Federal Agencies Partner with Healthcare Organizations to “eEnable” Healthcare
(But You Have to Know Where to Look for Funding Support)

By Neal Neuberger

By now most Community Health Center staff and advocates are familiar with various health information technology funding mechanisms resulting from the 2009 American Recovery and Reinvest Act (ARRA) stimulus law. The “HITECH” meaningful use incentive payments for both Medicare and Medicaid are well underway, and healthcare organizations including community health centers have been gearing up in large numbers to attain meaningful use. As of May 2013, more than 297,000 health care providers have received payment for participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Thus far, more than half of all eligible providers have been paid.

Beyond an estimated $30 billion in “incentive” payments over time, the Recovery Act also provided nearly $3 billion to support the expansion, improvement, and renovation of community health centers and other programs that serve patients in communities across the country to better serve the nation’s most vulnerable families. Much of this funding went to upgrade information technologies and systems.

Beyond the headlines though, are the finer details of the sources, objectives and availability of program support. For example, the ARRA or “stimulus bill” had also included a number of other helpful contract and grant programs to help boost HIT efforts at FQHCs, HCCNs and other health care organizations. These efforts (see also http://www.healthit.gov/policy-researchers-implementers/hitech-programs-advisory-committees) included

  • A Beacon Community Program designed to build and strengthen health information technology infrastructure and exchange capabilities.
  • The State Health Information Exchange Cooperative Agreement Program to support states or designated entities in establishing exchange capabilities among providers.
  • Health Information Exchange Challenge grants to encourage breakthrough innovations that can be leveraged nationwide.
  • A Strategic Health IT Advanced Research Projects (SHARP) program that focuses on solving difficult challenges like: information security; patient-centered cognitive support; health application and network platform architectures; and, secondary uses of EHR data.
  • A Workforce Development Program designed to train a new workforce of HIT professionals including support for: Community College Consortia; Curricula Development; University-Based Training; and, Competency Examinations.

While many of these opportunities are already well underway, it is instructive for the FQHC community to follow emerging results – given the replicable “lessons to be learned” and ongoing partnering opportunities that may exist.

The 2009 ARRA stimulus bill also funded supportive efforts, which may not be as familiar, at a number of federal agencies beyond the Office of the National Coordinator for HIT:

  • The Broadband Technology Opportunities Program within the US Department of Commerce that has already provided nearly $4 billion in ARRA grants to bridge the technological divide; create jobs; and improve education, health care, and public safety in communities across the country. http://www.ntia.doc.gov/category/broadband-technology-opportunities-program
  • A Broadband Initiatives Program at the Rural Utilities Service, USDA including just over $4 billion for loans, grants, and loan/grant combinations to address challenges of rapidly expanding the access and quality of broadband services across rural America and to meet the objectives of the Recovery Act. 
  • Several Comparative Effectiveness Research efforts (more than $1 billion) through the Agency for Healthcare Research and Quality, DHHS. 

While you may be familiar with some of these ARRA efforts, you may not realize that scores of federal agencies across the government have invested millions for decades to help healthcare organizations promote information technologies for healthcare.

For example, a long tradition of Telemedicine support stems back to the late 1970s when NASA first worked among the Papago Indians in rural Arizona to bring needed health services remotely to the reservation. The Departments of Defense and Veterans Affairs have been instrumental on the research and implementation side – developing and using Telehealth, disease monitoring, and EMR-related technologies for millions of active duty military, veterans and their families.

For years, many mostly rural (and occasionally urban underserved) Telehealth efforts have been facilitated across a handful of seemingly unrelated departments and agencies. These organizations continue to provide support and guidance:

  • The Office of Rural Health Policy, HRSA which administers competitive Telehealth Network grants, Telehealth Resource Center grants and Licensure Portability grants. http://www.hrsa.gov/ruralhealth/about/telehealth/telehealth.html
  • Health Resource and Services Administration which also administers multiple funding opportunities for Health Center Controlled Networks (HCCN) to advance the adoption and implementation of Health Information Technology (HIT). HRSA anticipates that up to $2 million may be available to support three to five additional grant awards in FY 2013. http://www.hrsa.gov/grants/apply/assistance/hccn/
  • The Rural Utilities Services, USDA which has run the Distance Learning and Telemedicine Loan and Grant Program for more than 20 years. Just recently, the RUS announced $17.5 million in available support for this fiscal year. The Notice of Funding Availability (NOFA) for the USDA’s Distance Learning and Telemedicine (DLT) Grant Program was published in the Federal Register on June 28, 2013. Applications for this program must be received by Monday, August 12, 2013. http://www.rurdev.usda.gov/utp_dlt.html
  • The Federal Communications Commission has long standing telecommunications and internet access programs, including a new Healthcare Connect Fund which supports broadband connectivity which provides up to 65% discounts on eligible expenses. Starting this year the FCC’s Healthcare Connect Fund will fund the development of broadband networks to support telehealth, linking urban medical centers to rural clinics. Non-rural HCPs may participate in Healthcare Connect Fund as part of consortia, but consortia must remain majority rural in their makeup. http://www.usac.org/default.aspx
  • The National Technology Information Administration, US Department of Commerce which for years ran a “Technology Opportunities Program” for underserved healthcare, education and library communities.

Of course, at the present time reimbursement for telehealth and telemedicine remains limited primarily to non-urban centers, and proscribed by local restrictions. Continued advocacy to expand telemedicine reimbursement remain essential, so that the opportunities can be maximized.

Finally, health centers that have targeted or specialized information technology development needs can often find support among some of the more obscure federal programs including:

  • Centers for Disease Control and Prevention (CDC) where funding programs focus on bioterrorism, disease surveillance, emerging infections, and global surveillance. http://www.cdc.gov/od/pgo/funding/grants/grantmain.shtm
  • Substance Abuse and Mental Health Administration (SAMHSA) where occasional solicited and unsolicited funding may be sought to support the mental health research, prevention and treatment goals of the agency. http://www.samhsa.gov/
  • National Library of Medicine (NLM) where small grants to support advanced information management systems, digital libraries, biotechnology information, and other NIH focused research may be found. http://www.nlm.nih.gov/grants.html
  • Indian Health Service (IHS) “Urban Indian Health Program” that supports contracts and grants to 34 urban health programs funded under Title V of the Indian Health Care Improvement Act to promote access to hospitals, health clinics, or contract health services administered by IHS and tribal health programs. http://www.ihs.gov/urban/index.cfm?module=dsp_urban_programs 

More recently, the Affordable Care Act (health reform) established a $10 billion CMS Innovation Center (CMMI) to test various payment and service delivery models that aim to achieve better care for patients, better health for our communities, and lower costs. Major healthcare IT collaborative partnering opportunities are available to help drive health system change For example, CMMI is in the process of evaluating existing projects (and new proposals) relating to Accountable Care Organizations including: Medical Shared Savings; Advanced Payment Models; Pioneer ACOs; and, a series of Accelerated Development Learning Sessions. (http://innovation.cms.gov/)

Over the years government grant and contract programs have come and gone. Their sustainability is usually dependent on the continual budget debates between the White House and Congress. (For example the Department of Commerce “Technology Opportunities Program” mentioned above simply hasn’t been funded for several years.)

Support for HIT initiatives is out there – from some well-know, and other less obvious agencies and programs. To maximize the available resources, Federally Qualified Health Centers, Primary Care Associations and Health Center Controlled Networks need to pay careful attention to the changing dynamics at scores of agencies and departments — and to think creatively about how they can further leverage the many collaborative funding partnerships available to them.