Remarks to the National Association of Community Health Centers

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by HRSA Administrator Mary K. Wakefield

March 25, 2011
Washington, D.C.

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Let me begin by thanking all of you for the tremendous work  you’ve done in the last two years  following the passage of the Recovery Act soon after President Obama took office, and, of course, following his signing of the historic Affordable Care Act just a year ago this week.

We know well that you’ve been working extremely hard on behalf of the health of your communities and we’re working hard with you to get programs in place.  Together we can continue to make important strides in expanding access to efficient and high-quality health care.

Through Recovery Act funding alone, health centers have served 3.7 million patients, including 2.2 million uninsured.  Through those resources, you’ve been able to address the health needs of hundreds of thousands of individuals who – because of tough economic times – lost their jobs and their health insurance.  The Recovery Act investments in health centers gave families needing health care a place to turn to, a place that wouldn’t turn them away  These were just-in-time resources that you’ve put to incredibly good use and with them, you should be proud of your contributions to improving Americans’ overall health and well-being.  We in the administration certainly are.

As part of the Recovery Act investments, we at HRSA set clear and ambitious goals for the use of these resources, and you’ve not only met those goals but in many, many cases exceeded them.   And for that, you have our congratulations.

As part of your effort, health centers have made tremendous progress on Recovery Act-funded construction projects.  These investments are resulting in over 1,600 new or improved health centers sites.

That’s an important and really rather amazing expansion in the ability of health centers to reach out to those in need.  To those of you who are still in the midst of construction projects, I know it can be a bit disruptive but of course we want you to keep pushing forward!

And please keep reporting on your Recovery Act projects – the stories and the photos you send us of your accomplishments are compelling.  Those reports are very important because they clearly show the presence and the value of health centers to the health of communities across the nation.

And now, through the Affordable Care Act, we’re working even more closely with you as this law’s unprecedented support for your work gets underway in earnest.

While we all know there is great uncertainly with the 2011 budget, what I’m about to describe are our plans as we have them today.

Our plans right now focus on establishing up to 350 new community health center sites in high-need areas.  The ACA means, in very real and concrete ways, that hundreds of communities now underserved will have access to health care services going forward.  That’s the Affordable Care Act at work.  To establish these new sites, we have received more than 800 applications.  Jim tells me this is the largest number of applications we have ever received — from rural and urban communities across the nation.  Winners of the competition will be very strong and important additions to the U.S. health care system. 

The law also supports expanding services to increase capacity.  We are expanding the availability of dental, behavioral, pharmacy, vision and enabling services at more than 1,100 existing health centers. 

And this year, the ACA supports planning grants to develop up to 125 new health centers in areas that currently do not have an existing facility.  Even in planning there is great demand; we’ve received more than 300 applications for those 125 planning grants.

It’s pretty clear that many Americans need the primary care and preventive health care services that you provide, and I encourage all of you to continue your efforts to extend high-quality health care to the individuals and families across the nation who need it most.    

Even as we expand health center sites and services through the provisions of the landmark health care law, I urge you to make a similar historic leap in the quality of care that health centers deliver.

I know that care quality at health centers often exceeds national targets such as those set in Healthy People, and that the care that health centers provide often meets and exceeds the quality of care provided in other settings.

I also know that you’re narrowing disparities in health outcomes across minority populations.

And I know, too, that health center patients typically report being more satisfied with their care than patients of other providers, and that the cost of the care that you provide is lower than in many other primary care settings.  You should be proud of those achievements, too.  We certainly are, as we support your efforts.

But we also know that there is ample opportunity to go even farther in achieving consistently efficient, effective high-quality care.

And for that reason, there is no room for less than average – or even average – care in the health center system.  We’re here to help you take care quality from good to great, and I encourage you to take advantage of what HRSA and others have to offer.

For our part, HRSA’s latest effort to report and improve quality in the system occurred just a couple of months ago, when an updated set of clinical performance measures for health centers was announced.

These include four new and important measures:

• weight assessment and counseling for children and adolescents;
• adult weight screening and follow up;
• tobacco use assessment and cessation counseling,  and
• asthma pharmacological therapy.

Like the quarterly Recovery Act reports you submit, your reporting on these measures will help us to know and to tell the crucially important story of how well you serve your patients.

We’re also focused on helping you improve care quality and efficiency by sponsoring grantee trainings on the web.  We’ve made a big push to expand Webinar training in recent months.  You can join them when they happen or view them later as archived Webinars when you and your colleagues back home have time.

The most recent Webinars over the last month have dealt with technical topics such as implementing a better quality improvement program, open source health IT tools, EHR meaningful use incentives, and health info technology and quality.

