

All provider subcontracts that are described within this proposal will be subject to review and approval by the District and would specify detailed provision of services, hours of operation, physician and ancillary staffing ratios, QI/QA requirements, insurance requirements and termination procedures.

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2. DC-WACH Provider Network: Inpatient Care Services

DC -WACH proposes to provide inpatient healthcare services at two full service acute care hospitals and one specialty care hospital. Each of these hospitals has current full accreditation by JCAHO, licensure by the District of Columbia and are approved providers for the Medicare and Medicaid patients. (See Exhibit 4).

Greater Southeast Community Hospital

DC-WACH proposes to provide the majority of primary and specialty inpatient hospital care at Greater Southeast Community Hospital (GSCH). GSCH has a long history of providing inpatient and outpatient care to the indigent and needy of Wards 7 and 8. Currently, GSCH has the ability to increase its inpatient bed availability to 442 from 266; upon 60 - 90 days advanced notice. This increase in capacity will easily allow for GSCH to handle the anticipated inpatient census resulting from the implementation of this plan. GSCH is also capable of providing all required inpatient and outpatient surgery, obstetric services, cancer therapy services and routine pediatric care. Any service currently offered by GSCH to its patients would be offered in kind to any eligible member of the target population.

Upon award of this contract, GSCH bed allocation will be as follows:

280 Medical Surgical beds, including

20 Intermediate care beds
20 Telemetry beds

20 ICU / CCU beds
20 NICU level II beds
28 Labor & Delivery beds
44 Bassinets
10 Pediatric beds
20 Psychiatric beds
20 Rehabilitation beds
442 TOTAL

GSCH currently utilizes only 6 of its 11 operating rooms. GSCH has committed to DC-WACH that it can dedicate these rooms to both the inpatient and outpatient needs of this program. In reviewing volume statistics provided by the PBC and the DOH, this would provide sufficient capacity for eligible target population.

DC-WACH proposes entering into a subcontract relationship with GSCH that will require that the hospital provide the services described above. In addition, this subcontract relationship will delineate the cost of each including hospital-based physician services: Any subcontract would be subject to review by the District and would specify payment mechanisms, reporting requirements, QI/QA requirements and insurance requirements.

Hadley Memorial Hospital

DC-WACH proposes to provide Skilled Nursing Facility services (SNF) and Long Term Acute Care Services (LTAC) hospital care at Hadley Memorial Hospital (HMH). HMH has a tremendous history of serving the needs of Ward 8 residents. Any service currently offered by HMH to its patients would be offered in kind to any eligible member of the target population.

Upon award of this contract, the HMH bed allocation will be as follows:

103 SNF beds
45 LTAC beds

DC-WACH proposes entering into a subcontract relationship with HMH that will require that the hospital provide the services described above. In addition, this subcontract relationship will delineate the cost of each service including hospital-based physician services. Any subcontract would be subject to review by the District and would specify payment mechanisms, reporting requirements, QI/QA requirements, and insurance requirements.

Children's National Medical Center

DC-WACH proposes to provide access to Children's National Medical Center for inpatient care. Although targeted mainly for tertiary care services, each physician will be able to direct patients to the most accessible and able facility for child members of the eligible target population. Children's National Medical Center is a full service acute care tertiary care facility that has the capacity to maintain an inpatient census of more than 900. The access to this facility will also provide for hospital-based specialty and faculty staff physicians to treat severely ill children who are members of the eligible target population.

DC-WACH would provide these services to the eligible target population by entering into a contract with CNMC on terms yet to be negotiated. However, preliminary discussions with the CNMC have resulted in significant interest. As evidence of this support, we have provided a letter of interest from CNMC for your review. (See Exhibit 3). Any subcontract would be subject to review by the District and would specify physician and ancillary staffing, QI/QA requirements and insurance requirements.

