Return on Community Investment (ROCI):
A High Impact Institute

Pre-Conference Data Collection
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Return on Community Investment Survey Responses

Respondent Name:

Sharon Baskerville

E-Mail Address:

sbaskerville@dcpca.org

Organization Name:

DC Primary Care Association

Phone:

(202) 638-0252   Ext. 111

Fax:

(202) 638-4557

Address:

1411 K St. NW, Suite 400    

City, State, Zip:

Washington, DC    20005
Category: Your Community

What is the service area of your initiative (counties, city, etc.)?

Washington, DC

What is the total population in your service area?

572,000

What percentage of the total population lives below the federal poverty level?

20% of DC's population of whom 32% are children

What percentage of the total population is uninsured?

10%
Category: Your Program Initiative

Indicate which of the following categories your initiative falls in:

Primary care capacity and access
Emergency room usage reduction

Describe the purpose of your initiative (in one sentence, if possible):

To create a funding investment and leveraging vehicle for improving, stabilizing and expanding the primary care delivery system in DC.

Describe the scale of your initiative in terms of budget, capacity, etc.:

Total project scope is estimated at 90 million dollars to create 200,000 square feet of high quality geographically accessible primary care space. It ensures connectivity between clinics and key institutions for better flow of patient information and follow-up.

Describe the operational components of your initiative:

The project is co-lead with Brookings Institution. The Project Director manages five Cluster work groups each having a cluster leader. The 14 contract partners are divided among the cluster groups of: Health Economics Development; Health Data; Clinical/MIS/Rate Reimbursement; Marketing/Fundraising and Outreach (political will building)

Describe your initiative's staffing level:

.85 Project Director, 1.0 Project Specialist .60 Clinical Coordinator, .5 Deputy Director, .25 Dir. of Development .25 Executive Director, Senior Policy Specialist, Political Consultant .5 Interns, .33 Receptionist, .27 IT Specialist Executive Director time is ''in kind''

If applicable, please describe your strategic use of an information system:

During the first year, there is extensive review of present IS currently in use across the nation and a decision process how to move forward with a system that will integrate communications among health care providers

Please list the major, time-framed, measurable objectives your initiative is designed to achieve:

Completed the first year of the grant: 14 site surveys using the Medical Homes Standards, Banking Survey, Clinic Survey, Legal Survey, commitment of funding from DC in the 05' budget, commitment from Feds for 05 DC Appropriations budget, selection and start of 2 pilot projects, mapping of health indices/special pops/center utilization/center location per ward, analysis of ER and hospital discharge data for primary care sensitive DX, development of prototype TA plan, MIS plan recommendation, Rate Reimbursement formula for centers, incorporation of Medical Homes DC into the major planning documents for the District.
Category: Measurable Results

Which of the following results can be attributed to your program initiative? Please check all that apply.

Coordinated System of Care Savings
Reduction of ER usage for non-urgent care
Savings from operational improvements within integrated system
Qualifying people for government subsidized programs
Increasing awareness of programs and services
Services brought into the community
Increased reimbursements
Improved health status
Improved productivity
Economic development factor
Social justice implications

Please list any other actual, measurable results of your initiative:

No response.
Category: Your ROCI Strategy

How do you define ROCI?

The project will result long term in the decrease in ER health seeking behavior, greater consistency in preventive health care to increase avoidable health crises (ER Asthma visit) and decrease avoidable hospitalizations. The hope is to improve the health indices for the district in stroke, diabetes, cardiovascular disease, asthma and hypertension. The TA will result in greater gains of efficiencies and productivity within the health centers. The IT connectivity will improve the financial status through comprehensive and timely review of eligibility. The upgrade and placement of centers will draw a mix payer base for economic stimulus to the center and the neighborhood. Leveraging the commitment monies from the Feds and District will resulting in a revolving fund for grants, loans and TA to sustain the Medical Homes DC certification process that will move the centers through three levels of achievement: basic, intermediate and comprehensive. With each level is a comprehensive plan to improve clinical standards, IT structures, fiscal health, Governance structure and address capital needs from total rebuild, relocation, and expansion depending the assessment outcome.

