July 30, 2003
San Antonio, Texas

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It is a pleasure to be in beautiful San Antonio.  Thank you for the invitation to speak with you.
 
I’d like to begin with an update on where we are with the President’s Health Center Expansion initiative and tell you about the gains we made in 2002 toward the goals the President has set out for us.  We’re very pleased not just with the latest UDS (Uniform Data System) numbers, but with the evaluation the Office of Management and Budget gave the health center network in a recent review.
 
Before I begin, however, I wanted to share with you a summary of information we collected on HRSA’s impact in the region you represent.  People sometimes call us “little HRSA” because we’re not as well-known as some of our sister HHS agencies like CDC or FDA, but we have a surprising impact on communities large and small.  The following statistics cover Fiscal Year 2003 grants HRSA has awarded to your states through the end of June, that is, with three months left to go:
 

• Texas has received 309 grants totaling $277.8 million;
• Louisiana has received 97 grants totaling $74.6 million;
• New Mexico has been awarded 105 grants worth $46.9 million;
• Arkansas has received 77 grants worth $39,330,228 and
• Oklahoma has been awarded 62 grants totaling $32,818,069.

In San Antonio alone we have awarded 42 grants worth more than $22 million, grants that give an indication of HRSA’s range and reach.  Grants for health centers and basic nurse education and nursing workforce diversity.  Grants for HIV/AIDS care.  And grants for training programs for physicians, dentists and physician assistants.
 
We are proud of our investment in your region and proud to have you as our partners as we work together to improve the health of the American people.
   
All of you know that one of HRSA’s most important responsibilities now and for many years to come is administering the President’s Health Center Expansion Initiative.
 
Soon after taking office, President Bush announced a five-year initiative to create 1,200 new and expanded health centers that will serve an additional 6 million patients annually by 2006.  Congress agrees with the President’s vision and has provided funds to significantly expand the system.
 
So far the President’s expansion plan is proceeding ahead of schedule.   In 2002 HRSA exceeded our targets by funding 171 new health center access sites and expanding capacity at 131 centers – 41 sites beyond our goal.   Already in 2003 we’ve announced grants to establish new sites or expand existing sites at 70 locations – and we plan to announce another 100 grants before the end of the year.
 
Let me tell you about some of the unprecedented gains in service delivery that health centers achieved during 2002, the first full year of the expansion initiative:
 

• We served more than 11.3 million patients last year.  That’s an increase of more than a million patients over the 2001 figures.  So that you have a measure of comparison, that’s close to double the annual average increase during the years 1998-2001.  Total patient encounters grew from 40.3 million to 44.7 million – that’s 4.3 million more encounters over the year.
  
  
• We managed this phenomenal increase while maintaining the focus on our traditional patient base – those who need us the most.  In 2002, 39 percent of our patients had no health insurance; 88 percent earned 200 percent or less of the poverty line; and 64 percent were members of a minority group.
  
  
• In 2002, we treated 373,000 more uninsured patients than in the previous year; during the 1998-2001 period, the annual average growth was 150,000 uninsured patients.
  
  
• We also served more Medicaid patients than ever before.  The growth in Medicaid patients served in 2002 was 419,000, far higher than the annual average growth of 247,000 patients between 1998 and 2001.
  
  
• Nine-tenths of the patient growth occurred among people whose income was below 200 percent of the poverty line.  917,000 of the 1 million patients we added during 2002 earned less than the 200 percent mark.  That compares to the average of 535,000 low-income patients added annually during 1998-2001.
  
  
• We increased the number of minority patients by 636,000, compared to the average increase of 358,000 during the 98-01 period.
  
  
• The number of babies delivered at health centers in 2002 increased by 12,000, compared to the annual average increase of 8,000 for the 98-01 period; HIV tests increased by 87,000, compared to the annual average of 25,000 more tests during 98-01; and the number of Pap smears increased by 185,000, compared to the 98-01 average annual increase of 77,000 patients.
  
  
• And we continued in 2002 the trend of expanding the services we offer: 72 percent of grantees now offer preventive dental care; 69 percent have pharmacy services; and 68 percent offer mental health treatment and counseling.

