Remarks to the 2002 Healthy Start Grantees Meeting

Prepared Remarks of Elizabeth M. Duke, Ph.D.
Administrator, Health Resources and Services Administration

Baltimore, Md. 
October 7, 2002

Good morning and welcome.  Thank you for this opportunity to share my thoughts on how critically important it is for us to continue working together to provide quality health care for all those mothers and children who count on us to get the job done.

I thank you all for your tireless effort on behalf of families in your communities.  For the people you serve, your work is invaluable.  And we at HRSA are proud to call you partners.

We are also fortunate that we have such passionate support from Secretary Thompson for the work we do to make sure moms and their babies get the best care possible.  As you will hear later from our guest speaker HHS Deputy Secretary Claude Allen, the entire Department is mobilized to promote and protect the health and well-being of all the Nation’s women and children.  In fact, the President has maintained funding for the Healthy Start program at the fiscal year 2002 level of $99 million.  This is a compliment to your dedicated efforts on behalf of healthy moms and babies everywhere.

I want to begin today by giving you an update on some exciting work we are doing at HRSA.  I know some of you are new grantees and it’s important for all of you to see how your work complements our efforts to increase access to quality health care for millions of uninsured and low-income fellow citizens.  President Bush and HHS Secretary Tommy Thompson have made it clear that providing more health care directly to Americans is HRSA’s most important task.

How do we accomplish this?  With a $6.2 billion annual budget that provides a solid safety net of health care services that reach into every corner in America.  In all, we administer over 80 different healthcare programs, and we give out 6,000 grants per year to 2,300 separate organizations.

Right now we are focused on implementing two high-profile presidential initiatives and awaiting word from Congress to begin work on a third.  These initiatives are at the heart of HRSA’s current and future efforts to expand access to health care and close the health disparities gap.

The first initiative is President Bush’s five-year plan to create new and expand existing Health Centers.  The Health Centers Presidential Initiative aims to increase the annual number of patients served to 16 million by 2006, up from just over 10 million currently.  The President’s long-term plan is to add 1,200 new and expanded health center sites over five years and ultimately double the number of patients treated at them.  For fiscal year 2003, the President is asking for $1.5 billion for health centers – a $114 million increase over this year’s budget and a two-year increase of almost $280 million.

The Health Center expansion will not only increase access to care, it will reduce health disparities.  Because almost two-thirds of Health Center patients come from minority groups, members of these groups will benefit most from the increased access to care and the expansion of available health care services.  That will improve their health and reduce disparities in health outcomes between minority and majority populations.

The second presidential initiative involves reforms at the National Health Service Corps to help the Corps get more clinicians to front-line areas of greatest need.  The NHSC gives scholarships to medical professionals and pays off their student loans; in exchange, these physicians, dentists, and other health professionals agree to practice in medically underserved areas for at least two years.

Funding increases for the NHSC of $20 million this year and a proposed $45 million in 2003 are tied to the expansion of the Health Center network, since many NHSC clinicians are assigned to Health Center sites.

Full implementation of the health center expansion will mean that the health center staff will increase by 30,000 people by 2006.  Of that number, about 4,500 will be primary care providers.  It’s an enormous challenge and expanding the number of NHSC clinicians will help us meet our goals.

Earlier this year, to meet the need for well-prepared clinicians able to respond to national crises, Secretary Thompson announced the launch of NHSC’s “Ready Responders.”  These Ready Responders – 36 family physicians and 4 dentists -- will spend most of their time in health professional shortage areas treating the underserved.  But they also will receive regular special training and will be ready at a moment’s notice to deploy to medical emergencies nationwide.

The President’s third initiative at HRSA is called the Healthy Communities Innovation Initiative.  It’s a new interdisciplinary effort that will bring together experts from throughout HHS to focus on ways to prevent asthma, diabetes and obesity.  These three chronic conditions are among the fastest-growing in the United States and present severe problems in many minority communities.

The President’s 2003 budget proposes $20 million for HRSA to set up demonstration programs in five communities.  Funds will be used to establish efforts to improve health outcomes in areas where illness and death rates due to asthma, diabetes and obesity are high.

The Healthy Communities initiative builds on the successes of a model that you are very familiar with -- the Healthy Start program.

HRSA, through our Maternal and Child Health Bureau, works with States, Territories, and other communities to ensure that babies are born healthy and that pregnant women and children have access to health care.  Each year, MCH programs serve 27 million women, infants, children, and adolescents.  This represents 95 percent of all infants, 23 percent of all children and adolescents, and 55 percent of all pregnant women.

Currently 96 high-risk communities in 37 states, the District of Columbia, Puerto Rico, and the Virgin Islands participate in Healthy Start.

