1. Introduction to Healthcare and Public Health in the US Delivering Healthcare (Part 1) Lecture a This material (Comp1_Unit2a) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. Delivering Healthcare (part 1) Learning Objectives Describe the organization of healthcare at the federal, state and local levels (Lecture a) Describe the organization of the VA system and Military Health System (Lecture b) Describe the structure and function of hospital clinical and administrative units (Lecture c) Describe different types of long term care facilities, with an emphasis on their function (Lecture d) 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

3. Delivering Healthcare (part 1) Learning Objectives Describe the organization of healthcare at the federal, state, and local levels –Overview of the US Department of Health and Human Services (HHS) –Role of state governments in healthcare –Local healthcare organizations 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

4. Purpose of the HHS Provides essential healthcare for all Americans Protects the needy or underserved State, local, and tribal levels Structure –Office of the Secretary –11 operating divisions 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

5. Organization of the HHS 1.1 Chart: (HHS.gov, ND) 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

6. Administration for Children and Families (ACF) Addresses the economic and social well-being of children, families, individuals, communities Vulnerable populations included Programs are both national, regional Well-known program: Head Start 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

7. Administration on Aging (AoA) Adults 65 years of age and older will be 19% of the US population by 2030 AoA funds non-medical programs to prolong health and independence Programs are both home-based and community- based Multiple needs served: nutritional, logistical, legal, quality of life 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

8. Agency for Healthcare Research and Quality (AHRQ) Mission: Provide data on healthcare in the US –Quality, safety, efficiency, effectiveness, access –Measurable outcomes: illness, death, spending –All stakeholders are included Focus areas of research: Health information technology Effectiveness of treatments Quality improvement and patient safety Illness prevention and care management Healthcare value 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

9. Agency for Toxic Substances and Disease Registry (ATSDR) Mission: Prevent illness/disease from toxic/hazardous substances –Examples: arsenic, asbestos, lead, mercury –Origins: environmental pollution, waste sites, disasters –Methods of intake: breathing, drinking, food, soil exposure Identifies exposures, evaluates risk, recommends action –Prepares for emergencies/disasters –Educates about toxicology, environmental medicine, chemical exposures –Issues public health advisories –Well-known example: Actions taken on and after 9-11-2001 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

10. Centers for Disease Control and Prevention (CDC) Responsible for health promotion, disease prevention, reduction of injury or disability Prepares for emerging health threats –Well-known example: “Swine” flu Enacts prevention strategies, develops public health policies, advocates for healthy behaviors. Works with national and international partners Educates healthcare providers, consumers 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

11. Centers for Medicare and Medicaid Services (CMS) Medicare/Medicaid cover 25% of US population Medicare –Largest health insurer in the US –For elderly or disabled people –Insured person pays premiums Medicaid For low-income patients and families Specific guidelines are determined by each state Insured person generally does not pay Children’s Health Insurance Program 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

12. Food and Drug Administration (FDA) Responsible for the safety and effectiveness of foods, drugs, and medical devices –Also veterinary drugs, cosmetics, radiologic health, toxicology Evaluates and approves new drugs Regulates tobacco manufacture and marketing Office of the Commissioner and 8 centers 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

13. Health Resources and Services Administration (HRSA) Mission: Improve access to healthcare –People with low incomes, no insurance –People with certain medical issues (such as patients with HIV/AIDS and children with special needs) –People who are isolated (for example, in rural communities) Other services Oversees organ, blood, bone marrow donations Combats bioterrorism Compensates people for severe vaccination reactions 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

14. Indian Health Service (HIS) Mission: Improve physical, psychological, and spiritual health of American Indians and Alaska Natives –Accessible public health services –Culturally sensitive; recognizes sovereign rights –564 federally recognized tribes in 35 states Medical and social issues –Disparities in health and life expectancy –Higher mortality from diseases, social problems 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

15. National Institutes of Health (NIH) World’s largest source of funding for medical research Funds universities, research institutions, its own laboratories 27 institutes and centers with focus on: –Diseases (for example, cancer, heart disease, alcoholism and drug abuse, arthritis, diabetes) –Specific groups (for example, children, the elderly) –Research issues (for example, nursing, alternative medicine, information technology) 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

16. Office of the Inspector General (OIG) Protects the integrity of HHS programs Protects the health and welfare of people who benefit from HHS programs –Performs nationwide audits, investigations –Reports abuses to the Secretary and Congress –Recommends corrections Examples of initiatives: –“Stop Medicare Fraud” program –“Healthcare Fugitives” list 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

17. Substance Abuse and Mental Health Services Administration (SAMHSA) Mission: Improve the health of people with mental illness/substance abuse, while reducing healthcare costs and social costs 8 strategic initiatives: –Prevent substance abuse and mental illness –Reduce the impact of violence and trauma –Support military families –Support patients with housing, employment, education –Improve insurance coverage and access to treatment –Promote information technology and electronic medical records –Gather data to measure the success of programs –Educate the public about mental illness and substance abuse 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