Tertiary Care Services

DC-WACH proposes to provide as its Safety Net five additional acute care facilities through its direct relationships or subcontracts with one or more of the identified HMO networks. DC-WACH plans to include these hospitals within its network of safety net providers:

  • Howard University Hospital
  • George Washington University Hospital
  • Washington Hospital Center
  • Georgetown Hospital
  • Providence Hospital

DC-WACH proposes that tertiary care services that cannot be provided at GSCH, HMH or CNMC would be provided at one of these facilities. Examples of these services would be transplant services, burn care and open heart procedures. Services provided to eligible target population members appropriately referred to these facilities will be the financial responsibility of DC-WACH. In addition eligible target population patients who are admitted for authorized or emergent inpatient services through emergency rooms at facilities other than GSCH, HMH or CNMC will be the financial responsibility of DC-WACH. However, DC-WACH will arrange for the appropriate transfer of these patients, if medically stable, to GSCH, HMH or CNMC. DC-WACH reserves the right to concentrate its tertiary services at one or more of the facilities above.

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3. Emergency Services

DC-WACH's primary hospital providers all provide urgent care and full service emergency room care or a combination of both. GSCH has the ability to absorb a significant portion of the current emergency room visits currently provided by DC General Hospital. DC-WACH's plan, as described earlier, provides for 24-hour urgent care services on site at DC General. In addition, both HMH and GSCH will provide extended urgent care hours. CNMC will also provide 24-hour urgent and emergency care services for pediatric patients. DC-WACH's plan provides 6 contracted emergency and urgent care sites in addition to those currently provided.

Target Population's current access sites to Emergency Care Services:

  • DC General Hospital

Target Population's Emergency Care Services under DC-WACH's plan:

  • DC General Ambulatory Care Site - 24-hour urgent care, physicians on site
  • Greater Southeast Community Hospital - 24-hour full service emergency room with urgent care, physicians on site, specialty physicians on mandatory call
  • Hadley Memorial Hospital - Expanded Urgent Care hours via the HMH ambulatory care providers. Projected hours will be 8:00 a.m. to 8:00 p.m. M-F and 9:00 a.m. - 5:00 p.m. on Saturdays
  • Children's National Medical Center - 24-hour full service emergency services - physicians on site
  • George Washington University Hospital Emergency Room
  • Washington Hospital Center Emergency Room

Of course, as with inpatient care, DC-WACH will provide for a Safety Net of local emergency rooms. This safety will be provided through the subcontracting relationship established with one of the identified HMO provider networks. Upon presentation at any of these contracted emergency rooms, DC-WACH will be financially responsible for all eligible target population members.

Tertiary Care Trauma services will be provided for in the following fashion. Currently, if a patient meets the District of Columbia Department of Health Service's trauma center transport criteria, the EMS authority is mandated to transport patients to the appropriate designated trauma center, unless transport time exceeds 30 minutes. DC-WACH proposes to enter into a subcontracting relationship with George Washington University Trauma Center and other local Level I designated trauma centers to accept patients who would have traditionally been transported to DC General Hospital. The District's statistics reflect a total of 821 "code yellow" trauma patients for the year. Capacity to meet this need is available at these facilities.

Patients who meet extremist criteria must always be transported by the EMS authority to the closest licensed emergency room. Again, eligible target population members would be provided for under the provider network contracts.

Of course, GSCH and DC-WACH are interested in providing all of the District's residents with a stable and well-managed trauma system. It is the understanding of GSCH that a plan for additional EMS ambulance resources has been developed by the DC Department of Health. GSCH and the DC-WACH affiliates would agree that additional ambulances located in the immediate area of DC General will also maintain minimum transport times to emergency rooms, regardless of the type of emergency. Therefore, DC-WACH recommends that the city closely review the implementation of the additional resources.

As a final consideration, GSCH will agree to become a Level I designated trauma center under the following circumstances:

  1. Award of this contract
  2. Agreement on the financial considerations detailed in Volume II.
  3. Agreement to negotiate and review the addition of EMS ambulance resource as described above.

4. Coordination of Care / Referral Management

DC-WACH proposes to have mandatory coordination of services from its own clinics as well as those subcontracted to other parties. All specialty physicians who are not categorized as primary care physicians within this RFP will be required to coordinate care with the members selected or referring primary care physician. Physicians or facilities providing care to members will be required, as they are for almost all other patients, to submit reports and results of test back to the primary care physicians.

Eligible patients presenting in primary care sites that require referral to other services will be referred by primary care providers. These providers will be required to submit such referrals, for tracking purposes only, to DC-WACH for referral management. All inpatient and hospital outpatient services will be reviewed in accordance with DC-WACH's utilization and care management plans.

