Federal preparedness funding for the healthcare sector of the nation has traditionally come from two sources, both of which are agencies of the U.S. Department of Health & Human Services (HHS): (a) the Hospital Preparedness Program (HPP) of HHS’s Office of the Assistant Secretary for Preparedness and Response (ASPR); and (b) the Public Health Emergency Preparedness (PHEP) Program of the Department’s Centers for Disease Control and Prevention (CDC). Both programs have an overall mission to improve U.S. healthcare preparedness in general, but the two agencies have historically operated with disparate goals and objectives.
Through the HPP program, ASPR provides funding to states, territories, and eligible municipalities to improve surge capacity and enhance both community and hospital preparedness to deal with public health emergencies. In most jurisdictions, HPP funding flows through the state to local hospitals and is used to increase surge capacity across the nation, enhance system planning and response capabilities, and improve the healthcare infrastructure. In contrast, the CDC administers the PHEP cooperative agreement, which provides funding to public health departments and is used primarily to improve the ability of health departments to respond to public health threats.
Both programs haveentified the specific capabilities that serve as national health preparedness standards and largely determine how program dollars are spent. Recognizing that both programs enhance preparedness, ASPR and CDC have recently been working in close cooperation to more closely align the sometimes varying goals and priorities of both programs. The newly aligned cooperative agreement between ASPR’s HPP and CDC’s PHEP is scheduled to take effect this summer – i.e., in July 2012.
The Coming Consolidation & Coordination of Coalitions Under the new agreement, ASPR and CDC have aligned the HPP and PHEP capabilities to assist healthcare systems, coalitions, and organizations in their preparedness, planning, and response activities. This new model, which will be consistent with the Department’s 2009 National Health Security Strategy, will be used to promote community resilience and response capabilities by establishing and leveraging coalitions that are charged with fully integrating the public health, public safety, emergency management, and healthcare sectors of the entire nation.
Providing support and funding to coalitions represents a shift from facility-level preparedness to a more community-centric model. As stated in ASPR’s January 2012 National Guidance for Healthcare System Preparedness, “strong and resilient healthcare coalitions are the key to an effective state and local ESF #8 [Emergency Support Function #8 – Public Health and Medical Services] response to an event-driven medical surge.” Going forward, the development, sustainment, and effective use of these coalitions will be central to achieving the goal of improving community resilience and community-wide planning efforts.
Although a few regions of the country currently have well-functioning healthcare coalitions already in place, most regions do not, and that lack creates the challenge of designing, developing, and implementing strategies designed to push competitors closer together in a timely fashion. The new guidelines will quite likely, therefore, challenge even the most forward-thinking localities to expand the depth, breadth, and utilization of existing coalitions. Establishing new coalitions, and expanding the scope of existing ones, will undoubtedly require considerable hard work on the part of dedicated staff experienced both in healthcare and in coalition building.
Healthcare Coalitions: Defining the Term At the most basic level, a healthcare coalition is a single organizational unit that coordinates and interfaces with other healthcare facilities and assets, community organizations, and a broad spectrum of various public and private sectors. Its strength usually is measured by the breadth and diversity of its membership. However, aneal coalition should be representative of the majority of healthcare assets, both public and private, within the same political jurisdiction and/or geographic area, and therefore should receive at least some degree of financial support from its members.
Membership in the coalition should include, but not necessarily be limited to, representatives of hospitals, public health agencies, skilled nursing facilities, long-term care facilities, ambulatory care centers, emergency medical services agencies, public safety agencies, dialysis centers, poison control centers, and other local healthcare facilities and organizations.
Understandably, competition between and among the providers within a given community may hinder development efforts to at least some degree. However, forming coalitions even in those communities is not an impossible task, as has been amply proved by the example of several national models described in ASPR’s May 2011 report From Hospitals to Healthcare Coalitions.
Not a One-Size-Fits-All Endeavor Under the new alignment, and consistent with the May 2009 ASPR handbook – “Medical Surge Capacity and Capability: The Healthcare Coalition in Emergency Response and Recovery” – the new coalitions are expected to provide support to the healthcare sector on a daily basis. Although they are particularly useful in times of sudden disaster, the true value of a coalition is demonstrated daily through improved coordination, management, and communications within the community’s overall healthcare system. For one thing, as a neutral third party, the coalition can focus more objectively on community-wide preparedness, planning, response, and recovery efforts and initiatives.
