Remarks to the National Association of Community Health Centers’ 2006 Annual Conference

by HRSA Administrator Elizabeth M. Duke

August 29, 2006
Chicago, Ill.

Let me start out with some welcome news in this hurricane season. HRSA has awarded almost $4 million to six states impacted by the Hurricane Katrina and other hurricanes last year to develop communications networks for use in natural disasters and other emergencies.

State Primary Care Associations in Louisiana, Mississippi, Alabama, Texas, Florida and North Carolina will each get grants of $666,000 to buy and maintain satellite phones and to establish or join already operating emergency communications networks.

The networks will link health centers, health departments, and major medical centers and will help coordinate the care and referral of patients during a major emergency.

Today I want to talk to you about the President’s expansion initiative and his 2007 budget request.

I’ll talk about quality and spreading the knowledge gained through the collaboratives.

I’ll emphasize the importance of Health Information Technology and its role in delivering quality health care.

I’ll develop what we mean by the “strategic use of information.”

And I’ll address your role in emergency preparedness.

First, where we are today on the expansion of the health center system. Under President Bush’s leadership, we have created an unprecedented period of sustained expansion and quality improvement through his Health Center Growth Initiative.

Between 2001 and 2005, the number of patients treated annually at health centers has grown from 10.3 million to 14.1 million, a 37 percent increase.

Grantees treated 5.6 million uninsured patients in 2005, 1.6 million more than were treated in 2001, a 40 percent increase.

These gains in expanding access to care at health centers are one part of the President’s strategy to eliminate health disparities among U.S. population groups. Expanding the type of care offered is another part of the strategy.

With targeted expansions in oral health and mental health care and in substance abuse treatment, health centers are treating the whole patient better than at any time in their history.

In 2005, 2.3 million dental patients made almost 6 million visits to dental health professionals at health centers, a 72 percent increase in such visits over 2001.

More than 400,000 patients made almost 2 million mental health visits to health centers, a 60 percent increase over 2001.

The President’s FY 2007 budget seeks an increase of $181 million to complete the Initiative by adding 300 new or expanded health center sites.

$52 million of the proposed $181 million increase will launch a new Presidential Initiative to increase access to primary care in the nation’s poorest counties. If approved, the $52 million will create 80 new health center sites in the nation’s “highest-poverty” counties.

$4 million will be cut out of the $52 million to support 50 planning grants for poor counties that want to create access to primary care services.

This is one good idea we’ve developed for targeting attention to areas of great need. We are open to other ideas you have for targeting our grants to ensure that we are reaching the poor wherever they are.

As we expanded the health center network, we have worked together to improve the quality of care by increasing the number of health centers that implemented health disparities collaborative pilots.

As all of you know, health centers implemented these collaboratives to keep chronic illnesses like diabetes, hypertension, heart disease, asthma and depression under control and reduce hospitalizations. Other collaboratives have tested ways to streamline financial and business practices and improve the overall management of health centers.

The pilots have showed us the best ways to improve treatments and patient outcomes.

The pilots were a success because they helped us see what top-quality health care looks like. Top-quality care emphasizes evidence-based, patient-centered treatments linked to appropriate information technology.

And it includes sharing those gains with peers. For example, the HRSA Health Disparities Web site has become a place where staff from health centers and other HRSA-funded programs can share best practices and strategies to provide high-quality care for underserved and vulnerable populations.

One of the great lessons of the collaboratives has been its emphasis on key patient outcomes. We know that tracking patient outcomes improves the quality of care, because data showed us where changes needed to be made to close gaps in the delivery of care. The collaboratives also demonstrated that improving patient health outcomes and quality of care often requires changes in health center practice and operations as well.

In our view, the pilots’ emphasis on collecting and using data strategically is a huge contribution to improvements in quality. That’s a concept I’ll speak more about in a few minutes.

In partnership with you, we want to broaden and accelerate the success of the collaborative pilots throughout the entire health center network.

HRSA will no longer dictate the use of a specific data-collection tool, but we can provide information that health centers need to make good business decisions about technology. In fact, last month we announced a new interactive Web site we’ve developed with colleagues at the Agency for Healthcare Research and Quality called the “HRSA Health Information Technology Community.” A demonstration of this new tool will occur later today, so you may want to add that to your schedule.

The Web site is a “virtual meeting place” for staff from health centers, networks and PCAs. It focuses on technologies that promote patient safety and quality of care. People who log on can take part in online discussions, share documents, and exchange tools and resources on using health IT in the community setting.

Within two weeks of the July 26 announcement of the “HIT Community” site, we received over 1,300 requests for user IDs from 325 health centers, networks, PCAs and PCOs. We are still accepting user ID requests and will continue to do so. I encourage you to sign on and get IDs so that your staff can utilize this valuable resource.

Soon we will supplement the HIT Community site with an online “toolkit” that offers advice on such topics as budgeting for HIT, funding opportunities, and how to use HIT to improve quality of care and program evaluations.

Developing an information strategy for HRSA and our safety-net grantees is a special concern of mine. To organize that strategy across the agency, last year we created the HRSA Office of Health Information Technology, and put Cheryl Austein Casnoff in charge of it. Cheryl is here with me. I wanted you to meet her because the scope of her work will touch all of HRSA’s bureaus, offices and grantees.