Another element of quality care that we want all health centers involved in is the patient-centered medical home model.  HRSA is dedicated to helping all grantees move toward becoming medical homes.

Many of you have already implemented a number of the elements of the model:  team-based care, HIT and information exchange, outreach, patient education, and integrating behavioral health into primary health care.

In addition, your internal structures make health centers uniquely well-structured to fully implement medical homes. 

Because health centers employ a diverse group of health professionals, you are also strongly positioned to use interdisciplinary teams to their fullest by re-distributing care responsibilities to the teams’ most appropriate, most capable, and most available clinicians – from doctors to nurse practitioners to pharmacists and others.

And thanks in large part to Recovery funds, many of you are far along in adopting and using electronic health records, which further improve quality and efficiency and promotes team-based care.

Going forward, we know there are ways we can improve how care is delivered through patient-centered medical homes, and we also know we can improve the way the next generation of health care clinicians is trained to provide that state-of-the-art care.

And so, this past January we announced a set of grants that impact quality and staffing, though over a longer term.  Nine FQHCs and two Lookalike health centers are sharing $1.9 million in grants to establish or expand primary care residency training programs.  This is the first step in one of the Affordable Care Act investments that will roll out over five years for the Teaching Health Center Program.

Grantees will use the funds to train additional primary care physicians and dentists in community-based ambulatory patient care settings.  

These grants are exciting because they provide a platform for expanding the primary care workforce.  They create additional opportunities to prepare physicians to deliver primary care in community settings.

This is important, of course, because physicians trained in health centers are more than three times as likely to work in a health center and more than twice as likely to work in an underserved area than those that are not trained at health centers. 

In another plus, the Affordable Care Act allows the National Health Service Corps clinicians to count as much as 50 percent of time they may want to spend teaching in a HRSA-approved teaching health center toward fulfillment of their service obligation. 

So that’s another way health reform helps us retain qualified primary care clinicians in community settings, while actively helping to invest in the education of the next generation of health care providers.   These are just a few of the perhaps lesser-known but critically important provisions the ACA brings to the health of the American public and some of the reasons why – as the HRSA administrator and also as a registered nurse – I’m so enthusiastic about the doors that this law opens for you and for the people you serve. 

Now I don’t want to give you the idea that change is only expected or only occurring from your end of our partnership with you.  At the federal level, we’re also pushing internally to improve the quality and efficiency of services we deliver to you. 

Even as we ask you to improve the quality of your work, we’re focused on doing the same.

For example, Jim Macrae and his staff at HRSA’s Bureau of Primary Health Care have moved the administration and management of the health center, FTCA and FQHC look-alike programs from a paper-based system to an electronic one, and one that’s fully incorporated with other agency and departmental systems.

As a result, BPHC now conducts most of its business with you online, which significantly improves reporting accuracy, data sharing, and overall program efficiency.  By the way, it saves hundreds of thousands of dollars in administrative costs, which allows us instead to invest those resources on health care services for people.

Many of you may not know it, but BPHC was one of three HRSA bureaus recognized in January of this year for their “comprehensive and committed approach to outstanding customer service” at the 2011 Government Customer Satisfaction Results Forum.  By implementing a system that asks you how we’re doing and then incorporates your perspectives into the management of our program, BPHC has become a government leader in responsive administration.

I’ll give you just a quick example of how it’s working.   After getting feedback from the field on the New Access Point applications, BPHC reduced the guidance by more than 50 pages – a 35 percent reduction from previous versions.   The changes improved the clarity of the guidance and will improve our ability to get Health Center resources to the highest-need communities.  And frankly, we have many other examples of efforts that have been undertaken to improve our own efficiency over the past two years.  This administration is committed to a highly efficient government and we’re acting on that commitment across HRSA to focus like a laser on improving our performance.  And we welcome your suggestions about how we can continue to do that.

I talked a minute ago about President Obama’s vision for health care.  Let me assure you his vision for health centers in U.S. health care remains front and center in the Fiscal Year 2012 budget that he submitted to Congress last month.

That budget asks for new investments in health centers and in the health care workforce to strengthen the quality and affordability of care available to millions of Americans.

It makes tough choices and smart, targeted investments today—with a sharp eye on achieving a stronger, healthier, more competitive America tomorrow.  That’s what it will take to win the future, and that’s what – in partnership with you – we’re determined to do.

HRSA’s FY 2012 budget strongly supports the goals in HRSA’s strategic plan to:

• improve access to quality health care and services;
• to strengthen the health care workforce;
• to work with you to build healthy communities; and to
• improve health equity.

