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Testimony of DC Health Care Alliance
Before the Committee on Human Services
Presented by
Karen M. Dale, RN, MSN, CS
Chief Operating Officer
June 22, 2001
Good morning Chairperson Allen and members of the Human
Services Committee. Thank you for this opportunity to discuss the
healthcare program for the uninsured persons residing in the District of
Columbia. My name is Karen Dale, and I am the Chief Operating Officer for
the DC Healthcare Alliance at Chartered Health Plan. With me is Thomas L.
Johnson, Director of Government Relations for Chartered.
Chartered's vision is to ensure that the underserved
are empowered with knowledge and awareness about achieving good health and
maintaining a healthy lifestyle. We are committed to serving the
disadvantaged population with dignity and respect. My testimony will cover
Chartered's responsibility in the Alliance, the implementation process,
and our current status and future plans. The Alliance program has already
started. We have been working diligently for weeks on the details of the
Program and I am pleased to report that we officially began operations on
Friday, June 15 at eight (8) enrollment sites. Additionally, trained
member services representatives were available by phone.
Greater Southeast Community Hospital Center has
contracted with Chartered to provide specific administrative services. For
the past several weeks our implementation team has focused on putting in
place the necessary infrastructure to support these functions. We have
worked collaboratively with the other Alliance members to ensure that the
program will deliver the highest level of member satisfaction and quality
health care.
I will briefly discuss some of the administrative
functions for which Chartered is responsible. Detailed information has
been provided to you in writing.
Eligibility Verification and Enrollment
To promote a seamless process for those members that
have traditionally received services at DC General, a letter and
information packet was mailed to 43,568 individuals identified as self-pay
patients and uninsured, including Medical Charities patients that received
services at DC General or one of its community clinics in the past two
years. The letter informed the recipients that based on our information
they will be presumed eligible under the Alliance program for 30 days.
Another letter and information packet was also mailed to 177 persons that
had been identified as having insurance. Finally, we ran a cross match
with the Medical Assistance Administration database, and 4,803 were deemed
Medicaid enrolled or eligible and therefore possibly not eligible for
participation in the program. These steps were designed to ensure that a
wide net was cast regarding access to the program. In addition to the
mailing, as of this morning Enrollment Specialists have enrolled 100
members who have provided appropriate documentation and we have screened
those persons that are not eligible for other public programs as
appropriate.
Member Services
We are committed to providing accurate and timely
public education to ensure that members have information about how to
access care. Our Member Services representatives are available Monday
through Friday between 8:00 am and 6:00 pm by phone and members may
contact our Nurse Advice line 24 hours a day seven days a week with health
questions.
Prevention Education and Outreach
An important shift that is an anticipated outcome of
managing the care of the uninsured is improved health status for those
persons served. One way that this can be achieved is through an investment
in primary prevention. Chartered will provide group and individual
education to Alliance members and link them to needed services. Our health
promotion offerings are aimed at assisting members to stop smoking;
develop habits that decrease risk factors for hypertension, manage their
weight; manage asthma; prevent diabetes or appropriately manage the
disease; reduce risk behaviors associated with sexually transmitted
diseases; establish wellness related behaviors; and engage in prenatal
care. These education programs specifically address the ambulatory
sensitive admissions at DC General Hospital. We will regularly evaluate
our efforts based on data and member and provider input.
Utilization Management
Appropriate utilization management can significantly
improve care by promoting a delivery system that assures that each patient
receives the right care, at the right time, at the right place. The
Utilization Management program for the Alliance is responsible for
assessment, planning, intervention and evaluation of ambulatory and
inpatient healthcare services provided to members of the program and will
help to assure appropriate follow-up for patients discharged from the
hospital. Our approach is member centered and the member is actively
involved in each step of the Care Management process. This type of focused
management places the care that Alliance members receive on par with
quality of care delivered to members of private employer-based plans.
Quality Management
Our definition of quality is simple - - Each Alliance member has a
positive experience. Our Quality Management program will produce this
outcome by monitoring, evaluating, and continually improving all clinical
and non-clinical services. The Quality Management program is designed to
comply with applicable quality standards, including those of the Centers
for Medicare and Medicaid Services Quality Improvement System for Managed
Care (QISMC) and the requirements of Federal and District authorities that
conduct Medicaid oversight.
Provider Relations
Members must have easy access to providers. The network
of providers available to members offers 89 primary care providers and 168
specialists in more than 75 locations. In addition, all provider systems
have been implemented to support enrollment and verification, utilization
management, and claims payment. Provider directories are available to
facilitate member selection of a healthcare home. We will conduct ongoing
accessibility analyses to refine our network of providers so that the
network gives members a choice of providers, encompasses the cultural
diversity of our city, and gives access to various specialties.
Data Collection and Reporting
We are looking forward to participating in the data
collection process outlined for this program that will ultimately allow
for a high level of accountability. Observations as well as formal data
will be collected to measure the performance of this healthcare reform
initiative. Chartered will track, analyze and report aggregate
quantitative and qualitative data. Examples of information that will be
collected include the types of encounters by age group, distribution of
network providers, number of children receiving well-child services,
number of health risk surveys performed, the immunization status of
members, information on the utilization of prenatal services, and types of
preventive services provided to Alliance members with Diabetes and other
chronic conditions. The reporting component will serve as the foundation
for ongoing evaluation and modification of the program.
No successful operation functions without qualified and
dedicated professionals. Due to the short implementation time frame, we
expedited our hiring process in order to have a complement of trained
staff available on June 15. We have made every effort to hire DC General
employees. We attended each job fair for employees and contacted 227 DC
General employees that submitted a data sheet to discuss employment. Our
staffing for the Alliance at this time consists of 21 persons
(Administrative, clinical, member services, provider relations, enrollment
specialists). By the end of the July we will have 39 staff members
supporting the Alliance program.
In closing, Chartered is committed and ready to provide
accessible, quality services to the uninsured persons in the Alliance
Program. The cornerstone of our efforts is member satisfaction. When we
are able to provide accessible quality health care and reduce unnecessary
and/or potentially preventable emergency room and inpatient use, we will
be improving the health status of our city and reshaping the future of
care for the uninsured. |