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National Association of Public Hospitals and Health Systems

Washington, DC
November 9, 2010

Remarks as prepared for delivery

Thank you for that very kind introduction. I am delighted to be here.

I want to thank Larry and the National Association of Public Hospitals and Health Systems for your great leadership. You have helped push our nation forward on so many fronts, from improving health care quality to training the next generation of doctors to confronting health care disparities.

And I especially want to thank you for your steadfast support of the Affordable Care Act. Throughout a marathon debate last spring, you were always there -- not only to make the case for reform, but also, to show us what’s possible.

You have shown that it is possible to provide low-income Americans access to safe, high-quality care.

It is possible to build seamless care networks where hospitals and community health centers work together to make sure patients get the right care at the right time.

And it is possible to invest in preventive care to reduce chronic disease and lower costs.

And you do all of this while providing care for anyone who shows up at your door..

Many Americans may not realize:

  • that public hospitals handle 25 percent of all emergency department visits.
  • that you deliver one out of every five babies and provide the graduate training to one of five dentists and doctors.
  • that in many communities you’re the only health facility that can treat the most serious traumas and burns.
  • And that you are the backbone of our response to most public health crises.

I saw this firsthand last year. Less than an hour after being sworn in as Secretary, I was in the Situation Room being briefed on the H1N1 flu. There were serious questions about whether our health care system would be able to handle the surging demand.

But when the second wave of H1N1 hit its peak and many of you saw your emergency room caseloads rise by 50 percent or more, you rose to the occasion.

Our department worked hard to make sure you had the resources and flexibility you needed. And you found more beds, accommodated the extra patients, and made sure people got the care they needed. In the end we avoided the worst predictions for flu season and public hospitals were a big part of that.

Every day, you work heroically. But as hard as you work to make sure every American gets the care they need, you also know that too many Americans fall through the cracks.

Too many Americans put off treatments because they can’t afford them.

Or don’t get critical preventive care because they don’t have a doctor.

Or live an unhealthy lifestyle because they don’t get the support they need to make healthy choices.

That’s why this Administration has undertaken a broad agenda to improve health in America, starting with the Affordable Care Act.

This is an agenda that supports the great work that public hospitals do.

For example, in 2008, our health care system provided $56 billion in uncompensated care – with public hospitals picking up a significant share of the bill.

If we stuck with the status quo, that number would be expected to rise to $141 billion within the next decade.

And that doesn’t even factor in the tens of millions of Americans who skip treatments or screenings or vaccinations because they don’t have health insurance.

We began to address these challenges in the very first months of the administration, enacting the Children's Health Insurance Program Reauthorization Act to extend health insurance to millions of uninsured children through Medicaid and CHIP. And I know how hard all of you worked on that great early victory.

Now, the Affordable Care Act makes additional advances in coverage.

The new law will reduce the burden on public hospitals and help Americans get the care they need by expanding coverage to 32 million Americans who would otherwise lack coverage.

Nearly half of those people will be covered by an expansion of Medicaid.

That means that many of the people who previously were coming into your hospitals without insurance now will have a Medicaid card, allowing you to be reimbursed.

There will also be some fairness in our health insurance market.

There will be a new marketplace where Americans who had been shut out of the market will be able to get affordable coverage. Public hospitals can expect to gain new private insurance partners as Health Insurance Exchanges are established.

When the Exchanges come online, insurance companies that want to participate will have to include essential community providers like Community Health Centers in their networks.

We’ve already established a Patient’s Bill of Rights with an independent appeals process for claims decisions and new protections for consumers to make sure their coverage isn’t taken away from them without justification.

That means more of your patients are going to be able to get the care they need, when they need it. They won’t have to worry about putting off treatment, and waiting until they have no choice but the emergency room. And they won’t have to worry about choosing between paying their rent and paying their hospital bills.

And you can spend less time arguing with insurance companies and more time delivering care.

But as important as these health insurance reforms are, we also know that a lack of health insurance is not the only obstacle preventing people from getting the care they need.