All of these achievements verify what the Office of Management and Budget discovered during its recent evaluation of the health center program.  OMB has a system called the Performance Assessment Rating Tool – PART, for short – that it is using over a five-year period to rate the value of every program in the federal government.  The President wants to see which programs work and deserve public support -- and which ones don’t.
 
The health center program was evaluated last year, part of the first fifth of programs OMB looked at.  Now let me tell you, OMB has some tough graders.  The health center program managed a grade of 85 from OMB.  But that was not only tied for the best score, it was among the top 10 scores in the 234 programs OMB evaluated!  That is reason to feel proud and I congratulate all of you for contributing to that great score.
 
Luckily for health centers, you not only do great work, you have a data collection system that proves it.  All the information I just shared with you about health centers’ performance was came from the Uniform Data System’s collection of calendar year 2002 data, which anyone can access at bphc.hrsa.gov.
 
With OMB’s rating tool now in place, no federal administrator will be able to stand up and say ‘we do a great job’ and have that statement go unchallenged.  From now on, program administrators have to collect data that allow performance to be measured in an objective, verifiable fashion.  Thanks to the UDS, the health center system is way ahead of a game that has much of the government playing catch-up. 

The unprecedented health center achievements of 2002 are only the first of many years of achievements that are expected of us.  To meet the ambitious goals the President and Secretary Thompson have set, we knew we had to reorganize BPHC.
 
The changes have one aim: to help BPHC concentrate its resources more directly on the essential elements of the President’s initiative.  Consider the demands of the President’s initiative and what we have to accomplish: we must increase the number of patients we serve by over 60 percent by FY 2006 without a commensurate increase in staff.   We must create dozens of new sites and expand existing centers each year.  And while we do that, we must also improve management capabilities and strengthen the quality of services.
 
Let me highlight some of the challenges we face over the next few years:

• First, we want to make sure we expand the system even deeper into America’s neediest communities while maintaining health centers’ high standards of quality.   How do we plan to do this?   By providing technical assistance to poor communities to help them produce competitive applications. We want to work closely with you and the other PCAs to make sure your statewide strategic plans reflect this emphasis.  Frankly, we already do well here – 92 percent of counties whose poverty rate exceeds 20 percent of their population already have health centers – but we want to do better.
  
  
• Second – the system needs 36,000 new staff to meet our goals, including more than 11,000 clinicians. We’ll need to develop new recruitment and retention strategies, improve existing ones, and work with residency and educational training programs.  The reform and expansion of the National Health Service Corps – the second of the Presidential initiatives HRSA is responsible for -- plays a fundamental role in our staffing plans.
  
  
• Third – you know better than anyone that state budgets are tight and Medicaid revenue is uncertain. We’ve been working with the Centers for Medicare and Medicaid Services to ensure timely certification and payment, and CMS has been very responsive to us.  With their help, we’ve developed an expedited process and streamlined forms to ease the burden on new health center sites seeking certification for Medicare and Medicaid reimbursements.
  
  
• Our fourth challenge is that the number of uninsured and underinsured is growing. Our solution is to provide base adjustments to strengthen the safety net and Secretary Thompson announced those awards at the All-Grantees meeting earlier this month.
  
  
• Fifth – we don’t want to just sustain the high-level of quality that the system is known for.   We want to enhance it.   We’ll do it by promoting excellence at all health centers through a quality-improvement strategy.
  
  
• Sixth – Health centers are seeing more patients with costly chronic diseases like diabetes, asthma, obesity, heart disease, depression and cancer, even as the system expands.  Here we have a proven strategy that reduces the harm done by chronic diseases: promote early intervention and patient management through our health disparities collaboratives.   Collaboratives are fairly new, but they have already spread to over two-thirds of our entire health center system.  Our goal is to implement the collaborative care model in all health centers by 2005, focusing on a core set of prevention and chronic disease measures.

The strategy to expand collaboratives to all health centers dovetails exactly with the emphasis by President Bush and Secretary Thompson on fighting chronic illness. In the May 9 Federal Register, the Secretary announced the availability of almost $14 million in FY 2003 to fight diabetes, obesity and asthma at the community level under the new “Steps to a Healthier US” initiative. The President is asking for $125 million for the initiative in his FY 2004 budget.
 
This announcement follows repeated calls by the Secretary to exercise more, lose weight – advice he has followed himself, I should add -- and get regular checkups.   All are great ways to fight the harm done by chronic disease.
 
