Remarks to the 33rd Annual Convention of the
National Association of Community Health Centers
Prepared Remarks of Elizabeth M. Duke, Ph.D.
Administrator, Health Resources and Services Administration
New Orleans, La.
September 17, 2002
By now you all know that President Bush’s historic Health Center
Initiative has put HRSA – and you -- at the heart of an unprecedented
push to increase direct health care to uninsured, underinsured and low-income
Americans. The expansion of access points and services that began last
year will be a top priority for HRSA and the Department of Health and
Human Services for many years.
In announcing the initiative, President Bush and Secretary Thompson
have expressed a great deal of confidence in our collective ability
to get the job done. At HRSA, we know that we cannot achieve success
by ourselves. We need partners and allies to support our mission and
join our quest. This exciting new era of ambitious goals and high expectations
makes NACHC’s continued partnership with HRSA more valuable and
more critical than ever.
So, let me begin by telling you about how exhilarated we are with this:
- First, President Bush and Secretary Thompson support this CHC program.
In speech after speech the President has repeated what he said last
year in Portland, Maine, when he called health centers “incredibly
important programs … that make an enormous difference for the
indigent and the poor.” The President’s expansion plan will,
in effect, institutionalize health centers as one of the nation’s
major health care delivery systems.
- Second, President Bush is effectively implementing his expansion
plan: he won an increase of $175 million in the Fiscal Year 2002 budget
and is asking Congress for an increase of $114 million in FY 2003.
If Congress agrees with his vision for America’s health centers,
by 2006 we will create new or expanded health center sites in 1,200
communities and increase the number of patients served annually to
more than 16 million, up from about 10 million last year. Already
we have exceeded our targets for 2002 by funding 158 new access points
and expanding capacity in 131 centers. Over time, President Bush wants
to double the number of patients served at health centers.
The network of community health centers in the United States started
out small, the result of a movement begun decades ago by health professionals
determined to spread the benefits of access to quality health care to
all of our people. Now we have a Presidential commitment to rapid, extensive
growth.
Growth on this scale is always accompanied by change. People often
think that more money solves all problems, but the truth is that implementing
a huge expansion like this one has problems and challenges that make
it very difficult. In an expansion of this size, changes in oversight,
administration and grants management are not just inevitable –
they are a vital part of the transformation.
We want make sure several things occur during the expansion of the
system. We want to strengthen existing health centers. We want to improve
the quality of the services you deliver. We want those services to be
integrated with other health delivery systems in the communities you
serve. And we want to manage the growth of the network so that we expand
in parts of the country where the need is greatest. That is crucial
to the success of the President’s initiative and we will be looking
to you and to the PCOs and PCAs for support in this endeavor.
In a report prepared for the Senate, we found a high correlation between
the funds HRSA invests in health centers and the geographic location
of large numbers of uninsured Americans. But there is always room for
improvement. One problem we have is that communities with the greatest
need often have the fewest resources to develop competitive grant applications.
This is especially true in the area of community leadership, which is
necessary to bring community support together to develop the application.
We have a daunting task: as many as 700 boards of directors will need
to be developed or structurally changed as we implement the five-year
expansion plan.
I recently visited a new center in Mena, Ark., the first health center
in the hill country of the state. What an impressive community effort
that was. And Sip Frasier of the PCA for Arkansas and an activist, devoted
community leadership can take pride in making that happen.
We’ll need PCAs and PCOs everywhere to help us identify need and
make sure we receive an adequate number of applications from all areas
of the country -- as you have been doing and continue to do through
your strategic planning work, which we’ll analyze and take very
seriously. But need alone is insufficient; a demonstrated need for services
must be accompanied by service plans and budgets if funds are to be
awarded. We also plan to use new geomapping technology to identify locations
that are most needy and that have the fewest HRSA and other resources
to address health needs. By working with state and local partners, organizations
like NACHC and by utilizing our geomapping technology, we hope to do
an even better job of identifying the communities that need us most.
Once we’ve accomplished that, then we can target technical assistance
to local groups to help them with the application process.
New technology is a big part of our expansion plan.
