MCHB ALL GRANTEES MEETING

Response to Highlights of Critical MCH Issues Town Meeting with HRSA Deputy Administrator/ MCHB Associate Administrator

October 4-7, 2004

DENNIS WILLIAMS: Thank you, Bonnie! It’s good to be back with you today. I must say, I enjoyed the previous session and I commend you for the seriousness with which you’ve taken the tasks that you were given. I heard a lot of hard work. I heard a lot of good ideas. I heard a lot of different ideas. There’s certainly a lot of different points of view about what your communities should be doing and what it should be trying to achieve, and I think that kind of controversy, dialog and discussion is very healthy. And to the extent that we in HRSA can help to support that kind of dialog and to move forward in the fronts where you have some consensus, we certainly want to do that and explore that with you. There’s several things I’ve heard which I’d like to at least make some comment on, and perhaps we can explore further in the question and answer session. I am, if not a stranger, perhaps a foreigner in your midst. I may not always speak your language precisely, and I may not always understand the culture that you work within, and so to that extent I may misinterpret things, but at least as a person listening carefully to what you had to say, I have some comments to make. One theme perhaps that I heard that is perhaps not surprising given the theme of the conference, has to do with collaboration, and this is something that you are thinking about and it is something that we in the Department of Health and Human Services are thinking about, and it’s something that is sort of in the wind so to speak.

Secretary Thompson, when he came to Washington, when he came to the Department of Health and Human Services, he saw a department that was very decentralized, very fractionalized, and his vision was to get us inside the department and its many and diverse programs to work more closely together. His word for that is one HHS. But it is a notion of how we in the department and the programs that we manage. How can we work together? How can we collaborate to achieve common objectives and goals? I think I hear you wrestling with the same thing: How can you, as a community at various levels, work together to achieve some of the goals which you are all dedicated to? Data sharing is one dimension of this. You all are collecting data. How can you share information? How can you benefit from each other’s experiences? I think we would like to think about how we can help you do that. You’ve talked about an evidence-based approach using that data, and I think I heard a plea for help: “How can we learn to be more evidence-based? How can we use data to best advantage to achieve our goals? Can you help us?” And I think we’d like to think about, as HRSA that’s probably a very good role for us to help you with, and so this winter, (what) I think I’d like to hear more about is how can we in the sense of providing technical assistance to you, how can we help you take maximum advantage of the data which you have and of course help you improve the quality and the quantity of data which is available to you?

Another dimension to this collaboration that I think you’re wrestling with is what’s the right level? I mentioned in my speech to you on Monday the U.S.-Mexico Border Health Week. It’s an effort on the part of the Mexican government, the U.S. government, and Health and Human Services in particular, and even more importantly, HRSA’s been a leader in this, to try to think about, for that geographic area, which is very extensive, across Texas, Arizona, New Mexico, California, to think about that long stretch of land coming inland about a hundred miles. That border area, there are tremendous problems, but a lot of these problems are common problems along this border. How can we in HRSA in all of our programs, not just Maternal and Child Health grantees, but our community health center program, our *Ryan Lake HIV programs, Maternal and Child Health programs, how can we collaborate together to address common issues in that border area. That can be one focus of collaboration. Also, working with CDC and other HHS agencies in this effort. We’re working with states, state health departments, local communities, universities in this area, to come together to try to address common problems. We’re also working using this as an opportunity to reach out to other federal agencies, such as EPA, for example.

There’s a lot of environmental issues in this geographic region which affect health and the well-being of individuals who live there. How can we work together? So we see this as an opportunity, as a mechanism, not a one-time mechanism, although this is the first time we’ve attempted this health route, but in putting together the various events that will take place over the next week or ten days, how can we build relationships based on those events that will enable us in the future to continue to support collaborations to reach out to other institutions in these communities and build relationships and opportunities for us to work together into the future? And one of the ways we’re going to try to do that is in December, after the week is over, after people have had a chance to reflect a little bit about what was achieved during that week, we want to get all of our grantees together and talk about lessons learned and how we might continue these relationships into the future, foster them and support them. You’re also wrestling with, I think, is just within your own community, how can you work better together horizontally and vertically, not only in your local communities but at the state level, regional level, and national level? I think one question is, at least initially, what’s the right level? What’s the right meaningful level?

