Rebuilding Place in the Urban Space

"A community’s physical form, rather than its land uses, is its most intrinsic and enduring characteristic." [Katz, EPA] This blog focuses on place and placemaking and all that makes it work--historic preservation, urban design, transportation, asset-based community development, arts & cultural development, commercial district revitalization, tourism & destination development, and quality of life advocacy--along with doses of civic engagement and good governance watchdogging.

Sunday, August 04, 2019

Community Health Improvement Planning

I have a bunch of pieces related to this, many within the rubric of a recommendation that DC could create a world class public health infused hospital and health and wellness program "East of the River", which I wrote about in a bunch of pieces in 2017.

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River"
-- "Part Two: Creating a graduate health and biotechnology research initiative on the St. Elizabeths campus"
-- "Part three: the potential for donations around an expanded program"
-- "Revisiting East of the River medical care: United Medical Center"
-- "Update on DC's plans to build a new United Medical Center," 2018

A couple months ago, DC's Mayor announced a "health task force." ("Mayor Bowser Establishes Commission to Help Transform Health Care Delivery," press release). Frankly they should start with my writings...

This piece, a kind of follow up, discusses how the Affordable Care Act requires that hospitals create community health impact assessments.  The ones I've read are so general as to be worthless, and that is the case for the documents I've read that have been produced within DC.

-- "Another example of a failure to do public capital planning in DC: Council votes to stop funding United Medical Center," 2019

While following up today on something else, I came across the Monroe County Nutrition Workgroup in Wisconsin, which is part of the county's public health system and also is connected to Cooperative Extension.

And that led to the county's Community Health Assessment and Improvement Plan, which is referred to as a CHIP or Community Health Improvement Plan.  According to the forward of the plan:
The Wisconsin Association of Local Health Departments and Boards, along with the University of Wisconsin Population Health Institute’s County Health Rankings & Roadmaps, partnered to develop the Wisconsin CHIPP Infrastructure Improvement Project.
There are plenty of writings about community health assessments of various sorts. DC has a formal process too:

-- Community Health Needs Assessment, DC Department of Health

But given the example of the cessation of the DC Cancer (Support Services) Consortium discussed in a recent Washington City Paper cover story, "The Collapse of the DC Cancer Consortium Left Gaps in D.C.'s Cancer Care Network," as well as the problems in implementing opioid abuse interdiction programs ("DC opioid crisis: Overdose initiatives still in planning stages," Washington Post), and the decision by the Department of Disability Services to shift a key support program from Georgetown University to a firm with a lot of DC contracts, but many of them around maintenance and construction ("Backlash intensifies over DC plan to end disabilities services contract," Post), I suppose like a lot of the city's planning documents, there is a major disconnect between planning and implementation let alone a sense of urgency to act.

Labels: , , , , ,


At 10:30 AM, Anonymous charlie said...

also interesting Washington local John Delaney ( I knew him when he lived in Georgetown 25 years ago) makes on medicare for all -- that is what Howard bas been going through (almost no private insurance) and why it was financially failing for a number of years. I don't think your proposed EOTR plan can deal with that reality (that medicare/medicaid can't pay for the cost of a hospital program).

I'd also say DC has a chance with the insurance market to drive some innovation (state-like) for urban needs. Better HSA options, better options for concierge medical care, more competition. Not an insurance person but I don't see why (other than Grasso doesn't want it as former Blue Cross lobbyist) that any company that want to sell a corporate plan (federal workers) has to offer a private option as well.

Granted the number of non-insured people is very low in DC as a result of medicaid expansion -- although the medicaid program is terrible.

At 3:19 PM, Anonymous Richard Layman said...

Good points, especially about Howard. I didn't realize you've been here that long... and I didn't know Delaney was once here, but it makes sense.

WRT your point about my SE hospital proposal, I am sometimes too pie in the sky theoretical. There's a reason the city doesn't want financial involvement with UMC, it's a sinkhole, and will only grow over time.

OTOH, not having decent health care EOTR results in different kinds of costs.

I figure that combining the two cost-revenue streams could make it work, but I am no financial analyst.

But it does get at the point that we are debating the wrong stuff. Ultimately, it's all about "insurance" when it should be about health and wellness care.

E.g., the article about the Type 1 diabetes 26 year old who went off family insurance, didn't have the $ for insurance, and died.

We need various methods of providing care, and paying for it.

I am not wedded to "Medicare for All." I do believe we need health care for all, special programs for dealing with chronic conditions, etc.


Post a Comment

<< Home