Remarks to Combating Autism Act Initiative grantees

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by HRSA Administrator Mary K. Wakefield

December 7, 2009
Bethesda, Md.

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Thank you, Peter (van Dyck, HRSA's Associate Administrator for Maternal and Child Health), and thanks to all of you for being here today and for your continued efforts to help all children with autism spectrum disorders and other developmental disabilities reach their full potential.

I've been asked to take just a few moments to give you a sense of the direction in which HRSA is moving and what our resources look like to get us there. And let me say at the outset that I feel very privileged to represent HRSA in these decisive weeks and months.

That said, at HRSA we've spent the past few months adapting to investments of unprecedented resources by President Obama and the Congress into our work. This commitment has translated into $2.5 billion for HRSA in Recovery Act funds, a huge investment to our agency with its $7.2 billion annual budget. These Recovery Act funds directed to HRSA serve to build a platform for some of the reforms likely to move forward.

For example, Recovery funds set aside $2 billion to expand the number of health center sites, their hours of operation, and the range of services they provide. The remaining $500 million is being invested to double the number of National Health Service Corps clinicians in the field and to expand health professions training and education programs. This booster shot of resources for the preparation and deployment of the health workforce comes not on the heels of years of stable funding, but rather follows about a decade of underfunding and neglect.

Looking forward, the President's 2010 budget proposal continues these investments in the health professions workforce. It also includes a $6 million increase over 2009 for the Combating Autism Act Initiative, boosting the total annual investment to $48 million.

HRSA's autism initiative is addressing some of the most urgent issues affecting people with autism and their families. Our professional training grants fund two different interdisciplinary leadership education initiatives and a resource center, for a total of over $28 million. Our grants for state demonstration and policy programs fund nine states and a State Public Health Coordinating Center to improve access to health care and services to children with autism. And we provide about $8 million for two large autism intervention research networks and seven research grant programs in several states.

In addition, we are very pleased to be partnering with the Centers for Disease Control and Prevention to coordinate our investments in combating autism.

Another indication of the change President Obama promised is the support in his administration and from Congress to reverse a trend that for many years under-funded primary care, de-emphasized health promotion and disease prevention, and — as I mentioned a moment ago — under-invested in health professions. There is — finally — a clear recognition that we need to expand care access and that this expansion must be in step with parallel increases in training, research and innovative approaches to providing care, and certainly including care of populations with special health care needs.

This brings me to HRSA's mission, and to the ways we're working to position the agency to best fulfill its mission within the context of new health care reforms, uncertain economic conditions, and changing demographics. For HRSA, we're targeting our internal reform efforts to focus on three key factors:

• Performance improvement,
• More intense efforts at collaboration, both across operating divisions in HHS and with external organizations, and
• a new approach strengthening public health across our programs.

Let me share a word about each.

Regarding performance improvement, it's impossible without up-to-date and accurate data.

To know exactly what we can contribute to health care delivery, and to know how we can best operate after health care reform is passed, we need to know how we're doing; that is, what we're doing extremely well that needs to be sustained and where our performance gaps are.

To accomplish that, we must:

• Collect the right data to determine performance of our programs, not just our grantees;
• Encourage testing of the effectiveness of our work; and
• Track outcomes and make changes when we're not getting the results we're looking for.

We need the very best and most reliable data to more sharply define our impact on U.S. health care. This doesn't necessarily mean adding more data requirements. But it does mean being even smarter about what we track, how we track it, and how often we track it. This orientation is not too dissimilar from the theme of this meeting: focusing on charting a course and tracking progress.

I expect all the HRSA bureaus to redouble their commitment to promote high-quality care. And using data to drive performance improvement is a model for what all HRSA's programs should do.

Performance improvement also requires collaboration involving both internal and external stakeholders.

Internally, I expect all the different HRSA bureaus and offices to work collaboratively when and where they can leverage resources and learning and enhance efficiency. We have silos at HRSA, some of which are inherent in our organizational structure because of the statutes that frame our programs.

But when they're not imposed on us, we're working to break down internal boundaries wherever they can be eliminated, and there is a clear expectation that all the different components of HRSA cooperate and work closely together. After all, it's what we expect of our grantees on behalf of the populations they serve.

And of course, external collaboration is also important. This administration is very serious about partnerships, and so am I. We are working, both strategically and operationally, with other federal and state partners more effectively than ever.

So the message I really want to underscore with you is that HRSA is ready and eager for a new phase in its partnership with stakeholders, and 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. Frankly, we need to know about them, and I encourage you to look hard for opportunities that support broader health care improvement strategies, and share those ideas with us. Laura mentioned the web-based tool — please take a few minutes and share your observations, concerns, suggestions with us — it's a new strategy to expand our capacity to hear from folks in the field.

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

The regional offices are strengthening links between states and communities and coordinating technical assistance, and they will become more active in a number of areas — links to Maternal and Child Health, for example — and engaging around the health professions workforce, particularly of the primary care workforce in their jurisdictions.

A third priority is developing 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 also incorporating a far more substantial focus, across our programs, on illness prevention and health promotion — not just patient by patient, but also community by community.

To keep moving this agenda, I recently appointed Dr. Kyu Rhee our Chief Public Health Officer. A primary care physician, Dr. Rhee oversees our HRSA-wide public health agenda. He is reviewing current programs and policies from a public health perspective, helping to drive a population health focus through HRSA's programs. He's working more closely with all our constituents and partners to promote disease prevention and healthier living.

So these are the themes that will help position HRSA and its critically important programs — including the activities funded through the Combating Autism Act Initiative — themes to position our programs more strongly in the health care environment that will emerge from health reform efforts.

We are passing through historic times, and these are decisive days for the people we are here to serve. While there are clearly a host of challenges, there is also almost palpable excitement, expectation and opportunity that accompany our work.

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 also influence the course of health care.

Let me conclude today by telling you how pleased I am as HRSA administrator to be a partner with your efforts, and to thank you so much for all of the very important work that you do in service to the population that relies heavily on your efforts. Please don't hesitate to let us know how you think we can engage even more effectively on behalf of people impacted by autism spectrum disorders and other developmental disabilities. Thank you for the opportunity to be here, and I hope you have a productive and successful meeting.