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Innovative Community-Based Approaches to Program and Policy Development Aimed at Reducing Disparities in Primary Care Sam S. Shekar, M.D., M.P.H. Associate Administrator for Primary Health Care and Assistant U.S. Surgeon General American Public Health Association (APHA)
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Sam S. Shekar, M.D., M.P.H.
for Primary Health Care and
Assistant U.S. Surgeon General
American Public Health Association (APHA)
131st Annual Meeting and Exposition
November 15 - 19, 2003
HRSA provides federal grant funding to health centers to deliver primary and preventive care
Authorized under 2002 Amendments of the Health Centers Consolidated Care Act of 1996, section 330 of the Public Health Service Act
Consolidated health centers include:
Community Health Centers
Migrant Health Centers
Health Care for the Homeless Programs
Public Housing Primary Care Programs
School-Based Health CentersFQHCs and Health Centers
4 and under
65 and over
Calendar Year (CY) 2002
Source: Uniform Data System, CY 02, June 2003
Source: BPHC, 2002 UDS
Decreased Avoidable Hospitalizations – Health Center Medicaid patients are 22% less likely to be hospitalized for potentially avoidable conditions than those obtaining care elsewhere.
Access to Care: Uninsured Health Center Patients Face Fewer Primary Care Access Barriers than Uninsured Overall
Source: Carlson et al. Primary Care of Patients without Insurance by Community Health Centers (CHCs). Journal of Ambulatory Care Management (JACM). 2001. *p<.001
A national effort to improve health outcomes for all medically underserved people
• Prevention Collaboratives
• Finance Redesign Pilot
• Perinatal Risk Management – Planned
The Care Model includes six essential elements for improving the care of people with chronic illness:
Health Center Patients With Diabetes Are Twice As Likely To Have Their Glycohemoglobin Tested on Schedule
Health Center Patients
Source: MDS Associates, Evaluation of the effectiveness and Impact of Community Health Centers, based on the National Health Interview Survey, 1999
“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
Advances Online, Robert Wood Johnson Foundation Newsletter, October 2002
Newly Established Legislative Authorization (340 Public Health Service (PHS) Act
Stronger Emphasis on Health Care for Underserved
Strengthens Vertical Integration
Improves Chronic Care Coordination
Builds Information Technology Systems
Assists Infrastructure Development
Healthy Community Access Program – FY 2003
35 new HCAP communities in 20 states received awards in FY 2003
129 HCAP communities received continuing funds.
Currently, HRSA has a total of 164 HCAP grantees in 43 statesHCAP Partnerships