by HRSA Administrator Mary K. Wakefield
March 26, 2010
Your chairman, Dr. Ciro Sumaya, is, of course, one of my predecessors as HRSA Administrator under President Clinton. Dr. Sumaya, it is a pleasure to see you.
Dr. (Elena) Rios, thank you for the invitation to visit with you and your members.
I see last night you honored NHMA's National Leadership Fellows, an effort HRSA was proud to have helped launch. Dr. Kathy Flores, secretary of the NHMA's board of directors, was a fellow, as was our own Dr. Ahmed Calvo, who is senior medical officer in HRSA's Office of Health Information Technology and Quality.
Besides Dr. Calvo, HRSA has a number of Hispanic health care professionals in senior positions.
Your Women-in-Medicine awardee, Dr. Tanya Pagán Raggio-Ashley, is medical officer for our Division of Healthy Start and Perinatal Services in the Maternal and Child Health Bureau.
At our HIV/AIDS Bureau, Dr. Margarita Figueroa-González is director of the Division of Community Based Programs, and Dr. José Rafael Morales, known to us as “Rafi,” is chief medical officer of the Global HIV/AIDS Program.
In addition, Henry Lopez runs the Office of Minority and Special Populations in our Bureau of Primary Health Care – Henry's office oversees the migrant health centers -- and Diana Espinoza is deputy administrator of our Bureau of Health Professions.
They are people whose expertise and advice I count on, and they are a real asset to HRSA. I want to add, however, that we need to markedly increase our numbers of Hispanic health care professionals at HRSA. This is a great time for faculty to think about a two-year stint at HRSA, for practicing clinicians, for former NHSC providers to think about public service through a new lens. If you are interested, or you know someone who might be, we'd welcome the opportunity to talk.
Today I'd like to talk about HRSA's future and the vital role President Obama has planned for us as health reform rolls out. HRSA is a $7.2 billion agency with varied responsibilities. Included among them are:
Even as he was working toward health reform, President Obama in the past year has focused resources, time, and attention on two key HRSA responsibilities:
Let me say a word about each of these priorities, which are targeted toward access to quality primary health care. They are rooted in the American Reinvestment and Recovery Act he signed early last year – an act that directed $2.5 billion in new funds to HRSA. These priorities are also reflected in his proposed budget for HRSA for 2011, and in the just-passed health reform legislation.
The President knows, as we all do, that regular access to primary care holds the promise of a healthier nation, with fewer people progressing to chronic illnesses, and fewer of them using expensive emergency room care. If we expand access to health homes and to health promotion and disease prevention activities, we can, as you well know, reduce the number of Americans with chronic disease and better manage the care needs of people who do present with these conditions.
In terms of primary care, HRSA delivers it to underserved populations through our network of health center grantees. These 1,100 community-based health center grantees operate 7,500 service delivery sites in urban and rural areas across the nation. Together with the nation's public hospitals, they form the foundation a large part of the nation's health care safety net.
Every person who enters a health center receives care, regardless of their life circumstances. Payment is determined by sliding fee scales; the poorest pay nothing. About 40 percent of health center patients have no health insurance.
Health centers provide a broad range of care, emphasizing the treatment and control of chronic illness such as diabetes, asthma, cardiovascular disease and HIV. They also provide prenatal care for expectant mothers and care for their infants after birth. Increasingly, health centers provide comprehensive dental care, mental health care, and substance abuse treatment.
Of the $2.5 billion in Recovery Act funds directed to HRSA, $2 billion of that was targeted to health centers to expand the number of sites, the range of services they provide, and their hours of operation. The additional funds also helped build new facilities, renovate old ones, and invest in health information technology. In addition, the Recovery investment helped health centers add or retain more than 6,700 staff, including more than 1,200 new primary care providers, and generated as much as $3.2 billion in related economic activity.
The $2 billion in Recovery funds was a remarkable infusion for a program accustomed to an annual budget of essentially the same amount. With it, our grantees now care for close to about 20 million people, an all-time high. That makes the HRSA health center network the largest deliverer of primary health care in the United States, public or private. In 2008, a third of health center patients identified themselves as Hispanic or Latino, making them the largest ethnic or minority population served through the health center network.
