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DC Health Systems Plan 2017

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DC Health Systems Plan 2017 DISTRICT OF COLUMBIA HEALTH SYSTEMS PLAN 2017 NOTICE OF NON-DISCRIMINATION In accordance with the D.C. Human Rights Act of 1977, as amended, D.C. Code section 2.1401.01 et seq., the District of Columbia does not discriminate on the basis of race, color, religion, national origin, sex, age, marital status, personal appearance, sexual orientation, family responsibilities, matriculation, political affiliation, disability, source of income, or place of residence or business. Discrimination in violation of the Act will not be tolerated. Violators will be subject to disciplinary action. Published July, 2017 Dear Residents: Upon taking office in 2015, my Administration focused on improving health outcomes for all residents, recognizing that all government policies—from education and housing, to economic development and transportation—impact the health and wellness of our communities. Every Washingtonian, regardless of where they live, should have the ability to live a healthy and fulfilling life in our nation’s capital. This Health Systems Plan will serve as a guide for all stakeholders as they implement initiatives aimed at strengthening Washington DC’s health system to improve the overall health status of residents by ad- dressing social determinants of health and promoting health equity. Through this plan, we will ensure that public and private agencies throughout DC have the direction they need to make sound investments and implement initiatives that will improve the health and well-being of residents across all eight wards. I am proud of the work we have done thus far. In 2016, the number of newly diagnosed HIV cases in Washington, DC decreased by 52 percent to 347. In addition, to maintain our overall fitness, we have made all District-operated fitness centers free for DC residents, helping to make DC the 2nd Fittest City in the country and a leading city for policies that improve the health and wellness of our residents. This plan lays out a clear strategy to ensure that residents are appropriately engaged in care and have access to comprehensive, high quality, and well-coordinated services. We will also continue to ensure that efforts are made the address the underlying social determinants of health and achieve inclusive prosperity by access to safe, affordable housing; sound educational opportunities; a robust transportation system; safer and stronger neighborhoods; and pathways to the middle class. Investments in new facilities and our health system infrastructure will be required, but care will be taken to ensure that these investments are targeted and well-integrated within DC’s already rich and robust health care system. Finally, the public and private sectors must continue to align their efforts and work collaboratively to ensure their efforts are integrated and coordinated in ways that build healthy, vibrant, and cohesive communities. One of my top priorities as your Mayor is to improve the health and well-being of all residents and this Health Systems Plan is a critical next step to that commitment. As we envision a future that is brighter, bolder, greener, healthier, smarter, safer, and stronger, we will continue focusing on bringing health resources to all Washingtonians and ensuring that health care dollars and jobs stay in DC. Sincerely, Muriel Bowser Dear District Residents and Partners: The Department of Health is pleased to present the District of Columbia’s Health Systems Plan (HSP), a tool to strengthen the health and healthcare systems in the District of Columbia in pursuit of our goal to become the healthiest city in America! The HSP will serve as a guide for public and private investments in public health and healthcare delivery systems and will help promote the health and wellbeing of residents across the District. The HSP is fully aligned with the Department’s five strategic priorities: • Promote a culture of health and wellness • Address the social determinants of health • Strengthen public-private partnerships • Close the chasm between clinical medicine and public health • Data-driven, outcome-oriented approach to program and policy development. The HSP is based on the qualitative and quantitative analysis of a wealth of local data that has identified a range of opportunities related to patient and community engagement, service integration, care coordination, care transition, as well as gaps in the District’s health infrastructure, and recommendations on how to address the challenges identified. One such opportunity identified in the HSP is creating environments in which every District resident has the ability to attain the highest level of health. In other words, to create conditions that will ensure health equity for all by eliminating