Remarks to the Federal-State Maternal and Child Health Partnership Meeting

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by HRSA Administrator Mary K. Wakefield

October 26, 2009
Washington, D.C.

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Thank you, and thanks to everyone here for coming today. I feel very privileged to represent HRSA at this very exciting time – It's a time of change in the way we view health care, and a time of renewed alliances among partners with common goals and aspirations.

Today, I'd like to outline some of the goals I envision for HRSA and the internal changes we are making to position the agency in line with President Obama's efforts to reform health care in America . But first, I would like to acknowledge the work and dedication of HRSA staff, some of whom are here today. If HRSA staff in the room would please stand up, so we can see who you are...

Please be sure to introduce yourselves to my colleagues over the course of this meeting. They are more than willing to hear about issues that are important to you and to answer any questions you may have and share information. Some HRSA folks are here from headquarters, but some are here from the HRSA regional offices, which are taking new, expanded, and I think exciting roles, as I will explain in a few minutes.

As you know, the Obama administration is investing unprecedented resources into HRSA's work. This commitment has translated into $2.5 billion for HRSA in Recovery Act funds, which—among other outcomes—will virtually double the number of National Health Service Corps members in the field. That will provide a substantial boost to the number of women and children served.

Our annual budget allocates about $662 million for HRSA's Title V programs, which served 40 million people in 2008. That number included over 2.5 million pregnant women, over 33 million infants and children, and over 1.8 million children with special health care needs.

But HRSA is helping the nation's children in more ways than through Title V, the set of programs well known to all of you. For example, HRSA-supported health centers provide care to more than 2.5 million children each year. Health centers provided prenatal care across the country last year. And there are the nation's poison control centers supported through HRSA: over half the calls made to these centers involve children under five years old.

So while MCHB is the standard bearer for the health of women and children, this population is also touched by other HRSA programs. It behooves us at HRSA to better understand what those touchpoints are and align them as effectively as possible through our programs and even across other HHS divisions and federal agencies.

I mentioned a moment ago that the role of our regional offices is changing. Going forward, our Office of Regional Operations now has a maternal child health point of contact in each of our 10 regional offices, and those contacts will be working closely with staff in the Maternal and Child Health Bureau at this table. Each regional office also has a person who works closely with the Centers for Medicare and Medicaid Services. Together, MCHB and CMS are implementing the Children's Health Insurance Program (CHIP) Outreach and Enrollment Grants to gain CHIP and Medicaid coverage for more children and women of child-bearing age.

Another resource for children at HRSA are our telehealth programs, which use IT resources to forge partnerships and leverage resources to reach vulnerable people, like children, and those in underserved areas.

HRSA and the Department of Agriculture, for example, are funding a school-based project in Kansas City that allows nurses at 13 inner-city schools to screen children through telehealth consultations with clinicians at the University of Kansas Medical Center. You may already know about it, it's called TeleKidCare. It has been running for a decade, providing everything from drug counseling and mental health, to dermatology and ENT services to kids who otherwise would have little or no access to care.

Speaking of leveraging resources, I want to express my sincere appreciation and enthusiasm for the way local and state partners have been able not only to match HRSA Title V grants, but to exceed all expectations in spite of the economic downturn. We all know that the recession is putting heavy fiscal pressure on local and state governments, which are increasingly hard pressed for financial resources. Yet, in 2010, we expect state and local funds, program income, and other funding resources to add to our allocation of $662 million and leverage a total of almost six billion dollars for Title V programs. Considering current economic conditions, that is an outstanding achievement.

This brings me to the crux of the issue at hand. Given that resources are unlikely to grow in the near future, even as needs continue to grow, how can HRSA and its partners work more efficiently and effectively to achieve better results, reach more people, provide more comprehensive services?

And this leads to the reasons why I consider this meeting with you today to be so important for HRSA, just as Secretary Sebelius, who will be here tomorrow, also considers this gathering very important for the Administration.

As the HRSA team knows well, I am stressing a number of themes throughout the agency. They are themes that will position HRSA more strongly in the health care environment that will emerge from health reform efforts. They are focused like a laser on:

• Collaboration,
• on performance improvement, and
• on a new approach to public health.

Collaboration is one of my top priorities, and it involves both internal and external stakeholders.

Internally, I expect all the different HRSA bureaus and offices to work collaboratively. We have silos at HRSA, and some of them are inherent in our organizational structure because of our statutes.

But I am working to break down internal boundaries wherever they can be eliminated, and I have instituted the expectation that all the different components of HRSA—from HIV/AIDS to Rural Health, to Health Professions, to Primary Health Care—all cooperate and work closely together. Ideally, for example, we would find ways of integrating Title V and other activities seamlessly into the care provided by health centers.

The sum is greater than the individual parts. And from your vantage point, it would mean that you would more easily know and be able to engage maternal and children's health issues articulated through other parts of HRSA.

