1 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

2 Objectives Understand HRSA’s mission, programs, and public health priorities, including prevention Demonstrate the importance of integration of public health and primary care

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

4 HRSA Strategic Plan 1.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

5 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.

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

7 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

8 Recommendation 1 A CHIEVING H EALTH E QUITY 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 A LIGNS WITH S TRATEGIC P LAN G OAL IV: I MPROVE H EALTH E QUITY

9 Recommendations 2-3 L INKING /I NTEGRATING P UBLIC H EALTH AND P RIMARY C ARE 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? ry-Care-and-Public-Health ry-Care-and-Public-Health or A LIGNS WITH S TRATEGIC P LAN G OAL I C : I NTEGRATE P RIMARY C ARE AND P UBLIC H EALTH

10 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)

11 Integrating Public Health and Primary Care at HRSA Behavioral Health Oral Health Maternal and Child Health

12 Recommendations 4-5 S TRENGTHENING R ESEARCH AND E VALUATION, A SSURING A VAILABILITY OF D ATA AND S UPPORTING H EALTH I NFORMATION E XCHANGE 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 A LIGNS WITH S TRATEGIC P LAN P RINCIPLE 5: F OCUS ON RESULTS ACROSS THE POPULATION BY USING THE BEST AVAILABLE EVIDENCE, MONITORING IMPACT, AND ADAPTING PROGRAMS TO IMPROVE OUTCOMES

13 Recommendation 6 S TRENGTHENING R ESEARCH AND E VALUATION, A SSURING A VAILABILITY OF D ATA AND S UPPORTING H EALTH I NFORMATION E XCHANGE 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 A LIGNS WITH S TRATEGIC P LAN P RINCIPLE 5: F OCUS ON RESULTS ACROSS THE POPULATION BY USING THE BEST AVAILABLE EVIDENCE, MONITORING IMPACT, AND ADAPTING PROGRAMS TO IMPROVE OUTCOMES

14 Recommendations 7-8 A SSURING A S TRONG W ORKFORCE 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 A LIGNS WITH S TRATEGIC P LAN G OAL II: S TRENGTHEN H EALTH W ORKFORCE

15 Recommendations 9-11 I NCREASING C OLLABORATION AND A LIGNING P ROGRAMS 9.Improve HRSA-Specific Collaboration 10.Increase Federal Collaboration 11.Promote External and Cross-Cutting Stakeholder Collaboration What are we doing? LOTS!! A LIGNS WITH S TRATEGIC P LAN G OAL III: L EAD AND COLLABORATE WITH OTHERS TO HELP COMMUNITIES STRENGTHEN RESOURCES THAT IMPROVE HEALTH FOR THE POPULATION The National Prevention Strategy

16 National Prevention Strategy 16 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

17 National Prevention Council Bureau of Indian AffairsDepartment of Labor Corporation for National and Community Service Department of Transportation Department of AgricultureDepartment of Veterans Affairs Department of DefenseEnvironmental Protection Agency Department of EducationFederal Trade Commission Department of Health and Human Services Office of Management and Budget Department of Homeland SecurityOffice of National Drug Control Policy Department of Housing and Urban Development White House Domestic Policy Council Department of Justice

18 National Prevention Strategy 18

19 NPS Priorities Tobacco 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,

20 Prevention: Common Foundation and Goal PREVENTION Assessment Policy Development Assurance Diagnosis Treatment Plan Adherence = PUBLIC HEALTHPRIMARY CARE

21 HRSA -the Affordable Care Act Improving access to health care Building the health care workforce Integrating public health and primary care

22 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.

23 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 Community Health Center Model

24 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 Community Health Center Performance, 2009

25 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

26 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

27 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 $3.2 M – Appropriations $15.4 M – Prevention and Public Health Fund

28 Prevention and the ACA - More Healthy Weight Collaborative Coverage of preventive services School based health centers Home visitation program Text4Baby

29 Other Prevention and Public Health Programs Tobacco cessation Stop Bullying Now Poison control centers

30 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). “).

31 CAPT Sarah Linde-Feucht, MD Chief Public Health Officer Thank you!