The District of Columbia’s Health Benefit Exchange Authority’s Social Justice and Health Disparities Working Group issued recommendations to address health disparities and systemic racism within D.C. Health Link plans, according to Health Affairs Forefront. Immediate actions include changing health insurance policies to eliminate cost barriers to care for conditions that disproportionately impact communities of color, starting with type 2 diabetes, and prohibiting race adjustment in a blood test that checks how well kidneys are functioning. In future plan years, the group will examine a no cost-sharing plan design for pediatric mental and behavioral health services, as well as for adult cardiovascular disease, cerebrovascular disease, mental health and HIV, as well as cancer of the breast, prostate, colorectal and lung/bronchus—other conditions that disproportionately impact communities of color in D.C.

Patients who take re-exposure prophylaxis (PrEP), a medication that prevents HIV, should not be paying anything out of pocket for the drug or any of the associated costs, yet that is not the case for many, reports Axios. Peter Sacco described copays he received for clinic visits and lab work associated with monitoring his health for his PrEP prescription. Federal officials told insurers there should be no copays for baseline and monitoring services for PrEP, yet when Sacco appealed his $130 bill for such services, his insurer denied the appeals.

CareFirst—an insurance company that provides plans in D.C., Maryland and Virginia—will pay $95 million to set up a fund in D.C. to address health disparities, reports the Washington Post. This comes as the result of a years-long legal battle between the District and CareFirst over the insurer’s surplus funds. CareFirst agreed to establish a Health Equity Fund for the District and will provide grants to reduce health disparities or to address social and environmental problems that affect D.C. residents’ health.

DC Mayor Bowser announced the awardees of the Health Innovation QuickFire Challenge that are aimed at addressing racial and socioeconomic health disparities within the District of Columbia. Grantees proposed potential solutions to transform patient outcomes in maternal mortality, cardiovascular diseases, autoimmunity and kidney diseases.

The DC Health Benefit Exchange Authority (DCHBX) Executive Board voted to adopt recommendations from its Social Justice and Health Disparities Working Group, in an effort to stop racism in healthcare, according to DC Health Link. These recommendations are focused on three crucial areas in order to establish practices, structures and policies that can be implemented by health plans on the exchange to (1) expand access to providers and health systems for communities of color, (2) eliminate health outcome disparities for communities of color, and (3) ensure equitable treatment for patients of color in healthcare settings and in the delivery of healthcare services. The recommendations include: requiring cultural competency training for network providers; stratifying quality measures by race, ethnicity and primary language; and providing incentives for both primary care and specialist physicians to practice in underserved areas in DC.

The District of Columbia was ranked the best state for children’s healthcare in a study from WalletHub. The study assessed states on 35 indicators of cost, quality and access to children’s healthcare. D.C. ranked number one in children’s oral health, number two in children’s health and access to healthcare and number seven in children’s nutrition, physical activity and obesity. 

Both primary healthcare need and demand in D.C. increased from 2015 to 2018, with Black and Latino populations experiencing greater need and demand than white and Asian populations, according to a report from the D.C. Policy Center. Healthcare need is measured as the number of annual primary care visits an individual is predicted to have based on their age, sex, and health status, and healthcare demand is the predicted number of annual primary care visits while accounting for barriers, such as cost, education and language. The report notes that there are higher shares of elderly residents among Black Washingtonians and higher shares of children among Latino Washingtonians—age groups that typically need more primary care visits. However, the report also finds that there is a larger gap between healthcare need and demand. Barriers to healthcare—including language, cost and education—are likely to be higher for Black and Latino populations. The authors suggest that the greater amount of primary healthcare need among Black and Latino populations could be a factor causing the inequitable COVID-19 outcomes that these groups are experiencing.

Mayor Bowser declared gun violence to be a public health emergency in the city and announced a new “whole-government” approach to address it, reports The Washington Post. The District of Columbia has seen an increase in gun-related homicides, which disproportionately affects Black men—one of the many health inequities that Black people in D.C. experience. The city is establishing a “gun violence prevention emergency operations center” that will be staffed with people from education, job training, mental health counseling and housing fields. The Center aims to address root causes of gun violence, such as poverty, lack of education, and poor physical and mental healthcare, among other upstream factors of health.