Emergency service providers within the District will each be provided with referral rosters for members who need follow-up care once discharged from an emergency room. Emergency service providers will be educated on how to refer eligible patients back to any one of the primary care sites or the patients selected primary care provider.

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5. School Health Services

DC-WACH proposes that CNMC will provide for the administration of the current School Health Program. The program will be administered under similar terms as outlined in the Memorandum of Understanding between the PBC and DOH. However, DC-WACH
would like to reserve the right to review this document and renegotiate terms directly with DOH.

DC-WACH recognizes that the program provides care to 147 schools and that the program focuses on preventive health services and referrals, when needed, to the appropriate agency. CNMC, as a committed and proven District provider of healthcare and services to children, is committed to managing the program to a high standard and meeting the needs of the District's pupils. CNMCs strong managerial and community experience will also be a catalyst in developing strong relationships with the District's public school administration and parent-teacher community programs. DC-WACH also proposes that a member from the DC Public School system be appointed to the DC-WACH advisory board.

DC-WACH would provide these services to the eligible target population by entering into a contract with CNMCs on terms yet to be negotiated. However, preliminary discussions with the CNMC have resulted in significant interest. As evidence of this support, we have provided a letter of interest from CNMCs for your review. (See Exhibit 3).

6. Dentistry Care Services

DC-WACH proposes to provide to the eligible target population comprehensive diagnostic, preventive, therapeutic and emergency dental services to adults and children. This service will be available to both outpatients and inpatients as required. The dental program offered by DC-WACH will be providing the eligible target population with the following services:

  1. Twenty-four hour emergency maxillofacial services
  2. Comprehensive general dentistry services to medically compromised patients with special needs
  3. Diagnostic, preventive and therapeutic periodontal services
  4. Comprehensive pediatric dental services for all children
  5. Ambulatory adult and pediatric anesthesia dental procedures
  6. Maxillofacial prosthodontics for patients requiring oral facial reconstruction and prosthesis
  7. Endodontic services necessary to support restorative treatment of patients
  8. Comprehensive dental services for oncology

DC-WACH will provide for these services either by directly managing a program similar in nature or subcontracting to a provider or provider network. Any subcontract will meet the requirements itemized in this proposal and be subject to review by the District. It is the intent of DC-WACH to provide dental services through additional access sites. Additional dental care sites will be provided for via contractual relationships with potential coalition members such as CNMC, CCHP, CHP and or UHC. In either case, it is the intent of DC-WACH to provide more access points to the eligible target population. DC-WACH will provide dental services, at a minimum, at the current level now being offered by the PBC.

The only limitations to the dental services program will be by benefit design. That is, services provided are to be limited to those services currently provided for under the program. DC-WACH would seek clarification of the specific services that are required prior to execution of this contract.

7. Miscellaneous Healthcare Programs

DC-WACH proposes to maintain the current block grant programs now in place. DC-WACH will provide for the operations and management of these program's through subcontracts directly with one or both of the following nonprofit providers:

  1. Children's National Medical Center
  2. Unity Health Care, Inc.

The operational and management services provided will be for the following block grant programs:

  1. WIC Program
  2. HIV
  3. Maternal and Child Health
  4. Day Care Program

To the extent possible, depending on block grant requirements, DC-WACH will operate these grants at locations within the proposed ambulatory care or inpatient sites.

DC-WACH would provide these services to the eligible target population by entering into a contract with Unity Health Care and or Children's on terms yet to be negotiated. However, preliminary discussions with the CNMC have resulted in significant interest.

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8. Mental Health / Substance Abuse

DC-WACH views this service as highly integral to any comprehensive care program for the uninsured. Therefore, DC-WACH would be interested in meeting separately with the District and DOH after the successful implementation of the plan outlined in this response.

Regardless of the outcome of any future discussions, DC-WACH will provide for the timely referrals and integration of these patients into the District's current mental health and substance abuse service network.

9. Corrections

DC-WACH will assist in the coordination, referral and planning of services utilized by the department of corrections and its designated contractor. DC-WACH would also very much like to meet with the District and the Department of Corrections in order to offer access to specific components of the DC-WACH system. Specifically, GSCH and HMH would be interested in discussions that would enable these facilities to provide inpatient and outpatient care to this population.

10. Long Term Care / Long Term Rehabilitation

DC-WACH will assist in the coordination, referral and planning of these services for the District. Again, specific components of DC-WACH, specifically HMH is in an excellent position to offer these specialized services.

