Remarks to the National Conference of State Legislatures on the President's Health Center Initiative

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

Rockville, Md. 
August 14, 2002

Good afternoon.  I’m delighted to be here with you to discuss the President's Health Center Initiative.

Since HHS Secretary Thompson appointed me to lead the Health Resources and Services Administration almost a year and a half ago, HRSA employees have been working to implement President Bush’s unprecedented plan to increase direct health care to uninsured and underinsured Americans.  To succeed in this endeavor, we are counting on the active collaboration and assistance of our partners at the state level, especially the state Primary Care Associations and Primary Care Offices and the State Loan Repayment Programs.

The President's Health Center Initiative is at the absolute heart of Federal efforts to expand access to health care and close the health disparities gap among Americans.

For 35 years, the national network of health centers has worked to meet its main mission: to provide family-oriented primary and preventive health care services for people in medically underserved communities -- regardless of their ability to pay.

Our 3,300 health centers and clinics serve a significant portion of America’s uninsured and medically underserved families and individuals – 40 percent of the more than 10 million patients we serve at health centers each year have no health insurance.  About two-thirds of health centers’ patients are from racial and ethnic minority groups, and more than 85 percent live below 200 percent of the poverty line.

Strong partnerships with the communities they serve are key to the health centers’ success.  By working closely with community groups, health centers tailor their services to meet their customers’ most pressing health care needs.  These close community ties help health centers reflect their clients’ cultural, ethnic and linguistic backgrounds.

You can see from this slide that the system we are expanding is already a substantial health care network with roots in hundreds of local communities.  Millions receive high-quality medical care at health centers, and tens of thousands are employed there.  America’s Health Centers have an enormously positive impact on people and communities across the nation.

This slide shows the scope of President Bush’s plans to further strengthen the nation’s health care safety net.

The President’s proposed budget for 2003 would raise health center funds to about $1.5 billion, an increase of more than $114 million over fiscal year 2002.  And that proposal follows an increase of $175 million for health centers in this year’s budget.

These requests lay the foundation for the President’s five-year plan to create new or expanded health center sites in 1,200 communities and increase the number of patients served annually to more than 16 million by 2006.

The additional funds will not only expand access to care, they’ll also help 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 help improve their health and reduce disparities in health outcomes between minority and majority populations.

The President’s initiative places a nearly equal emphasis on the creation of new access points and the expansion of existing access points.  As this graph shows, over the initiative’s five years we plan to add 630 new access points in areas where there currently are no health centers. In addition, we will create satellite units at 570 existing centers and increase services by remaining open for additional hours, increasing the number of providers, and offering additional services.

In addition to funding 1,200 new or expanded health centers, our grantees will need to hire approximately 30,000 new staff members, including more than 4,000 new primary care providers.  In addition -- and this is most important during the initial development phase -- we will need to create hundreds of community-based boards of directors at new center sites. These boards ensure that the center is community based and controlled, and thus is responsive to the health care needs of the population it serves.

If all goes as planned—which we expect it will—the nation’s health centers will be able to provide care for approximately 1 million more Americans each year until we reach our goal of 16 million patients served in 2006.  This gain represents a greater than 50 percent increase in the number of Americans who have access to quality health center services over the five-year initiative.

As you can imagine, this expansion—the largest in the program’s history—presents us with significant challenges. The greatest of these is managing the growth with an eye toward strengthening existing health centers and ensuring continuing improvements in quality across the board.

Our quality improvements include reforms we're making throughout HRSA in the way we award and manage grants.  These reforms respond to a mandate set by Secretary Thompson for the entire Department.  He wants each of HHS' operating divisions to centralize key functions related to grants management, because he's concerned that the current process is too complicated for applicants and wastes both Federal and applicant resources.  Additionally, he feels that grant administration could be reviewed in a more systematic way, that efforts are duplicated, and that too little technology is used throughout the process.  Increasingly, HRSA grantees - including health center grantees -- will be funded on the strength of their organizations and their proposals and their ability to meet verifiable performance measures.

How do we intend to “manage quality improvement?”  We know from experience that we can use several measures to improve quality while we expand the health center network.

First, we will increase use of our “health disparities collaboratives,” which bring together staff from dozens of health centers to target improvements in diseases common among their clients.  These collaboratives, which emphasize patient involvement in their own care, have had very positive results in treating diabetes, cardiovascular disease, asthma, HIV/AIDS and depression.  Because of these quality gains, we have proven that health centers offer some of our nation’s poorest citizens some of the best primary and preventive care available anywhere.

Second, we will use accreditation by an independent organization, such as the Joint Commission on Accreditation of Health Care Organizations, to verify quality improvements.

And finally, we will continue to work to re-engineer health care practice to ensure that our centers have the resources they need to provide quality care in their communities.

The President's Health Center Initiative focuses not just on adding new access points and expanding services, but on strengthening existing health centers.  We will look to save staff time and energy and cut costs by investing in information technology and telehealth projects.  We will work to expand and strengthen community networks and partnerships.  We will support essential services such as oral health and pharmacy services and pay close attention to the training and development of health center providers and staff.

Managing the growth of the health center program presents many challenges, but it also gives us a rare opportunity to leave a positive permanent legacy.  Federal and State governments are stewards of countless programs that help citizens resolve serious problems.  Indeed, one of the benefits of belonging to an organization like the National Conference of State Legislatures is finding out how your peers in other parts of the country successfully deal with problems that also trouble your community.  You learn how they’ve done it, then you try to make it work where you live.

With his expansion of the health center network, President Bush is saying, “We know this works.  This is a ‘best practice’ on a national scale.”  He is saying, “This program has a solid track record of providing poor Americans greater access to quality health care.  Let’s use it as the base to offer even more quality health care to even more needy Americans.”

That’s where the opportunity, the challenge – and the excitement – come in.

I thank you for listening and look forward to working as partners in implementing the President's Health Center Initiative.

Thank you.

Click The President's Health Center Initiative to download the complete Microsoft PowerPoint presentation.

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