September 10, 2004
Nashville, Tenn.
 

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Good morning.  Let me extend a warm welcome to all of you who have gathered here in Nashville for this National Congress.
 
On behalf of the entire HRSA family, I want to thank you for the important work you do. Your efforts deliver tremendous payoffs to the entire nation. The lessons learned from our Health Disparities Collaboratives have the potential to save lives and improve the health of thousands of Americans.  We know from experience at hundreds of health centers around the nation that the changes promoted by collaboratives result in verifiable health benefits for patients as they struggle with chronic diseases like diabetes, asthma, obesity, heart disease, depression and cancer.
 
Did you know that there are 15 chronic illnesses that account for more than 50 percent of the $200 billion rise in health spending by the nation between 1987 and 2000.  Five conditions – heart disease, pulmonary, mental disorders, cancer, and hypertension – alone account for one-third of the cost increase.
 
Preventing the onset and adverse impact of chronic disease to the nation has been a central focus of Secretary Thompson’s term at HHS. With the Steps to a Healthier US Initiative, HHS continues to look for innovative ways to get more Americans involved in improving their own health and fitness.
 
And, of course, at HRSA we have our own answer to the problem of chronic disease. Pat yourselves on the back, ladies and gentlemen. Because of you, our health disparities collaboratives have become nothing less than a national success story.  As we work together to expand the number of collaboratives and to implement them at all of the HRSA-supported health centers, we give visibility to the emphasis that both President Bush and Secretary Thompson have placed on fighting chronic illness.
 
As you know, for the past few years, we have been fully engaged in making real the promise of the President’s Health Center Initiative. And, by any measure, we are making great progress.  By the end of 2004, HRSA will support about 3,650 health center sites across the country, serving an estimated 13.2 million people. In 2003, we served 12.4 million people, an increase of more than 2 million patients in just two years.  These are remarkable achievements and we take great pride in them.
 
And I am also proud to say that, with all of the challenges that come with an expansion of this size and scope, we have continued our focus on quality and prevention.
 
With our health disparities collaboratives, we have in place an intensive, full-court press that results in breakthrough transformations in the performance of many health organizations.  We’ve seen dramatic improvements in teamwork among health professionals. Procedures that track treatments and reach out to residents are better than ever. And, perhaps, most important, more and more patients are being encouraged to take greater responsibility for monitoring their own illnesses.
 
Our health disparities collaboratives are designed to define and document good ideas about primary care and best practices. Your teams work together and learn from each other.  You test and implement changes based on the best science, not by chance or guessing. In fact, we have an abundance of knowledge that we can now share throughout the vast health center network.
 
Our collaborative work has also generated many important supportive partnerships. I am so pleased that we can work so effectively with other federal agencies like CDC, NIH, and EPA, in addition to many national and community organizations that are dedicated to improving the public health.  It is through these partnerships that the good news about your work is spreading and catching national attention.
 
Just listen to the words of a senior scientist at the Robert Wood Johnson Foundation who said that the health disparities collaborative model “has become arguably the largest, most important health care quality improvement initiative in the country.”
 
Of course, the main reason that our collaboratives have become the focus of national attention is this – they work.
 
Our cardiovascular collaborative model has demonstrated remarkable achievements at a time when the disease in on the rise nationally, especially in the African Americans and Hispanic communities.  In fact, core measures from this collaborative will be added to the Diabetes Collaborative in next February, in our first attempt at integration.
 
The diabetes collaborative has made great strides of its own. When diabetes prevention studies recommended a particular level of intervention, our collaboratives were able to implement these recommendations in just one year. The diabetes prevention collaborative outperformed clinical trials reaching diabetes prevention outcomes faster than anyone anticipated.
 
We’re also moving to integrate mental health more significantly in our collaborative work.  Today, double the number of  health center patients have experienced a 50 percent reduction in their depression.
 
And with asthma — a condition that so negatively impacts millions of American children — our collaboratives are dramatically increasing the numbers of patients who maintain symptom-free days.  This result was possible because of improved educational outreach to families and children and persistent reliance on state-of-the-art medical regimens.
 
In the past year, I have been fortunate to see some of your outstanding work firsthand. I have had the pleasure of visiting a dozen health centers that have kicked off pilot cancer collaboratives.  These collaboratives are important, because they build on an impressive record already achieved by our health centers. Our health centers offer a broad spectrum of cancer care for patients, including prevention, screening, diagnosis, referral, and follow-up. More than 88 percent of adult women seen at these centers are up-to-date with their Pap smears and more than 63 percent are up-to-date with mammograms, outpacing the national average for these services.
 