disparities. In order to achieve health equity, we must make investments in our healthcare infrastructure and adopt a “health in all policies” approach to improving health where healthcare providers and healthcare administrators work collaboratively with partners in education, planning, economic development, transportation, and public safety to advance the health of our communities. Finally, I would like to thank all of those who were involved in the development of the HSP through interviews, community forums, and planning meetings. The Department of Health is committed to engaging the community and the HSP would not have been possible without the time and effort of the more than one- hundred community stakeholders and residents that were involved in this process. This Health Systems Plan is a living document and I look forward to your continued engagement as we work collaboratively to create a patient-centered, high quality, equitable, accessible health system that enables all DC residents to live happy, healthy, and fulfilling lives. Sincerely, LaQuandra S. Nesbitt MD, MPH Director Acknowledgments The District of Columbia (DC) 2017 Health Systems Plan (HSP) was developed by the DC Department of Health (DOH), State Health Planning and Development Agency (SHPDA) with advice and guidance from the Statewide Health Coordinating Council (SHCC). The DOH and SHPDA would like to acknowledge the tremendous work and commitment of the SHCC and specifically the SHCC’s Plan Development Committee. Special thanks and appreciation go to Ms. Barbara Ormond, Chair of the SHCC’s Plan Development Committee and Mr. Robert Brandon, Chair of the SHCC, who worked tirelessly to guide the HSP development. The SHCC and its consultants met with more than 100 individuals who participated in interviews and community forums. These participants included representatives from health and social service organizations, the DC Department of Health, other DC govern- ment agencies, elected officials, community advocacy groups, community businesses, as well as individuals from the community at-large. The information gathered as part of these efforts was pivotal and very useful to the Plan’s development. The SHPDA and the SHCC would like to thank everyone who was involved in the develop- ment of the HSP for their time, effort, and expertise. While it was not possible for the HSP process to involve all of DC’s stakeholders, care was taken to ensure that a representative sample of key stakeholders was engaged through the interviews and community forums. Those involved showed a real commitment to strengthening the District’s system of care, particularly for segments of the population that are most at-risk. The HSP would not have been possible or nearly as comprehensive without the support of all the individuals who were involved. The SHPDA was supported in this work by John Snow, Inc. (JSI), a public health management consulting and research organization dedicated to improving the health of individuals and communities. The SHPDA appreciates the contributions that JSI has made in analyzing data, interviewing stakeholders, and conducting research throughout the Plan development process. Special thanks are due to Mr. Alec McKinney for playing a leading role in producing the document. Government of the District of Columbia Muriel Bowser, Mayor Department of Health Office of the Director LaQuandra S. Nesbitt, MD, MPH, Director Jacqueline Watson, DO, MBA, Chief of Staff Keith Fletcher, Chief Operating Officer Center for Policy, Planning and Evaluation Fern Johnson-Clarke, PhD, Senior Deputy Director State Health Planning and Development Agency Amha W. Selassie, Director Thomas McQueen, Health Systems Specialist Statewide Health Coordinating Council Robert M. Brandon Chairperson Barbara A. Ormond Chair, Plan Development Committee Sandra C. Allen Steven A. Nash Jacqueline Bowens Stephen Neuman Zinethia Clemmons Chioma Nwachukwu Goulda A. Downer, Ph.D. Marc Rankin Brenda J. Kelly Table of Contents Chapter 1: Background and Approach 1 Background and Overview 1 Approach and Methods 6 Chapter 2: Community Characteristics, Underlying Determinants, and Health Status 11 Community Characteristics 11 Social Determinants of Health and Barriers to Care 14 Health Status and Disparities 21 Chapter 3: Health System Strengths, Service Distribution, and Utilization Trends 29 Hospital Services 29 Primary Care and Specialty Care 50 Behavioral Health 69 Post-Acute Care Services 82 Chapter 4: Strategic Recommendations 99 Strategic Priority Area 1: Health Services Strengthening 99 Strategic Priority Area 2: Health Systems and Structures 105 Strategic Priority Area 3: Community Health 106 Certificate of Need Guidance 109 References 133 Appendices 141 Appendix A: Health Systems Plan Key Informant Interviewees 141 Appendix B: Data Limitations
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