11. Additional Considerations

Community-Based Primary Care Clinics:

DC-WACH proposes to conduct all enrollment, eligibility, data initiation and referral management from these clinics. Specifically, all members eligible within the target population must, unless unable due to medical condition, be seen at one of the enrollment/ eligibility sites described as a community clinic above. It is at these locations that patients will complete eligibility and enrollment applications and be educated and provided with materials on the DC-WACH coalition.

Each member will be provided an eligibility card that is utilized during the first sixty days of eligibility verification. All providers within the coalition will be available for access as referred or assigned once members have possession of this temporary card. If applications and all verification procedures are completed to the requirements of the District and the provider, then members will receive permanent cards that will be used until the member is no longer eligible. Each provider site within the DC-WACH coalition will be held responsible for having eligible members present an eligibility card and confirm eligibility by signing an affidavit as to still meeting financial and resident eligible requirements. Providers that do not complete this process will not receive payment for services under this program.

Patients presenting for the first time at the ambulatory or community clinic sites will also be encouraged to select a primary care provider. Each site will provide potential eligible members with easy to understand materials about eligibility, increased access / physician sites and preventive health services.

Transportation Issues:

DC-WACH also proposes to provide an easily accessible van transportation network that will provide transportation for patients with no transportation resources. This program will be developed in concert with the District's plan to provide additional EMS / Ambulance resources. Van transportation will be provided from the neighborhood clinics to and from the DC General ambulatory care site and GSCH.

Pharmacy Issues:

DC-WACH will work with the District in order to develop a comprehensive pharmacy program for the eligible target population. Currently this is not addressed in the RFP. However, DC-WACH is eager to develop a plan that can better the healthcare for this population. DC-WACH believes that its all encompassing provider network and pharmacy providers could indeed offer the District a valuable and high quality service.

Renal Care Issues:

DC-WACH believes that it will maintain its current compliment of 8 inpatient and 4 outpatient dialysis beds at GSCH. In addition, DC-WACH is working toward a new plan that would re-allocate specific beds now under the operation of a private dialysis company in the District. This company currently provides these services near DC General, HMH and GSCH. It is our hope to develop a coordinated plan that meets the needs of the renal disease population while working in concert with the District's DOH.

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B. Administrative Services

1. Enrollment & Eligibility

DC-WACH proposes to enter into a subcontractual relationship with CHP, CCHP or a similar vendor capable of providing the myriad of management information tools for standard HMO management services, which include enrollment and eligibility. Other potential vendors such as HRHMO have expressed an interest in providing these services. DC-WACH strongly believes that the MIS component is a significant aspect of this proposal. Therefore, DC-WACH is carefully considering and evaluating the systems and their capabilities of both CCHP and CHP. Both companies have different information technology models which provide advantages to DC-WACH. In any case, DC-WACH clearly understands and commits to the provision of data collection and reporting. It is DC-WACH's intent to provide the following services:

  1. Enrollment and specialized data gathering (i.e. the development and maintenance of a target population database)
  2. Enrollment procedures as defined by the Authority and DOH
  3. Eligibility verification and maintenance and conduct verification of eligibility as defined in the RFP
  4. Eligibility documentation to all subcontracted providers
  5. The issuance of member ID cards
  6. Authorization and referral services
  7. Inpatient and outpatient utilization management
  8. Discharge planning
  9. Claims management including verification of eligibility, authorization and payment processing
  10. Coordination of Benefits
  11. Quality Assurance in coordination with DC-WACH quality assurance plan
  12. Required data reporting
  13. Customer and patient services
  14. Coordination with Medicaid
  15. Assistance in enrollment in Medicaid

It is clearly understood that the DC-WACH will manage the patients within this program similar to a managed Medicaid program. Current local Medicaid HMO providers as well as companies like CHP's and United HealthCare's experience with such programs have already been proven successful in the District.

DC-WACH proposes that it would establish enrollment / eligibility sites at the four ambulatory care sites, each full time neighborhood health center and each full service primary care hospital (GSCH, HMH, CNMC).

