 |
|||||
|
|||||
|
Remarks to the Bureau of Primary Health Care All-Grantees Meeting by HRSA Associate Administrator Sam S. Shekar
June 30, 2003 For a printable version of the PowerPoint presentation, please see the PDF version . Slide 1 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 June 30, 2003 Update from the Bureau of Primary Health Care Presidential Initiative: A Report Card Good morning! It is a privilege for us to present the Report Card of America’s Health Centers – its performance during the first year of the Presidential Initiative to Expand Health Centers. Slide 2 President’s Initiative Report Card New Access Points (NAP): A+ Expanded Medical Capacity (EMC:) A Service Expansion (MH/SA, OH, Rx): A- People Served/Reducing Disparities: A- Workforce: A- Quality/Reducing Disparities: A We divided our work into 6 general categories and we graded these areas - as you can see Health Centers got straight As – As you know others think we are a “straight A” program too – even “tough” OMB graded us first in the Department and in the top ten in all of Government (as Dr. Duke mentioned). We want to present our reasoning behind these grades. Let’s begin. Slide 3 President’s Initiative to Expand Health Centers By 2006: – 1,200 new or expanded health centers – 6 million additional people This is our unifying goal: – 1200 new or expanded centers by 2006 – 60% increase in people served – greater than 16 million Let’s see how we did in year 1. Slide 4 Bar Chart showing New Access Points (NAP): A+ Expanded Medical Capacity (EMC): A 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 5 On Our Way To: – 90 New Access Points – 80 EMC In 2003 From what we see in Year 2, we are well on our way to meeting and perhaps exceeding the goals for year 2. Slide 6 Presidential Initiative -Year Two New Access Points (NAP): A+ Expanded Medical Capacity (EMC): A Service Expansion (MH/SA, OH, Rx)A- 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, Oral Health, and Pharmacy services has increased over 1996, with explosive growth in the MH/SA sector. The growth in MH is clearly an “A,” 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 we want to 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 7 Presidential Initiative -Year One [Chart showing People Served/Reducing Disparities] 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. Slide 8 The more than 1 million increase reflects only early capacity, as you who run and work in HCs 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 9 The unprecedented growth of the past year is reflected dramatically in this slide depicting new patients from 1998 - 2002. From 1998 - 2001, we averaged just approximately 540,000 annually in the number of new patients. Between 2001 and 2002, we nearly doubled that figure. Average Change 1998-2001: 540,686 Average Change 2001-2002: 1,041,251 Slide 10 IIn the number of uninsured patients during 2001-2002, we well more than doubled the average annual growth from 1998-2001. We almost doubled our historical growth in Medicaid beneficiaries too, maintaining our continued commitment to reducing disparities in access. Uninsured Average Change 1998-2001 149,919 Average Change 2001-2002 372,769 Medicaid Beneficiaries Average Change 1998-2001 247,000 Average Change 2001-2002 419,000 Slide 11 Not quite as dramatic as the the rate of change for uninsured patients, but still remarkable is the increase in the number of Health Center patients at/below 200 percent FPL. They already represent more than 88 percent of people served in HCs. In addition, our growth in our racial/ethnic minority population nearly doubled—358,000 compared to 636,000. Again demonstrating our commitment to reducing disparities in access. Below 200 Percent FPL Average Change 1998-2001 432,299 Average Change 2001-2002 697,638 Racial Ethnic Minority Average Change 1998-2001 358,000 Average Change 2001-2002 636,000 Slide 12 [chart showing users at/below poverty line, % uninsured, and % racial/ethnic minorities] So, as you can see, 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 13 Health Centers: Located Where the Need Is Source: AHRQ People Served/Reducing Disparities: A-
Let me explain this slide. The left column contains the percentage of county population that are impoverished (below the Federal Poverty Level) while the right column contains the percent of those counties with health centers. As you can see, less than 16 percent of our health centers are in counties where less than 6 percent of the population are impoverished. Half of counties where about 10 percent of the population is impoverished have health centers. Almost 80 percent of counties where almost 20 percent of the population is impoverished have health centers. Over 90 percent of counties where over 20 percent of the population is impoverished have health centers. The take away message is that we continue to start-up and operate health centers where they are most needed. Slide 14 Workforce By 2006, Need 36,000 additional staff, including >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 Presidential Initiative -Year One Workforce A- Source: Uniform Data System, Preliminary FY 2002 With regard to workforce: As we increase the numbers of health centers and people served, meeting our workforce needs in a competitive marketplace will continue to be a challenge. Now assuming no turnover at health centers – of course all staff that work at health centers make it a career! In the past year, we have exceeded our targets for additional overall staff (7600 vs 7200), but have fallen short for new clinical staff (2000 vs 2200). However, these aggregate figures camouflage differences in the disciplines. Slide 15 With regard to specific disciplines in 2002: We can see that we have exceeded our targets for NPs, PAs, and CNMs, dentists, and administrative staff, but we fell slightly short in physicians and considerably short in nursing. 