Connecting and Integrating
Public Health, Primary Care, and
Prevention at HRSA
USPHS Scientific Training Symposium
College Park, MD
June 21, 2012
CAPT Sarah Linde-Feucht, MD
Chief Public Health Officer
Health Resources and Services Administration
U.S. Department of Health and Human Services
1
Objectives
• Understand HRSA’s mission,
programs, and public health
priorities, including prevention
• Demonstrate the importance of
integration of public health and
primary care
2
HRSA Mission
“To improve health and achieve health
equity through access to quality
services, a skilled health workforce and
innovative programs.”
3
HRSA Strategic Plan
1.
Improve Access to Quality Health Care and Services



2.
Strengthen the Health Workforce


3.
Align the composition and distribution to best meet needs of communities
Support development of interdisciplinary teams
Build Healthy Communities


4.
Integrate primary care and public health
Strengthen health systems to support the delivery of quality health services
Expand and integrate oral and behavioral health into primary care
Lead and collaborate with others
Strengthen the focus on illness prevention and health promotion across
populations and communities
Improve Health Equity


Partner with diverse communities to create, develop, and disseminate
innovative community-based health equity solutions, with a particular focus on
populations with the greatest health disparities
Further integrate services and address social determinants of health
4
Access and Workforce
• Nearly 19 million patients are served through more than
8000 HRSA-funded health centers, including 1 in 3 people
with incomes below the poverty level.
• Over 500,000 people living with HIV/AIDS receive services
through more than 900 HRSA-funded Ryan White Clinics.
Two-thirds are members of minority groups.
• 34 million women, infants, children, and adolescents
benefit from HRSA’s maternal and child health programs.
• Currently more than 10,000 National Health Service
Corps clinicians are working in underserved areas in
exchange for loan repayment or scholarships.
5
Access and Workforce
•
•
•
•
•
Workforce training programs
Rural health care
Federal organ procurement system
Poison Control Centers
340B low-cost drug program
6
HRSA’s Public Health Priorities
1) Achieving Health Equity and Improving Outcomes
2) Linking/Integrating Public Health and Primary Care
3) Strengthening Research & Evaluation, Assuring
Availability of Data and Supporting Health
Information Exchange (HIE)
4) Assuring a Strong Public Health/Primary Care
Workforce
5) Increasing Collaboration and Alignment of
Programs Within HRSA and Among Our Partners
7
Recommendation 1
ACHIEVING HEALTH EQUITY
1. Strive to achieve equity and improve
outcomes via policy, program,
partnership, research, service delivery,
workforce development and other
activities
ALIGNS WITH STRATEGIC
PLAN GOAL IV: IMPROVE
HEALTH EQUITY
What are we doing?
•
HRSA’s Office of Health Equity
• HHS Action Plan to Reduce Racial and
Ethnic Disparities
8
Recommendations 2-3
LINKING/INTEGRATING PUBLIC HEALTH AND PRIMARY
CARE
2. Develop and implement the next generation of
quality breakthrough collaboratives
ALIGNS WITH STRATEGIC
PLAN GOAL IC: INTEGRATE
PRIMARY CARE AND
PUBLIC HEALTH
3. Enhance and strengthen linkages between public
health and primary care through support of an
IOM study and a series of roundtable discussions
What are we doing?
•
www.collaborateforHealthyWeight.org
•
http://www.iom.edu/Reports/2012/Prima
ry-Care-and-Public-Health
•
www.ajph.org or www.ajpmonline.org
9
Why Integrate? Why Now?
“the health of the individual is
almost inseparable from the
health of the larger community.
And the health of each
community and territory
determines the overall health
status of the Nation…”
(Source: Koh; A 2020 vision for healthy people.
N Engl J Med 2010)
10
Integrating Public Health and
Primary Care at HRSA
• Behavioral Health
• Oral Health
• Maternal and Child Health
11
Recommendations 4-5 A
STRENGTHENING RESEARCH AND EVALUATION, ASSURING
AVAILABILITY OF DATA AND SUPPORTING HEALTH INFORMATION
EXCHANGE
LIGNS WITH
STRATEGIC PLAN
PRINCIPLE 5: FOCUS
ON RESULTS ACROSS
THE POPULATION BY
USING THE BEST
4. Build and strengthen HRSA’s internal capacity to
conduct research and evaluation
5. Promote grantee participation in health
information exchange (HIE) at local, State,
regional, and national levels to facilitate public
health activities
AVAILABLE EVIDENCE,
MONITORING
IMPACT, AND
ADAPTING
PROGRAMS TO
IMPROVE OUTCOMES
What are we doing?
•
Office of Research and Evaluation
•
Office of Health Information Technology and Quality
12
Recommendation 6
STRENGTHENING RESEARCH AND EVALUATION, ASSURING
AVAILABILITY OF DATA AND SUPPORTING HEALTH INFORMATION
EXCHANGE
ALIGNS WITH
STRATEGIC PLAN
PRINCIPLE 5: FOCUS
ON RESULTS ACROSS
THE POPULATION BY
USING THE BEST
AVAILABLE EVIDENCE,
6. Develop “HRSA Health Landscape”- a web-based
portal - to include a tool that produces readymade or customizable State and county profiles
of HRSA programs and resources to help primary
care and public health officials increase
knowledge of the health of their community
MONITORING
IMPACT, AND
ADAPTING
PROGRAMS TO
IMPROVE OUTCOMES
What are we doing?
