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Ivan Walks, Chief Health Officer
Testimony to the Committee on Health and Human Services
June 22, 2001

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GOVERNMENT OF THE DISTRICT OF COLUMBIA
Department of Health
Office of the Director
825 North Capitol Street, N.E., Suite 4400, Washington, D.C. 20002 (202) 442-5999 FAX (202) 442-479

Committee on Human Services
Council of the District of Columbia
Hearing on the Status of the DC Healthcare Alliance Transition

Testimony Delivered by Ivan C.A. Walks, MD
Chief Health Officer and
Director, Department of Health
Washington, DC

On April 30 2001, the District began a new era in the delivery of health services to the District's low income, uninsured residents with the finalization of the DC Healthcare Alliance contract. Over the past two months the transition has moved ahead efficiently.

Status of System and Services During Transition

Throughout the transition DC General Hospital, the Ambulatory Care Center, and community health centers have continued to provide primary and specialty care services. DC General's emergency room, while it has periodically been closed to ambulances (a situation also occurring in most other District hospitals during the same period) has remained open to walk-ins and is currently open to ambulance transports. Over the long haul, DC General's ER will continue to receive EMS transports.

The nearly 2 months since the contract went into effect, though condensed, have been extremely productive. Some of the objectives completed during this period include:

The Healthcare Safety Net-Administration has been established within the Department of Health to carry-out contract monitoring and management functions.
Employee transition support services including job fairs, an onsite employee assistance center and one-on-one support services have been provided. The center located at DC General will begin having evening and weekend hours on Monday, June 25.
Each of the Alliance partners have expanded their capacity and have begun to take over functions formerly provided by the PBC.
Arrangements for maintenance of special programs and services including inpatient care for Corrections' patients, school health, the Phoenix center for HIV patients, and prescription coverage are in place. Greater Southeast is completing construction of a locked unit for prisoners requiring inpatient care. Until this unit is complete, GSCH will provide secure care for these patients.
EMS services have been expanded. Two new ACLS-equipped ambulances, that are not in the 911 system, are now stationed at DC General. While these vehicles are available to respond to emergencies in the immediate area of DC General, their primary function is to transport patients from the DC General ER, who require more extensive care, to Greater Southeast Community Hospital, Children's National Medical Center, George Washington University Hospital, and other facilities as necessary. At least 3 additional new ambulances will be stationed at locations throughout the Eastern part of the District to ensure that enhanced EMS patient stabilization and transport services will be in place. New protocols have been developed to guide the operation of the 24-hour emergency room at DC General and EMS transports. These will take effect within the Alliance system and District government by Monday, July 2, 2001.
The DC Alliance enrollment process has been developed and implemented and materials have been mailed to 45,000 District residents.
Also during the transition, Greater Southeast assumed responsibility for some of the hospital services historically provided by the PBC. During May, 40 med/surg. patients were transferred to Greater Southeast - 10 of these patients where uninsured. On May 15, 2001, Greater Southeast also took over the delivery of mammography services.

Major Milestones in Service Transition have been Achieved

One of the most significant challenges facing the DC General had been the continued delivery of services that few consumers utilized. The low utilization not only contributed to the institution's financial instability but it also jeopardized the quality of care. For this reason, on May 18, 2001, all pediatric inpatient services were transferred to Children's National Medical Center and OB delivery care was transferred to Greater Southeast.

The next major milestone was achieved when on June 15, 2001, with transfer of inpatient admissions to Greater Southeast and its Alliance partners. On Monday, June 25, 2001, will the initiation of summer school, Children's National Medical Center will begin providing school health services. Transfer of DC General's remaining inpatients will be also be completed by June 25. The Alliance will assume full responsibility for the delivery of healthcare safety net services on Monday, July 2, 2001.

These dates reflect an expedited transition timeframe necessitated by the pending departure of DC General's residents. Dr. Fernando Daniels, DC EMS Medical Director will provide details on concerns about EMS transports being delayed in District emergency rooms.

Throughout this transition, DOH and other District agencies have worked closely with the Alliance partners to ensure that quality and comprehensive health services continued to be delivered to District residents.

Implementing a System and Infrastructure for Oversight and Assurance

As the transition of health services advanced, the Administration, led by DOH, has put into place the infrastructure necessary to monitor and management effectively the city's comprehensive health reform efforts. During this period, DOH has advised the Financial Authority on the closure of inpatient services at DC General. To ensure access to services and problem resolution, DOH established a consumer call center. From mid-April until June 21 the call center received over 370 calls. Quick response is our goal -- all effort is made to resolve a caller's issue at the time the first contact is made. In more complicated - nonurgent clinical -- situations, our commitment is to resolve problems by the end of the following day. To more expeditiously respond to consumer requests, the center added two member service coordinators.

DOH will continue to play a critical role after July 2. The Healthcare Safety Net Administration will: maintain historical patient and hospital operational records; provide contract oversight for the DC Health Alliance; ensure service quality and effectiveness; make certain that the system provides early and appropriate access; track access and utilization of services; assess and report on system deliverables and health outcomes.

The consumer is the focal point for the Alliance's success and for the District's achievement of its health status improvement goals. Within this context, increasing consumer's access to and satisfaction with, critical health services is our first priority. The Alliance will provide a mechanism for its members to receive an expedited review on service grievances. If the member is not satisfied with the Alliance response, he or she has the right to request a review of their case by the Health Care Safety Net Administration. DOH and the Alliance partners also recognize the importance of consumer input for system improvement. In addition to consumer advisory activities carried out by the Alliance, DOH will be initiating CHAT (Consumer Health Access Team) together with community groups including "Use Your Power Parent Council." The CHAT initiative will train 50 consumers from medically underserved areas of the city to reach out to fellow consumers, provide feedback on Alliance services, assist in the development and coordination of outreach and education efforts, and aid DOH in monitoring and management of the Alliance contract. For outcomes of the District's new safety net to be fully assessed, the plan also includes external review. On June 7, 2001, Mayor Williams established the Health Services Reform Commission. Comprised of a wide spectrum of community leaders, health providers and planners, nationally recognized experts and consumers, the Commission's mandate is to independently track the Alliance's progress and outcomes and to report on both achievements and areas for improvement. The Commission's first meeting is on July 12, 2001.

A Plan that Builds on Success

Mayor William's bold leadership led the District to select a strategy focused on increasing access to community-based primary care services, improving health outcomes and decreasing the city's historical dependence on its emergency rooms. The DC Healthcare Alliance was selected because it is grounded in the best possible marriage of resources and skills - the expertise of private sector healthcare providers and the capabilities of public health. It is a model whose effectiveness is reflected in the successes of an increasing number of public health departments across the country that have privatized service delivery and focused on health promotion and health status monitoring.

Another lesson learned from other communities transforming their healthcare safety net -- one system can not meet all needs. While comprehensive, we recognize that the DC Healthcare Alliance can not provide free services to all the District's uninsured residents. In response to concerns voiced by Councilmembers during earlier hearings, the Alliance system is a blending of free care for those most at risk, those with the lowest family incomes, and care on a sliding scale for individuals with family incomes above 200% of poverty. DOH will continue to pursue opportunities to collaborate with local and national charitable services and expand Medicaid coverage, to ensure health services are available to all District residents.

So far this strategy is demonstrating that a partnership between private providers and public health can work successfully. The Administration remains committed to ensuring that the DC Alliance truly achieves measurable improvements in the health of District residents.