Medical Homes DC

Medical Homes DC (MHDC) focuses on building a system of primary care medical homes that serve DC residents in greatest need in high performing, up to date health facilities convenient to where they live.   In 2001, the District of Columbia created the DC Health Care Alliance to provide health coverage for its low income residents not eligible for Medicaid.  This was a welcomed approach to help provide low income residents with better financial access to basic health care.  But, it also created a challenge – where were people going to get the care they needed and find a “medical home”? In 2004, the City issued a challenge – it would invest $15 million (later raised to $21 million) to expand and strengthen the safety net clinics if the District of Columbia Primary Care Association (DCPCA) could provide a 50 percent match in private funds. Members of the Health Working Group of Washington Grantmakers took on the challenge – and DC Medical Homes became a reality.  The long-term goal of the program is to “rebuild DC’s primary care system for an estimated 210,000 low income residents who live in areas of DC that lack sufficient medical services”.

MHDC program has two components: “Capital Projects”, and “Quality and Performance Improvement”. Through Capital Projects, DCPCA leverages investments and grants from DC government, foundations, and private partners to assist individual community-based health centers (CHCs) for the building, renovation, and expansion of their primary care facilities. The Quality and Performance Improvement encompasses two initiatives: The Quality Transformation Series (QTS) and the Chronic Care Initiative (CCI) and coordinates with the DCPCA’s effort to expand the use of Health Information Technology which includes helping clinics secure and use electronic medical records and facilitating appropriate exchange of patient health/medical records among providers. QTS is a three year program providing technical assistance to CHCs with a focus on Quality Improvement {1}and implementing small changes into the day to day work of the centers. CCI was created by the Department of Health in 2009 with the aim of improving service delivery to persons with chronic illnesses. DCPCA serves as the facilitator of CCI and works with all program participants to embed quality improvement practices in intervention programs{2}.  

Capital Grants

With support from the DC government, DCPCA began the Capital Projects program with two initial grants totaling 51 million dollars. Since 2004, 12 different sites across DC’s 8 wards have begun the process of building, rebuilding, or renovating facilities{3}. Six health center renovations have already been completed, with an additional six renovations underway. To obtain funding, the health centers applied directly to DCPCA for grant money and were selected by an independent committee using criteria developed by the Priorities Setting Panel. The committee evaluated the centers’ proposed projects, their adherence to the District’s priorities, and the availability of funds when making an award decision. Selected health centers are given money and assistance through the planning, design, and construction phases of their capital development processes.

The real estate market has been challenging to navigate. Even when sites are secured by MHDC Capital Projects, the development process can take many years to complete—impeding on the success of the program and slowing the revitalization of medical homes in DC. In addition, low reimbursement rates in DC (which lags far behind the national average payment/visit) make it even harder to obtain additional funding. The large initial sum of money from the local government certainly helped to begin Capital Projects, but completion of the total project will require more than double the money that was already granted. Noting these challenges, DCPCA plans to consider the “feasibility of loan pools, guaranty products, New Markets Tax Credits, and other tools (used) to increase the availability of low-cost financing for health centers...{4}" At this time DCPCA is not planning additional grant rounds.  

Quality and Performance Improvements

Quality and Performance Improvement—the second component of Medical Homes DC—has executed the Quality Transformation Series (QTS) as a way to “develop a culture of quality in the District of Columbia’s community-based health centers (CHC){5}”.  With help from CareFirst BlueCross BlueShield, this three year series was launched in the fall of 2008 to (1), improve health outcomes by looking at racial/ethnic health disparities, and (2) facilitate the efficient use limited resources by securing quality care and protecting patients’ safety.

In the first year of the program, the curriculum for the Quality transformation Series was developed based on the existing level of integration of Quality Improvement principles into each community-based health center. For the remaining two years of the program, each CHC will be evaluated monthly based on the Institute for Healthcare Improvement (IHI) Quality Improvement standards. The RAND Corporation will also perform an analysis of the QTS and will measure “cultural change, penetration, and spread of the initiative{6}” among CHCs.

Preliminary data and analysis from the first year of the program have revealed that there has been an increase in understanding of Quality Improvement principles. So far, the DCPCA has hosted three QTS Leadership Sessions with CHCs to begin assessing the current quality in their organizations. Detailed action plans and strategies were created to be tested by the teams in their respective CHCs. In addition, the DCPCA hosts regular Quality Improvement leader meetings as a means of sharing experiences and best practices among teams. Leaders are given tools, resources, and assistance by DCPCA so that they can better equip and properly train their teams. Thus far, 90% of the teams in the QTS have reported some level of Quality Improvement.

Medical Homes DC, by increasing access to quality primary care in DC’s low income communities, can improve health outcomes and reduce patients’ reliance on the emergency room for primary care. In addition, Medical Homes DC shows the tremendous effects that an expanded primary and preventative care network have outside of the health care system. When the impact of DC community health centers was assessed by Capital Link in April of 2008{7}, it was concluded that DC health centers contributed more than 210 million dollars and 2,121 jobs in 2006 alone to the district. The 11 DC health centers that were audited in the assessment spurred substantial growth in DC’s household purchasing power (over 140 million dollars)—resulting in a higher household income in neighborhoods they served. Thus, with the expansion of health centers through the Capital Projects program, these expenditures are likely to grow and continue the revitalization of DC communities in most need of economic and healthcare development. Put simply, “DC’s community health centers are investments in the economic developments of the communities they serve and the District as a whole{8}.”

DCPCA will continue to include MHDC updates on its website. For additional information about Capital Projects, contact Robin Halsband at rhalsband@dcpca.org or 202-638-0252 (ext 204). Inquiries related to the Quality Transformation Series can be directed towards Gwendolyn Young at gyoung@dcpca.org or 202-638-0252 (ext 243).

Resources

(1) Institute for Health Care Improvement. Quality Improvement Methods.

(2) Medical Homes DC Capitol Projects. DCPCA One-pager sent to RPCC by Cindy Yeast.

(3) Medical Homes DC

(4) Medical Homes DC Capitol Projects. DCPCA One-pager sent to RPCC by Cindy Yeast.

(5) DCPCA Quality Transformation Series. DCPCA One-pager sent to RPCC by Cindy Yeast.

(6) DCPCA Quality Transformation Series. DCPCA One-pager sent to RPCC by Cindy Yeast.

(7) Financial Trends and Economic Impact of District of Columbia Community Health Centers. Study by Capital Link, April 2008

(8) For a complete list of the Medical Homes DC project sites awarded grants in 2007, visit http://www.dcpca.org/initiatives/expanding-access-to-care/