Remarks to State Health Officers in Region III

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by HRSA Administrator Mary K. Wakefield, PhD, RN

August 9, 2012
Washington, D.C.

HRSA’s regional offices play an important role connecting us and our programs with stakeholders – and I’m appreciative that so many folks from throughout the region were able to be here today.

Let me begin by making sure that everyone knows Pam Kania. Pam has been with HRSA since April 2011, but her promotion to Regional Administrator just became effective last month. Pam has more than 25 years of private and public sector health care experience in improving access to health care for vulnerable populations, and it’s great to have her in this important leadership position.

HRSA’s Regional Administrators are the agency’s representatives in the regions and serve as a first point of contact for you. With that in mind, Pam has been asked to reach out personally to each of you, and make herself available to respond to any HRSA-related questions. She can expedite your inquiries, connect you to appropriate HRSA staff members and programs, and assist as needed with activities in your individual states.

Pam will provide you with more information about the roles and responsibilities of the HRSA Regional Offices shortly. In the meantime, be aware she is a “ready resource” and HRSA’s leading representative in your region.

Right now we are continuing our push full steam ahead on implementation of the Affordable Care Act, as are our fellow federal agencies. Our primary interest under the law is to expand access to high-quality health care services, primarily through two key HRSA programs – Community Health Centers and the National Health Service Corps. The ACA has made enormous new investments in these programs, which focus on providing care to underserved populations and communities that need it most. And there’s a lot of need out there.

As you may know, the ACA provided $11 billion for the operation, expansion and construction of health centers. The expansion that began under the Recovery Act of 2009 and was strengthened by the ACA a year later has allowed HRSA’s health center grantees to serve more than 3 million additional patients since President Obama took office. Health centers now deliver a wide range of care – which, increasingly, includes oral health and behavioral health care – to more than 20 million patients each year. Of course, what makes our health centers an essential part of the national safety net is that they serve anyone who walks in. Nearly 40 percent of health center patients are uninsured. Fees are set on a sliding scale.

Health centers also are primary sites for deploying National Health Service Corps loan repayors. To meet the growing need for primary care and support the expansion of the health center network, the ACA dedicated $1.5 billion to build the ranks of the NHSC through 2015. And that followed a $300 million investment in the Corps through the Recovery Act.

The Corps places primary care providers in underserved urban and rural areas for at least two years in exchange for paying down their student loans. Eligible specialties include nurse practitioners, certified nurse-midwives, doctors, dentists, physician assistants, social workers, and other health professionals.

Last year, we made a policy change in the Corps to encourage clinicians to practice in areas that need their help the most. Health professionals who work in the very neediest areas now qualify for up to $60,000 in annual loan repayments, and those who practice in less needy areas can qualify for up to $40,000 in loan repayments.

The ACA also created and supports a new Home Visiting program administered by HRSA in partnership with the Administration on Children and Families. Under the program, nurses, social workers and others visit expectant mothers and their families – including fathers – in high-risk communities.

There, they provide counseling and intervention services designed to improve health outcomes for mothers and infants, school readiness for children, and economic self-sufficiency. Evidence behind the program clearly indicates that providing these interventions sooner decreases the need for more costly clinical care and social services later.

Jamie Resnick, director of the Office of Policy Coordination in HRSA’s Maternal and Child Health Bureau, will tell you more about our progress in implementing the home visiting model in a few minutes.

In addition to our work to implement the ACA, HRSA also is invested in efforts to integrate public health into the delivery of primary care that our key programs support.

After all, we all know that an individual’s health is greatly influenced by the overall health of the community in which that individual resides. So we’re working to increase the alignment between public health and primary care. By doing so, we’re following the recommendations of an Institute of Medicine report released in March (Primary Care and Public Health: Exploring Integration to Improve Population Health) that urged federal agencies to identify ways to integrate primary care and public health.

HRSA is at the forefront of this work. We are sharing the information and recommendations from the IOM report throughout the agency, from senior leaders to staff level. We’re reviewing funding announcements with an eye to increase integration and we’re working closely with CDC to explore new opportunities to work together. One example is CDC’s effort to incorporate public health teaching into primary care residencies, some of which HRSA funds.

At the same time, discussions are ongoing among CDC and HRSA’s primary care clinician placement program staff about opportunities for collaboration and cross-training. We have made and are making more links between CDC’s Community Transformation Grant Program and HRSA-funded programs related to workforce, health centers and rural health.

Of course, the IOM report recommendations, while focused on CDC and HRSA integration, apply more broadly than to just our two agencies. And HRSA also is engaged with other government agencies and with external partners such as ASTHO, AAFP, the National Governors’ Association and health foundations to transform the IOM recommendations into reality.

I understand that Region III has several activities underway that support efforts to integrate public health and primary care.

For instance, in support of the Healthy Weight Collaborative teams, HRSA’s Philadelphia Regional Office has joined the outreach efforts of the National Initiative for Child Healthcare Quality and the collaborative coaches from Nemours in Delaware. On September 21, in conjunction with the next virtual learning session, the HRSA Philadelphia office will host area Healthy Weight Collaborative teams and coaches for a face-to-face meeting.

And HRSA is an active participant in the regional Prevention Collaborative for HHS convened by Assistant Secretary for Health Dr. Howard Koh. I’m told that staff from Dr. Koh’s office will share more information about this important prevention initiative later today. I hope you’ll be able to attend that presentation to learn more.

HRSA also is stepping up prevention activities through the establishment of a new Integrative Medicine Program created by the Affordable Care Act. The program will incorporate evidence-based integrative medicine content into existing preventive medicine residency programs. The program also will promote faculty development to improve clinical teaching in both preventive and evidence-based integrative medicine.

In addition to making an estimated 16 integrative medicine grants to preventive medicine residency programs, HRSA will make a single award this fall to create a National Coordinating Center for Integrative Medicine. The coordinating center will provide technical assistance to program grantees related to faculty development, data collection, evaluation and dissemination of information on best practices, and lessons learned. We anticipate awards will be made by September 20.

And, of course, HRSA has long played a role in supporting public health through our Public Health Training Centers program.

The program’s primary purpose is to train a broad range of occupations that make up the current and future public health workforce: nurses, epidemiologists, health educators and administrators, and others. Additionally, Public Health Training Centers help local health departments meet accreditation standards by working to boost their staffs’ scientific, managerial and leadership competencies and capabilities.

In Region III we support three Public Health Training Centers: the Mid-Atlantic Center at Johns Hopkins University; the Pennsylvania Center at the University of Pittsburgh; and the Commonwealth Center at Eastern Virginia Medical School.

If you’re not familiar with the resources available through your nearest Public Health Training Center, I hope you’ll get in contact with them. Pam can help you with that.

The activities I’ve just reviewed give a snapshot of activities supported by the ACA and by HRSA program dollars that will improve health care access in the states you represent and across the nation more broadly.

I trust that the direction we’ve set for HRSA’s future will allow us to deepen and solidify our working partnerships with you, and I thank you for the opportunity to speak to you today.