U.S Department of Health & Human Services
Health Resources & Services Administration

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Remarks to the National Association of Community Health Centers
 

by HRSA Associate Administrator Sam S. Shekar

March 24, 2003
Washington, D.C.

For downloading or printing: PDF file of PowerPoint presentation (598 KB)
 
The following is the text version of the PowerPoint presentation (with descriptions of charts and graphs) used by Dr. Shekar in his remarks to the National Association of Community Health Centers on March 24, 2003.
 
Slide 1: Update from the Bureau of Primary Health Care
to the The National Association of Community Health Centers
 
by Sam S. Shekar, M.D., M.P.H.
Associate Administrator for Primary Care and Assistant U.S. Surgeon General
Health Resources and Services Administration
U.S. Department of Health and Human Services
March 24, 2003
 
Slide 2: Health Center Patients - Calendar Year 2001
 
The following are facts about health center patients in calendar year 2001:
  • 10.3 million served
  • 40 million patient encounters
  • more than 3,300 service sites
  • 88% below 200% poverty
  • 64% racial/ethnic minority
  • Serve all ages:
    13.3% are 4 and under;
    14.3% are 5-12 years;
    20.0% are 13-24 years;
    45.3% are 25-64;
    7.2% are 65 and over.
Slide 3: President's Initiative to Expand Health Centers
  • By 2006, 645 new and 555 expanded health centers
  • Increase patients from 10 to 16 million
    - 10 million = 20% of 50 million people without access
    - 16 million = 30% of 53 million people without access
  • Goals for FY 2002 exceeded
    - 171 new access points (41 greater than target)
    - 131 sites with expanded services (1 greater than target)
Slide 4: Managing Health Center Growth - Adding Over One Million Patients Per Year!
 
There will be 1 million to 1.35 million additional people served at health centers each year from 2002 through 2006. In 2006, it is projected there will be 6.15 million more people served than in 2001.
 
The following is a list, by year, of the number of additional people that were or will be served:
  • In 2002, there were 1.25 million additional people served, for a total of additional people served since 2001 of 1.25 million.
  • In 2003, there will be 1 million additional people served, for a total of additional people served since 2001 of 2.25 million.
  • In 2004, there will be 1.2 million additional people served, for a total of additional people served since 2001 of 3.45 million.
  • In 2005, there will be 1.35 million additional people served, for a total of additional people served since 2001 of 4.8 million.
  • In 2006, there will be 1.35 million additional people served, for a total of additional people served since 2001 of 6.15 million.
Slide 5: Health Communities Access Program
  • Authorized for fiscal years 2002-2006 under Section 340 of the Public Health Service Act
  • FY 2003 Funding: $105 million in 35 new awards; funding limited to three consecutive years
  • HCAP consortia must include at least one of each:
    - FQHC;
    - Hospital with low-income utilization rate greater than 25%;
    - Health department;
    - Public or private sector provider targeting underserved;
  • Up to 15% of funds may be used for direct patient care
Slide 6: Expanding Health Centers: Challenges
 
Organizing BPHC to meet demands of the President’s Initiative
  • Health center patients will grow by 60%
  • Addition of Project Officer Function (about 80 FTEs of work effort)
  • Federal staff levels will remain constant
Solution: Restructure BPHC according to President's Initiative 3 functional areas
  • Expand health centers
  • Strengthen health centers
  • Improve clinical quality
Slide 7: Bureau of Primary Health Care Organization
 
In the Bureau of Primary Health Care, under the Office of the Bureau Director, there are two offices and six divisions. The table lists the offices and divisions and key staff in each.
 
Office or Division Name
Office of the Bureau Director Sam Shekar, M.D., M.P.H., Associate Administrator;
Caroline Lewis, Acting Deputy Associate Administrator
Office of Minority and Special Populations Ben Flores
Office of Policy, Evalution and Data Jeffrey Dunlap
Division of Health Center Management Regan Crump, Tom Coughlin
Division of Health Center Development Dick Bohrer, Lynn Spector
Division of National Hansen's Disease Programs Charles Stanley
Division of Immigration Health Services  Eugene A. Migliaccio, M.D.
Division of State and Community Assistance John Cafazza, Cephas Goldman
Division of Clinical Quality Sam Shekar, Amy Taylor

