Remarks to the 2002 Primary Care Symposium

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

Bethesda, Md.
July 17, 2002

I am delighted to be here today with so many of you representing State Primary Care Associations, Primary Care Offices and, for the first time, State Loan Repayment Programs. As HRSA’s state-level partners, you play a key role in our continuing efforts to make more quality health care available to all those who need it most.

I also want to recognize a few people in the audience. I met recently in my office with several members of the AHEC community and they have joined us today. The work they are doing at the state and local level is just phenomenal. For example, Kerry Hummel, who directs the Western Maryland AHEC, provided great insight on how we can all better collaborate and enhance linkages across traditional boundaries. And Woody Hanes, from the Virginia AHEC, shared with us some positive outcomes from the AHEC’s nurse managed clinic. I had the opportunity to visit this AHEC several months ago and witnessed firsthand their innovative use of local interpreters and teleservices to provide culturally competent services to clients who speak many different languages.

This forum is an opportunity for me to say thanks to all of you for your many contributions to the accomplishment of HRSA's mission and to the health care community in general. PCA, PCO and SLRP grantees bring a great deal of experience and wisdom to the challenge of serving low-income and uninsured Americans.

Your work helps HRSA make the best use of its federal investment in states, avoid duplication of effort, and better target resources to those most in need.

The lessons you’ve learned and are still learning can – and will-- be enormously useful to HRSA as we embark on one of the most exciting periods in the life of the agency.

When I spoke with you last year, I promised when I came back that we’d take a look at the many ways HRSA has changed. You know the old saying: “ the proof is in the pudding.” Well the real proof is in the taste. And I know for some of you the taste is good, for others it could be better. But, it is my heartfelt belief that change is good. It forces us in new directions…takes us places we might not have considered before.

At HRSA, we must constantly adapt and change to fit a new order and to meet new expectations. Why? Because President Bush has put us at the heart of an unprecedented push to increase direct health care to uninsured and underinsured Americans. And, by doing so, he and Secretary Thompson have expressed a great deal of confidence in our ability to get the job done. To be successful, we know there is no way that we can operate alone. Your continued partnership with us will be more valuable and more critical than ever.

I’d like to begin today by telling you about the three presidential initiatives we’re implementing at HRSA. These initiatives are at the absolute heart of HRSA’s current and future efforts to expand access to health care and close the health disparities gap.

The first initiative, of course, is President Bush’s five-year plan to create new and expand existing Health Centers. The Health Centers Presidential Initiative aims to increase the annual number of patients served to 16 million by 2006, up from just over 10 million currently. The President’s long-term plan is to add 1,200 new and expanded health center sites over five years and ultimately double the number of patients treated at them. For fiscal year 2003, the President is asking for almost $1.5 billion for health centers – that’s a $114 million increase over this year’s budget and a two-year increase of almost $280 million.

These Health Center increases will not only expand access to care, they’ll also 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 improve their health and reduce disparities in health outcomes between minority and majority populations.

Our challenge is to manage this growth with an eye toward strengthening existing health centers and ensuring quality improvement across the board. This is a significant management challenge, but, with you and other partners, I am sure we will achieve our goal.

The second presidential initiative involves reforms at the National Health Service Corps to help the Corps improve their service to America’s medically underserved and get more clinicians to “front-line” areas of greatest need. Funding increases this year and proposed in 2003 for the Corps are tied to the expansion of the Health Center network, since many NHSC clinicians are assigned to Health Center sites. In fact, the health center initiative will result in over 30,000 new people working in health centers. And about 4,500 new primary care providers will be needed to staff these new and expanded sites.

Just a few months ago, to meet the need for well-prepared clinicians able to respond to national crises, Secretary Thompson announced the launch of NHSC’s “Ready Responders.” These Ready Responders -- 40 highly skilled Commissioned Officer physicians and dentists -- will spend most of their time in health professional shortage areas treating the underserved. But they also will receive special training and will be ready at a moment’s notice to deploy to medical emergencies nationwide.

Earlier this month, Dr. Shekar and I announced a plan to reengineer NHSC’s business processes, fruit of a collaboration between Corps staff and the management firm Booz, Allen and Hamilton. Even great organizations can be made better, more productive, more customer-focused. That’s what these changes will do.

As you know, last year we moved the NHSC, the Division of Scholarship and Loan Repayment, and the Division of Shortage Designation from the Bureau of Primary Health Care to Health Professions – a step made to put in a single bureau the entire spectrum of HRSA’s recruitment, training, loan, scholarship and placement programs for health professionals. I’m pleased to report that this transition has gone very well. And, many in the Corps share my view. At a recent NHSC Forum, several Corps members told me they were thrilled with their new home and that the benefits had been enormous. This response was a complete turnaround for many who had their doubts when we first announced this move.

While I’m talking about health professionals, let me add a plug for a HRSA program Secretary Thompson helped us unveil in February. Called “Kids Into Health Careers,” the program aims to attract young people, especially those from minority and medically underserved communities, to careers in nursing and other health professions in which shortages are expected in the future.

We’ve assembled information on more than 270 health careers, information on salary forecasts, required education, and on obtaining financial assistance to enroll in course of study. It’s information that parents, teachers and civic organizations can use to motivate and encourage our nation’s promising young talent to pursue health professions careers.

