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District of Columbia

About the Team

The District of Columbia (DC) team is composed of:

The D.C. team’s initiative aims to address inequities disproportionately affecting dual-eligible individuals (those enrolled in Medicaid and Medicare) with serious mental illness or substance use disorder who frequently use the emergency department (ED).  The team is working on identifying root causes of the inequities and designing a care and payment transformation.

Identifying and Diagnosing the Problem

To identify a health equity focus, the D.C. team reviewed current equity efforts in the District;  quantitative healthcare process and outcome data from UHC; and which organizational strengths to leverage. The team identified lack of access and utilization of best-practice behavioral health and substance use disorder treatment as primary barriers to health for their population of focus.

Partnering with Patients, Members, and Communities

The team is focused on developing partnerships with trusted community organizations and community leaders to better understand the root causes of inequities in the treatment and intervention of substance use disorder in the ED. It hopes to initiate and sustain these partnerships as they begin to design their care and payment transformation.

Creating Cultures of Equity

To improve team creativity and the potential for long-term success,  the D.C. team established operating norms that challenged dominant hierarchies found in work culture, such as conflict avoidance. The team recognized that each organization has their respective priorities and perspectives and that working through conflicting viewpoints is crucial for progress. The D.C. team also co-created a common definition for health equity to guide their work.

Designing and Implementing Change

The team is gathering information on: existing substance use disorder initiatives in the district; documented root causes of inequities in literature; and examples of evidence-based practice to inform the design of its care and payment transformation. The team hopes to build on the momentum of existing substance-use initiatives in the district as it transforms care and payment processes to advance health equity. 

Looking Ahead

The team hopes to gain insights on how to improve the integration of Medicare and Medicaid benefits to support quality healthcare and advancement of health equity for dual-eligible beneficiaries through their initiative.  The team also aims to develop a value-based payment roadmap that can be shared with all Medicaid managed care organizations in the District of Columbia.