The Districts Dime

Stronger Oversight of Medicaid Managed Care Could Mean Better Health Outcomes for Residents

November 10th, 2014 | by Wes Rivers

The District could be doing a better job of connecting residents on Medicaid with basic health services, which would improve health outcomes and avoid costly services that do not improve patient care. A recent report on the managed care organizations (MCOs) that serve 175,000 DC Medicaid participants suggests that better oversight and monitoring is needed to contain health care costs and improve health outcomes for DC residents.

In the District, most Medicaid recipients are assigned to one of three MCOs. The District pays each MCO a fee for each enrollee and in return the company reimburses doctors and hospitals for health care services used. Since the rate the District pays is fixed, the companies have an incentive to connect members with the services that will manage and improve their health.

Yet a report from the Department of Health Care Finance suggests that the three managed care organizations could be doing a better job. The share of Medicaid patients who see a primary care doctor each year has fallen steadily over the last nine months and is now at 70 percent. Seeing a primary care doctor regularly makes it more likely to manage health needs and reduces the likelihood of needing more costly services.

The inadequate basic care means that DC’s Medicaid managed care organizations incur millions in costs associated with poorly coordinated care. Over three-fifths of emergency room visits by DC Medicaid recipients are for basic care that could be avoided by regular visits to a primary care doctor. In addition, many Medicaid recipients who seek hospital care end up being re-admitted, and the new report shows that half of those readmissions could be avoided through better service delivery and follow-up care.

The District needs stronger oversight and performance evaluation of the Medicaid managed care program. Stronger performance standards will to lead to improved health outcomes among residents and fewer avoidable costs. Three areas that should be addressed to improve patient care include:

  • Ensuring a sufficient network of doctors. A major barrier to routine care is a lack of doctors available to see patients. The District can improve access to care by making sure that the MCO networks have a large number of providers available for patients, and that those providers are located throughout the community.
  • Providing access to a care coordination program. Care coordination means that patients’ needs are identified and that they are referred to an appropriate service provider. Many primary care clinics take on a care coordination role by acting as a “medical home” to their patients, providing on-going care, and storing and sharing electronic health records. It is important that MCOs attach their enrollees to a medical home and make sure they are getting this level of comprehensive care.  
  • Establishing outcome-based benchmarks of performance. The District has already begun to establish standards for the MCO’s financial performance and how well they manage the care of their enrollees. Those standards should be subject to public input and should be tied to improved health outcomes – especially outcomes related to health disparities that exist in the District.

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Steps to a Better DC United Stadium Deal

November 7th, 2014 | by Ed Lazere

We’ve been saying for a while that the plan to develop a new soccer stadium is really complicated. And, boy, was that confirmed this week – by a new 400-page consultant’s report and an assessment from DC’s Chief Financial Officer. Together, these documents suggest that a new stadium could bring economic benefits, especially if the stadium is accompanied by a hotel developed by the team.

But the new information also shows that the plan has a way to go before it is a good deal for DC residents. Rather than rushing, the District should take the time to get the deal right. 10-22-14 Soccer

  • DC’s Share of the Deal Would Be Over 50 Percent, Higher Than the Typical Deal.  The District would contribute at least $131 million in land and infrastructure, as well as $50 million in tax breaks. Together, that’s 63 percent of the total cost, which is higher than the government share in most soccer stadium deals.
  • Reeves Center Swap is a Financial Loser for DC.  The consultant’s report finds that the plan to trade the Reeves Center for stadium land with the developer Akridge would generate $25 million less than if the Reeves Center were sold to the highest bidder and if parcels of the stadium land were bought at market value.
  • Tax Breaks for DC United Are Not Justified. Most stadium deals do not include tax breaks for the team. DC’s Chief Financial Officer finds that the proposed sales and property tax breaks for DC United are not needed for the deal to go through.
  • Risks.  There are a number of unknowns, such as the full cost of environmental remediation or relocating a Pepco substation.

The consultant’s report finds that a new stadium will generate $109 million in economic benefits to DC over 32 years, but that assumes a stadium will last that long and that DC United builds an adjacent hotel, which is not required under the deal. Without the hotel, the net benefits are closer to $40 million over a 32-year period, about $1 million per year. 

These details suggest that the DC Council and mayor-elect Bowser should take time to review the deal and make it better for the District. Getting a new stadium for DC United is a good thing, but it is more important to get it right than to rush it and get it wrong.