The framework for the coalition also provides a helpful forum where providers can come together not as competitors but as members of the same community to address a myriad of issues – e.g., the reallocation of personnel, equipment, resources, and supplies during large-scale incidents. Planning and discussing these and other issues at the coalition level can and should lead to the complete visibility of a jurisdiction’s overall healthcare resources and capabilities.
As coalitions are established throughout the country, they will undoubtedly possess certain attributes that reflect the local landscape. However, although recognizing that a one-size-fits-all approach may not be entirely appropriate, there are a number of common features and functions that should define a true healthcare coalition – specifically including the following:
- It should be an active daily partner in the healthcare system, not a working group that meets solely to allocate HPP or PHEP dollars, whether for individual facilities or to build core caches of equipment or supplies;
- Although ASPR guidance dictates that it should be response-oriented, it is not active only during disasters, but instead provides daily support and value to the community it represents; and
- Its success and long-term sustainability depends in large part upon its ability to be fiscally self-sustaining.
A Shift in Both Thinking and Planning As all U.S. political jurisdictions are well aware, ASPR and CDC funding for preparedness has decreased significantly over the past 10 years. Moreover, in the current fiscal and political climate, it is very likely that funding for healthcare preparedness will continue to decline. It is also likely that federal funding streams will continue to be consolidated – as demonstrated by the planned consolidation of the Department of Homeland Security’s preparedness grants in fiscal year 2013.
It seems almost certain, therefore, that healthcare coalition leaders cannot rely on government funding to pay for any significant share of their future operations. Instead, they must develop fiscal strategies that are well defined and reflect the local landscape – including extensive plans and outreach capabilities to ensure that senior executives of member organizations understand the value-added services that the coalition provides.
Viewed in that context, the alignment of ASPR and CDC capabilities represents a major shift in preparedness thinking and planning. Although facility-level preparedness continues to be important, history has shown that community-level planning and engagement are even more important for response and resiliency operations. Coalitions are thus in a unique position to greatly increase and improve coordination, collaboration, and communication between and among public health, public safety, emergency management, and overall healthcare system operations. Acting as on-the-scene facilitators, these coalitions should also help to ensure that communities are both better prepared and more resilient in the future. Achievement of that goal also will lead to better coordination and planning in both day-to-day activities and during future disaster planning and preparedness operations.
For additional information on: HHS’s 2009 National Health Security Strategy, visit http://www.phe.gov/Preparedness/planning/authority/nhss/Pages/default.aspx
ASPR’s May 2009 handbook “Medical Surge Capacity and Capability: The Healthcare Coalition in Emergency Response and Recovery,” visit http://www.phe.gov/Preparedness/planning/mscc/healthcarecoalition/Pages/default.aspx
ASPR’s May 2011 report “From Hospitals to Healthcare Coalitions,” visit http://www.phe.gov/Preparedness/planning/hpp/Documents/hpp-healthcare-coalitions.pdf
ASPR’s January 2012 “Healthcare Preparedness Capabilities: National Guidance for Healthcare System Preparedness,” visit http://www.phe.gov/Preparedness/planning/hpp/reports/Documents/capabilities.pdf
________________________ Andrew Roszak, JD, MPA, EMT-P, serves as Senior Preparedness Advisor at MESH (formerly Managed Emergency Surge for Healthcare), which is a non-profit, public-private coalition enabling healthcare providers to respond effectively to emergency events, and remain viable through recovery. Previously, he served as a Senior Advisor in the Office of the Administrator in the HHS’s Health Resources and Services Administration (HRSA), and as the Senior Public Health Policy Advisor for the Department’s Emergency Care Coordination Center (an ASPR agency). During the 110th and 111th Congresses, Roszak served as a Winston Health Policy Fellow, working on healthcare reform, in the U.S. Senate. Prior to shifting into federal service, he worked for eight years as a firefighter/paramedic in the Chicago area, and for two years in the Illinois Department of Public Health.