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Remarks to the National Association of Community Health Centers by HRSA Associate Administrator Sam S. Shekar
August 26, 2003 For a printable version of the Power Point presentation, please see the PDF version. Slide 1 Update from the Bureau of Primary Health Care Sam S. Shekar, M.D., M.P.H. Associate Administrator for Primary Care and Assistant U.S. Surgeon General Health Resources and Services Administration U.S. Department of Health and Human Services Slide 2 The Health Center Program at HRSA focuses on four things: - Strengthening health centers; - Expanding health centers; - Improving Clinical Quality and the Health Workforce; and - Enhancing State & Community Partnerships. Slide 3 Health Center Program – FY 2002 (Map shows locations of Consolidated Health Centers) With regard to the people served: We are pleased to present these UDS 2002 data. The number of persons served has increased substantially and our commitment to our core population groups remains largely unchanged. We are still taking care of America’s most needy and thus reducing disparities in access to care. National/Regional UDS rollups are posted on the BPHC website. 11.3 million served 44.7 million patient encounters >3,400 service sites 88.1% below 200% poverty 38.9% uninsured 63.9% racial/ethnic minority Serve all ages: 12.8 % 4 and under 14.3% 5-12 years 20.2% 13-24 years 45.6% 25-64 7.0% 65 and over Slide 4 Health Center Base Adjustment
Slide 5 Goals of the President’s Initiative to Expand Health Centers, starting in 2001, include: By 2006: - 1,200 new or expanded health centers - 6 million additional people served. Slide 6 President’s Initiative to Expand Health Centers Expansion elements include: - New Access Points (NAP) - Expanded Medical Capacity (EMC) - Service Expansion Slide 7 President’s Initiative to Expand – year one Let’s see how we did in year one: With regard to NAP and EMC: As you can see from this slide, the Health Center program exceeded our goals for FY 2002. 171 new access points (41 > target) 131 sites with expanded services (1 > target) this demonstrates your hard work…. improving the health status of the nation’s most vulnerable. Slide 8 From what we see in 2003, we are exceeding our goals with 100/90 New Access Points 88/80 Expanded Medical Capacity 125 Service Expansions Slide 9 The more than 1 million increase reflects only early capacity, as you who run and work in health centers (HC) understand and appreciate. In fact, if we look at typical patterns of HC utilization, we have created the actual capacity to serve 1.4 million, which would well exceed the target. We want to underscore the magnitude of what we are collectively accomplishing – THIS YEAR’S INCREASE OF OVER 1 MILLION SERVED IS THE SINGLE LARGEST ANNUAL INCREASE IN THE HISTORY OF THE PROGRAM, and we expect to sustain this growth in the out-years of this initiative. Slide 10 Presidential Initiative – Building Access [Chart shows users at/below poverty line, percentage uninsured, and percentage of racial/ethnic minorities] Health centers continue to serve a disproportionate share of the Nation’s poor, uninsured, and racial/ethnic minorities. Nearly 70 percent of our patients are poor and are from racial/ethnic backgrounds. Nearly 40 percent of our patients are uninsured. Slide 11 Presidential Initiative – Service Expansions Percent of Grantees that Offer Selected Services On-site, 1996 and 2002 (est.) [Chart showing Dental Care - Preventive - Pharmacy - Mental Health Treatment/Counseling Percent 1996 - 2002 (est.); Presidential Initiative -Year One] With regard to service expansion: In 2002, the percentage of grantees that offer mental health/substance abuse (MH/SA), oral health, and pharmacy services has increased over 1996, with explosive growth in the MH/SA sector. The growth in MH is clearly an extraordinary, and it is our intention to achieve the same expansion success in oral health and pharmacy services. We want to build on existing increases and recognize those who have already contributed to this growth. FY 2002 Service Expansion (Total = 202) MH/SA 76 Oral – New 65 Pharmacy 7 Oral – Exp 52 Homeless Capacity 2 Slide 12 Low Birth Weight among U.S. Rural, Urban and Health Center Infants (chart showing that infants whose mothers received services at health centers have a lower incidence of low birth weight) US Urban infants: 8.8 out of 1,000 births Urban health center infants: 7.9 U.S. rural infants: 6.8 Rural health center infants: 6.2 African American urban infants: 