To date, Healthy Start projects have made great strides in reducing infant mortality and helping mothers to have healthy infants.  The infant mortality rate for the year 2000 reached a historic low of 6.9 deaths per 1,000 live births.  This resulted predominately from a 3.4 percent decline in the rate for black infants -- from 14.6 to 14.1.  However, the mortality rate for black infants was 14.1, still over two and half times the 5.7 rate for white infants.  Disparities for infants of Puerto Rican, Hawaiian and American Indian mothers also continue.

In 2000, the proportion of pregnant women across the nation receiving prenatal care in the first trimester reached 83.2 percent.  Still, only 74.3 percent of black, 74.4 percent of Hispanic, and 69.3 percent of American Indian pregnant women received early prenatal care compared with 88.5 percent of white non‑Hispanic pregnant women.  Striving to overcome these disparities is a priority for HRSA and HHS.  This is why your efforts and successes are so important to all of us.

Recently, the District of Columbia Health Department Director reported that the local Healthy Start program achieved a zero infant mortality rate among its clients in 2000.  And here in Baltimore the local Healthy Start project has been cited by Johns Hopkins University for its effectiveness in preventing very low birth weight births.  We can all strive to replicate and celebrate this kind of progress.

I am also pleased to hear of your achievements in creating family-friendly and culturally competent care for young mothers-to-be.  I cite, for example, the Michigan Sault Ste. Marie project that has been very successful in making lasting changes for American Indian families in the area.  At several hospitals near reservations, these families are now welcome to practice traditional spiritual rituals before and after the birth of a baby.

The knowledge, familiarity and acceptance of such practices on the part of hospital personnel build long lasting trust between the community and the hospitals.  It is this kind of work -- ensuring ongoing primary care and the cultural competence of providers -- that will help to bridge the continuing gaps in access to health care.

HRSA is also working to assist you with issues surrounding third party reimbursement.  Through our Center for Health Services Financing and Managed Care, HRSA helps grantees better understand and participate in the various health service financing and reimbursement systems to ensure the maximum use of Federal grant funds for services to the uninsured.  HRSA has embarked on a new three-year program to improve the third party reimbursement status of community-based organizations.  Our contractor, the Center for Health Policy Studies, has brought together a team of experts in third party reimbursement who have developed a training program to address state-specific requirements related to third party reimbursement for the grantees of each HRSA bureau.

The training has been designed to help HRSA grantees, especially Healthy Start projects and all Healthy Start providers and contractors, to improve revenues from third party sources.  Training and follow up technical assistance will be offered in each state, in the areas of billing, coding, and collections.  This effort recently kicked off in seven states -- Texas, Michigan, Colorado, Oregon, New Jersey, Delaware, and Arkansas.  Five more states are being added this fall.  The remaining states will be covered over the next two years.  For further information on this activity, a list has been included in your registration packet along with the website address for further information.

HRSA is also a leader in the promotion of screenings for and intervention to reduce perinatal/postpartum depression.  About 10 to 15 percent of women have a major depressive episode during the perinatal/postpartum period.  Untreated maternal depression of this magnitude can have serious, long-term consequences for the depressed mother’s children – including developmental problems, especially in social and language skills, lower intelligence quotient, behavior problems, and poor school performance.  For these children, there is a 40 percent chance of developing an episode of major depression by the age of 20.

We also promote screening for alcohol and other substance abuse in pregnant women.  Four projects targeted to increasing alcohol screening by providers will be ending this year.  MCHB recently awarded two three-year grants to replicate the lessons learned in two of its original prenatal alcohol screening grants in new geographic areas.

We are also looking closely at family and domestic violence because we know that physical violence during pregnancy is significantly associated with fetal death and low birthweight.  This summer, we made grants totaling almost $1.2 million to eight communities that will help women in need of domestic violence services.

HRSA is also committed to bringing high quality research to bear on our policies and practice with regard to the health and well-being of pregnant women and their children.  For example, we are looking at how welfare reform impacts the health of immigrant mothers and their infants in New York and California.

We are in the midst of a three year case study to determine whether enhanced perinatal services that include nutrition, psychosocial, and health education services are associated with measurable benefits for women enrolled in Medicaid Managed Care plans, and whether those benefits differ for African-American, Hispanic, and white/non-Hispanic women.

You can be sure that our findings from these and other research projects will be shared with all of you through our website, conferences and training activities for grantees. 

In closing, I share with you my belief that strengthening partnerships is the best way to create healthier women, infants and families.  We can be proud that our work improving maternal and child health has a tremendous payoff for the Nation.  With you -- and people like you in communities across America -- working collectively and collaboratively to build quality systems of care, I am confident we can do an even better job of meeting the needs of mothers and their babies.

Thanks again for coming today and for being a part of the intensive and beneficial learning experience this annual education meeting provides.

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