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Transforming Community Health in the District of Columbia
Are we making a difference? Are there outcome measures for primary care?
For children enrolled in Medicaid, a key outcome measure of primary care is successful delivery of EPSDT services. CMS requires each state Medicaid program, including the DC Department of Health Care Finance, to provide a comprehensive program of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services to its Medicaid enrollees. These EPSDT services are based on “best practice” recommendations and clinical guidelines from the American Academy of Pediatrics and Bright Futures developmental screening and counseling.
A Community Health Improvement Story
For more than ten years, DC’s Department of Health (DOH), Medical Assistance Administration [now the DC Department of Health Care Finance, DCHF], health plans, and provider community have struggled to improve documentation of EPSDT care. Unfortunately, this often translated into increasingly burdensome documentation requirements for frontline providers – redirecting precious resources away from actual care delivery. In 2002, Children’s National Medical Center (CNMC) pediatricians, Drs. Mark Weissman, Nathaniel Beers, and Denice Cora-Bramble, petitioned to meet with Judge Kessler to identify a more constructive approach. Following an unprecedented meeting with DC’s pediatric provider community in her chambers, Judge Kessler approved an innovative collaborative quality improvement approach to improving EPSDT delivery. Modeled after DC’s successful immunization registry, the provider community proposed to partner with DC’s DHCF, and the plans to develop and implement city-wide “standardized medical record forms” (SMRFs) to guide and document a comprehensive “HealthCheck” EPSDT visit. Copies of SMRFs have been submitted to DC’s DHCF for entry into one of the nation’s first comprehensive child health data registries. Key child health data will then be available to improve point-of-service care and continuity as well as track outcomes and identified improvement initiatives. Provider participation and registry use will be encouraged through provider quality report cards and pay-for-performance (P4P) – also among the nation’s first for Medicaid. |
Providing
all the recommended EPSDT services is a huge challenge – especially
for the underserved children covered in Medicaid. In a
landmark legal decision, Salazer vs District of Columbia,
U.S. District Judge Gladys Kessler ordered the District
of Columbia to improve delivery of comprehensive EPSDT services to its Medicaid enrollees.
Progress and Accomplishments
Late in 2005, the Goldberg Center received start-up funding from the Commonwealth Fund, National Initiative for Children’s Healthcare Quality, and Children’s National Medical Center to formally establish the DC Partnership for Children’s Healthcare Quality (DC PICHQ) – with the EPSDT improvement as its initial quality improvement initiative. DC PICHQ has engaged an unprecedented collaboration of public health, managed care organizations, academic health centers, community pediatric providers, and parent advocates.
DC PIHCQ Collaborative Partners
American
Academy of Pediatrics – DC Chapter- Bright Futures at Georgetown University
- Chartered Health Plan, Inc.
- Children’s National Medical Center
- District of Columbia Department of Health
- DC Department of Health Care Finance
- George Washington University School of Medicine
- Health Services for Children with Special Needs (HSCSN), Inc.
- Howard University
- MEDSTAR – Georgetown University Medical Center
- Unison Health Plan, Inc.
DC PICHQ Executive Committee
- Mark Weissman, MD, Chief, General Pediatrics & Community Health, Children’s National Medical Center
- Nathaniel Beers, MD, Medical Director, Children’s Health Center, Children’s National Medical Center and President-Elect, DC Chapter, American Academy of Pediatrics
- Vincent Schuyler, Program Director, DC Partnership to Improve Children’s Healthcare Quality, Goldberg Center for Community Pediatric Health
- Danny Bellamy, Chief Operating Officer, Health Services for Children with Special Needs, Inc.
- Colleen Sonosky, JD, DC Department of Health Care Finance
- Cyd Campbell, Chief Medical Officer, Health Services for Children with Special Needs, Inc.
- Joan Christopher, JD, Family Advocate and LEND Fellow, Children’s National Medical Center
- Matthew Levy, MD, Medical Director, Community Pediatrics, MEDSTAR – Georgetown University Hospital
- LavDena Orr, MD, Chief Medical Officer, Chartered Health Plan, Inc.
- John Richards, MA, Program Director, Bright Futures at Georgetown University
- Tamara Smith, JD, President and Chief Executive Officer, Chartered Health Plan, Inc.
- Robert Watkins, Chief Operating Officer, Chartered Health Plan, Inc.