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 (03), all but two states will have completed the SSP process. Slide 16 [chart: up-to-date-pap tests by race] Now with regard to quality: We continue to outstrip the preventive services delivered to comparable groups by other providers. We continue to contribute to reducing disparities in access to important preventive services, which we know can make a difference in health. Slide 17 [chart: health promotion counseling for uninsured adults, by topic] 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 18 One example of the very real impact the health disparity collaboratives have had on patient outcomes is in the area of diabetes – health centers participating in this collaborative are lowering client HbA1c levels by one percent or more. A one percent reduction results in a 15-18 percent reduction in mortality, heart attacks, and stroke. Source: BPHC Health Disparities Collaboratives data reviewed 4/03 S. Feetham, B Politzer, D. Stevens Slide 19 [chart: African Americans and Hispanics with hypertension at healt hcenters 3 times as likely to report blood pressure under control as NHIS comparable group] Also, we outstrip the chronic care that similar populations receive elsewhere. Source: NHIS = National Health Interview Survey Measure is 140/90, and hypertension control is self-reported Slide 20 Quality/Reducing Disparities:A African Americans & Hispanics with Hypertension At Health Centers 3 Times as Likely to Report Blood Pressure Under Control as NHIS Comparison GroupSource: NHIS & BPHC HC User Survey, 1995 LBW rates for HC women are comparable to the Nation's, yet HC women are at greater risk, and national disparity in rates between African American & others is reduced by 50% for those women served by HCs. (Politzeret al. Med. Care Research Rev. June 2001.) HC Medicaid patients are 22% less likely to be hospitalized forpotentially avoidable conditions than those obtaining care elsewhere. Faliket al. Medical Care Vol. 39, No 6; 2001. Cost of treating HC 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. Quality encompasses financial and administrative excellence, and we are impressed by the results showing that health centers provide cost-effective care. Reducing disparities in LBW is laudable as is providing better and more cost-effective care to Medicaid beneficiaries than who obtain care elsewhere. Slide 21 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 You will note that health center quality care gets an “A” when compared with the care similar populations receive elsewhere. To become the model for primary health care in the nation, we must strive to meet these goals for quality care. Slide 22 Quality: Where We are Going - Division of Clinical Quality - Health Disparities Collaboratives - Accreditation - Risk Management The Agency and Bureau have a strategic plan for raising the bar at America’s Health Centers to help meet this demanding goal for continually improving the quality of care. Slide 23 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 24 The Changing Health Care Environment – Preventive care – Electronic health records – Geriatrics – Genetics – Emergency preparedness/bioterrorism Now let’s take a moment to “vision” the health care system of the future. Who will lead the Nation’s system in these innovations? Who is poised to take on that role? Slide 25 The Changing Health Care Environment “[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 26 Collaborative Success “Inputs should also be obtained from organizations that have made significant efforts to improve quality…The Bureau of Primary Health Care.” Crossing the Quality Chasm, IOM, P.91, March 2001 In the recently published Institute of Medicine report, Crossing the Quality Chasm, the Bureau was one of three organizations cited for outstanding quality improvement initiatives. Slide 27 “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.” Tracy Orleans, Ph.D., senior scientist at the Robert Wood Johnson Foundation As you can see, others find our quality improvement initiative the lead for the entire nation’s primary health care delivery system, not solely for care to the most vulnerable. Slide 28 Health Center Outlook: Improving Access 10 million = 20% of 50 million people without access in 2000 16 million = 30% of projected 53 million people without access in 2006 20 million = 36% of projected 55 million without access in 2010 So what does all this mean for the Nation. Let’s take a look at the future – IF WE SHOULD DOUBLE OUR PATIENTS SERVED BY SAY THE END OF THE DECADE: And if America’s Health Centers are at the cutting edge of health care innovation, increasing access, improving quality, and reducing costs – then we will serve and have an opportunity to improve the health of just under 40% of those without access. Slide 29 Moreover, if we continue to maintain our commitment to THE most needy – those with the poorest health status in this nation – and continue to provide increased access to the highest quality care at reduced cost - we have the potential to improve the health of nearly half of those most in need by the end of the decade So why is this important? Slide 30 Because HEALTH CENTER performance can drive this Nation’s performance—your report card can drive the national report card. 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 – AND THEREFORE BECOME #1. Slide 31 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. |
|||||||||||||
|
Go to: HRSA News Room | HRSA | HHS | Accessibility | Privacy | Disclaimers | Search | Questions? |