18. State Healthcare All states have a Department of Health –Organizational structures vary –Responsible for disease treatment, health promotion, care of special groups –State governments partner with HHS National Academy for State Health Policy –Mission: Improve healthcare access and quality –Encourages states to collaborate with federal government, private companies, other states –Well-known example: national healthcare reform 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

19. Local Healthcare: Private Healthcare Agencies Independent healthcare providers –Single-provider practices –Group practices Corporate healthcare –Employees, families, retirees Some agencies operate community health centers Can have for-profit or nonprofit status 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

20. Local Healthcare: Hospitals Profit or nonprofit Government-supported or not General or specialty University-affiliated or community-based Single or chain Critical-access hospitals get Medicare reimbursement 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

21. Delivering Healthcare (Part 1) Summary - Lecture a HHS –Multiple agencies –Oversight role: disease prevention, healthcare quality, medical insurance for special populations, research, mental health, food/drug safety, and more State departments of health –Many of the same types of programs as HHS Local healthcare –Private agencies –Clinics and hospitals 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

22. Delivering Healthcare (Part 1) References – Lecture a References Administration for Children and Families. http://www.acf.hhs.gov. Accessed April 5, 2011.http://www.acf.hhs.gov Administration on Aging. http://www.aoa.gov. Accessed April 6, 2011.http://www.aoa.gov Agency for Health Care Research and Quality. http://www.ahrq.gov. Accessed April 4, 2011.http://www.ahrq.gov Agency for Toxic Substances and Disease. Agency for Toxic Substances and Disease Registry. http://www.atsdr.cdc.gov. Updated March 23, 2011. Accessed April 4, 2011.http://www.atsdr.cdc.gov Alliance for Advancing Nonprofit Health Care. The value of nonprofit health care. http://www.nonprofithealthcare.org/reports/5_value.pdf. Accessed April 5, 2011. http://www.nonprofithealthcare.org/reports/5_value.pdf AmericanHospitals.com. Hospital locator: all hospitals are not created equal. http://www.americanhospitals.com/hospitals/hospitalsequal.htm. Accessed April 5, 2011. http://www.americanhospitals.com/hospitals/hospitalsequal.htm Centers for Disease Control and Prevention. http://www.cdc.gov. Accessed April 6, 2011.http://www.cdc.gov Centers for Medicare and Medicaid Services. CMS programs and information. http://www.cms.gov. Accessed April 4, 2011.http://www.cms.gov Corporate Health Care Coalition. http://www.corporatehealthcare.org. Accessed April 5, 2011.http://www.corporatehealthcare.org Health Resources and Services Administration. http://www.hrsa.gov/index.html. Accessed April 4, 2011.http://www.hrsa.gov/index.html HHS.gov. http://www.hhs.gov. Accessed April 4, 2011.http://www.hhs.gov Indian Health Service. http://www.ihs.gov. Accessed April 4, 2011.http://www.ihs.gov Indian Health Service. IHS fact sheets: Indian health disparities. http://info.ihs.gov/Disparities.asp. Updated January 2011. Accessed April 4, 2011.http://info.ihs.gov/Disparities.asp Medicare.gov. http://www.medicare.gov. Accessed April 4, 2011.http://www.medicare.gov Medline Plus. Medicare. http://www.nlm.nih.gov/medlineplus/medicare.html. Updated March 16, 2011. Accessed April 5, 2011.http://www.nlm.nih.gov/medlineplus/medicare.html National Academy for State Health Policy. http://www.nashp.org. Updated March 2011. Accessed April 4, 2011.http://www.nashp.org National Association of Community Health Centers. http://www.nachc.org. Accessed April 5, 2011.http://www.nachc.org 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a

23. Delivering Healthcare (Part 1) References – Lecture a (continued) National Institutes of Health. http://www.nih.gov. Accessed April 4, 2011.http://www.nih.gov Office of Inspector General. http://oig.hhs.gov. Accessed April 6, 2011.http://oig.hhs.gov Rural Assistance Center. CAH frequently asked questions. http://www.raconline.org/info_guides/hospitals/cahfaq.php#whatis. Updated October 26, 2010. Accessed April 6, 2011. http://www.raconline.org/info_guides/hospitals/cahfaq.php#whatis Substance Abuse and Mental Health Services Administration. http://www.samhsa.gov. Accessed April 4, 2011.http://www.samhsa.gov U.S. Food and Drug Administration. http://www.fda.gov. Accessed April 6, 2011.http://www.fda.gov Images Slide 5: US Department of Health and Human Services organizational chart. Available from http://www.hhs.gov/about/orgchart/ http://www.hhs.gov/about/orgchart/ 23 Health IT Workforce Curriculum Version 3.0/Spring 2012 Introduction to Healthcare and Public Health in the US Delivering Healthcare (part 1) Lecture a