Goals of the Expansion Initiative:
  • Expand: Increase the number of primary care access points, people served, and services provided
  • Strengthen: Increase clinical, managerial and financial efficiency
  • Improve Quality: Improve quality of care for patients and families
Slide 8, 9, 10: Expanding Health Centers: Challenges (continued)
  • Balancing Expansion and New Access Points.
    - Reaching the neediest while sustaining productivity.
    Solutions: Technical assistance for competitive applications; work with PCAs on Statewide Strategic Plans.
  • Need 36,000 staff, including more than 4,100 clinicians.
    - The demand for health professionals will grow at twice the rate of all occupations through 2006.
    Solutions:  Develop/improve recruitment and retention strategies, and work with residency and educational training programs.
  • State and Medicaid Revenue Uncertainty.
    - States expect budget deficits to reach $58 billion in 2003.
    - State fiscal crises equals cutbacks to programs for indigent.
    Solution: Work with PCAs on state-specific strategies; work with CMS to ensure timely certification and payment.
  • Growth in Uninsured and Underinsured.
    - Uninsured rose to 41.2 million, or 14.6% of population.
    - More reliance on Federal grant & non-patient revenue.
    Solution: Provide base adjustments to strengthen health center safety net.
  • Sustaining and enhancing quality.
    - Goal: Establish health centers as the best primary care system in U.S.
    Solution: Promote excellence at all health centers through quality improvement strategy.
  • Costly Chronic Disease.
    - More patients with diabetes and asthma seen at health centers.
    Solution: Promote early intervention/ patient management through the Collaboratives.
Slide 11: Clinical Quality: Where We Are Today
 
When comparing up-to-date pap tests by race, Health Center women exceeded the National Health Interview Survey comparison group and the Healthy People 2000 Objectives.
  • In comparing Health Center users (1.54 million women, aged 18 and older) against the National Health Interview Survey comparison group, Health Center women had more pap tests than the National Health Interview Survey comparison group for all women, Hispanic women, white non-Hispanic women, black non-Hispanic women, and other women.
  • In comparing the Health Center women against the Healthy People 2000 Objectives, the Health Center women exceeded the Healthy People 2000 Objectives. The Healthy People 2000 objective is 85% of women with up-to-date pap tests. 88.5% of Health Center women had up-to-date pap tests.
The source for the data was the National Health Interview Survey, Healthy People 2000 and Community Health Center User Survey 1995.
 
Slide 12: Clinical Quality: Where We Are Today
 
African Americans and Hispanics with hypertension who are health center patients are three times as likely to report blood pressure under control as the National Health Interview Survey comparison group. The source for the data was the National Health Interview Survey and the Bureau of Primary Health Care User Survey, 1995.
 
Slide 13: Quality: Where We are Today
 
Low birth weight rates for health center women are comparable to the Nation's, yet health center women are more likely to be at greater risk, and the national disparity in rates between African American and others is reduced by 50% for African American women served by health centers. (Politzer et al. Inequality in America: The Contribution of Health Centers in Reducing and Eliminating Disparities in Access to Care. Medical Care Research and Review June 2001.)
 
Health Center Medicaid beneficiaries are 22% less likely to be hospitalized for potentially avoidable conditions than beneficiaries who obtain care elsewhere. (Falik et al. Ambulatory Care Sensitive Hospitalizatoins and Emergency Visits: Experiences of Medicaid Patients Using Federally Qualified Health Centers. Medical Care Vol. 39, No 6; 2001.)
 
The cost of treating Health Center Medicaid recipients is 30-34% less than the cost for beneficiaries receiving care elsewhere; 26-40% lower for prescription drugs; 35% lower for diabetics, and 20% lower for asthmatics. (Center for Health Policy Studies. Health Services Utilization and Costs to Medicaid of AFDC Recipients in New York and California Served and Not Served by Community Health Centers. Final Report; November 1994.)
 
Slide 14: Quality: Where We are Going
  • Division of Clinical Quality
  • Health Disparities Collaboratives
  • Accreditation
  • Risk Management
Slide 15: Quality Strategy - Division of Clinical Quality
  • Provides clinical and quality leadership to meet the President's initiative
  • Supports BPHC functions to assess the health care needs of underserved populations
  • Serves as the focal point for leadersip, coordination, and communication of BPHC clinical and quality activities
Slide 16 - 21: Quality Strategy - Health Disparity Collaboratives
 