Let me point out, too, that at the Department level, one of Secretary Leavitt’s main priorities is encouraging greater use of HIT. His view of the future emphasizes the value of information and technology in improving the quality of health care and the management of disease. Secretary Leavitt is convinced – as we are – that HIT can lead to better informed health care decisions by consumers, to reduced costs, to fewer medical errors, and to better health care quality.

The Secretary’s Office of the National Coordinator continues to lead the nation towards HIT adoption and interoperability. Cheryl and our HIT Office work closely with the National Coordinator’s office to ensure that the needs of safety-net providers are not overlooked as these discussions progress.

While I’m talking about information systems here, let me tell you that HRSA is extending the project periods for IT networks that were due to end this year and next year. And we will provide some additional funding to let them continue their efforts. We’re doing this because networks are an important part of our strategy to improve performance.

In addition to emphasizing HIT, we want grantees that deliver primary health care services to improve and expand oral health and mental health care.

And, of course, we also want them to continue working to improve the quality of the health care they deliver.

As I said a few moments ago, when we talk about “quality” in programs that deliver direct health care, we mean better health outcomes for patients. That’s the “end” we want to reach through our “means” of focusing on quality. Outcomes are straightforward. They’re direct. They’re easy for everyone to understand.

That emphasis leads to this question: What’s the best way to track and measure patient outcomes?

Our answer is that grantees must gather and critically analyze that information needed to determine whether their programs improve outcomes for the people they serve. That’s what I mean by the phrase, using information strategically.

As a first step toward this goal, HRSA is working to streamline and integrate its performance measurement system and reduce burdens in data reporting. We have undertaken a major review of the ways we collect data from you, including the Uniform Data System, Grant Applications, the Collaborative Registry, and more.

We're examining:

• what we collect and why;
• how we collect it; and
• whether there are gaps or duplications in the collection process.

Based on this review, we will develop a set of core performance measures on such key categories as:

• early entry into prenatal care;
• cancer screenings;
• outcomes related to diabetes and cardiovascular care; and
• preventive measures such as age-appropriate immunizations.

We are cognizant that your have data reporting requirements beyond HRSA and we will work to align our measures with those other responsibilities. As we move forward, we will ask for your input to assure that we are on the right track toward improving the quality of care and the health outcomes for the patients we serve, with the least possible reporting burdens consistent with quality outcomes.

Our approach is not driven by a need to cut costs, but by a desire to improve quality. We want to simultaneously reduce your reporting burden and improve the results you get from those reports. We want less volume, more quality.

Obviously, in this effort, health information technology will play an essential role. Data by itself is useless without the concepts, policies and technology that allow us to make sense of them, to show us how we can do things better, smarter and quicker than before. HIT is key.

Let me switch gears for a second, in the middle of the 2006 hurricane season, and talk to you about emergency preparedness.

Health centers can play an important role in delivering critical services during an emergency. To do so, you must be integrated into local and State emergency operations planning and response activities. At the State level, your Primary Care Associations and Offices should be able to help you.

At your end, we encourage health centers to develop and implement emergency management plans in collaboration with local partners. Base your plan on a thorough risk assessment, and make sure it includes ways to maintain financial viability during an emergency.

Additionally, we encourage you to develop procedures for communicating with local and State emergency management agencies, as well as with your staff, patients and your associations during such an event.

At the personal level, we know that many of your health care professionals are anxious to help out stricken neighbors in their hours of need.

The best way to volunteer for such duty is to enroll in your state’s Emergency System for Advance Registration of Volunteer Health Professions. That way you’ll avoid controversies over credentials, licensing and malpractice coverage.

As we do with every government program, we’ve reduced it to an acronym. In this case, it’s an unwieldy one – ESAR-VHP, which we pronounce: ee-sahr-vip.

Congress created ESAR-VHP in the days following the September 11 attacks. Lawmakers gave HRSA the responsibility to help each State and Territory establish a system capable of maintaining verifiable, up-to-date information on each volunteer’s identity, licensing, credentialing and privileges in hospitals or other medical facilities.

The benefit of registering health professionals and verifying their credentials in advance of an emergency are obvious:

• States that request help will know who is coming into the emergency zone and they’ll know what skills these visitors bring.
  
  
• For health professionals, those who deploy after enrolling in ESAR-VHP will be able to practice to a fuller extent of their professional capabilities.

Currently 13 States have operating ESAR-VHPs; another 7 are expected to come on line by the end of the year.

That may not be as far along as we would like, but the system already made a major mark last year during last summer’s hurricanes: more than 8,300 health care professionals were deployed to hurricane-damaged areas through existing State ESAR-VHPs.

Responsibility for setting up ESAR-VHPs rests with each State. I encourage you and interested staff to contact your State Health Department or your HRSA program officer to find out how you can enroll.

Our challenge at HRSA is to get everyone to focus on the themes I’ve discussed today -- health information technology, quality, the strategic use of information, and emergency preparedness -- and integrate them into all of our daily work.

With health centers, we want to craft a national system of quality health care. When appropriately applied, health information technology can enhance quality by helping you gather and analyze data more efficiently. That strategic analysis will lead to discoveries of ways to continually improve care to the patients you serve.

The health center movement is bound by common principles. At the same time, each one of you is strongly influenced by the locality you serve and the state environment you operate in.

Within the limits of laws and regulations that guide us all, we ask grantees to respond to the themes I’ve discussed today in ways consistent with this movement and that reflect the health care needs and demands of your home communities.

Thank you for listening. Now I’ll be glad to take any questions you may have.

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