The D.C. Council created the Council Office of Racial Equity (CORE), which will assess proposed legislation for its impact on racial equity, reports DCist. CORE will primarily use Racial Equity Impact Statements to evaluate how a piece of legislation could hurt or benefit groups of people who have traditionally been underserved and discriminated against and provide a list of possible effects or racial and social inequities.

D.C. Health announced changes to its COVID-19 vaccination distribution plan to ensure equitable distribution throughout the district, reports WJLA. Additional vaccination appointments will be made available to residents in wards that have a high proportion of BIPOC members and have been disproportionately impacted by the coronavirus. The plan to ensure equitable distribution comes after data from D.C. Health revealed that very few residents in wards that have had the most deaths from COVID-19 have been able to get a vaccine appointment, while residents in areas with the least deaths have been able to obtain the most appointments.

D.C.’s Commission on Healthcare Systems Transformation released a report including more than 42 recommendations to address the District’s healthcare delivery needs, according to the Office of the Mayor. The commission, which focuses on addressing current stresses in the D.C.’s healthcare system, is divided into six committees that examine and provide recommendations on: equitable geographic distribution of acute, urgent, and specialty care; overcrowding in emergency departments and the general reliance on inpatient hospital care; discharge planning and transitions of care; access to critical and urgent care services, specifically maternal, behavioral, and emergency services; allied healthcare professionals and workforce development; and value-based purchasing of healthcare services.

D.C.’s Medicaid program is the first in the country to receive approval for a demonstration project that will use federal Medicaid money to pay for patients with severe mental illness to be treated in large residential psychiatric institutions and treatment centers, according to Modern Healthcare. Medicaid currently prohibits payments to institutions with more than 16 beds, which behavioral health advocates claim has contributed to the high unmet need for the treatment of both mental health and substance use disorders.

Washington D.C.’s Department of Health Care Finance (DHCF), the District’s Medicaid agency, announced that it will transition nearly 22,000 individuals currently in the Medicaid fee-for-service program to a Medicaid managed care program in addition to launching two major changes that will improve equity and value for the Medicaid, Alliance and Immigrant Children’s Programs. First, DHCF will expand value-based purchasing requirements in the managed care program to promote an enhanced focus on health outcomes for Medicaid enrollees. Second, DHCF will implement universal contracting for critical providers in the city’s healthcare market to even the playing field and improve access to needed healthcare providers for all Medicaid enrollees. Given DHCF’s role as the payer for 40 percent of the District’s population, these changes are expected to have a broader positive impact for the District’s healthcare delivery system, as well.

The District’s largest Medicaid managed care organization and a nonprofit law firm are teaming up to reduce healthcare costs by going after mold and infestations, according to the Washington Business Journal. AmeriHealth Caritas D.C, a local insurance provider with more than 100,000 members, has formed a partnership with Children’s Law Center (CLC), a network of lawyers who serve more than 5,000 families each year, to reduce asthma-related hospital visits by targeting unsafe housing conditions. Under the collaboration, AmeriHealth care managers refer members to the CLC team, which speaks with those families to understand their living environments and what needs to change. The attorneys then work to get landlords to fix poor housing conditions or relocate the residents to safer homes. The goal is to reduce the number of medical interventions needed by children with asthma in the District over time.

The District’s latest “health equity” maps show a city divided by race and income – how well you live, or sometimes whether you live at all, can depend on what side of the line you are on, reports The Washington Post. Average life expectancy in Woodley Park, a wealthy and predominantly white neighborhood, is 21 years higher than in the St. Elizabeths neighborhood, which is poor and predominantly black. Additionally, infant mortality for babies with black mothers is three times higher than for babies with white mothers. Mothers’ hypertension is a factor in these premature deaths, and stress from continued exposure to racism and discrimination – in addition to structural and institutional factors that perpetuate persistent inequities – exerts a great toll both on physical and mental health. The D.C. Health Department’s report recommends engaging a broad spectrum of the community in efforts to address these stressors and focusing on “changing community conditions, not on blaming individuals or groups for their disadvantaged status.”

D.C. residents who call 911 are no longer guaranteed an ambulance ride to hospitals if responding medics and a nurse determine that their ailments are minor, according to The Washington Post. Instead, after an assessment by firefighter and EMT crews, patients who are not in serious straits will be connected (by phone) with a nurse, who will help them find care at a clinic or a primary care facility. The new policy is the city’s latest attempt to deal with a crippling call volume that frequently causes emergency responders to be unavailable for life-threatening situations.

