September 24, 2004
Washington, D.C.

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I want to begin with a huge thank you to Dr. Charles Grim, Director of the Indian Health Service. At HRSA, we are indeed fortunate to have such an inspired and gifted leader as a partner in our effort to improve access to essential health care services for Indian Country.
 
As many of you know, HRSA’s mission is to expand access to health care and reduce health disparities among all Americans in communities nationwide. And to be successful in this effort, we must have partners on the ground who have intimate knowledge of what local residents want and need in terms of health care. That’s why these kinds of meetings are so important. We have a perfect opportunity to listen and learn from each other and broaden our collaboration in the interest of all those we serve.
           
I can tell you that, at HRSA, our commitment is clear. HRSA Administrator Elizabeth Duke and I travel all around the country in an effort to see firsthand the wonderful work being done at the state and local level. We have had the good fortune to meet with many tribal leaders, and we always tell them the same thing. We want Indian Country to have access to the same essential health care services other regions of the country take for granted. We’re going to do all that we can to make sure that no one who needs care falls through the cracks.
 
In my time with you today, I want to give you an update on the many collaborative efforts we at HRSA and IHS have undertaken.
 
Last April, at the direction of both Dr. Duke and Dr. Grim, work began on an action plan that would identify opportunities for collaboration between the two agencies. Three workgroups made up of program experts from each agency were formed to specifically look at three program priorities.   The program priorities were: reducing health disparities in chronic and other diseases; increasing the supply of health professionals in Indian country; and reducing the burden of HIV/AIDS on Indian people.
 
Let me begin with HRSA’s health center program. HRSA is now in the third year of implementing a five-year health center expansion initiative that President Bush announced soon after taking office.  So far we’re ahead of schedule.
 
Since 2002, the first year of the expansion, HRSA has awarded about 650 grants to create new health centers or expand capacity at existing centers. Eighteen of these centers are managed by tribal organizations mostly in Alaska.  By the end of 2004, HRSA will support about 3,650 health center sites across the country, serving an estimated 13.2 million people. As you can see, this is quite a vast network and a huge number of people are being served.
 
One key goal of the health disparities workgroup was to find ways to make it easier for  Indian and tribal organizations to participate in the health center program.   However, for those with little experience, the application process can be a daunting task.  For example, many applicants do not realize the federal dollar is less than 25 percent of a health center’s budget, on average, and that funding from various other sources is critical to a center’s viability. And some tribes are not sure that they are ready to serve everyone who comes to the center for health care, whether a tribal member or not, as required by the health center legislation. We understand and respect that point of view. But to those who view the community health center program as an opportunity to provide needed health care to everyone in their community, we stand ready to provide support and assistance.
 
In August, the workgroup came up with a “Frequently Asked Questions” document that was distributed, along with a joint letter from Dr. Duke and Dr. Grimm, to all Indian and tribal organizations interested in health center funding opportunities.  In addition, we have started technical assistance phone calls with Primary Care Associations located in areas where they can be of help to tribal organizations who want to improve their applications for health center funding. We recently held our first such call and had 30 PCAs participating. And next week, I am meeting with the Montana Primary Care Association and interested tribal organizations in Billings to discuss health center opportunities. We are convinced that a good working relationship between HRSA and IHS will lead to many future achievements in this area.
 
And we will share with IHS best practices resulting from the work of our nationally recognized Health Disparities Collaboratives. Hundreds of health centers around the nation participate in the collaborative process.
 
As a result, we now have documented verifiable health benefits for patients struggling with chronic diseases like diabetes, asthma, obesity, heart disease, depression and cancer.  We have seen these collaboratives lead to breakthrough transformations in the performance of many health organizations.  We’ve seen dramatic improvements in teamwork among health professionals. Procedures that track treatments and reach out to residents are better than ever. And, perhaps, most important, more and more patients are being encouraged to take greater responsibility for monitoring their own illnesses.  Without a doubt, the lessons learned from these collaboratives have the potential to save lives and improve the health of thousands of Americans. 
 
In the health professions area, we know that there are not enough well-trained health professionals to meet the health care needs of the underserved in Indian Country. In addition, a culturally competent workforce is also often lacking in these areas. At HRSA, we support numerous activities that are specifically designed to strengthen the academic performance of American Indian and Alaska Native students and to recruit, train and retain more Indian and Alaska Native faculty. In 2002, 218 American Indian and Alaska Native students and faculty were in health professional schools supported by our Centers of Excellence program. And we fund a tribal college in Fort Totten, North Dakota,   through our Health Careers Opportunity Program. These activities and many more should have a direct impact on the numbers of health professionals we will have available in the future to serve in Indian and Alaska Native communities.
 
Looking ahead, the Health Professions workgroup also has identified some changes that could get even closer to the workforce goals we all share. Here are a few highlights:
 

• Currently, existing policy in the National Health Service Corps, which places health professionals in shortage areas, excludes loan repayors from fulfilling their obligations in IHS/tribal and community sites. The National Health Service Corps will revise this policy to allow its loan repayors to fulfill their service obligations at these sites.
  
  
• Both Agencies have loan repayment programs for health professionals. HRSA and IHS will evaluate the feasibility of coordinating these programs—a process that could lead to a common application and coordination of loan repayment awards.
  
  
• IHS has developed significant expertise and experience in the measurement and reporting of clinical outcome data. HRSA’s Bureau of Health Professions is seeking to expand and refine its capabilities in this area--- a process made easier though collaboration between HRSA and IHS.
  
  
• And the process of designating health professional shortage areas can be streamlined through the use of tribe-specific demographic information. Both agencies will work to obtain and use such data to more accurately designate and score Health Professional Shortage Areas.

HRSA’s HIV/AIDS Bureau and IHS have long been collaborating on improving services to American Indians and Alaska Natives. We have worked on improving care and treatment outreach programs, designed specific provider training through the AIDS Education and Training Centers, and created innovative models of care through the Special Projects of National Significance program. Most important, we have made it clear that American Indians and Alaska Natives who suffer from HIV/AIDS may receive services at any clinic supported by funding under the Ryan White CARE Act anywhere in the U.S., even if they are also eligible for similar services at an HIS or tribal managed facility.
 
In 2002, the Ryan White CARE Act provided HIV-related services to more than 6,200 American Indians and Alaska Natives. Since FY 2000, more than $2 million has been shared between IHS and HRSA to improve HIV/AIDS training and technical assistance for providers servicing these communities. And, more than $19 million has been awarded to develop innovative models of care that support effective delivery systems and access to HIV care for both American Indians and Alaska Natives.
 
HRSA has also established formal linkage with the Association of American Indian Physicians through our AIDS Education and Training Centers. And we believe that continued collaboration between IHS and HRSA will ensure that access to quality HIV services is maintained and encouraged in those places where the need is greatest. 
 
The good news is that what I’ve touched on today just skims the surface of the work HRSA and IHS are doing together.  With this Summit, new ideas and strategies will be generated and we will be able to accomplish even more for the many people we serve.
 
Again, I’m delighted to be here with you today. On behalf of the entire HRSA family, I offer best wishes for a most successful Summit.