May 28, 2003
Atlantic City, N.J.

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Good afternoon. I am delighted to return to my home state to speak with the members of the New Jersey Primary Care Association.
 
Today I’d like to do something different from the norm when I speak with Primary Care Associations. Usually I focus exclusively on the health center program and the President’s expansion initiative. And I will, of course, address those issues. But I imagine that many of you outside of Washington are curious about the changes you see coming from HRSA, from the Bureau of Primary Health Care and our from old Office of Field Operations – which we now call the Office of Performance Review.
 
Today I’d like to explain the reasons behind the changes we’ve made at HRSA and what to look for in the future.
 
Many of you, I’m sure, deal with other agencies in the Department of Health and Human Services. So you know that the changes in management and organization occurring at HRSA are part of a broader strategy being implemented by Secretary Thompson in HHS and by President Bush in the entire Federal government to make all of us operate more efficiently. The Secretary and the President are determined to streamline administrative services and eliminate redundant management activities so that we have more people and more money to invest in programs that directly serve the public.
 
Under the direction and guidance of Secretary Thompson, we have already done a great deal to improve operations.
 

• In the last 20 months, HRSA’s offices of legislation and communications have been consolidated.
• The consolidation and reorganization of our grants management and grant oversight process is almost complete.
• Our human resources office is part of an HHS-wide effort that will consolidate 40 HR offices down to four by October 1.
• And we -- and the rest of the federal government -- are in the midst of a review of jobs inside HRSA under a process known as “A-76.” These studies look at specific support activities to determine whether private sector firms could do them better. If the answer is “yes,” and these positions are eventually contracted out, the Secretary has pledged to retain the affected employees. Agencies will then place these employees into jobs that will provide direct services to needy people.

The net effect with all these changes – the consolidations, the reorganizations and the A-76 process -- is to redeploy people who currently work in administrative and support positions into mission-critical slots with program responsibility.
 
It is a huge undertaking. And it is one that will continue -- not diminish -- in the future.
 
Now I’d like to tell you in a bit more detail about changes that will affect you directly: the consolidation of HRSA’s grants management operations, the centralization of project officer functions at Headquarters, and the retooling of our field operations.
 
The biggest advantage of the consolidation of the grant offices is that, for the first time, HRSA will have consistent, agency-wide procedures for dealing with grants and grantees. No more dealing with separate grant offices in each HRSA bureau. From now on, grants that originate in HRSA’s four bureaus will deal with the same forms, talk the same lingo, operate in the same manner.
 
We have set up three offices to standardize and professionalize the process:
 

• The first new office, the Division of Grants Management Operations, handles the nuts and bolts of the process.  It works with program staff to advertise grant opportunities and receive applications on the front end; issues grant awards and obligates federal funds; manages business aspects of the grants during the project period; and closes out grants on the back end.  We will soon offer an electronic web-based grant application process to all applicants.  We're testing it now and expect it to be available to the public around July 1.
• The second new office, the Division of Independent Review, coordinates the review of all applications for HRSA funds in a fair and objective manner.  The office assigns people to objective grant review panels that rate and rank the applications we receive.  HRSA receives tens of thousands of grant applications in a year; with this office, each one will receive the careful consideration it deserves. 
• The third new entity, the Office of Financial Policy and Oversight, oversees policies and procedures for all of the 80 or so HRSA grant programs.  The office does pre-award reviews of potential HRSA grantees to make sure that they have the financial and administrative expertise to handle the grants and do the work.  Staff there also works with grantees having financial problems to help them improve their performance.  Additionally, the office is responsible for HRSA-level investigations of fraud and abuse charges, which may be referred to the HHS Inspector General.

HRSA's new approach to our grant responsibilities will:
 

• make it easier for the public to learn about and apply for HRSA grants;
• set in place mechanisms to ensure that our grant officers and project officers treat grantees fairly, under policies and procedures that are consistent throughout the agency;
• award grants to organizations that are capable of helping us deliver quality health care services; and
• ensure Congress and the American people that we are capable of processing applications, distributing funds and overseeing grantees’ performance in a professional manner.

Another key change in how HRSA interacts with grantees involves the centralization of Project Officer duties at Headquarters. We feel confident that these new single points of contact on specific grants will help grantees resolve problems more quickly and give them more consistent guidance. The transition to the new Project Officers began in March with our HIV/AIDS grantees and will conclude with health center grantees on July 1.

In the field, our renamed Office of Performance Review will refocus the work done in HRSA’s regional offices on monitoring and program accountability. These changes will improve face-to-face contact by field employees with grantees by increasing grantee performance reviews to 60 percent of the work of OPR staff, up from 30 percent currently.
 
All of you here today know that some of the most important of the recent changes at HRSA have occurred at the Bureau of Primary Health Care.
 
The rapid expansion of the health center network presents an enormous management challenge for the Bureau of Primary Health Care and for HRSA as a whole. By now you know the outlines of President Bush’s expansion initiative: 1,200 new or expanded health centers and clinics over five years, and an increase in the number of people served annually from about 10 million in 2001 to more than 16 million by 2006.
 
At the end of Fiscal Year 2003 we expect to have added about 2.2 million people to the annual patient load served by the Consolidated Health Center network. Last year we added 171 new health center sites and expanded services at 131 existing centers. This year we will fund 90 new access sites and expand services at 80 existing health centers. We’re right on schedule.
 
