Merle Cunningham, MD MPH

Connecting the Dots:

Interagency & Intergovernmental Collaborations

Related to Health Care

Learning Objectives

At the end of this session, participants will be able to:

1. Better understand the key Federal players and collaboration among Federal Executive Branch agencies with respect to health care & CHCs

2. Better appreciate the role of key State and Local government players who relate to health care & CHCs and their collaboration with Federal agencies  

Session Overview

• Federal level: Executive Branch– Administrative agencies related to health care

• State and local (county/city) level– Administrative agencies related to health care

• Examples of collaboration among key players

Collaboration among Key Players

• Childhood & Adolescent life cycles– Early childhood development -Asthma– Immunization registries -Obesity

• Women’s Health life cycles– Family planning & prenatal care (reproductive health)

– Screening & prevention (breast & cervical CA, HTN)

• Adult life cycles– Diabetes -Obesity– Heart disease -Cancer– Depression

Federal Executive Branch

• Key Powers related to Health Care– Agenda setting– Interact with legislative & budget process

– Issue/promulgate regulations within statutes

– Provide oversight and monitoring– Financing – grants, contracts, health insurance

Federal Executive Branch

Key Health Care Players (Cabinet level)– Administrative Agencies (Direct healthcare roles)•DHHS (HRSA, CDC, SAMHSA, AHRQ, ONC, NIH, AoA, FDA, OGC, CMS)

– Administrative Agencies (Indirect healthcare roles)•USDA (WIC, Food Stamps, Coop Extension Service)•Education (Health Educ Curriculum, School Health)

•DVA (Veterans Health Administration) •Defense (Tri-Care: Military Health Service)

Note: for underlined agencies Organizational Chart provided

HHS Organizational Chart

CDC

Bureau of Primary Health Care

Administers Health Center programs •Policies: Policy Information Notices (PINs) and Program Assistance Letters (PALs)•Program requirements, grants management•Technical Assistance•UDS data•FTCA deeming

State Government• Key Health Care Players

– Variable agency structure & authority related to State constitutions

– Typical players in some variation or combination:• State Health Department • State Mental Health Department• State Medicaid Office• State Office: licensing & regulation of insurance companies

• State Office: licensing & regulation of facilities (CON, etc)

• State Education Department (staff licensing)

• Complex relationship with Federal Agencies– Varying levels of federal intervention over time

Local Government (County or City)

• Local Public Health Agencies (LPHA):– Created by referendum or legislation– Part of state network with shared responsibilities

– Usually formed and managed by local government

– May share oversight or directly operate health services

• Typical Players/Structures– County health and or mental health departments

– City health or mental health departments

Collaboration among Key Players

• Childhood & Adolescent life cycles– Early childhood development -Asthma– Immunization registries -Obesity

• Women’s Health life cycles– Family planning & prenatal care (reproductive health)

– Screening & prevention (breast & cervical CA, HTN)

• Adult life cycles– Diabetes -Obesity– Heart disease -Cancer– Depression

Questions?