The President’s third initiative at HRSA is called the Healthy Communities Innovation Initiative. It’s a new interdisciplinary effort that will bring together experts from throughout HHS to focus on ways to prevent asthma, diabetes, and obesity. These three chronic illnesses and conditions are among the fastest growing in the United States and present severe problems in many minority communities.

The President’s 2003 budget proposes $20 million for HRSA to set up demonstration programs in five communities. Funds will be used to establish efforts to improve health outcomes in areas where illness and death rates due to asthma, diabetes and obesity are high.

The Healthy Communities initiative builds on the model established by the Maternal and Child Health Bureau’s Healthy Start program, which targets funds to specific geographic areas to reduce exceptionally high infant mortality rates.

We also expect the initiative will look to the successes of the Bureau of Primary Health Care’s Health Disparities Collaboratives, which bring together staff from dozens of health centers to target improvements in the management of common chronic diseases. So far, the Health Center collaboratives have shown impressive results in treating diabetes, cardiovascular disease, asthma and depression.

These three initiatives – and especially the health centers and NHSC expansions – are guideposts to HRSA’s future. And the three groups represented here -- PCAs, PCOs and State Loan Repayment Programs -- will play an important role in helping us succeed.

I’ve been in Washington many years, and this much I know: When the President of the United States puts more money in your budget and takes a personal interest in improving, refining and expanding your activities – as he is doing with health centers and the Corps -- you are doing good work.

You are intimately familiar with the health centers network—in fact, you have already helped us create or expand services at 114 community-based sites.

And your community development activities are also important to the health center expansion. This is how you make things happen on the ground…how you help communities make real their plans for new or expanded health center sites.

I know many of you are concerned about having the resources available to do the job we ask of you. And at HRSA, we’re going to do our part for you in the states. You know we have millions invested at the state level through our MCH block grants, HIV Title ll grants, and for anti-bioterrorism planning. For this fiscal year, we have $35.5 million invested in PCA/PCO activities. In fact, we plan to continue to fund all 22 SEARCH grantees through September 30, 2003.

But, let’s face it. We all have to be more realistic about money. Since September 11, we all have been living with new fiscal realities that have been necessary to ensure that the government has the funds needed to fight the continuing war on terrorism.

What you must do is look for new ways to leverage what you have and work more creatively through partnerships. Look to other areas – like AHECS and the Nurse Education and Loan Repayment program – to search for more and better ways to get things done.

Other things we’re doing include a look at the PCA/PCO work group and its task forces. I assure you this will be accomplished through open dialogue and collaboration with work group leadership.

We’re also taking a look at how we determine Shortage Designation Areas. Our intent is to streamline this process and use technology in a more effective way. We want to be able to better target resources and strengthen the scientific foundation for the designation process.

If you were to ask me how I see the future of HRSA’s relationship with the PCOs, PCAs and SLRPs, I would answer that in some ways our future will be very much like our past – a strong and important partnership in improving the health of our nation. It is also a partnership that must evolve and must be refocused on the challenges and opportunities facing us today. We not only need to change to keep up with our times, we need to change to keep up with our future.

Now I have a very special announcement to share with you – one that will be discussed for the first time outside of HRSA.

Soon we’ll be making reforms in grants management and the organizational changes needed to implement them. These reforms respond to a larger mandate set by Secretary Thompson for the entire Department. He wants each of HHS’ operating divisions to centralize key functions related to grants management. He’s concerned that the grants process within the Department is too complicated for applicants and wastes both Federal and applicant resources. Additionally, he feels that grants are not monitored in a systematic way, and that efforts are duplicated and too little technology is used throughout the grants process.

Our plan involves changes in entities that report to me, the Administrator, and in entities within the Office of Management and Program Support, or OMPS.

Here is the structure of our grants management reform plan:

First, the bureaus’ grants management functions will be abolished and centralized in a new Office of Grants Management within OMPS.

Second, we will establish another, separate office in OMPS called the Office of Objective Review to centralize the grant application review and ranking process. This office will have responsibility for identifying and training reviewers, scheduling panel reviews, and assuring that application ranking lists are developed through a fair and competitive process. The office also will be at the forefront of e-government as they work to implement an all-electronic grant review process.

Third, we will establish an Office of Financial Integrity that reports directly to the Administrator. This new entity will make sure policies and procedures are in place to provide proper controls over HRSA assets, both internally and at grantee institutions.

Fourth, the current Office of Field Operations will shift its workload priorities to double the amount of time spent on monitoring grantees. In recognition of this shift, OFO will be renamed the Office of Program Accountability. In the future, staff in the renamed office will spend most of their time tracking and monitoring the performance of all HRSA-supported programs throughout the country. Office staff also will perform periodic community-wide assessments and make recommendations to the Administrator on programs and policy.

These changes will build new levels of professionalism and accountability into the grants process by separating the responsibility for awarding grants from the responsibility for reviewing and assessing grantees’ performance.

Increasingly, grantees will be funded on the strength of their organizations and their proposals and their ability to meet verifiable performance measures.

Soon we plan to publish a Federal Register notice describing all of the grants management changes. We'll instruct grantees and other interested parties about the full details of our reform plan at that time.

Our charge is clear. We are investing our resources where they can bring the maximum benefit to the millions of Americans who rely on HRSA for essential health care services.

I want to thank you for inviting me to be with you and I encourage you to take full advantage of the many learning opportunities offered at this conference. I am sure this forum will provide a wonderful opportunity to meet with your colleagues and share information that will prove valuable to your programs.

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