We feel strongly, for example, that telehealth and telemedicine technology
has the potential to revolutionize the delivery of health care, especially
for those who live in remote or underserved communities. In my visit
to Alaska we were very impressed with “ the cart,” a telehealth
initiative, which is paying off in better care in that frontier setting.
About 2/3 of the villages have a cart and more are on the way. At a
modest investment, the cart provides technology links for teledermatology;
ob/gyn; eye, ear, nose and throat; telepsychology; and teleradiology.
The links go to specialists in sites remote from the clinic -- in Anchorage,
Seattle and Ohio. The result: better, more timely care at home.
We’re using telehealth technology to keep clinicians in isolated
areas up-to-date with new developments. And we’re developing distance
learning and training programs to help staff around the country learn
and grow throughout their careers. When I was in Baldwin, Mich., recently,
I spent time with the board of directors who gave up their board room
to make it into a telehealth room. This will make a tremendous difference
for the provision of timely, quality care for the community by linking
radiology to the hospital many miles away.
Late last year Secretary Thompson announced a pharmacy demonstration
project in which pharmacists at a central health center site in Spokane,
Wash., will network with other health centers and use computer equipment
to dispense prescription drugs through vending machines to patients
at remote health clinics. The project will also use videoconferencing
equipment that allows the centrally located pharmacist to counsel patients
in the remote clinics on proper drug usage.
This is the kind of innovative project we encourage you to integrate
into your own services to fill the gaps for people and communities who
might otherwise go without the health care they so desperately need.
And in the HRSA Preview this year we tell you that we want to fund the
use of telehealth to improve access to health care. So please consider
this for the use of our grant funds.
We also plan to infuse HRSA’s new grant process with a jolt of
technology. In response to several initiatives from the Administration
and Congress, we plan to introduce new information technology to dramatically
cut the time spent on manual record-keeping. That will free up both
grantees and federal staff to work more closely together on programs
rather than paperwork.
I noted earlier that we want to work with you to see that health center
services and patient outcomes actually improve during the changes and
growing pains that the expansion will provoke. This is obviously crucial,
since health centers have a well-deserved reputation for providing some
of our nation’s poorest citizens with some of the best primary
and preventive care attainable anywhere. We want to maintain that incredible
reputation and even improve upon it if we can.
It seems that we already have an in-house answer to the question of
improving quality: more collaboratives. Hundreds of you already have
been involved in or are now participating in Health Disparities Collaboratives
to combat diabetes, asthma, cardiovascular disease, HIV/AIDS and depression,
and we just launched our cancer collaborative in 12 centers.
The next one will focus on pregnancy, delivery and the first six months
of life. It will be a collaboration between BPHC and MCHB. We’ll
be moving out on it quickly and we’ll ask you to join in. We all
want our babies to have a good start in life.
Our collaboratives help patients set personal goals to manage and improve
their condition and reach out to local organizations for support in
getting discount drugs, space for health promotion classes and other
in-kind contributions. They are leading a fundamental change to a patient-oriented
system of care.
I was recently in Alpena, Mich., Kim Sibilisky’s old stomping
grounds, and there I met some very special moms and children. The center
had helped one grandmother who had adopted her granddaughter, a child
with special health care needs. The center helped her get a wheelchair
for the little girl to drive with her head and neck through special
switches in the neck band. You should have seen her drive that thing
… and after only one week!
Both that mom and the others talked about the support they get from
the center ... not just great medical care, but superb listening and
support during periods of great stress in rearing special children.
We see expansion as not just bricks and mortar, but expansion of support
for populations such as these children, and for our elderly.
The over-85 are our fastest-growing population group. Too few providers
have had special training in geriatrics and we at HRSA are working to
help with this in our health care delivery system. Sam Shekar has been
leading a work group of all of HRSA units to advance geriatric training
for the nation and he’ll be applying this in our CHC world as well.
As we implement the President’s initiative, HRSA will ask health
centers to step up your service to these underserved populations –
and others, such as people living with HIV/AIDS. We need to do much
more outreach because a third of our HIV population know their condition
and are in treatment, a third know their condition and are not in treatment,
and another third don’t know their condition. Recently, I was in
New Hampshire to make a grant award to a small program there that did
an outstanding outreach job to get moms into care to prevent HIV transmission
to new babies—and they had a 100% success rate. We want to spread
that success through outreach and treatment.