With the cancer collaborative, we are creating local events that inform the broader community about the importance of early cancer screening and detection. We are mobilizing the grass-roots leadership to target those people hardest to reach and those who experience the greatest disparities in access to needed preventive and primary care services and get them into care.
 
Ultimately, as you have done with our other collaboratives, we want to drive organizational change to ensure that coordinated and supportive cancer screening and follow-up occur in a predictable, timely fashion.  Our goal is to develop a cancer prototype that will lead to:

• Major improvements in communication with patients and among providers;
• Improved levels of screening;
• Better coordination of follow-up after diagnosis; and
• A detailed documentation of treatment.

Some of our cancer collaboratives are seeing almost immediate results.  Take for example the West End Health Center in Cincinnati, Ohio.  Since October, 2003, this health center has made remarkable progress on all cancer screening measures.  The number of patients receiving breast, cervical, and colon cancer screenings has increased an average of 27 percent. The percent of patients who improved their self-management goals around cancer screening  increased 41 percent and 61 percent respectively.  And, the percent of additional evaluation or treatment done within an appropriate amount of time has increased from nearly 8 percent to a little more than 18 percent.
 
On another front, I met recently with the folks working on the launch of our first Perinatal Care and Patient Safety pilot collaborative. For the first time, we are involving other HRSA bureaus in a collaborative.  The Perinatal/Patient Safety Collaborative will be a HRSA-wide effort that will involve staff in the Maternal and Child Health Bureau, the Bureau of Health Professions, and the HIV/AIDS Bureau.  It also will have a broader community impact than previous collaboratives by including local hospitals in its activities.
 
Health centers will be identified in four states -- Illinois, Michigan, Mississippi and South Carolina -- that will participate in the model collaborative.  These states have been targeted by Secretary Thompson's Closing the Health Gap on Infant Mortality initiative because they have the highest infant death rates for African Americans.
 
Recently, Secretary Thompson announced $2.25 million in cooperative agreements between HRSA’s Maternal and Child Health Bureau and health departments in those four states to implement research-based best practices in their services for mothers and infants.
 
The Closing the Health Gap initiative represents a joint effort among HRSA, the Office of Minority Health in the Office of the Secretary, CDC, NIH and the Indian Health Service.  All of these HHS entities will join forces on research, risk reduction efforts, and a campaign to improve awareness of factors that contribute to infant mortality.  The Perinatal/Patient Safety Collaborative pilot, of course, is a vital new element of the overall initiative.
 
As part of this coordinated effort, we are delighted that the HHS Office of Minority Health has signed an interagency agreement with HRSA’s Bureau of Primary Health Care to invest $500,000 in the success of the new collaborative.  This investment from the Office of the Secretary shows his deep interest in the aims of the collaborative and in reducing health disparities among minority populations.
 
Before I tell you about our plans for the future, I would like to highlight just one more example of how the collaborative model works in another HRSA program.  I am extremely pleased to report that we are having real and significant success in increasing organ donations.  Before the collaborative began we averaged 500 donations per month or less.  Now after only 10 months of the collaborative we are averaging over 600 per month, and, for the first time ever, we hit a high of 650 on the most recent month for which we have data.
 
The question now for all of us is: what is next?  Well, in the month and years ahead, our intentions are clear.  We want to reach every health center, every site, every provider, and every patient.
 
As we move forward, several things must take place. We need to change health care systems from a disease specific focus to a methodology that centers on general health care.  Therefore, we are moving to a new care model which focuses on whole persons, not solely the disease of current national focus.  A key aspect of this change is the use of an electronic registry that will track patient data and their treatments.  This process will allow us to see whether treatment is working and what impact is being made.  We also need to work on cost reductions as we expand the number of collaboratives, and I am convinced that we can do this and still improve outcomes that reduce health disparities.
 
I can also tell you that we at headquarters are prepared to change ourselves just as we have asked you to change in order to serve your patients better and smarter.  Organizational realignments that need to be made will be done smoothly and well. When you tell us you need help, our commitment is to listen and respond.
 
In closing, I want to tell you again how proud I am of what you have accomplished. You are all nationally recognized innovators with a track record that is the envy of many.  At HRSA, we greatly appreciate the collegial relationship we have with all of you here. It’s because of the efforts of fine people like you that our nation is a healthier and safer place to live for many Americans and their families.
 
Thank you for giving me the opportunity to speak to you today.