2. Establishment of Residency Status

Each uninsured patient who presents him or herself to any access site of DC-WACH will be subject to eligibility criteria that is developed and agreed to by the District of Columbia. Current eligibility criteria submitted with the RFP requires each potential enrollee to be a "bona fide" District resident. DC-WACH proposes that it will make every attempt to verify resident status using standard techniques. Examples of these techniques are:

  1. Utility bills
  2. Tax bills
  3. Verification by US Mail
  4. Phone verification

3. Provider Network

A partnership with CHP, CCHP or similar provider network provides DC-WACH with access to more than 300 primary and specialty care physicians. In addition to physician providers and extenders, these networks offer multiple dentistry sites, vision centers and other ancillary providers. These networks also will provide DC-WACH with safety net contracts at every acute care hospital within the District of Columbia. These current networks, which provide care to the District's Medicaid participants, are eager to tie into this population segment. Specifically, the providers and patients will have a real continuum of care as members move from the uninsured product into Medicaid or visa versa. It is important to note here the importance of the need to clarify the benefit structure for this program, especially when it comes to the provision of dentistry, vision, ancillary and durable medical equipment (DME).

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4. Customer / Patient Services

DC-WACH's proposed relationship with CHP or CCHP or a similar provider will require the provision of quality customer and patient services. Each named HMO management company has approved existing policies and procedures for these services will provide for educated and experienced staff in dealing with patients and contracting providers.

5. Coordination with Medicaid

Each of DC-WACH's subcontract relationships with its partners will require that each entity provide coordination and enrollment services with the District. Currently each partner has significant experience in this endeavor. GSCH, HMH and CNMC each actively coordinate and enroll patients that meet eligibility requirements for Medicaid. This process begins for identified individuals in the emergency room and outpatient centers. DC-WACH proposes to continue these identification and enrollment services at each partner's site of responsibility.

6. Maintenance of Effort

GSCH and HMH commit to maintaining the current uncompensated care policies now in effect. DC-WACH proposes requiring a similar commitment in any direct contract language for other acute care hospital partners of DC-WACH. Please see Exhibit 8 for GSCH and HMH's current uncompensated care policies.

7. Management Information System

GSCH and HMH currently both have excellent management information systems (HBOC Star and Meditech) that can prepare all required encounter and experience data such as UB-92, HCFA 1500's and utilization management information. DC-WACH will require each subcontractor to provide such data in appropriate formats as required by the city and DC-WACH. DC-WACH is confident that each of its potential subcontractors have the capability to supply data for patient utilization, patient cost and demographic information in an electronic format.

8. Prior Authorization / Utilization Management

DC-WACH proposes to utilize the utilization and authorization management plans of its selected HMO management services vendor. These plans will be customized to meet the needs of the eligible target population. The ultimate medical authority for authorizations and utilization management will be the Medical Director and the associated Physician Advisory Committee. DC-WACH anticipates over the course of the first year of this program implementing specific procedures and specialty referrals that will require authorization or authorization review. DC-WACH strongly believes that the immediate implementation of a closed referral authorization program will be confusing and a potential barrier for entry to care. However, DC-WACH does understand the direction the District hopes to take this uninsured program. That is, over the maturity of this contract, that a formal utilization referral program for outpatient specialty and diagnostic procedures is implemented. Procedures such as MRIs, CTs and other high end diagnostics or referrals will ultimately require prior authorization. DC-WACH strongly believes that the specifics of this program, including the use non-referred second opinions, need to be developed by DC-WACH, PAC and the District's DOH.

Authorization and concurrent review of hospital inpatient and outpatient care will begin immediately upon implementation of this contract. All surgeries and admissions will be reviewed and authorized prospectively, concurrently and retrospectively by the DC-WACH PAC. The mechanics of data reporting and daily hospital inpatient utilization, case management and discharge planning will be conducted by the selected HMO services vendor. Any such contract will require that the vendor use nationally recognized guidelines, such as Millman and Roberts, for the basis of any inpatient case management services.

Benefit management will also be required of any selected HMO service vendor. It is subject to the benefits mandated by this RFP. DC-WACH will require, however some determination of a benefit plan by the Authority and the District. Items such as Durable Medical Equipment (DME), home oxygen, home healthcare and other such services are not specifically mentioned or accounted for within this RFP.

Any utilization and authorization plan will be overseen by the DC-WACH, PAC and quality subcommittees. The establishment of any referral and formal utilization management program must and will assure timely access and must not be perceived or act as a barrier to care.