Many of you know that the health center program includes a targeted effort to improve the health of migrant and seasonal farmworkers. The migrant health centers we support served 834,000 patients in 2008, the latest data compilation available to us.
With such a diverse patient base, health centers are keen to deliver culturally competent care, and they work diligently to furnish medical translations, when needed, in the language of the patient.
Health centers are operated by local, community-based organizations, so none of their names starts with “HRSA,” and their affiliation as a federal grantee is often unclear even to patients and community residents. But I imagine you're familiar with many of them:
When they were created more than four decades ago, health centers existed simply to provide access to care to those who had no other opportunities. But for many years now, HRSA has developed strategies to improve patient outcomes, to the point where multiple independent studies have concluded that health center care is equal to or better than care that can be obtained most anywhere.
For example, 90 percent of our health centers have participated in what we call “health disparities collaboratives,” which bring together teams of health center staff – doctors, dentists, nurses, and social workers – to improve care systems by learning about and then implementing better ways to work together and better ways to care for their patients.
Data collection and analysis of patient outcomes are at the core of this work. Health centers track patient outcomes and that information informs their thinking about the value of the changes they implement. Each year all of our health center grantees input information on patient demographics, services provided, staffing, clinical indicators, utilization rates, costs and revenues.
HRSA staff first review data to ensure compliance with legislative and regulatory requirements. Then they use the data to identify interventions capable of improving care for patients with chronic diseases.
In 2008, health centers established a core set of clinical performance measures for several key health conditions and age groups served by health centers. These measures – which include childhood immunization rates, entry into prenatal care, and control of hypertension -- are aligned with those of national quality measurement organizations, such as the Ambulatory Care Quality Alliance and the National Quality Forum.
Right now we're deeply engaged in efforts to see that health centers make full use of electronic health records and other health information technology. Because we, of course, view EHRs and HIT are central elements in our multi-layered strategy to improve health outcomes for our patients. As part of this we're using new technologies to expand data collection and analysis because we know it can point the entire network toward improvements in individual care, in management of resources, and in strategies to improve health at the community level.
Dr. Calvo has been deeply involved in developing and directing our quality efforts, and he can explain in detail about our health center controlled networks, our HIT technical assistance to grantees, and our efforts to improve patient safety by improving pharmacy services.
So that's where we're headed with health centers and their delivery of federally supported primary health care.
As I mentioned earlier, the second key element of President Obama's support for HRSA's programs involves health professions, an area where federal support had seriously eroded over the last decade. The President wants to make sure we have more trained health professionals, especially nurses and primary care physicians and others in high demand. Clearly, increasing access to appropriate care has implications for the numbers of nurses, dentists, doctors and others to provide it.
Under the Recovery Act, HRSA received $500 million to bolster the health professions, an effort to build a platform anticipating the passage of health care reform:
Looking forward, the President's drive to improve and expand primary care and health professions continues in the FY 2011 budget proposal that he announced in February.
The President's budget proposal includes an additional $290 million for health centers (to a total of more than $2.45 billion) over the 2009 level to keep up the increased pitch of activity initiated by the Recovery Act. If agreed to by Congress, the additional funds will create 25 new health centers across the country and further expand health centers' ability to provide behavioral health care.
That's the first step in a series of funding increases for health centers included in the health care reform bill the President signed on Tuesday. The health care reform legislation contains provisions that will allow us to nearly the double the number of patients that health centers over the coming five years.
The 2011 proposal continues the increase over the past year for the Nurse Loan Repayment and Scholarship program. The President again asks for $94 million, an increase of more than 150 percent over the FY 2009 total of $37 million. This infusion of funds supports hundreds of additional contracts for nurses in critical-shortage facilities.
And the President's request sustains his expansion of the NHSC. He asks for $169 million in 2011, an increase of $34 million over the 2009 appropriation. That's in addition to a very significant boost for the NHSC in the health care reform legislation.
In addition, other continuing investments to increase the number of primary care doctors, nurses and others are included in the health care reform legislation.
That's a summary of where HRSA is headed under President Obama's leadership and of the investments he's supported to build a brighter future for primary health care, for the health professions and, as a result, for the American people.
Now I'll be happy to take any questions you may have for me.