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Our Mission

HRSA’s Role in Public Health NNPHI Annual Conference June 8, 2010 Kyu Rhee, MD, MPP, FAAP, FACP Chief Public Health Officer Health Resources and Services Administration U.S. Department of Health and Human Services. Our Mission

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Our Mission

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  1. HRSA’s Role in Public HealthNNPHI Annual ConferenceJune 8, 2010Kyu Rhee, MD, MPP, FAAP, FACPChief Public Health OfficerHealth Resources and Services AdministrationU.S. Department of Health and Human Services

  2. Our Mission “To improve health and achieve health equity through access to quality services, a skilled health workforce and innovative programs.”

  3. Goals of Our Strategic Plan • Improve Access to Quality Health Care and Services • Strengthen the Health Care Workforce • Build Healthy Communities • Improve Health Equity

  4. Safety Net and Workforce

  5. Public Health at HRSA… • Public Health Steering Committee • Public Health Enumeration • Public Health Workforce Training & ARRA • Public Health and Affordable Care Act

  6. HRSA Public Health Steering Committee • To define, advise and advance HRSA-wide public health agenda • Four LEAD working groups to: • Use evidence-based Institute of Medicine public health report framework • Engage internal/external stakeholders and review recommendations • Develop recommendations that establish a dynamic agenda

  7. Public Health Enumeration Study Findings (2000) • 450,000 strong (ratio of 158:100,000) • 44.6% professional • 10.9% Nurses • 3.1% Lab professionals • 1.5% Nutritionists • 1.3% Physicians • 1% Epidemiologists • 13.9% technical • 12.9% clerical/support • 3.6% official/administrative

  8. Public Health Workforce Training FY10 & ARRA Funding • Preventive medicine and dental public health residencies: $2.7 million - $7.5 million from ARRA • Public health training centers: $5.8 million • Public health traineeships: $1.4 million - $3 million from ARRA

  9. HRSA, Public Health and the Affordable Care Act • Increasing Access to Primary Care • Investing in the Health Workforce • Supporting Maternal and Child Health • Broadening Access to 340b Program Discounts and Other HRSA Programs

  10. Increasing Access to Primary Care

  11. Community Health Centers • The Affordable Care Act provides $11 billion in funding over the next 5 years for the operation, expansion, and construction of health centers throughout the Nation. • $9.5 billion is targeted to: • Create new health center sites in medically underserved areas. • Expand preventive and primary health care services, including oral health, behavioral health, pharmacy, and/or enabling services, at existing health center sites. • $1.5 billion will support major construction and renovation projects at community health centers nationwide. • This increased funding will double the number of patients seen by health centers, making primary health care available for 40 million people.

  12. 51% User Board- by, for, with the community “Core” Health Services Primary and Prevention Care Oral, Mental, Substance Abuse Pharmacy, Lab, Imaging “Enabling” Services Care Coordination Interpreter Services Health Education Outreach– navigation, CHWs Transportation and Home visiting Community Health Center Model

  13. Community Health Center Overview, 2008 • 17.1 Million Patients (1 in 18) • 92% Below 200% poverty (1 in 6) • 70% Below 100% poverty (1 in 3) • 38% Uninsured (1 in 7) • 934,000 Homeless Individuals • 834,000 Migrant/Seasonal Farmworkers • 157,000 Residents of Public Housing 67 Million Patient Visits • 1,087 Grantees – half rural • 7,500+ Service Sites • Over 113,000 Staff • 8,400 Physicians • 5,100 NPs, PA, & CNMs Source: Uniformed Data System 2008

  14. Access 17.1 Million Patients 92% Below 200% of Poverty 70% Percent below 100% 38% Uninsured Quality 73% Diabetes Under Control 62% Blood Pressure Under Control 65% First Trimester Prenatal Care 7.6% Low Birth Weight 70% Childhood Immunization 57% Pap Tests for Women Cost $588 Cost Per Patient; $129 Per Visit Community Health Center Performance, 2008 Source: Uniformed Data System 2008

  15. School-Based Health Centers • Appropriated $50 million per year for FY2010 – 2013. • Funds can be used for expenditures for facilities (including the acquisition or improvement of land, or the acquisition, construction, expansion, replacement, or other improvement of any building or other facility), equipment, or similar expenditures. • No funds provided shall be used for expenditures for personnel or to provide health services.

  16. Investing in the Health Workforce

  17. National Health Service Corps The Affordable Care Act Builds on: Significant Program Expansion • $300 million in expansion funds for the NHSC from the Recovery Act • More than 6,300 clinicians presently serving • 7,358 Primary Care Providers estimated in 2010 vs. 4,760 in 2009 • Over 8,600 NHSC-Approved sites; 46% Community Health Centers Recent Program Improvements • Simplifying the NHSC site application and approval process. • Examining NHSC disciplines to ensure the primary care workforce needs are supported. • Assessing NHSC program implementation with the goal of driving more people into primary health care careers to meet public health needs.

  18. National Health Service Corps and the Affordable Care Act • Reauthorization of NHSC Program through 2015 • Increases Maximum Annual Loan Repayment Award from $35,000 to $50,000 • Allows for Half-Time Opportunities; 2 & 4 Year Contracts • Expanded to Include Loan Repayment & Scholarship Programs • NHSC Funding in the Community Health Center & NHSC Fund • FY2011: $290 million • FY2012: $295 million • FY2013: $300 million • FY2014: $305 million • FY2015: $310 million

  19. National Health Service Corps and the Affordable Care Act (cont.) • Teaching as Clinical Practice - Up to 20% Credit for Service Obligation • Teaching Health Center Graduate Medical Program - Up to 50% Credit for Service Obligation • Extends Tax-Free benefit to recipients of State Loan Repayment Program awards • Allows Indian Health Facilities that serve only Tribal members to qualify as an NHSC site

  20. National Health Service Corps and the Affordable Care Act (cont.) • Investment in NHSC has more than doubled since FY2008 • By FY2011, funding will increase by over 400% • Substantially increases access to care and grows primary care workforce FY2011 Appropriation Assumes FY2011 President’s Budget Level; FY2012 Appropriation Assumes Authorized Level in the Affordable Care Act.