Describe your ROCI objectives and strategy:

Build a broad community -meet with the City Officials, all City Council Members, area health researches, meet with all Exec. Directors of Health Centers, interested Foundations and Universities. Conduct 3 Community Forums 2004. Develop and institute long-term sustainability strategy -determine seed monies from the District gov. and Feds. Create standards/certification model -MH standards based on FQHC standards Create communication tools -MH Website Develop MIS connecting centers with the hospitals, DOH and pharmacies etc. -Education of the Office of Economics and Planning, and the Dept. of Housing and Community Development are underway. Map critical health indices, economic indicators for each ward -IT linkage with ER to review core set of health data and redirect patient to their PCP. -improved systems for case management of chronic diseases through TA and enhanced IT systems Include the school health programs in the total assessment and integration of center services -on site review of school health programs, review of Medicaid monies/programs on school health care underway and review of national school based health models is underway

Describe the players involved in the ROCI conversation (by title and/or function):

Brookings Institution-Co-lead, economic dev./mapping RAND-ER/Hosp. dischg data analysis, MIS research 21st Century School Fund-research school based health Children's Nat. Medical Center-mapping data Capital Link, Inc. - intensive financial assessment/planning National Capital Revitalization Corp.-banking survey Management Solutions Consulting Group- Site surveys/TA plan Howard University College of Medicine-community consultation Crowell & Moring-legal advice Dept. of Health-linkage with Medicaid, IMAM, stats DC Bar Pro Bono Program-Legal survey DC Hospital Assoc.-consultation

List the milestones in your ROCI strategy that pertain to deal making (a prospective approach):

District and Federal strategies on securing seed monies and its uses Development of TA process, MIS plan, and rate reimbursement Selection of pilot projects

List the milestones in your ROCI strategy that are tied to outcomes (a retrospective approach):

Implementation of MIS Implementation of MH Certification process Development of vehicle to disseminate funds Mapping of all data and statistical analysis of data Establishment of a progress rate reimbursement

List the milestones in your ROCI strategy that are linked to sustainability:

Seed monies form the Feds and DC leveraged into a revolving pool MIS integration MH Certification process Progress rate reimbursement process Mixed payer for centers All city planning docs contain Medical Homes issues
Category: Your ROCI Methodology

Describe the analytic or economic logic underlying your ROCI method:

By creating a mechanism to improve and expand access and availability to health care to the most vulnerable, there will be a decrease in ER/hospital utilization, creation of a mix payer sources to allow more time by the centers on clinical standards etc., and the connectivity of the MIS will provide linkages with other centers/DOH/hospitals for tighter case management as well as follow-up on referrals.

Is your method supported by scientific research? If yes, please describe:

Reduced ER/hospitalizations translate into costs savings by having health services provided more consistently at a lower cost with improved outcomes.

Describe the measures that you used to define "returns" or value:

Decreased ER/hospitalizations for primary care sensitive Dx. Increase utilization of case management, decrease rates of diabetes, CVD, hypertension, asthma and stroke (long term). More centers with mixed payer based becoming less dependent on grants/philanthropic donations.

Describe the measures that you used to define investments or costs:

Seed monies from Feds/DC Supplemental grants for MIS, evaluation methodology and rate reimbursement development In kind contributions

Please briefly describe your data collection methods.

To be determine
Category: ROCI Communication and Negotiation

Describe the conversations that define your ROCI process:

Ongoing dialogue with the City Administrator's office on interactions with city agencies/data/contract issues, quarterly meetings with partners, Cluster group meetings as needed to maintain project deliverables, leadership team meetings with Brookings Inst. on a monthly basis to discuss strategic planning/progress.

Describe how ROCI conversations are tailored to specific audiences:

As stated above

Describe what enabled effective conversations to occur:

Aggressive outreach strategy and building a sense of inclusion with potential partners. This is a project that will eventually change the culture of how health care is delivered in the District and thus requires continual inclusion of critical organizations as the project unfolds.
Category: Results from the ROCI Process

Describe the outcomes, the successes of your ROCI strategy:

Long term decrease in health indices already described, horizontal and vertical integration of the health care delivery system, standardized levels of primary care, and an established revolving fund for grants/loans/TA that will all result in elimination of health disparities.
Category: Lessons

What do you see as the critical success factors that can guide others?

Collaboration on this scale requires a great deal of facilitation and multiple prong approaches that must be coordinated so that there is a logic to the approach and the message is consistent. Prioritization of issues is critical and should be sequenced to maximize impact.

Do you believe that your results can be replicated successfully with other similar initiatives? Can you suggest how replication may be facilitated?

Possible, but this is a very intense process in a small city that is unlike any other in the nation.
Category: Finalize Survey Responses

Please list any websites that provide valuable ROCI information:

CAP