Of course, external collaboration is just as important. This administration is very serious about it, and so am I. We are working with other federal and state partners more effectively than ever:

• For example, the Substance Abuse and Mental Health Services Administration has developed Project LAUNCH (Linking Actions for Unmet Needs in Children's health) together with HRSA and the Administration on Children and Families. The first phase of the project was launched last year in five states. The second phase was funded just last month and includes another 12 states and the District of Columbia . The project uses the existing network of Title V grantees to integrate mental health and social, emotional and behavioral planning in the delivery of care.
• HRSA is also part of broader inter-agency efforts to provide comprehensive services in early childhood. One such effort is the Federal Partners Early Childhood Systems Work Group, which supports deeper multi-agency efforts to build an integrated system of services focused on children and their families. The Group includes SAMHSA, the CDC, the Departments of Education and Justice, and other HHS offices.
• Another effort we are involved with is the State Early Childhood Comprehensive Systems Initiative, which is now in its third phase of helping states build and implement comprehensive service systems for the physical, social and emotional development of children. This one also involves SAMHSA and the ACF.
• In oral care, we co-sponsored an Institute of Medicine (IOM) workshop, which found that “the current oral health workforce fails to meet the needs of many segments of the U.S. population.” We also just awarded contracts to the National Academy of Sciences to conduct a wide-ranging study of oral health care in the United States and suggest ways it could be improved.
• And you are probably familiar with the five-year program we started in 2007 with the USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) called Building Collaboration for Oral Health. That collaboration enables WIC to serve as the entry point for dental care to increase the number of at-risk one-year-olds who receive preventive dental services, are able to access early dental care, and have a relationship with a dental provider.

I could provide many more examples, but I hope you understand that this Administration, the Department, and HRSA are all eager to expand and strengthen joint efforts wherever they can be found and wherever they can measurably improve results.

For me, collaboration is also about working strategically and operationally with all important stakeholders. I really want to underscore that HRSA is ready and eager for a new phase in its partnership with AMCHP members, with each one of you. We are open to exploring new ways of working together.

If you have suggestions, we want to hear them. If you see avenues for breaking down silos, eliminating redundancies, improving efficiencies, we want to know about them. I encourage you to look hard for opportunities that support broader health care improvement strategies, and share those ideas with us through our regular office staff and our MCH Bureau staff.

Performance improvement is another theme I plan to hammer on as HRSA administrator.

First, I want to recognize the outstanding work all the grantees have done in collecting, analyzing and interpreting data. It may seem like a secondary task, but it is crucial, especially now: The next five-year needs assessment—due next July—will probably be shaped within the context of wide-ranging new health reform legislation. It will require reliable, accurate, up-to-date and complete data.

To know exactly what we can contribute to health care delivery for women and children, including those with special health care needs, and to know how we can best operate after health care reform is passed, we need to know exactly what we do best. This means:

• Collecting the right data to determine performance;
• Encouraging testing of the effectiveness of our work; and
• Tracking outcomes.

We need the very best data to more sharply define our impact on U.S. health care. This doesn't necessarily mean adding more data requirements. It may well mean being even smarter about what we track it, how we track it, and how often we track it.

In terms of performance, HRSA bureaus are deeply involved in efforts to promote care quality. And some of the most interesting work in the area of quality assessment and improvement comes from the Maternal and Child Health Bureau.

As you know, all of the 59 states and territories that get MCH block grants report annually on their progress toward meeting targets on 18 National Performance Measures. We publish these data on our Web site. When state officials apply for block grant funds each year, as they are required to do, MCHB program staff meets on site with them and engages in a conversation about their performance, and, if needed, about ways to improve it. I think that this linking of data to performance improvements is a model for what all HRSA's programs should do.

Since 2001, MCHB has funded a smaller quality effort, not as widely known, but with an impact that touches the delivery of care to children everywhere. It's called PECARN, for the Pediatric Emergency Care Applied Research Network, and it's the first federally funded pediatric emergency medicine research network in the United States.

More specifically, with an investment of just over $5 million a year, PECARN conducts research on the prevention and management of acute illnesses and injuries in children and youth of all ages through a network of 21 participating hospitals. PECARN research has already improved care for children with bronchiolitis and for those with head injuries. It's a great example of how we are leveraging research and data to improve outcomes.

Performance improvement also requires closer collaboration at the regional level, which is why the duties of HRSA's regional offices will now reach substantially beyond site reviews to focus on core functions such as increasing access, reducing disparities, and analyzing health care trends.

The regional offices will focus more on strengthening links between states and communities and coordinating technical assistance, and they will become more active in the recruitment and retention of the primary care workforce in their jurisdictions.

My third priority is a new approach to public health. Joint efforts to improve performance in the coming years will take place within a rapidly changing economic and demographic landscape. This requires all of us to shift our focus from the treatment of acute conditions to incorporate a far more substantial focus, across our programs, on prevention.

That is why I recently appointed Dr. Kyu Rhee our Chief Public Health Officer. A primary care physician, Dr. Rhee will oversee our HRSA-wide public health agenda. He will review current programs and policies from a public health perspective and work more closely with all our constituents and partners to promote disease prevention and healthier living.

He's already led federal efforts to reduce health disparities through his prior work at NIH and at the largest network of Federally Qualified Health Centers in Maryland. And he has a special awareness—having served for five years as one of our National Health Service Corps Scholars, and as medical director at the HRSA-supported Upper Cardozo Health Center in Washington, D.C.

In conclusion, we are passing through historic times; there is palpable excitement, expectation and appreciation that accompany our work.

And I really think that for our portfolios of programs, and for the people we are here to serve, these are decisive days. Our ability to prove the value of your programs – and to improve their performance further – will influence the health of the populations we collectively care deeply about, and will influence the course of health care. This year, it's already begun.

So I ask you to join us, renew your commitment to our common goals, and know that HRSA is an active and passionate partner in the mission we share.

Thank you for the opportunity to be here. Thank you for the very important work you do on behalf of the American public. If you have any questions, I'll try to answer them.