We will emphasize prevention activities to combat chronic conditions
such as diabetes, asthma and obesity by building on the remarkable successes
of the collaborative model. We’ll be working with you to curtail
disparities in health outcomes in these and other chronic conditions
among ethnic and racial groups.
We’ll also be looking at how to improve oral health for folks.
Recently I was at a community health center in Michigan and heard this
tragic story about a young man—just 20 years old—who had an
abscessed tooth. No dental care was easily or readily available for
him. To make a long story short, this young man had to have all his
teeth removed, was in intensive care for some time, and still needs
lots of specialized care—all because he couldn’t get an abscessed
tooth treated. We’ll work on this through our BPHC and by drawing
oral health into the Secretary’s prevention focus. We can do better.
The easiest way to see the difference between the rich and poor in America
is to look at people’s mouths. We’re going to make this a
key part of our agenda. You and I can make a difference as we
look at ways to get health care to people when and where they need it.
And we’ll encourage you to work more closely with other HRSA grantees
to obtain the synergy that comes when organizations pool resources and
efforts in pursuit of similar goals. An example of this is our very
recent change in our conduct of the border health program. I asked Howard
Lerner, who heads our international program, to do a thorough study
of the HRSA border work and make recommendations to me. Based on that,
we’ve brought all of our regional folks working on the border health
program under Frank Cantu. Howard is heading a HRSA-wide central office
border workgroup made up of all the offices and bureaus of the agency.
The goal is to insure that we get synergy from all of our efforts through
a unified approach to the initiative.
Clearly, this is an area where expansion of health centers is needed
and where we hope an integrated approach to the four state strategic
plans can bring us closer to our goal of quality care in a complex setting
of our federal system and our bilateral relations with Mexico.
Another complex area is the Mississippi Delta area of eight states
and 235 counties. This is an area of great need and challenge. Congress
created the Delta commission, funded through our Office of Rural Health
Policy, to make signification improvement in health outcomes there.
Working with these new commissions -- the bilateral commission in the
border area, the Delta commission and the Denali commission in Alaska
among others -- is a new challenge in American government. HRSA is planning
on looking into this as an opportunity for cross-departmental collaboration
(as well as collaboration within HRSA) to provide more and better health
care … which means greater attention to CHCs there, too.
Finally, let me discuss an issue I know you are all very concerned
about – the tort claims issue. I want to assure you that we plan
to work very closely with you to bring this problem to a satisfactory
resolution. I personally have been assured that the Department has put
money into its FY 2003 budget request to address your needs on this
issue.
Now I’d like to give you a concrete example of how much HRSA values
our relationship with NACHC and its members by introducing you to the
many top agency officials I’ve brought with me to meet you and
listen to your concerns. First let me point out BPHC’s new associate
administrator, Dr. Sam Shekar. Sam, please stand up.
Dr. Shekar is a physician, a board certified fellow of the American
College of Preventive Medicine, and an Assistant Surgeon General. He
earned his medical degree and masters of public health degree from the
University of Michigan.
Sam has been at HRSA since 1998, first as associate administrator at
the Office of Field Operations and then as associate administrator at
the Bureau of Health Professions, where he successfully managed the
bureau’s $800 million budget and 46 programs. He has adeptly managed
many other projects during his 15-year, Public Health Service career.
He is, like myself, a career civil servant appointed to his position
by Secretary Thompson. Traditionally, associate administrators for primary
health care are career officials who are also physicians. Secretary
Thompson and I are very confident that Dr. Shekar is the leader we need
to guide BPHC through the challenges of the next few years.
Besides Sam, I’ve also brought with me the following officials.
Please stand when I recognize you so that everyone can see you and knows
who you are. Let me begin with:
- Don Weaver, who heads the National Health Service Corps, which is
also the focus of a presidential initiative. Don is leading that.
- Dick Bohrer, chief of BPHC’s Division of Community and Migrant
Health, and Regan Crump and John Cafazza from the Division for Special
Populations.
- Steve Smith, my senior advisor and
- Kay Garvey, who heads HRSA’s Office of Communications.
We are all delighted to be here with you, to exchange views and to
learn your concerns.
Thank you again for the invitation to join you today and thanks for
listening.
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