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Connecting and Integrating Public Health, Primary Care, and

Prevention at HRSA

USPHS Scientific Training SymposiumCollege Park, MD

June 21, 2012

CAPT Sarah Linde-Feucht, MDChief Public Health Officer

Health Resources and Services AdministrationU.S. Department of Health and Human Services

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Objectives

• Understand HRSA’s mission, programs, and public health priorities, including prevention

• Demonstrate the importance of integration of public health and primary care

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HRSA Mission

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

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HRSA Strategic Plan1. Improve Access to Quality Health Care and Services

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

2. Strengthen the Health Workforce Align the composition and distribution to best meet needs of communities Support development of interdisciplinary teams

3. Build Healthy Communities Lead and collaborate with others Strengthen the focus on illness prevention and health promotion across

populations and communities

4. 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

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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.

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Access and Workforce

• Workforce training programs• Rural health care• Federal organ procurement system• Poison Control Centers• 340B low-cost drug program

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HRSA’s Public Health Priorities

1) Achieving Health Equity and Improving Outcomes 2) Linking/Integrating Public Health and Primary

Care3) 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

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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

What are we doing?

• HRSA’s Office of Health Equity

• HHS Action Plan to Reduce Racial and Ethnic Disparities

ALIGNS WITH STRATEGIC PLAN GOAL IV: IMPROVE HEALTH EQUITY

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Recommendations 2-3LINKING/INTEGRATING PUBLIC HEALTH AND

PRIMARY CARE

2. Develop and implement the next generation of quality breakthrough collaboratives

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/Primary-Care-and-Public-Health

• www.ajph.org or www.ajpmonline.org

ALIGNS WITH STRATEGIC PLAN GOAL IC: INTEGRATE PRIMARY CARE AND PUBLIC HEALTH

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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)

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Integrating Public Health and Primary Care at HRSA

• Behavioral Health

• Oral Health

• Maternal and Child Health

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Recommendations 4-5STRENGTHENING RESEARCH AND EVALUATION,

ASSURING AVAILABILITY OF DATA AND SUPPORTING HEALTH INFORMATION EXCHANGE

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

What are we doing?

• Office of Research and Evaluation

• Office of Health Information Technology and Quality

ALIGNS WITH STRATEGIC PLAN PRINCIPLE 5: FOCUS ON RESULTS ACROSS THE POPULATION BY USING THE BEST AVAILABLE EVIDENCE, MONITORING IMPACT, AND ADAPTING PROGRAMS TO IMPROVE OUTCOMES

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Recommendation 6STRENGTHENING RESEARCH AND EVALUATION, ASSURING AVAILABILITY OF

DATA AND SUPPORTING HEALTH INFORMATION EXCHANGE

6. Develop “HRSA Health Landscape”- a web-based portal - to include a tool that produces ready-made 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

What are we doing?• HRSA in Your State

• Data Warehouse

ALIGNS WITH STRATEGIC PLAN PRINCIPLE 5: FOCUS ON RESULTS ACROSS THE POPULATION BY USING THE BEST AVAILABLE EVIDENCE, MONITORING IMPACT, AND ADAPTING PROGRAMS TO IMPROVE OUTCOMES

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Recommendations 7-8ASSURING A STRONG WORKFORCE

7.Enumerate the Workforce

What are we doing?

• Bureau of Health Professions -

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

ALIGNS WITH STRATEGIC PLAN GOAL II: STRENGTHEN HEALTH WORKFORCE

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Recommendations 9-11INCREASING COLLABORATION AND

ALIGNING PROGRAMS

9. Improve HRSA-Specific Collaboration

10.Increase Federal Collaboration

11.Promote External and Cross-Cutting Stakeholder Collaboration

What are we doing?

LOTS!!

ALIGNS WITH STRATEGIC PLAN GOAL III: LEAD AND COLLABORATE WITH OTHERS TO HELP COMMUNITIES STRENGTHEN RESOURCES THAT IMPROVE HEALTH FOR THE POPULATION

The National Prevention Strategy

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National Prevention Strategy

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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

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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

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National Prevention Strategy

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NPS PrioritiesTobacco Free Living

Preventing Drug Abuse and Excessive Alcohol Use

Healthy Eating

Active Living

Mental and Emotional Well-being

Reproductive and Sexual Health

Injury and Violence Free Living

Source: National Vital Statistics Report, CDC, 2008

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Prevention:Common Foundation and Goal

PREVENTION

•Assessment•Policy Development•Assurance

•Diagnosis•Treatment Plan•Adherence

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PUBLIC HEALTH PRIMARY CARE

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HRSA -the Affordable Care Act

• Improving access to health care

• Building the health care workforce

• Integrating public health and primary care

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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.

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o 51% User Board- by, for, with the communityo “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

Community Health Center Model

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Accesso 18.8 Million Patientso 92% Below 200% of Povertyo 71% Percent below 100%o 38% Uninsured

Qualityo 71% Diabetes Under Controlo 63% Blood Pressure Under Controlo 67% First Trimester Prenatal Careo 7.3% Low Birth Weighto 69% Childhood Immunization o 58% Pap Tests for Women

Costo $617 Cost Per Patient

Source: Uniformed Data System 2009

Community Health Center Performance, 2009

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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

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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

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Public Health Training Centers Budget

FY 2000: $2.5 MillionFY 2001: $4.6 MillionFY 2002: $5.5 MillionFY 2003: $5.5 MillionFY 2004: $4.9 MillionFY 2005: $4.8 MillionFY 2006: $4.4 MillionFY 2007: $4.5 MillionFY 2008: $4.7 MillionFY 2009: $5.2 MillionFY 2010: $18.6 Million

$3.2 M – Appropriations

$15.4 M – Prevention and Public Health Fund

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Prevention and the ACA - More

• Healthy Weight Collaborative• Coverage of preventive services• School based health centers• Home visitation program• Text4Baby

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Other Prevention and Public Health Programs• Tobacco cessationwww.HRSA.gov/stopsmoking

• Stop Bullying Now

• Poison control centers

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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).

“).

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CAPT Sarah Linde-Feucht, MDChief Public Health Officer

301-443-2216slinde-feucht@hrsa.govhttp://www.hrsa.gov

Thank you!