Prepared Remarks of Elizabeth M. Duke, Ph.D.
Administrator, Health Resources and Services Administration
Washington, D.C.
July 24, 2002
I am delighted to be here with all of you today. Thank you for inviting
me.
These are exciting times at HRSA because President Bush has put us
at the core of an unprecedented push to increase direct health care
to uninsured and underinsured Americans.
I’d like to begin today by telling you about the three presidential
initiatives we’re implementing at HRSA. These initiatives are at
the absolute heart of HRSA’s current and future efforts to expand
access to health care and close the health disparities gap. Then I’ll
talk more specifically about the Federal Credentialing Program.
The first initiative is President Bush’s five-year plan to create
new and expand existing Health Centers. The Health Centers Presidential
Initiative aims to increase the annual number of patients served to
16 million by 2006, up from just over 10 million currently. The President’s
long-term plan is to add 1,200 new and expanded health center sites
over five years and ultimately double the number of patients treated
at them. For fiscal year 2003, the President is asking for almost $1.5
billion for health centers – that’s a $114 million increase
over this year’s budget and a two-year increase of almost $280
million.
These Health Center increases will not only expand access to care,
they’ll also reduce health disparities. Because almost two-thirds
of Health Center patients come from minority groups, members of these
groups will benefit most from the increased access to care and the expansion
of available health care services. That will improve their health and
reduce disparities in health outcomes between minority and majority
populations.
Our challenge is to manage this growth with an eye toward strengthening
existing health centers and ensuring quality improvement across the
board. This is a significant management challenge, but we have many
partners who are working with us to make sure we achieve our goal.
The second presidential initiative involves reforms at the National
Health Service Corps to help the Corps improve their service to America’s
medically underserved and get more clinicians to “front-line”
areas of greatest need. Funding increases this year and proposed in
2003 for the Corps are tied to the expansion of the Health Center network,
since many NHSC clinicians are assigned to Health Center sites. In fact,
the health center initiative will result in over 30,000 new people working
in health centers. And about 4,500 new primary care providers will be
needed to staff the new and expanded sites.
I know the NHSC – and our Division of Immigration Health Services
-- already participate in the Federal Credentialing Program and use
VetPro to verify the backgrounds of their current providers. You can
expect a lot more business from the Corps in the future.
A few months ago, to meet the need for well-prepared clinicians able
to respond to national crises, Secretary Thompson announced the launch
of NHSC’s “Ready Responders.” These Ready Responders
-- 40 highly skilled Commissioned Officer physicians and dentists --
will spend most of their time in health professional shortage areas
treating the underserved. But they also will receive special training
and will be ready at a moment’s notice to deploy to medical emergencies
nationwide.
And recently we announced a plan to reengineer NHSC’s business
processes, fruit of a collaboration between Corps staff and the management
firm Booz, Allen and Hamilton. Even great organizations like the NHSC
can be made better, more productive, more customer-focused. That’s
what these changes will do.
While I’m talking about health professionals, let me add a plug
for a HRSA program Secretary Thompson helped us unveil in February.
Called “Kids Into Health Careers,” the program aims to attract
young people, especially those from minority and medically underserved
communities, to careers in nursing and other health professions in which
shortages are expected in the future.
We’ve assembled information on more than 270 health careers. That
information includes salary forecasts, required education, and ways
to obtaining financial assistance to enroll in a course of study. It’s
information that parents, teachers and civic organizations can use to
motivate and encourage our nation’s promising young talent to pursue
health professions careers.
The President’s third initiative at HRSA is called the Healthy
Communities Innovation Initiative. It’s a new interdisciplinary
effort that will bring together experts from throughout HHS to focus
on ways to prevent asthma, diabetes and obesity. These three chronic
illnesses and conditions are among the fastest-growing in the United
States and present severe problems in many minority communities.
The President’s 2003 budget proposes $20 million for HRSA to set
up demonstration programs in five communities. Funds will be used to
establish efforts to improve health outcomes in areas where illness
and death rates due to asthma, diabetes and obesity are high.
The Healthy Communities initiative builds on the model established
by the Maternal and Child Health Bureau’s Healthy Start program,
which targets funds to specific geographic areas to reduce exceptionally
high infant mortality rates.
We also expect the initiative will look to the successes of the Bureau
of Primary Health Care's Health Disparities Collaboratives, which bring
together staff from dozens of health centers to target improvements
in the management of common chronic diseases. So far, the Health Center
collaboratives have shown impressive results in treating diabetes, cardiovascular
disease, asthma and depression.
These three initiatives – and especially the health centers and
NHSC expansions – are guideposts to HRSA’s future. The success
of the health center initiative will rely, to a great degree, on the
NHSC’s ability to hire and retain qualified medical professionals
to staff the new and expanded centers and clinics. Certainly the FCP
will play an important role here.
But the FCP plays perhaps an even more important role in showing the
rest of HRSA – and, indeed, all of government – what can be
accomplished when Federal agencies and departments work closely together,
using the latest technologies, in pursuit of a single goal. In this
case, the goal of improving the delivery of health care services.
You may not know this about me, but using computer technology to promote
efficient government is a special interest of mine, stemming from my
days before HRSA, when I was Chief Information Office at the Department’s
Administration for Children and Families and Office of the Assistant
Secretary for Management and Budget.
A few weeks ago I announced a thorough-going reform of HRSA’s
grants management system. These reforms respond to a larger mandate
set by Secretary Thompson for the entire Department. He wants each of
HHS’ operating divisions to centralize and standardize key functions
related to grants management. He’s concerned that the grants process
within the Department is too complicated for applicants and wastes both
Federal and applicant resources. Additionally, the Secretary feels that
grants are not monitored in a systematic way, that efforts are duplicated,
and that too little technology is used throughout the grants process.
As part of the reform, we are establishing an office called the Office
of Objective Review to centralize the grant application review and ranking
process. This office will have responsibility for identifying and training
reviewers, scheduling panel reviews, and assuring that application ranking
lists are developed through a fair and competitive process. We intend
to put the office at the forefront of e-government efforts as we work
to implement an all-electronic grant review process.
So I am very interested in the work you’ve done –- in the
FCP as a model. I’m interested in how you developed uniform standards
and procedures in collaboration with various organizations, then applied
the latest technology to improve efficiency and reduce costs. We want
to bring those characteristics to the grants management reform process.
President Bush also is very interested in work like yours. Two weeks
ago the President sent a memo to the heads of executive departments
and agencies reiterating the importance of e-government initiatives
in making the Federal government more cost-effective and more responsive
to the American people.
I’m sure he would be very impressed by the fact that the FCP is
fully self-supporting and recovers all operating costs through reimbursements
from participating agencies. And by the fact that the FCP last month
received the “Trail Blazer” award at the Fifth Annual E-Gov
Conference as “an outstanding E-Government Best Practice application
that has streamlined operations and improved Government services.”
Congratulations to all of you at the Division of Practitioner Data Banks
and the Bureau of Health Professions for this honor.
I salute you in your efforts to expand and enhance the Federal Credentialing
Program and for the success you have achieved to date. The future of
Federal efforts in this post-September 11 world may very well need to
follow the example set by the FCP – standardization, collaboration,
application of advanced technology. Your work is important and, as HRSA
Administrator, I greatly appreciate your commitment to quality medical
care for all Americans.
Thank you for listening.
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