Health Disparity Collaboratives
  • Generates positive health outcomes/builds capacity for quality improvement
  • Asthma, cardiovascular disease, depression, diabetes.  Pilots for: cancer, diabetes prevention, prevention, redesign, and financial management
  • By July 2003, 642 health center teams will be in or have completed either phase 1 or 2 (over 2/3 of total)
  • In FY 2003, over 175 health centers are competing for 135 openings for Phase 1 Collaboratives
  • PCA leads: California, Texas, Michigan, South Carolina, and Connecticut
Collaborative Sustainability and Spread: Survey of 103 health centers 15 months after end of Phase. (Source: Laura Morlock, Ph.D., The John Hopkins University)
  • Response rate: 84% (87 health centers)
  • 95% continue to maintain registry
  • 87% integrated Collaborative work into their ongoing performance improvement activities
  • 76% of sites utilizing chronic care model for diabetes
  • 57% have spread care model to at least one other site
  • 29% have been able to spread the care model to at least one other health condition
Collaborative Results
  • Over 70,000 health center patients in a registry; over 25,000 patients have a self-management goal
  • Over 12,500 patients in the Diabetes collaborative have had at least two HbA1c tests per year
  • 90% of patients with hypertension have had at least two blood pressure exams per year
  • 50% of patients with hypertension have a blood pressure reading of less than 140/90; the national average is 20%
  • 90% of patients with severe asthma are on the proper medication
BPHC Vision for Collaboratives
  • By 2005, implement care model in all Health centers
  • Core set of prevention and chronic disease measures
  • Sustain and spread care model and accelerate improvement using State and national infrastructure, leadership and partnerships
  • Generate knowledge to improve primary and preventive care at practice and system levels
  • Major improvement in health status of patients
  • Evaluate effectiveness through collaboration with the Agency for Healthcare Research and Quality
New Support for Collaboratives
  • Pilots of Financial Management and Redesign for Open Access; Cancer collaborative will be available in July
  • In 2004, prevention and diabetes prevention collaboratives will be available
  • 2003 is the second year of direct funding to health centers in Phase two
    - Approximately $2 million in FY 2003 will support 50 organizations; awards of approximately $40,000
Collaborative Success
"With federally funded health centers having fully embraced the (Health Disparities Collaborative) model…this has become arguably the largest, most important health care quality improvement initiative in the country.
 
It's exactly what the health care system needs right now - a demonstration that it is possible both to improve care dramatically and even reduce health care costs."
 
Tracy Orleans, Ph.D., senior scientist at the Robert Wood Johnson Foundation
Slide 22, 23: Quality Strategy - Accreditation
 
Accreditation
  • Key independent quality verification by Joint Commission of Ambulatory Healthcare Organizations
  • One third of health centers (273) have achieved JCAHO accreditation
  • Eight States have 75% or more of health centers accredited: Connecticut, New Hampshire, Rhode Island, Michigan, Arkansas, Texas, North Dakota, and Utah
  • BPHC provides support for behavioral health and extension surveys due to changes in scope - savings to health centers of $8500 (behavioral health) and $3000 (extension) per survey
Slide 24, 25: Quality Strategy - Risk Management
 
Risk Management:
  • In FY 2003, $40 million for FTCA, an increase of $25 million.
  • FY 2004, President's Budget requests $45 million.
  • Estimate FTCA coverage saved health centers over half a billion dollars in FY 2002.
  • BPHC Training to prevent and mitigate malpractice claims.
New Support for Risk Management:
  • Second Year of onsite analysis of risk issues and Risk Management Helpline (866-FTCA-HELP) to answer technical questions.
  • Hotline hours will be extended 2-3 hours in 2003 to meet needs of health centers in western areas of the country; will increase number of same-day response.
  • Risk Management Newsletter to be implemented.
Slide 26: How Do Health Centers Improve the Nation's Health?
  • US ranks 28th in infant mortality; 20th in life expectancy.
  • Racial and ethnic minorities below the Federal poverty level are at greatest risk of poor health.
  • Access to appropriate primary and preventive care makes a difference.
  • Health Centers:
    - Target racial and ethnic minorities below the Federal poverty level in underserved areas.
    - Provide appropriate primary and preventive care.
Slide 27: Health Centers Improve the Nation's Health
 
Let's look at the years 2000, 2006, and 2010. In those years how many people will be served by health centers and what percentage are they of the people without health care access?
  • In the year 2000, there were 10 million people served at Health Centers, which is 20% of the 50 million people without access.
  • In the year 2006, there will be 16 million people served at Health Centers, which is 30% of the projected 53 million people without access.
  • In the year 2010, there will be 20 million people served at Health Centers, which is 36% of the projected 55 million people without access.
Slide 28: Health Centers Improve the Nation's Health
  • 4 million racial/ethnic minorities below the Federal Poverty Level served at health centers = 24% of 16.6 million racial/ethnic minorities below the Federal Poverty Level in the nation in 2000
  • 7 million racial/ethnic minorities below the Federal Poverty Level will be 40% of projected 17.5 million in the nation in 2006
  • 8.5 million racial/ethnic minorities below the Federal Poverty Level will be 47% of projected 18.1 million in the nation in 2010
Slide 29: BPHC's Ultimate Challenge and Goal:
Be THE model for Primary Health Care in the United States