Obviously, the strength of the health center system is integral to achieving these goals and it is a major priority for this President.

One of the keys that I’ve mentioned to all of this is embedded in our efforts to continue to build a health workforce for the 21st Century.  The President’s 2012 budget supports a health workforce strategy that:

• expands the capacity and improves the distribution of the primary care workforce;
• encourages team-based care; and
• focuses on care for our nation’s seniors.

In addition to supporting a record-high National Health Service Corps field strength of approximately 10,700 clinicians deployed to underserved communities across the country – an achievement largely due to the Recovery Act and now the Affordable Care Act – the 2012 budget will help expand the nation’s capacity to train over 4,000 new primary care providers – including physicians, nurse practitioners, physicians, and physician assistants – over five years.

The 2012 Budget also increases support for the Ryan White HIV/AIDS program to address the unmet health needs of people living with HIV, including AIDS drug assistance for states that right now are struggling to meet their population’s pharmaceutical needs for HIV care.

Through the 2012 budget, through the Recovery Act, and through the Affordable Care Act, President Obama has signaled his recognition of the importance that access to primary health care and clinical preventives services plays in getting and keeping Americans healthy. 

These investments signal the President’s enduring support for the role health centers can play in making that care available across the nation.  It’s really taking the wisdom of many of our mothers and grandmothers and their admonition to us as we were growing up – that an ounce of prevention is worth a pound of cure.   And, given my own background as a nurse – having worked in intensive care units – I saw first-hand and too frequently the financial and human costs from illnesses that absolutely could have been prevented by solid primary care services focused on preventing illness and promoting health.  

So, because of the support for keeping people healthy and more effectively managing chronic conditions that is found in the 2012 budget and in the Affordable Care Act, health centers face a world of new opportunities and expectations.  At HRSA, we face them, too.  We’re taking advantage of new and creative partnerships with private foundations and other government agencies, including CMS.

For example, we’re working with CMS and the Office of the National Coordinator for HIT to help primary care providers become meaningful users of electronic health records.

It’s a model in interagency collaboration:

• CMS provides financial incentives;
• ONC provides technical support through the Regional Extension Center program; and
• HRSA provides technical support and partnership support through the Health Center Controlled Networks and Primary Care Associations in states across the country.

We’ve also built a strong partnership with the Centers for Disease Control and Prevention on the issue of integrating primary care and public health.  In fact, on Monday, I’ll be speaking to the Institute of Medicine as experts there kick off research on a 21-month study – co-funded by HRSA and CDC – that addresses this central question: “How do we improve population health and reduce health disparities by effectively integrating and coordinating public health and primary care?”

The report will develop evidence-based, actionable recommendations that CDC, HRSA, relevant agencies and partners can undertake to further integrate these spheres.

We are also working with the Institute of Medicine to identify ways to improve access to oral health care.

This is directly relevant to the work you do.  Today, nearly nine out of 10 health centers provide preventive oral health care services, either on-site or by referral, reaching more than 3 million patients annually.

We’re also working with the Substance Abuse and Mental Health Services Administration on a couple of fronts that will impact health center care.

HRSA and SAMHSA are working together to support the integration of behavioral health and primary care and to expand the capacity of health centers to care for patients with mental illnesses and addiction disorders.

In addition, we’re working more closely with the Indian Health Service than ever before.  We’re using this renewed partnership to identify activities that HRSA can do to provide greater assistance to existing and potential American Indian/Alaska Native grantees and stakeholders.  We’re doing that across all our programs and policies, not just in the health center program.

We’re also reaching out to foundations for their insights.  Last month we convened a meeting in partnership with Macy Foundation, the Robert Wood Johnson Foundation, and the American Board of Internal Medicine Foundation to examine competencies for interprofessional team-based care. 

About 80 experts from government, academia and foundations worked to frame an action plan that can advance the implementation of these competencies in health professions education and practice.  I was pleased to share the stage with Don (Berwick, CMS administrator) that day, too.  Just as you are doing, we too are aligning and leveraging federal resources in new, more efficient and effective ways.  It’s what Secretary Sebelius expects and frankly—we wouldn’t want it any other way.

Let me wrap up by simply saying that we know you have opportunities, but we also know you currently face many challenges.  Know that we’re in this with you.

We’re working hard across the Department of Health and Human Services to implement the Affordable Care Act, and that allows us to expand and improve our support for the critically important work that you do. 

At HRSA we really can’t think of a more important mission than investing in keeping and strengthening the health of America’s families and communities. And it’s a privilege to work alongside of each of you in pursuit of this goal.  Thanks so much for all that you do.

Thank you.