A 90-day evaluation of a nursing triage line at D.C.’s 9-1-1 call center revealed that the program has yet to meet one of its intended goals: reducing ambulance trips for patients who don’t need them, according to The Washington Post. The program, known as “Right Care, Right Now,” aims to avoid unnecessary and costly trips to the ED by diagnosing callers who have non-life-threatening conditions and ordering quick, private transportation to clinics through a ride-share service. While the goal is to deploy ambulances, medics and fire crews more wisely, the evaluation showed that nearly half of all calls routed from a 9-1-1 dispatcher to triage nurses still resulted in a fire unit being sent out after the nurses heard a caller describe their medical need. Early evidence suggests that the nurses have become more comfortable with referring callers to clinics over time, although similar efforts in Philadelphia and Richmond have failed due to lack of return on investment.

The mayor of Washington, D.C. announced a new blueprint to address health inequity in the capital, based on a wide-ranging report detailing barriers to healthcare that are specific to resident demographics across the District’s eight wards, reports The Washington Times. The report, called the District’s Health System’s Plan, complements the Department of Health’s earlier proposed “D.C. Healthy People 2020 Initiative,” which outlined 150 objectives to address health issues in the city, both preventive and chronic. According to the Department of Health’s director, the report will better inform the department when considering proposals by healthcare partners, where their services are most needed and what will make the most impact throughout the city.

In December 2014, the D.C. Department of Securities and Banking determined that the cash reserves held by CareFirst were “excessive” and ordered the company to spend $268 million to reduce health needs Washington, D.C., and surrounding areas. A 2016 report by the Urban Institute draws on community health needs assessments and other public data to identify health needs in CareFirst’s service area and highlight opportunities for investment.

Ten out of Washington D.C.’s more than two hundred zip codes account for 83 percent of total resident hospital discharges, according to this Health Affairs Blog post. New technology could create a virtual community of resources—including information on clinical providers, aging support services, housing, nutrition, transportation and family support groups—to increase support for the city’s most high-risk patients. 

D.C.’s Insurance Commission has ordered CareFirst BlueCross BlueShield  to rebate $51 million in excess profits to the more than 200,000 subscribers with D.C.-based CareFirst contracts, according to Washington Business Journal. The average refund will be more than $200 per subscriber, but will vary depending on the amount paid in premiums.

A 2016 report from Georgetown University’s School of Nursing & Health Studies explores the differences in health outcomes and quality of life experienced by the District’s African American residents compared to the general population. 

The Commonwealth Fund released a case study that examined MedStar Washington Hospital Center’s Medical House Call Program. The program features teams of geriatricians, nurse practitioners, and social workers who make house calls to patients too sick or weak to visit a primary care physician. The case study found that the program increased the continuity of care, adherence to care plans, and respect for patients’ care preferences at end of life. Early results suggested that the model could reduce Medicare spending for the highest-risk patients by 20 percent or more.

Most D.C. residents who buy health insurance through the District’s online marketplace will see 4 percent premium increases in 2016, compared to Maryland, where the most popular plan will cost on average 26 percent more starting in January 2016, according to The Washington Post.

Most D.C. metro area hospitals are sticking to fee-for-service reimbursement strategies and plan to attract patients by building urgent care centers and freestanding emergency departments in affluent areas, according to a report from the JKTG Foundation for Health and Policy. Some hospitals, however, are using these ambulatory service centers to position themselves for population health management under value-based payment.

As required by the AccessRx Act of 2004, the District of Columbia Department of Health reported that in 2014, pharmaceutical and device manufacturers spent $22.6 million on gift expenses, $7.9 million on advertising expenses and $65.1 million on aggregate expenses.  Advertising expenses increased by $2.2 million compared to 2013, while the publicly reportable gift expenses decreased by $7.9 million. The findings suggest there may be a shift away from payments captured by the federal Sunshine Act and publicized in the database Open Payments and toward more confidential practices.

The District’s healthcare exchange, D.C. Health Link, is significantly different than any other state exchange, according to The Washington Post. It is signing up young adults at the highest rate of any exchange, about 46 percent. In addition, only 15 percent of those signing up for coverage qualify for government assistance. District residents are picking platinum, gold, silver, and bronze plans almost equally in contrast to the rest of the nation where the silver plan is by far the most commonly chosen plan (63 percent).