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Get Out and Vote!

November 4th, 2014 | by DCFPI

Today is Election Day! DCFPI encourages all DC residents to vote today.  Don’t forget, in DC you can register to vote at the polls on Election Day!* Polls open at 7 a.m. and close at 8 p.m. You can find your polling place here. The offices, candidates and questions on the ballot are listed here.

 * Read more about how to do same-day registration here.

by justgrimes, available at:

by justgrimes, available at:

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Helping DC Students Facing Mental Health Challenges

November 3rd, 2014 | by Jenny Reed

Living in poverty can create tremendous pressure on families, which affects their children and makes it harder for them to go to school ready to learn. In Sunday’s Washington Post, DCFPI highlighted how addressing the impact of poverty on children is key to unlocking opportunities and closing the achievement gap in DC.

In particular, schools need to be prepared to help children who face
emotional or mental health  challenges. Low-income children are more often exposed to trauma and stress, which makes it more likely they will miss school, get suspended or drop-out. Repeated exposure to trauma and stress is especially harmful, leading to “toxic stress” with physiological effects that interfere with development of key learning skills, including memory, attention, and language.

Photo by Slowking4, available at:

Photo by Slowking4, available at:

Schools are a logical place to identify students with mental health needs, yet as many as 5,000 DC children may not be getting the mental health services they need. Children are more likely to engage in mental health services in a school setting compared to other outside services, so improving mental health services provided through schools is critical to improving school outcomes in the District.

The District provides a variety of services to address the mental health challenges of students in schools, but they are not found at all schools, and many schools have mental health staff with caseloads that are too large to provide adequate services. The District should increase services and funding to better meet the mental health needs of students in the following ways:

  • Expand Access to School Mental Health Programs: The District set a goal of having a mental health program in every school by 2016-17, but currently only 36 percent are covered.
  • Increase the Availability of School Social Workers and Psychologists: More than one-third of DC schools have too few social workers and psychologists to meet the needs of their students.
  • Expand the Use of Positive Behavior Intervention and Supports to all Schools:  These programs focus on encouraging desired behaviors rather than punishing negative behavior, and they can increase attendance and reduce suspensions and special education referrals.  
  • Create Trauma-Sensitive School Environments in All Schools: DCPS uses a number of programs that can help students address trauma, but not system-wide and often serving only a small number of students with the greatest needs. Schools in Massachusetts, San Francisco, Washington State and Wisconsin engage in all-staff training to be sensitive to students affected by trauma and to understand how to respond.

You can read more about what DC schools can be doing to help low-income children succeed here.

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How Will DC Shelter Families This Winter?

October 31st, 2014 | by Kate Coventry

Tomorrow marks the official beginning of hypothermia season, and an increase in family homelessness is expected, but the District has yet to release details of how it will meet the legal obligation to shelter families during cold weather months. Last year, insufficient planning and a large increase in homelessness led the District to place some families in recreation centers, yet preliminary court decisions stopped this practice because of its risks to children. And just this week, the DC Council gave preliminary approval to legislation clarifying that homeless families must be sheltered in private rooms.9-5-14-winter-plan-blog-f1

This means that other options are needed. There are three key issues that need to be addressed soon to avoid the crisis of last year: securing needed overflow shelter capacity, addressing a shortfall in homeless services funding, and improving services that move families from shelter.

Shelter Capacity:  The Interagency Council on Homelessness (ICH) predicted in its Winter Plan that shelter capacity would not be sufficient to get through the winter. Yet the District has not developed and shared how it will meet overflow needs, such as using motels or suitable DC properties. The Department of Human Services reported at a Council hearing this week that it was in contract negotiations for additional capacity but offered no details such as the number or location of this capacity.

Addressing the Funding Shortfall: The ICH also recognized that the homeless services budget was inadequate to pay for needed overflow shelter, and the Chief Financial Officer recently confirmed an $11 million shortfall in the family shelter budget.[1] This is partly because this year, the District does not have access to some sources of federal funds that were used last year. Identifying resources soon to fill that gap will make it possible provide appropriate services efficiently and effectively.

Read DCFPI’s testimony on the Winter Plan here.

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[1] Fiscal Impact Statement – Dignity for Homeless Families Amendment Act of 2014. October 15, 2014.





[1] Fiscal Impact Statement – Dignity for Homeless Families Amendment Act of 2014. October 15, 2014.

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