13.6 African American health center infants: 10.7 African American rural infants: 13.0 African American rural health center infants: 8.4 Slide 13 Access to Care: Uninsured Health Center Patients Face Few Primary Care Access Barriers than Uninsured Overall Chart shows that 98.5 percent of community health center (CHC) patients have a usual source of care, while 74.9 of the U.S. population has a usual source of care. 57.3 percent of CHC patients have three or more annual doctor visits in 2001, while 39.4 percent of the U.S. population has three or more doctor visits. Slide 14 [Health promotion counseling for uninsured adults, by topic -- diet, activity, smoking, alcohol, drugs and STDs] Even amongst the nation’s most disenfranchised – those least likely to get any care, let alone counseling – uninsured health center patients are far more likely to receive this important, effective counseling than the uninsured who obtain care elsewhere. Health centers are already doing what NIH has demonstrated as effective. Slide 15 Health Centers and Medicaid Relationship: -- 1/3 of Health Center Patients -- 1/3 of Health Center Total Revenue -- 2/3 of Health Center Patient Revenue Result: Health Center Medicaid patients are 22% less likely to be hospitalized for potentially avoidable conditions than those obtaining care elsewhere. (Falik et al. Medical Care Vol. 39, No 6; 2001.) Health Center Medicaid patients are 11% less likely to be hospitalized for potentially avoidable conditions than those with a usual source of care who obtained care elsewhere. Cost of treating Health Center Medicaid patients is 30-34% less than cost for those receiving care elsewhere; 26-40% lower for Rx; 35% lower for diabetics; 20% lower for asthmatics. (Center for Health Policy Studies, Final Report; November 1994.) Slide 16 What is Quality Care? - Safe - Effective - Patient/ Family Centered - Timely - Efficient - Equitable (Source: IOM study Crossing the Quality Chasm: A New Health System for the 21st Century) The quality of care among patients served by health centers is excellent when compared with the care given similar populations elsewhere. To become the model for primary health care in the nation, we must always strive to meet the goals just listed for quality care. Slide 17 Quality: Where We are Going The agency and the Bureau of Primary Health Care have a strategic plan for raising the bar at America’s health centers to help meet the demanding goal for continually improving the quality of care. This includes a new division, expanding health disparities collaboratives, and more. - Division of Clinical Quality - Health Disparities Collaboratives - Accreditation - Risk Management Slide 18 Collaborative Success Tracy Orleans, Ph.D., senior scientist at the Robert Wood Johnson Foundation said in Advances Online, the Robert Wood Johnson Foundation newsletter, in October 2002: "With federally funded health centers having fully embraced the (Health Disparities Collaborative) model...this has become arguably the largest, most important health care quality improvement initiative in the country. It's exactly what the health care system needs right now- a demonstration that it is possible both to improve care dramatically and even reduce health care costs." Slide 19 Progress in Quality, Accreditation and Risk Management Collaborative(s) Participation: 497/842 (59%) JCAHO Accreditation in FY 2002, 285 out of 842 (34%) of grantees had JCAHO accreditation FTCA-Deemed Health Centers: 670/842 (80%) Slide 20 New Investment in Quality Over $2 million in Service Expansion grants was awarded in FY 2003 to 52 health centers to implement and expand Health Disparities Collaborative(s). Slide 21 Building the Workforce Health Careers in Health Centers will be a Preferred Option By 2006, - Need 36,000 additional staff, including more than 11,000 additional clinicians - Goal for FY 2002:7,200 additional staff/2,200 additional clinicians - FY 2002 Performance: 7,600 additional staff/2,000 additional clinicians (Source: Uniform Data System, FY 2002) Slide 22 With regard to specific disciplines in 2002: We can see that we have exceeded our targets for nurse practitioners, physician assistants and certified nurse midwives, dentists, and administrative staff. But we fell slightly short in physicians and considerably short in nurses. We, too, are feeling the national shortage. We have special sessions on workforce during this conference where we can tackle this issue together. I am personally moderating the workforce session, which reflects our