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9. Quality Improvement

Each affiliate of DC-WACH, GSCH and its parent organization DCHC is strongly committed to quality assurance and improvement. Along with the standard HMO management services quality components that include physician credentialing, timely access and customer services, DC-WACH proposes to overlay the entire uninsured plan with a comprehensive quality improvement and assurance program

DC-WACH, through its senior management, executive advisory board and PAC, is dedicated to the provision of quality healthcare that is effective, safe and consistent with achievable goals and available resources. In order to ensure consistently high-quality care the program will systematically monitor, evaluate and improve its patient care. All quality improvement activities will be targeted toward the program's prioritized goals and those systems and processes most critical to achieving those goals. In evaluating systems and processes, the following dimensions will be included: access to care and timely availability of required services, appropriateness of care both with regard to the patient's needs and the District's public health goals, effectiveness and efficiency of diagnosis and treatment, safety and patient satisfaction. The following functional areas are included in the quality improvement program:

  • Departmental Performance Measurement
  • Medical Staff Performance Measurement
  • Patient Satisfaction and Patient's Rights
  • Utilization Management
  • Risk Management and Patient Safety
  • Outcomes Measurement
  • Community Outreach

Accountability and Responsibility

The final authority and responsibility to ensure optimal quality and achievement of the program's goals rests with DCHC through GSCG and DC-WACH. The program's management commits to ongoing analysis of the program's quality, outcomes and progress toward defined goals. DC-WACH and its affiliates propose to create and support a Quality Improvement Council (QIC) to continually assess and improve the performance of the program.

Composition of Quality Improvement Council:

DC-WACH Medical Directors
DC-WACH CEO
DC-WACH CFO
DC-WACH Program manager
Representatives from each significant subcontractor
Administrator, School-based Clinics
Director, Nursing (Clinical Staff)
Director, Quality and Risk Management
Director, Information Management / Medical Records
Director, Patient Services / Social Work
Director, Utilization Management
Representative, DC Dept. of Health

Priorities for quality improvement will be established by the QIC. The District's established public health agenda will be a primary consideration in the prioritization process as will be aspects of the Healthy People 2010 report.

Goals:

  • Optimize the care of the District's most vulnerable patient population by assessing and improving the processes and systems that most affect outcomes
  • Protect the safety net aspects of the program while furthering DC's commitment to Healthy People 2010 goals.

Objectives:

  • Assess the current status of the program's target patient population
  • Conduct ongoing assessments of indicators and identify processes with the greatest impact on key outcomes.
  • Prioritize quality improvement agenda to reflect patient needs, program resources and established public health goals. Organize quality improvement activities.
  • Measure outcomes of those activities.

Scope:

  • Medical Staff (primary providers: Physicians, NPs): The following key Medical Staff organization systems, processes and functions are carried out. The QIC receives quarterly reports from the Medical Staff on

    Credentialing
    Performance evaluation and utilization management
    Peer review
    Medical record review
    Clinical risk management

  • Patient Services / Patients Rights
    Patient satisfaction surveys will be incorporated into all patient service areas. Results of surveys are collected, analyzed, trended and reported quarterly to the QIC. Problem areas will be identified and action plans made to correct system deficiencies.
  • Public Health
    The program's progress on the key Healthy People 2010 indicators will be assessed annually. Reports will be made to the QIC and to the DC DOH.
  • Inpatient Services / Emergency Services / Community Health Clinics/ Ambulatory Clinics / School Health Services / Dentistry
    The Director of each service sector is responsible for including the specific service activities in the quality improvement system of the organization. Each service sector participates in the following:
    • Identification of key aspects of care relative to program goals and objectives
    • Identification of indicators used to monitor the quality of these aspects of care
    • Evaluation of the quality of care
    • Findings, conclusions and action plans are communicated to the service sector staff
    • Summary reports are sent as required to the QIC

The goal of the QI program for DC's uninsured is to foster improvement throughout the system, ensure that care is responsive to needs of the patients and protect the safety net aspects of the system. Quality demands both doing the right thing for the uninsured in the District of Columbia and doing it well.