  21. Workforce Planning, and Assessment • National Health Care Workforce Commission • An independent entity to develop a national strategic plan for the health care workforce. • National Center for Health Care Workforce and Analysis • A national center to provide analysis, modeling, and data collection to project current and future workforce demands to inform policy making. • Grants to States for Workforce Planning and Implementation • Funding to assist States in developing and implementing innovative plans to meet current and projected workforce needs.

  22. New Workforce Programs Authorized • Mid-career scholarships • Public health loan repayment • Cultural competency, prevention and public health and individuals with disabilities training • Expanded public health training fellowships • Geriatric workforce development fellowships • New program for individuals to apply for and receive loan repayments if serving as nurse faculty • Develop and implement programs to provide education and training in pain management • Family and direct caregiver training • Alternative dental health care providers demonstration project • Mental and behavior health education and training

  23. Supporting Maternal and Child Health

  24. Maternal, Infant, and Early Childhood Home Visiting Program • The Affordable Care Act creates a Maternal, Infant, and Early Childhood Home Visiting Program to fund States to provide evidence-based home visitation services to improve outcomes for children and families who reside in at-risk communities • Home visiting is a strategy that has been used by public health and human services programs to foster child development and address problems such as infant mortality • HRSA and ACF are working collaboratively on this program • Funding in FY2010 is $100 million • Provides $1.5 billion for Home Visitations to new mothers in low-income, high-risk communities

  25. Broadening Access to 340B Drug Pricing and Other HRSA Programs

  26. 340B Drug Pricing Program • The Affordable Care Act amends the 340B program to add the following to the list of covered entities that are entitled to discounted drug prices: • Certain children’s and freestanding cancer hospitals excluded from the Medicare prospective payment system • Critical access and sole community hospitals • Rural referral centers • Requires the Secretary to develop systems to improve compliance and program integrity activities for manufacturers and covered entities, as well as administrative procedures to resolve disputes • Also requires a GAO Study on Improving the 340B Program, due within 18 months of enactment to make recommendations on whether the program should be expanded

  27. The Affordable Care Act and People Living with HIV/AIDS • Access: Eliminates discrimination based on pre-existing medical conditions • Exchanges: A competitive marketplace for easy-to-compare, one-stop shopping of health insurance plans • Affordability: Premium tax credits for people less than 400% of poverty level ($88,200 income for a family of four today) when purchasing insurance through the exchange • Immediate Consumer Protections: No lifetime and restricted annual limits, prohibition on rescissions, and temporary high risk pool program for people who are uninsured and have a pre-existing condition

  28. The Affordable Care Act and People Living with HIV/AIDS (cont.) Medicare • Eliminates cost sharing for recommended preventive services • Part D donut hole closed by 2020 • $250 rebate in donut hole (only in 2010) • 50% brand-name discount (beginning 2011) Medicaid • Expands the Medicaid program to more Americans. This expansion will increase access to care for low-income adults including many people living with HIV/AIDS.

  29. Rural Programs and the Affordable Care Act Supporting the Rural Infrastructure • Payment Extensions • 340B Changes • Value-Based Purchasing Demonstration for Critical Access Hospitals • Low-Reimbursed Rural Hospital Payments • Frontier Wage Index & Practice Expense Floor • Low-Volume Adjustment Changes • Medicare-Dependent Hospital Extension • Expansion of the Regional Extension Assistance Center for HIT (REACH) Demonstration

  30. Determinants of Health

  31. Leading Causes of Death, 1900

  32. Leading Causes of Death, 2000

  33. Vision for the Future – 2100? Source: Turnock, Public Health: What It Is and How It Works, 2009

  34. Partners at the Table of Public Health

  35. “Historically, public health and primary care have shared a common goal: a healthy population. Yet, public health and primary care have had separate identities, in the views of healthcare professionals and the public.”…Lubetkin et al. 2003, Institute for the Future 2003

  36. Common Goal, Common Foundation PUBLIC HEALTH PRIMARY CARE • Assessment • Policy Development • Assurance • Diagnosis • Treatment Plan • Adherence = PREVENTION

  37. Triangulation on Success RESEARCH develops breakthrough innovations PUBLIC HEALTH outreach, education, screening and dissemination Success in Improving America’s Health Diffusion in routine PRIMARY CARE Adapted from George Rust et. al. Triangulation on Success: Innovation, Public Health, Medical Care, and Cause-Specific US Mortality Rates over a Half Century (1950-2000). Am J Public Health. 2010 Apr 1;100 Suppl 1:S95-104. Epub 2010 Feb 10

  38. Summary HRSA has an important role in public health with a focus on safety net and workforce The Affordable Care Act offers many opportunities to improve the public’s health We have a chronic care crisis which will require integration of primary care and public health and a common goal of prevention We need to work transdisciplinary and trans-sectorally

  39. What did Ella Mei choose?

  40. Thank you! Kyu Rhee, MD, MPP, FAAP, FACP Chief Public Health Officer 301-443-2216 krhee@hrsa.gov http://www.hrsa.gov

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