commitment to working with you. PCAs/PCOs have been working hard on state planning in the workforce area of the growth initiative, which will help health centers meet their workforce goals. By the end of this spring (2003), all but two states will have completed the SSP process. Slide 23 State Primary Care Associations Workforce Recruiters State Partners in State Strategic Planning Leading the JCAHO Strategy BPHC is committed to 50+ State Participation in the President’s Health Center Initiative Slide 24 HCAP Partnerships Communities Access Program - FY 2002 - 22 new CAP communities in 15 states received awards in FY 2002 - 136 CAP communities received continuing funds. - Currently, HRSA has a total of 158 CAP grantees in 44 states Healthy Communities Access Program - Newly Established Legislative Authorization (340 PHS) New Direction - Stronger Emphasis on Health Care for Underserved - Strengthens Vertical Integration - Improves Chronic Care Coordination - Builds Information Technology Systems - Assists Infrastructure Development Slide 25 Changing the Health Care System [image showing inverted triangle with tertiary care at the top, secondary care in the middle and primary care at the bottom tip transforming into a triangle with primary care at the base in the largest space, secondary care in the middle and tertiary care at the smallest tip] Reaching these goals means that we have the potential to lead the nation’s health care delivery system in a restructuring. Instead of a system dominated by expensive secondary and tertiary care that is often complicated and inefficient, a system founded on a strong primary and preventive care base can ultimately improve health by addressing problems early and effectively. In such a system costs are lower and the probability of a successful outcome is higher. Slide 26 Changing the Health Care System “[Health Centers] have a strong base of innovation upon which to build…” (Source: Fostering Rapid Advances in Health Care, Institute of Medicine) Many influential people believe, as we do, that America’s Health Centers are poised to take on that role. Health centers will bring these new technologies and health care practices to those who are most vulnerable. Slide 27 Challenges Lag Time from Discovery to Practice (Slide shows the first of three graphs, with two lines upward from the left corner, each representing the gain in knowledge in science and health professional practice from years 1990 through 2020. The science line climbs steadily at a 45-degree angle from the graph’s baseline, indicating constant growth, while the health professions practice line also climbs but at a much lower angle to the baseline. At year 2010, a third bisecting line between science and practice is meant to indicate the so-called “lag time” between scientific discovery and the actual time it takes to incorporate research into practice.) Slide 28 Challenges Gap in Knowledge (Photographs on the graph depict some of the more than 31,000 health professionals currently working in health centers around the nation to bring knowledge of the latest science into practice.) Slide 29 Scientific Discoveries and Health Care Bridging the Gap (On the same graph, smaller pictures of health professionals are next to text that says “HRSA, in Partnership: health centers, primary care associations (PCAs), primary care organizations (PCOs), National Institutes of Health (NIH), Agency for Health Care Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), states, organizations and universities.) This list names the organizations, etc., that participate in funding as well as making scientific discoveries, then implementing those discoveries into health practice to bridge the gap. Slide 30 Instead of mediocre U.S. outcomes as we observe at the beginning of this millennium (28th among developed countries in infant mortality and 20th in life expectancy), by the end of the decade we could gain health care prominence among all the nations of the world – Slide 31 AND THEREFORE BECOME #1. We are in an incredible moment in time when we can transform the state of primary health care in the U.S. When the U.S. ranks low among industrial nations yet spends twice as much per capita, it is clear that more needs to be done to improve. — and Health Centers are the ones who can lead the charge! Slide 32 AMERICA’S HEALTH CENTERS ULTIMATE CHALLENGE AND GOAL: BE THE MODEL FOR PRIMARY HEALTH CARE IN THE UNITED STATES. Slide 33 CALL TO ACTION … AND WE CAN BEGIN TODAY! |
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