These are themes you will continue to hear from Secretary Thompson.  America’s growing problem with obesity and overweight now affects two-thirds of all adults, and rates have doubled in our children over the past 20 years.  The epidemic has two prime causes – eating too much and moving too little.
 
The Secretary wants Americans to face the simple fact that most of us eat too much, and particularly too much fat and sugar.  He said recently that “most Americans know that sensible eating habits and regular exercise are the keys to losing and keeping weight off.  But knowing and doing are two different things.”
 
He wants to raise people’s knowledge of the link between being overweight and other chronic diseases.  People who are overweight or obese have a greater chance of developing high blood pressure, diabetes, heart disease, stroke and certain cancers.  The total of direct and indirect costs attributed to overweight and obesity amounted to $117 billion in the 2000 – that’s $400 for every man, woman and child in this country.
 
On September 16 the Secretary will advance his prevention campaign by sponsoring the second annual “Take a Loved One to the Doctor Day.” Radio personality Tom Joyner will again join him in encouraging Americans – especially those from minority communities – to take charge of their health by encouraging family members and friends to get a checkup from a health professional.  We recently sent out a letter to all health centers encouraging you to get involved in this activity.  I know many health centers were involved in last year’s first “Take a Loved One Day,” and I greatly encourage you to join in this year’s event.

Why are President Bush and Secretary Thompson so concerned about fighting chronic illness?  One, because it lowers the strain on the entire health care system if people take care of conditions before they become life-threatening events that require expensive interventions and hospitalization.

And two, because fighting chronic illness is key to closing the “health gap” in minority communities.  Because rates of diabetes, asthma and many other chronic diseases are, in general, far worse among minorities than for the nation as a whole, fighting chronic disease represents an important way to improve their health.
 
Since minority Americans are almost two-thirds of all health center patients, you can see that President Bush’s expansion initiative has enormous potential to improve minority health.

It will happen like this: expansion of the health center system means greater access by minorities to quality health care.  That, in turn, results in greater access by them to the chronic-disease-fighting benefits that health centers – through the collaboratives – are focusing on.   The certain result: improved health outcomes.
 
Let me now go quickly through BPHC’s new structure:
 
·        The Office of the Director, of course, will direct the President’s Initiative.

·        The Division of Health Center Development will implement the plan to expand the health center network.  It will oversee the heart of the growth process: the creation of new primary care access points and the expansion of medical capacity at existing centers.

·        The Division of Health Center Management will promote efficient management and financial strength in the health center network.  Its responsibilities include the development of integrated services and shared management information systems, monitoring, and reinvestments in the health center network.

·        The Division of Clinical Quality will coordinate improvements in the delivery health center services that result in better patient health outcomes.  It will share models to improve clinical care, facilitate accreditation, and promote risk management strategies.

·        The Division of State and Community Assistance will coordinate resources at the state and community levels to support the Presidential initiative. The division will manage grants to state primary care associations and organizations, the Healthy Community Access Program grants, technical assistance contracts and cooperative agreements.
 
Under this plan, no one Division or Office carries the weight alone.  And no one Office or Division “owns” a single issue.  Divisions and Offices may and will be called upon to lead a given issue, but they will not own it solely.  I really think this arrangement makes for the best product, by bringing in diverse perspectives to get the outcomes we need.
 
We also will be better able to assume most of the responsibilities that were previously done by regional staff.  This is a huge challenge and a big change for us at BPHC, especially when we estimate that over 80 project officers in the Field are currently responsible for this work.  And, by and large, we will be picking up these responsibilities at headquarters without any additional FTEs.
 
Let me conclude by stating the obvious, by restating what I’ve been saying: we face great challenges at HRSA and at BPHC.  But no one should consider the goals that the President of the United States has set for us to be a burden.  They are not.  They are an honor to work toward, because the result of our success will be a healthier nation.
 
With his expansion initiative, the President said to the nation what his Office of Management and Budget later confirmed: that the health center system works -- and that the American people need vastly more of the important services it provides.  We should be inspired – not perplexed -- by the responsibility he has placed on our shoulders.
 
The agency and the Bureau have a unique window of opportunity to showcase the Health Center program nationwide.  It’s an opportunity we must make the most of.
 
I thank you for inviting me to be with you, and I thank you for listening.