DHCF is involved in numerous strategic planning and delivery system redesign initiatives with the goal of continuously innovating to improve care and outcomes within the District’s Medicaid program. Further information is provided on specific initiatives below.
For questions and comments on these efforts, please contact [email protected]
Innovation Initiatives
The Medicaid Business Transformation DC Initiative was led by DHCF’s grantee, Health Management Associates (HMA), to design and implement an innovative approach for delivering targeted legal and business resources to the healthcare community. HMA partnered with the DC Behavioral Health Association (BHA), Medical Society of the District of Columbia (MSDC), DC Primary Care Association (DCPCA), and DHCF to assess Medicaid provider technical assistance needs, make policy recommendations, and deliver a pilot technical assistance learning collaborative focused on financial, operational, and legal capacity building.
Key findings from the DC BTTA report include:
- District healthcare organizations/providers have specific technical assistance (TA) needs, and providers exhibit significant variation in their understanding of and readiness for a transition from fee-for-service to value-based payment (VBP) models.
- Nationally, successful states advance VBP by building on the Health Care Learning and Action Network (HCP-LAN) framework to develop additional guidance for managed care organizations, with criteria, benchmarks, and standards that include both medical and behavioral health expenditures. These states also provide free TA, upfront investments, and resources to prepare healthcare organizations to deliver high-quality value-based care.
- The transition to VBP for states across the country can take multiple years and significant technical support to prepare healthcare organizations to transform business, legal, and financial operations. This work includes supporting provider readiness for success with advanced payment models (APMs), facilitate provider collaboration and integration through individual and system-level transformation (e.g., mergers, acquisitions, and formation of provider-level entities). Examples include accountable care organizations, clinically integrated networks, and provider-led entities (PLEs).
The report includes findings from a literature review of national value-based payment (VBP) best practices, published materials, and a scan of the District’s healthcare reform landscape, results from focus groups, interviews, and a technical assistance (TA) survey with District organizations, agencies, and stakeholders on provider barriers and readiness to deliver value-based care, and policies and best practices for the District and DHCF that are drawn from leading edge states to advance value-based care and transform the healthcare delivery system. All Business Transformation Grant training and technical assistance resources can be found here Medicaid Business Transformation DC.
- CMS 1003 SUD Provider Capacity Grant
The Centers for Medicare & Medicaid Services (CMS) is conducting a demonstration project to increase the treatment capacity of Medicaid providers to deliver substance use disorder (SUD) treatment and recovery services. CMS selected the District of Columbia for a planning grant of $4.6 million.
Planning grant activities include:
1. A comprehensive needs assessment of Medicaid provider capacity to diagnose and treat SUD. The needs assessment will build on the District’s 1115 waiver application and enable consideration of payment redesign options to increase and sustain provider capacity to address SUD;
2. Education and technical assistance among Medicaid providers to build capacity to treat individuals with SUD in community settings. This effort will include education to reduce the impact of negative treatment bias among community providers and a competency-based approach to enhance Medicaid providers’ ability to diagnose and treat SUD;
3. Infrastructure to enable structured data collection and communication with District behavioral health providers, as well as the development and implementation of consent management tools to facilitate appropriate exchange of 42 CFR Part 2 data.
For more information please visit: https://dhcf.dc.gov/page/demonstration-project-increase-substance-use-provider-capacity
- Practice Transformation Technical Assistance
DHCF in partnership with the DC Department of Behavioral Health, manages a five-year program, known as the Integrated Care Technical Assistance (ICTA) Program. The ICTA program will enhance provider practice capability to deliver person-centered care across the care continuum; use population health analytics to address complex medical, behavioral health, and social needs; and engage leadership to support value-based care.
Providers have several options for participation, including individual practice coaching, webinar sessions, learning collaboratives, and this virtual learning community. More information available at: https://www.integratedcaredc.com/about-icta/
- Medicaid Accountable Care Organization (ACO)
In April 2017 DHCF issued a Request for Information (RFI) soliciting stakeholder interest and feedback on the prospect of developing Medicaid Accountable Care Organizations (ACOs) in the District. DHCF received 16 responses from respondents, including community primary care practices, Federally Qualified Health Centers, health systems, managed care organizations (MCOs), home health agencies, trade associations, and nonprofit interest groups. A summary of the responses to the RFI is available at: https://dhcf.dc.gov/release/public-notice-report-stakeholder-responses-request-information-potential-medicaid-acos
- State Innovation Plan
In 2015, the Centers for Medicare & Medicaid Services (CMS) selected the District of Columbia for a State Innovation Models (SIM) Initiative Design Award of $999,998 to support the design and implementation of new health service delivery and payment methods. The overall goal of the plan is to bolster primary health care and to better coordinate the care of the District’s most vulnerable resident, in order to:
- Improve the health of the District’s population;
- Enhance the patient experience of care; and,
- Reduce or at least control healthcare costs in the District.
The result of the SIM award was the District of Columbia’s State Health Innovation Plan (SHIP) which is available at: https://dhcf.dc.gov/page/innovation-district-health-landscape