As director of the D.C. Department of Health Care Finance (DHCF), Julie Hudman, PhD, has shown herself to be deeply committed to serving and improving the health of the residents of Washington, D.C. Hudman, a political appointee who will leave DHCF in January when the administration changes hands, lives in the city with her husband and two young children, who attend their local public charter school. She says they love to travel as a family, especially to India, where her husband is from, but feel that D.C.’s vibrancy and diversity is a wonderful place to live and raise a family. Hudman grew up and went to college in Oklahoma, and attended graduate school at both Georgetown University and Johns Hopkins. Connections spoke to Hudman in early December about her work over the last few years and the challenges that lie ahead.
Connections: Tell us a little bit about you, your department, and what you’ve tried to accomplish in your role as director.
Julie Hudman: The Department of Health Care Finance is the city’s Medicaid agency. We’re responsible for paying the bills incurred under our public health insurance programs, including Medicaid and the State Children’s Health Insurance program (SCHIP). Mayor Adrian Fenty hired me in 2007 as a health care advisor in his office and the DHCF didn’t exist yet. At that time, it was the Medical Assistance Administration and was part of the D.C. Department of Health.
But, in 2008, the D.C. City Council passed a bill creating a new cabinet-level agency, the DHCF, which the Mayor asked me to head. It was a much-needed change: DHCF is a $2 billion agency that provides health insurance coverage to more than one-third of all D.C. residents—and as such it should be accountable directly to the mayor and, by extension, to the city’s residents. The change not only brought more direct accountability to the agency, but it allowed us to focus our mission more precisely on serving the city’s residents and improving health outcomes.
Connections: What do you mean the agency focused its mission on serving residents and improving their health—wasn’t that the focus before the restructuring?
Julie Hudman: Yes, it was, but those bigger, people-centric goals seemed lost in the all the financial paperwork and bill paying, which is understandable given that we don’t provide services or run programs, we pay nursing homes, hospitals, and providers. With the creation of the new DHCF, we articulated a new mission to improve health outcomes by providing access to comprehensive, cost-effective, and quality healthcare services for residents of the District of Columbia. Our slogan is “investing in your health.”
It seems like a relatively simple change, but it heralded a major realignment that refocused and reenergized the agency and filtered into everything we do. We brought in Medicaid beneficiaries, for example, and talked to them about their experiences with Medicaid and SCHIP and made changes accordingly. We created an ombudsman’s office—the Office of the Health Care Ombudsman and Bill of Rights—to work with individual beneficiaries, helping them to navigate the system and resolve issues. We also started investing our public funds more wisely by asking questions about what we were getting for our dollars. Now we’re creating a perinatal outcomes collaborative to begin measuring quality—we pay for prenatal care, for visiting nurses, but are our babies healthier as a result? Is the infant mortality rate improving? Our managed care providers are now measuring these things and trying to get a handle on what works and what doesn’t. We have plans to do the same thing with chronic disease prevention. It’s long-term work, but it’s so important.
Connections: With health care reform now underway, how does health care access in D.C. stack up against the rest of the nation?
Julie Hudman: The District is very fortunate that we were already ahead in terms of health insurance coverage before the Patient Protection and Affordable Care Act became law. That’s because our Medicaid program already covered a higher proportion of residents than any other state. And, together with coverage provided under the D.C. Alliance for Health Care, any D.C. resident of modest income could obtain health insurance.
That’s still true now—in fact, only 6.2 percent of our residents are now uninsured, the second lowest rate in the nation next to Massachusetts—but the Affordable Care Act (ACA) can help with some of the budgetary issues we’ve started having due to the economy. By opting for early implementation of the ACA’s required Medicaid expansions, for example, we were able to move approximately 32,000 D.C. Alliance beneficiaries into the Medicaid program. We’re also moving an additional 4,000 residents as part of a waiver we submitted to the federal Department of Health and Human Services. We’re anticipating these moves to save District an estimated $66 million in local dollars over the next four years.
Connections: With coverage already so far along, what are the challenges that DHCF faces going forward as reform is implemented?
Julie Hudman: I see two challenges going forward. The first is budgetary—given the economic climate, the agency will have a challenge maintaining the enrollment levels that we’ve achieved to date while the details of reform are being hashed out. And the second relates to those details: the DCHF will be responsible for setting up an insurance exchange, which for those who don’t know is the ACA’s way to reduce health care costs by bringing private insurers together with government insurance to compete for enrollees. We don’t know yet what the details of that will be, how hard that will be to do in the Washington metropolitan region. There are bound to be a lot of technical challenges. And there’s just a big question mark hanging over everything: how do you implement the most ambitious social program at a time when you’re at your weakest as a government in terms of finances and personnel. I think the District is in the best position it could be at this point.
Connections: Given these challenges, what advice can you give consumer health advocates and funders like CHF? What can we do to further advance health care access and improve health outcomes in the region?
Julie Hudman: I have a few ideas that might be helpful. One is to suggest that Consumer Health continue and expand its regional efforts, and get more funders and organizations focused regionally. The D.C. metro area sees a lot of movement across jurisdictions—residents that move across city, county, and state lines for health care, for employment, for housing. There’s a very important regional convening function that needs to continue to happen and even be stepped up. Those relationships will be particularly important as health reform moves forward.
A second idea is that small, community-based providers—free clinics and others—are doing such phenomenal work but they need help upgrading their technology and their systems. Federally-Qualified Health Centers have to meet certain standards for reimbursement and they have an incentive to continually invest in better and better technology that creates efficiencies. The smaller providers can’t really keep up right now, but they need to be able to operate in that high-tech, data driven environment.
And a third is to help develop a more inclusive consumer advocacy community. The city has a strong health care advocates—they’re very sophisticated in terms of data analysis and synthesis, but they’re also very focused on specific constituencies rather than the whole. There are hard-working groups who represent clinics and community providers, who represent the needs of children, of the elderly, of people with disabilities, etc. But we’re missing a strong umbrella organization that is focused on health care more broadly, that represents and educates healthcare consumers regardless of what segment of the population they’re from. Absent of creating a new organization, Consumer Health and other similarly inclined organizations could begin building the health-focused capacities of existing groups that are more broadly consumer focused.
Connections: What’s next for you?
Julie Hudman: I’m planning to take some time with my family. My kids are young and it’s been an intense few years. And I’ll return to consulting, which is what I was doing before I went to work for Mayor Fenty. It’s an exciting time in health care and I want to be part of it.
