Prepared Remarks of Elizabeth M. Duke, Ph.D.
Administrator, Health Resources and Services Administration
San Antonio, Texas
October 13, 2002
Thank you for inviting me to be with you today.
Jose (Camacho, president of the Texas Association of Community Health
Centers), let me thank you and your staff in particular for everything you’ve
done to make this possible.
I am delighted to be here to discuss President Bush’s Health Center
Initiative with you, because it has put HRSA -- and all of you -- at the heart
of an unprecedented push to increase direct health care to uninsured,
underinsured and low-income Americans. The expansion of access points and
services that began last year will be a top priority for HRSA and the Department
of Health and Human Services for many years.
In announcing the initiative, President Bush and Secretary Thompson have
expressed a great deal of confidence in our collective ability to get the job
done. At HRSA, we know that we cannot achieve success by ourselves. This is our
shared mission and our joint quest.
So, let me begin by telling you about how exhilarated we are with this:
First, President Bush, Secretary Thompson and I support this CHC program. In
speech after speech the President has repeated what he said last year in
Portland, Maine, when he called health centers “incredibly important programs …
that make an enormous difference for the indigent and the poor.” The President’s
expansion plan will, in effect, institutionalize health centers as one of the
nation’s major health care delivery systems.
The Secretary has been personally involved in supporting the reauthorization
and the HRSA leadership, working through our legislation office, has been
supporting those efforts.
Second, President Bush is effectively implementing his expansion plan: he won
an increase of $175 million in the Fiscal Year 2002 budget and is asking
Congress for an increase of $114 million in FY 2003. If Congress agrees with his
vision for America’s health centers, by 2006 we will create new or expanded
health center sites in 1,200 communities and increase the number of patients
served annually to more than 16 million, up from about 10 million last year.
Managing the growth of the health center program presents many challenges,
but it also gives us a rare opportunity to leave a positive, permanent legacy
for our nation and people. You should take special pride in the expansion
initiative. The President, while Governor of Texas, recognized the strength of
the Texas health center/primary care delivery system. The President’s agenda was
modeled after the fine work he witnessed here.
Already we have exceeded our targets for 2002 by funding 170 new access
points and expanding capacity in 131 centers. Twenty-one (21) of these expansion
grants have come to Texas, totaling more than $6.8 million.
We want make sure several things occur during the expansion of the system:
- We want to strengthen existing health centers. We know the
problems you are facing in the base. We will be looking at options to help
-- whenever we get a budget.
- We want to improve the quality of the services you deliver. We
are looking at more collaboratives to help expand the advances we’ve made.
- We want those services to be integrated with other health
delivery systems in the communities you serve.
- And we want to manage the growth of the network so that we
expand in parts of the country where the need is greatest. That puts Texas
front and center. About 20 percent of Texans are uninsured, compared with
the national average of 14 percent. And up to a quarter of all Texas
children are uninsured. We will be looking carefully with you at strategic
planning to close this gap.
In a report we prepared for a Senate committee, we showed a high correlation
between the funds HRSA invests in health centers and the geographic location of
large numbers of uninsured Americans.
But there is always room for improvement.
One problem we have is that communities with the greatest need often have the
fewest resources to develop competitive grant applications. This is especially
true in the area of community leadership, which is necessary to bring community
support together to develop the application. We have a daunting task: as many as
700 boards of directors will need to be developed or structurally changed as we
implement the five-year expansion plan.
Community boards with user majorities are a key feature of the CHC movement,
are central to the legislation, and continue to be a focus in our administration
of the program.
We’ll need PCAs and PCOs everywhere to help us identify need and make sure we
receive an adequate number of applications from all areas of the country, which
we’ll analyze and take very seriously. But need alone is insufficient; a
demonstrated need for services must be accompanied by service plans and budgets
if funds are to be awarded. We also plan to use new geomapping technology to
identify locations that are most needy and that have the fewest HRSA and other
resources to address health needs.
By working with state and local partners and organizations like the Texas PCA,
and by utilizing our geomapping technology, we hope to do an even better job of
identifying the communities that need us most. Once we’ve accomplished that,
then we can target technical assistance to local groups to help them with the
application process.
New technology is a big part of our expansion plan.
We feel strongly, for example, that telehealth and telemedicine technology
has the potential to revolutionize the delivery of health care, especially for
those who live in remote or underserved communities. Earlier this year I visited
Alaska and was very impressed with “the cart,” a telehealth initiative which
provides better care in that frontier setting. About 2/3 of the villages have a
cart and more are on the way. At a modest investment, the cart provides
technology links for teledermatology; ob/gyn; eye, ear, nose and throat;
telepsychology; and teleradiology. The links go to specialists in sites remote
from the clinic -- in Anchorage, Seattle and Ohio. The result: better, more
timely care at home.
We’re also using telehealth technology to keep clinicians in isolated areas
up-to-date with new developments in their field. And we’re developing distance
learning and training programs to help staff around the country learn and grow
throughout their careers. When I was in Baldwin, Mich., recently, I spent time
with the board of directors who gave up their board room to make it into a
telehealth room. This will make a tremendous difference for the provision of
timely, quality care for the community by linking radiology to the hospital many
miles away.