To manage this incredible expansion we have adopted a new management structure for BPHC that will improve our ability to meet the ambitious goals set for us by the President and Secretary Thompson.

The new structure includes Divisions of Health Center Development, Health Center Management, and Clinical Quality. They will help BPHC concentrate its resources more directly on the essential elements of the President’s Health Center Initiative. Those elements are:

• creating new sites and expanding existing centers;
• improving management capabilities; and
• strengthening the quality of services.

We want to work with existing grantees, new applicants and our state partners in primary care offices and primary care associations to meet the daunting challenges we face during the expansion. Let me highlight some of them:

• First, we want to make sure we expand the system into America ’s neediest communities, even as we maintain health centers’ high standards of quality. How do we plan to do this? By providing technical assistance to poor communities to help them produce competitive applications. We’ll also work with PCAs on Statewide Strategic Plans.
• Second – the system needs 36,000 new staff to meet our goals, including more than 4,100 clinicians. We’ll need to develop new recruitment and retention strategies, improve existing ones, and work with residency and educational training programs.
• Third – state budgets are a mess and Medicaid revenue is uncertain. We’ll work with PCAs on state-specific strategies and with the Centers for Medicare and Medicaid Services to ensure timely certification and payment.
• Fourth – the number of uninsured and underinsured is growing. Our solution: provide base adjustments to strengthen the safety net. We have reserved $37 million out of this year’s budget for base adjustments, which will be similar to a cost-of-living adjustment for centers that meet great need with great effectiveness.
• Fifth – we don’t want to sustain quality. We want to enhance it. And we’ll do it by promoting excellence at all health centers through a quality-improvement strategy.
• Sixth – Health centers are seeing more patients with costly chronic diseases like diabetes and asthma. Here we have a proven strategy that works to reduce the harm done by chronic diseases, and that is to promote early intervention and patient management through the health disparities collaboratives. What we need to do now is expand collaboratives throughout the system. Our goal is to implement the collaborative care model in all of our health centers by 2005, focusing on a core set of prevention and chronic disease measures.

Another great thing about collaboratives, besides how well they work, is that their focus dovetails exactly with the emphasis by President Bush and Secretary Thompson on fighting chronic illness. In the May 9 Federal Register, the Secretary announced the availability of almost $14 million in FY 2003 to fight diabetes, obesity and asthma at the community level under the new Steps to a Healthier US initiative. The President is asking for $125 million for the initiative in his FY 2004 budget.
 
This effort follows repeated calls by the Secretary to exercise more, lose weight – advice he has followed himself, I should add -- and get regular checkups. All are great ways to fight the harm done by chronic disease.
 
A couple of months ago, he joined with HRSA to announce the launch of our "Su Familia" National Hispanic Family Health Helpline, which gives Hispanic families access to basic health information that will help them prevent and manage chronic conditions. And more recently, as part of National Diabetes Alert Day, Secretary Thompson asked Hispanics to cut their high rates of diabetes by committing to take preventative steps against the disease and toward a healthier future.
 
On September 16, the Secretary will sponsor the second annual “Take a Loved One to the Doctor Day.” Radio personality Tom Joyner will again join him in encouraging Americans – especially those from minority communities – to take charge of their health by making encouraging family members and friends to get a checkup from a health professional.
 
A central element of the Administration’s strategy to fight chronic illnesses, of course, is that it is the best way to close the “health gap” in minority communities. Because rates of diabetes, asthma, obesity, heart disease and stroke, and HIV/AIDS are, in general, far worse among minority populations than for the nation as a whole, fighting chronic disease represents the best way to improve minority health.
 
And with minority Americans making up almost two-thirds of all health center patients, the initiative with perhaps the greatest potential to limit the spread of chronic diseases and improve the health of U.S. minorities is the President’s Health Center Initiative.
 
Expansion of the system means an expansion of service to these populations. That will result in greater minority access to health care, and greater access by them to the benefits of the health disparities collaboratives. The certain result: improved health outcomes.
 
Let me conclude by reminding all of you about the first “All Grantees Meeting” for Primary Health Care grantees that HRSA is organizing in Washington from June 29 through July 2. We expect some 2,000 BPHC grantees and other participants to attend.
 
I was so impressed last summer by the all-hands meeting for Ryan White grantees that HRSA's HIV/AIDS Bureau put together that I felt we should do the same for our primary care grantees. The meeting will give primary care grantees, HRSA Project Officers, and BPHC’s National Partners a chance to share ideas on ways to expand and improve health centers and systems of care for all underserved families and individuals.
 
The meeting has three primary goals:
 

• first, to stimulate a dialogue between grantees and HRSA officials that will improve the way we all work together;
• second, to help grantees better understand and work with new structures in HRSA and at BPHC; and
• third, to help grantees learn more about other HRSA health care programs beyond BPHC.

The meeting will offer plenary sessions, breakout sessions and panel discussions. Breakout sessions will be grouped by geographic areas so that grantees can meet their new project officers.  The draft agenda is now available on BPHC's web site at bphc.hrsa.gov.
 
As I said earlier, the transition to new Project Officers takes effect for health center grantees on July 1, so the all-grantees meeting is timed perfectly for you to meet with and talk to their new Project Officers.
 
Thank you for listening. I’ll be happy to take your questions.