Today, 60 million Americans live in areas without a primary care physician. And these communities don’t just need doctors; they need mental health providers, dentists, physician assistants, and nurse practitioners, too.

These are the people who help patients get preventive care and make sure our children get their immunizations. They help patients manage their chronic diseases and coordinate care with specialists.

As we add millions of Americans to the system, demand for care is only going to grow.

That’s why we’ve undertaken a broad agenda to expand our health care workforce from almost doubling the size of the National Health Service Corps to making it easier for minority students to fulfill their dreams of joining a health profession.

When you add all these initiatives together, we’re going to train 16,000 new primary care providers over the next five years, many of who will practice in the rural and inner-city communities where they’re needed most.

We’re also supporting proven models of high-quality, affordable care like community health centers.

The Recovery Act invested $2 billion in community health centers over the past year and a half – supporting everything from new buildings to new services to new staff to new technology.

The Affordable Care Act adds $11 billion to that investment. Combined with the Recovery Act it will help America’s community health centers to serve nearly twice as many patients as before.

As many of you have shown, community health centers can be even more effective when they are part of a broader, integrated network equipped to coordinate care among a community’s many safety net providers.

That’s the idea behind community-based Collaborative Care Networks.

Under the old approach, a patient in his mid-fifties with very little or no income might visit a local community health center for help managing his asthma and high-blood pressure.

He’d get a prescription and some directions. But when he got chest pains the next week, he would call 911 and the ambulance would take him to a hospital.

They would treat his immediate symptoms, make sure he was safe, then send him home with a different prescription and directions to follow up with his primary care provider.

But for whatever reason, he might not get it right. Maybe he didn’t eat the right diet, or took the wrong dose of the new medicine.

And because he didn’t really have his own primary care provider, he might wait a few months until he starts feeling sick again before getting help once more at the community health center where they would start from very beginning.

With collaborative care networks, we can do better.

When we have integrated networks that coordinate services for low-income populations by connecting both a safety net hospital and all federally qualified health centers across a region, there are fewer opportunities for patients to fall through the cracks

With these networks, the patient should get the tools and attention he needs to keep his conditions in check so he can stay out of the ER in the first place.

But if he does have to go the hospital, his doctors will have access to his history. When he returns home, he will already have a follow-up appointment on his calendar. And until then, he will have a care manager he can call if he has any questions.

Coordination helps the patient stay healthy and helps our health care system avoid costly readmissions and unnecessary care.

Which is why the new health care law authorizes our department to award grants supporting just these kinds of community-based Collaborative Care Networks.

If Congress appropriates the funds, the grants can serve many purposes -- from case management and care management; to health outreach with neighborhood health workers; to expanded capacity through tele-health, after-hours services, or urgent care.

I know you have made this program a top priority. And we need you to continue to be a powerful voice, showing just how important integrated networks are to connecting our communities and coordinating care.

Ultimately, programs like these are part of a broader effort to shift the focus of attention within our health care system from waiting for people to become acutely ill, to giving them access to care earlier, in a way that is more cost-effective and more health-effective.

Dr. Richard Gilfillan – the former President of the Geisinger Health Plan is now leading our efforts at the new Center for Innovation at the Centers for Medicare and Medicaid Services.

The Center will be tasked with identifying and testing other promising new models for delivering and paying for health care – and, just as importantly, sharing and disseminating them.

Many of the models we’re trying to promote don’t need to be invented. They’re already being tested and used in communities across the country, making a real impact on people’s lives.

Just as you have done with Collaborative Care Networks, we need you to lead the way. You are among the best innovators we have when it comes to figuring out how to reach an entire community with high-quality care at an affordable price.

We’re eager to be informed by your experience and to work with you to encourage medical care that saves lives and lowers costs.

I want to thank you again for hosting this important conference on implementation and for giving me this opportunity to speak with you today.

The Affordable Care Act provides a strong platform for change -- expanding coverage, protecting patients, lowering costs and shifting incentives to reward value over volume.

With your help, we’ve passed historic health legislation that has given us an incredible opportunity to work together to build a healthier America. Now we need your help to make the most of it. Thank you.