I think collaboration in all of those levels is useful, but collaboration at the community level at least for starters, not just in your own Maternal Child Health community at the community level, but across all of the public health and other healthcare providers in your community. How can you work more closely together to meet your objectives and to help others meet theirs? The states through our block grant obviously have a big role to play here, too. Is that the right next focus up? Should we be focusing on states or should we take a broader approach such as regions? I’ve heard some discussion about the fact that regional centers are not as available as they used to be. Does that suggest that regions is a more important focus than states? I’m not sure about the answer to that question; we’re all wrestling with that, but I wouldn’t mind hearing more from you about it. There is clearly a big focus here on prevention and wellness. We support that. The Secretary has made prevention a big focus of everything that we are doing in the department. How HRSA can help you in that focus, I’d like to hear some more about; I’m sure Peter would love to hear more about: How can we help you, how can we focus our resources on prevention and wellness? What do we need to do to shift priorities if that represents for you a shift in priorities?

Another area that I heard a lot about, or seemed to hear, is perhaps a change in orientation. A struggling to move towards a more almost business model-a more business-like approach to what you do, and I’m sure this involves for a community who has been around for a very, very long time. Your Maternal Child Health community stretches back longer than almost any other federal program, at least in the department. Does this represent a cultural shift for you from a more compassionate model that someone mentioned to some of the business aspects that you have I think rightly pointed out as perhaps necessary as you move forward. There was a mention about revenues, Medicaid. Medicaid is really the glue that holds a lot of safety net providers together, including supporting a lot of the services that you provide. Cost-benefit analysis, I heard. Health Economists can be helpful to you in trying to document cost-benefit. These are all ideas, it seems to me, themes of trying to think about your work in a more business-like way for the purpose of both sustaining what you do and thinking about how you can be more effective. Accountability, use of data, again, I think is a business concept that is worth struggling with. How can you use data to best advantage for your operations? One thing I would point out to you that I think you’ll want to take advantage of, we’re still just beginning to experiment with, and that is our Office of Performance Review. One of the things we’ve asked that group to do around if they’re located at the regional offices, our ten regional offices, they’re going to be going out and reviewing our grantee operations across all of HRSA, state operations as well as local grantees.

The purpose of these reviews is not to find problems that you have to fix. Our purpose here is to try to find strengths and weaknesses in what you do, where there are weaknesses, work with you to think about strategies for addressing them. It’s a mechanism, and I’ve heard this, it’s a mechanism that can bring good practices to bear. It can be a mechanism for communicating to you as they look at your operations, what other people are doing to address the same issues. What are some of the best practices we encounter that might be of help to you? So we’re looking at these Office of Performance Review visits almost as a form of technical assistance, helping you think through your strengths and weaknesses, coming out with a plan that helps you and brings our resources to bear to help to address those weaknesses and help you go in the direction that you think you need to go in. Technology is another area: You’ve heard the President talk about electronic health records, the use of health information technology. This is going to be a theme you’re going to hear a lot about over the next ten years. How can technology address some of your issues, some of your services, some of your concerns? I think you’re at the beginning of thinking about that. Distance learning is another dimension. Perhaps we can help you think through that. We’d like to engage you at least in a discussion about how we might support the technology you need, how technology might be useful to you.

Finally, let me say one thing: I’ve heard two contradictory themes if I listened carefully. One is: “The Feds need to listen.” If we’re not listening enough I think we need to think about how to open our ears. We need to listen to you. This meeting is one way for us to try to listen to you, bring you together, help you talk among yourselves. But we want to listen to what your concerns are and where you think we can be helpful to you. And if we need to think about changing priorities, we’d like to engage you in that dialog, and we’re looking for mechanisms like this to do that. So help us listen. I think we want to listen. If we’re not listening, I think you need to keep pounding on our door. But I also heard a theme that says, “The Feds need to help us; tell us what to do.” This was something that was especially, I thought, sharp in the discussion on data: “We don’t know how to do this data thing. Tell us what to do, tell us how to do it.” I think HRSA does have a technical assistance role, but I’m not sure we always want to be in the position of telling you what to do. We work within the framework of a law, with a mission; we have some ideas that we think can be helpful to you, but there ought to be a dialog. I don’t think we want to be in a position always of telling you what to do, although we want to coordinate your work so that we’re all moving in a similar direction, but we need to listen to you and we need to give you feedback, so there needs to be an interchange here more than just top-down, or just bottom-up. My modest comments. I commend you again for the seriousness of your discussions. I learned a lot today. You’re obviously struggling with a lot of issues, but you’ve also demonstrated, I think, a lot of expertise and commitment to an issue that’s extremely important to us and we look forward to continuing to work with you. Thank you.