Late last year Secretary Thompson announced a demonstration project that
allows pharmacists at a central health center site in Spokane, Wash., to use
computer equipment to dispense prescription drugs through vending machines to
patients at remote health clinics. The project will also use videoconferencing
equipment that allows the centrally located pharmacist to counsel patients in
the remote clinics on proper drug usage.
This is the kind of innovative project we encourage you to integrate into
your own services to fill the gaps for people and communities who might
otherwise go without the health care they so desperately need. And in the HRSA
Preview we tell you that we want to fund the use of telehealth to improve access
to health care. The Preview is a document you can access from the homepage of
our Web site at
www.hrsa.gov that lists all our grant opportunities in the coming
year. So please consider telehealth in applying to use our grant funds.
I noted earlier that we want to work with you to see that health center
services and patient outcomes actually improve during the changes and growing
pains that the expansion will provoke. This is obviously crucial, since health
centers have a well-deserved reputation for providing some of our nation’s
poorest citizens with some of the best primary and preventive care attainable
anywhere. We want to maintain that incredible reputation and even improve upon
it if we can.
It seems that we already have an in-house answer to the question of improving
quality: more collaboratives. Many of you already have been involved in or are
now participating in Health Disparities Collaboratives to combat diabetes,
asthma, cardiovascular disease, HIV/AIDS and depression. Last July we just
launched a cancer collaborative in 12 centers.
Let me stop here to congratulate Jose and the staff for the leadership
training sessions you’ve established to improve the ability of Texas health
centers to implement the changes brought on by the collaboratives. That type of
training is exactly what we need to make sure the benefits of the collaboratives
are successfully integrated into service delivery.
Our next collaborative -- a partnership between BPHC and our Maternal and
Child Health Bureau -- will focus on pregnancy, delivery and the first six
months of life. We’ll be moving out on it quickly and we’ll ask you to join in.
We all want our babies to have a good start in life.
By establishing the best research-based screening techniques and follow-up,
by helping patients set personal goals to manage and their conditions, and by
reaching out to local organizations for support in getting discount drugs, space
for health promotion classes and other in-kind contributions, collaboratives are
leading a fundamental change to a patient-oriented system of care.
We see the President’s Health Center Initiative as not just more buildings --
those are important, of course -- but as an expansion of support for populations
such as children and our elderly. The over-85 are our fastest-growing population
group. Too few providers have had special training in geriatrics and we at HRSA
are working to help with this in our health care delivery system. Sam Shekar has
been leading a work group of all of HRSA units to advance geriatric training for
the nation and he’ll be applying this in our CHC world as well.
As we implement the President’s initiative, HRSA will ask health centers to
step up your service to these underserved populations -- and others, such as
people living with HIV/AIDS. We need to do much more outreach because a third of
our HIV population know their condition and are in treatment, a third know their
condition and are not in treatment, and another third don’t know their
condition. Recently, I was in New Hampshire to make a grant award to a small
program there that did an outstanding outreach job to get moms into care to
prevent HIV transmission to new babies-and they had a 100% success rate. We want
to spread that success through outreach and treatment.
We’ll also be looking at how to improve oral health for folks. Recently I was
at a community health center in Michigan and heard this tragic story about a
young man -- just 20 years old -- who had an abscessed tooth. No dental care was
easily or readily available for him. To make a long story short, this young man
had to have all his teeth removed, was in intensive care for some time, and
still needs lots of specialized care -- all because he couldn’t get an abscessed
tooth treated. We’ll work on this through our BPHC and by drawing oral health
into the Secretary’s prevention focus. We can do better. The easiest way to see
the difference between the rich and poor in America is to look at people’s
mouths. We’re going to make this a key part of our agenda. You and I can make a
difference as we look at ways to get health care to people when and where they
need it.
And we’ll encourage you to work more closely with other HRSA grantees to
obtain the synergy that comes when organizations pool resources and efforts in
pursuit of similar goals. An example of this is our very recent change in our
conduct of the border health program. I asked Howard Lerner, who heads our
international program, to do a thorough study of the HRSA border work and make
recommendations to me. Based on that, we’ve brought all of our regional folks
working on the border health program together under Frank Cantu, who reports to
Howard. Howard is heading a HRSA-wide central office border workgroup made up of
all the offices and bureaus of the agency. The goal is to insure that we get
synergy from all of our efforts through a unified approach to the initiative.
Clearly, this is an area where expansion of health centers is needed and
where we hope an integrated approach to the four border state strategic plans
can bring us closer to our goal of quality care in a complex setting of our
federal system and our bilateral relations with Mexico.
Finally, let me discuss an issue I know all CHCs are very concerned about --
the tort claims issue. I want to assure you that we plan to work very closely
with you to bring this problem to a satisfactory resolution. I personally have
been assured that the Department has put money into its FY 2003 budget request
to address your needs on this issue. We have worked closely with the Office of
Management and Budget and we are encouraged that this can come to a successful
outcome.
Let me close by again saying how delighted I am to be here with you, to
exchange views and hear your concerns.
Thank you for listening.
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