•
HRSA in Your State
•
Data Warehouse
13
Recommendations 7-8
ASSURING A STRONG WORKFORCE
7. Enumerate the Workforce
What are we doing?
•
Bureau of Health Professions -
ALIGNS WITH STRATEGIC
PLAN GOAL II:
STRENGTHEN HEALTH
WORKFORCE
National Center for Workforce Analysis
•
Bureau of Clinician Recruitment and Services National Health Service Corps
8. Enhance the capacity of HRSA’s workforce
What are we doing?
HRSA Learning Institute
14
Recommendations 9-11
INCREASING COLLABORATION AND ALIGNING
PROGRAMS
9. Improve HRSA-Specific Collaboration
10. Increase Federal Collaboration
11. Promote External and Cross-Cutting
Stakeholder Collaboration
ALIGNS WITH STRATEGIC
PLAN GOAL III: LEAD AND
COLLABORATE WITH OTHERS
TO HELP COMMUNITIES
STRENGTHEN RESOURCES
THAT IMPROVE HEALTH FOR
THE POPULATION
What are we doing?
LOTS!!
The National Prevention Strategy
15
National Prevention Strategy
Vision: Working together to improve the
health and quality of life for individuals,
families, and communities by moving the
nation from a focus on sickness and disease
to one based on prevention and wellness.
Goal: Increase the number of Americans
who are healthy at age 85.
Four Pillars:
•Healthy Communities
•Preventive and Clinical and Community
Efforts
•Empowered Individuals
•Eliminate Health Disparities
16
16
National Prevention Council
Bureau of Indian Affairs
Department of Labor
Corporation for National and
Community Service
Department of Transportation
Department of Agriculture
Department of Veterans Affairs
Department of Defense
Environmental Protection Agency
Department of Education
Federal Trade Commission
Department of Health and Human
Services
Office of Management and Budget
Department of Homeland Security
Office of National Drug Control Policy
Department of Housing and Urban
Development
White House Domestic Policy Council
Department of Justice
17
National Prevention Strategy
18
18
NPS Priorities
Tobacco Free Living
Preventing Drug Abuse and
Excessive Alcohol Use
Healthy Eating
Active Living
Mental and Emotional Wellbeing
Five Causes Account For
66% of All Deaths
Heart Disease
All Other
Causes
34%
5%
5%
Cancer
27%
Chronic Lower
Respiratory Disease
23%
Stroke
6%
Reproductive and Sexual
Health
Injury and Violence Free
Living
Unintentional Injuries
Source: National Vital Statistics
Report, CDC, 2008
19
19
Prevention:
Common Foundation and Goal
PUBLIC HEALTH
PRIMARY CARE
•Assessment
•Policy
Development
•Assurance
•Diagnosis
•Treatment
Plan
•Adherence
=
PREVENTION
20
HRSA -the Affordable Care Act
• Improving access to health
care
• Building the health care
workforce
• Integrating public health
and primary care
21
Increasing Access to Primary Care:
Expanding Community Health Centers
• $9.5 billion is targeted to:
o Create new health center sites in
medically underserved areas.
o 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.
22
Community Health Center Model
o 51% User Board- by, for, with the community
o “Core” Health Services
• Primary and Prevention Care
• Oral Health
• Behavioral Health
• Pharmacy, Lab, Imaging
o “Enabling” Services
• Care Coordination
• Interpreter Services
• Health Education
• Outreach– navigation, CHWs
• Transportation and Home visiting
23
Community Health Center Performance, 2009
Access
o 18.8 Million Patients
o 92% Below 200% of Poverty
o 71% Percent below 100%
o 38% Uninsured
Quality
o 71% Diabetes Under Control
o 63% Blood Pressure Under Control
o 67% First Trimester Prenatal Care
o 7.3% Low Birth Weight
o 69% Childhood Immunization
o 58% Pap Tests for Women
Cost
o $617 Cost Per Patient
Source: Uniformed Data System 2009
24
Building the Primary Care Workforce
National Health Service Corps
•$1.5 billion over next 5 years
•Increased number and
amount of awards
•Part-time service option
•2 or 4 year contracts
•Service credit for teaching
•Streamlined application and
approval processes
25
Building the Health Care Workforce:
Workforce Training/Planning
•
•
•
•
Primary care residencies
PA training in primary care
Nursing students support
Nurse managed health
clinics
• State workforce planning
• Advanced Practice Nursing
26
Public Health Training Centers Budget
FY 2000: $2.5 Million
FY 2001: $4.6 Million
FY 2002: $5.5 Million
FY 2003: $5.5 Million
FY 2004: $4.9 Million
FY 2005: $4.8 Million
FY 2006: $4.4 Million
FY 2007: $4.5 Million
FY 2008: $4.7 Million
FY 2009: $5.2 Million
FY 2010: $18.6 Million
$15.4 M – Prevention and
Public Health Fund
$3.2 M – Appropriations
27
Prevention and the ACA - More
•
•
•
•
•
Healthy Weight Collaborative
Coverage of preventive services
School based health centers
Home visitation program
Text4Baby
28
Other Prevention and Public Health Programs
• Tobacco cessation
www.HRSA.gov/stopsmoking
• Stop Bullying Now
• Poison control centers
29
Connecting Public Health, Primary Care
and Prevention–
Final Thoughts
“The health of“).the individual is almost inseparable
from the health of the larger community. And the
health of each community and territory determines
the overall health status of the Nation”
(Source: Koh; A 2020 vision for healthy people. N Engl J Med 2010).
30
Thank you!
CAPT Sarah Linde-Feucht, MD
Chief Public Health Officer
301-443-2216
slinde-feucht@hrsa.gov
http://www.hrsa.gov
31