Program components:

  • Analyze current and ongoing performance on a range of potential quality problems - program must be data driven to provide well-motivated people timely information to improve their practice
  • Select areas for priority attention based on potential health impact, community needs regulatory demands and organizational resources.
  • Foster and sustain improvement throughout system in a manner acceptable to providers and patients, including positive incentives and system support rather than negatives.
  • Improve patient and population based outcomes (status of key indicators) in a measurable way.
  • Include patient and public by a) including community input into priority setting and definition of key indicators and goals, b) providing mechanisms to respond to patient concerns and suggestions and c) by communicating with community about progress.

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10. Reporting Requirements

DC-WACH will be able to comply with the reporting requirements delineated in the RFP. Currently each subcontracting entity provides this information directly to various payers and review organizations. DC-WACH does believe, however, that a cure period for non-compliance of reporting should be introduced into the contract prior to the deduction or penalty against any payment.

11. Performance Standards

DC-WACH proposes that it be held accountable for standards developed jointly with the Authority and the District's DOH. However, DC-WACH and its coalition partners are concerned that the proposed standards are not based on any substantiated base line. Therefore, DC-WACH proposes developing a base line for the standards outlined in the RFP as well as additional standards as developed by the executive advisory board and the PAC.

Once base line numbers or statistics have been established and agreed to, DC-WACH would agree to be held to improving these standards. In addition, by virtue of this proposal, DC-WACH has already exceeded some of these standards dramatically. For example, increasing access to primary care physician sites. This proposal increases the number of these sites from 7 to well over 150. Given this early commitment to meeting or exceeding such standards, DC-WACH proposes restructuring the incentives and penalties of this section of the RFP. Issues that need to be negotiated are the definition of "inappropriate hospitalizations," the definition of preventive health exams and other such specifics that DC-WACH feels are important determinants in any base line standard.

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C. Consideration of New Acute Care Hospital Facility

DC-WACH proposes that it will analyze and review the need for a new acute care facility to be constructed upon the DC General campus. During the implementation and execution of this contract, DC-WACH will propose to review utilization and cost data that will give significant insight into the feasibility of financing the construction and operation of a community oriented acute care hospital upon the current DC General site within the next three to five years. DC-WACH will provide a report of these findings no less than 24 months after the execution of this contract.

D. Residency Commitment

GSCH and its parent company are committed to residency programs and the significant educational need for such programs among this population. Therefore, GSCH would gladly agree to meet with the sponsor of the current residents now working and learning at DCGH in order to have all or some of these residency programs continued at GSCH and HMH.

E. Cultural and Linguistic Competence

GSCH is not only aware of the economic, ethnic, racial, social, special needs, cultural, linguistic and community climate of the target population, but experienced in identifying healthcare needs and increasing access to care in underserved areas. We understand the considerable challenge of developing measurable, culturally sensitive and cost effective healthcare services, including primary and specialty care, emergency services, healthcare finances and effective community outreach. As will be demonstrated throughout the following proposal, DC-WACH is committed to the cultural and linguistic diversity of the District. In order to meet these important issues with an effective plan, DC-WACH has committed to adopting the National Standards for Culturally and Linguistically Appropriate Health Care. These standards are provided for your review in Exhibit 2.

GSCH will function in accordance with these standards and through these standards commit to monitor and evaluate cultural appropriateness and identify opportunities for improvements within every aspect of the DC-WACH program

In conclusion, DC-WACH feels that the proposal detailed in this response to RFP # DCFRA 008-039 is in the best interest of the Authority and the District. The eligible target population will receive increased access to hundreds of physician and ancillary providers now available to insured patients. DC-WACH is in the process of developing a committed community coalition of healthcare providers who provide experienced, local operations that are already present in the community. These providers are dedicated to this program and committed to work with the District's DOH in order to achieve high quality medical care and provide data to assure adherence to medical standards and public health. DC-WACH offers the District and the Authority a viable and effective alternative in providing care to the District's uninsured and public schools.

DC-WACH stands ready to meet with the Authority and the District in order to negotiate the contractual terms of this proposal.

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1. Prepared by Resources for Cross Cultural Healthcare at the Request of the Department of Health and Human Services of Minority Health.

2. Joint Commission Publishers, "Standards for Ambulatory Care 2000 - 2001" Joint Commission on Accreditation of Healthcare Organizations, 285 pages.

3. Qualified is defined as board eligible or board certified physicians who meet the credentialing requirements of GSCH.

4. These programs are proposed to be managed by a coalition of Children's National Medical Center and Unity Health Care.

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