By: Adam Luecking
January 24th, 2023
Social Sector Hero Spotlights tell stories of exemplary organizations and agencies making measurable differences in their communities. The following Health Resources and Services Administration spotlight is an excerpt from “Social Sector Hero – How Government and Philanthropy Can Fund for Impact” by Adam Luecking. You can download the book for free here and read all 16 Social Sector Hero Spotlights.
In this Social Sector Hero Spotlight, learn more about how HRSA’s Bureau of Primary Health Care is achieving Healthy People 2030 goals by engaging in effective dialogue and utilizing Results-Based Accountability principles.
Table of Contents
1. BPHC Centers: Serving One in 11 People in the USA
2. Promoting Transparency and Racial Equity With Universal Measures
3. Introducing Results-Based Accountability and Engaging Leadership
4. Creating the Program Analysis and Recommendations (PAR) Guiding Principles to Engage Grantees
5. Consistent and Effective Dialogue Leads to Measurable Improvements
6. Jim Macrae’s Leadership and Communication Tips
1. BPHC Centers: Serving One in 11 People in the USA
The Bureau of Primary Health Care (BPHC) is one bureau within the Health Resources and Services Administration (HRSA). HRSA is an agency of the U.S. Department of Health and Human Services. BPHC funds health centers in underserved communities so they can provide access to high-quality, affordable, patient-centered, comprehensive primary health care for nearly 29 million people who are low-income, uninsured, or face other obstacles to receiving health care. A little over 90 percent of the health center clients are at or below 200 percent of poverty, and roughly two-thirds are racial and ethnic minorities. Health centers also serve 1.4 million homeless people and 400,000 veterans. All told, health centers serve one in 11 people in the US.
2. Promoting Transparency and Racial Equity With Universal Measures
Social Sector Hero Jim Macrae has been at HRSA since 1992 and has led BPHC for more than 15 years. As head of BPHC, Jim manages a $5.7 billion budget that supports nearly 1,400 health centers operating approximately 14,000 health service delivery sites in every US state, the District of Columbia, Puerto Rico, the US Virgin Islands, and the Pacific Basin. Early on, as Associate Administrator, Jim (and other BPHC staff) decided to create some universal measures to better track the performance of HRSA-supported health centers. They initially chose six clinical measures and three financial measures. The really powerful decision was in making these measures transparent to the health centers themselves and to the public. This transparency created healthy competition among the health centers and pushed the entire health center community to improve. They also had the wisdom to disaggregate the data by race and ethnicity on health outcome measures from the beginning to ensure a focus on health equity.
Read more Heroes’ Spotlights and become a Social Sector Hero.
Download our free book: Social Sector Hero – How Government and Philanthropy Can Fund for Impact.
3. Introducing Results-Based Accountability and Engaging Leadership
BPHC introduced Results-Based Accountability into the mix when they realized they needed a better way to engage grantees and create cultures that foster performance improvement. They wanted to transition from being a compliance-oriented grant-maker to a performance-oriented funder in service of improved health in underserved communities. They also wanted to enhance the skills of their roughly 160 program officers to more meaningfully engage with grantees around performance.
In 2008, Jim and BPHC contracted with Clear Impact to train all of the program officers on how to have effective conversations with grantees. The conversation guidelines were based on Turn the Curve planning; customized training and individualized coaching were provided to each of the Bureau’s various branches. The training was also provided to BPHC contractors to reinforce the language and process of Results-Based Accountability.
In this process, it was important to engage the entire BPHC leadership team to embrace this new way of working and get their buy-in before rolling it out to staff. Some of the leaders included in this process were HRSA Associate Administrator Cheryl Dammons, BPHC Director of Strategic Partnerships Tracey Orloff, BPHC Office of Health Center Program Monitoring Director Angela Powell, BPHC Office of Quality Improvement Suma Nair (instrumental in setting up BPHC’s unified data system for reporting — Clear Impact Scorecard), and National Association of Community Health Centers Senior Vice President Gina Capra.
4. Creating the Program Analysis and Recommendations (PAR) Guiding Principles to Engage Grantees
BPHC integrated Results-Based Accountability concepts into a site visit guide named, “Program Analysis and Recommendations (PAR) Guiding Principles.” The PAR Guiding Principles served as a comprehensive programmatic review tool for BPHC staff and health center grantees. It had three overall purposes:
- To provide a rationale and record for grant decisions
- To provide a history of the applicant’s compliance and overall performance
- To develop an Action Plan for working with health center grantees on compliance issues and/or performance improvement areas for the upcoming year.
The PAR Guiding Principles help BPHC Project Officers ask effective questions about grantee performance. The questions help Program Officers analyze the grantee’s unique situation and review the key factors impacting their performance. BPHC uses this information to help health centers develop action plans to improve health outcomes and financial performance. One of the best things about the PAR Guiding Principles is that the questions are open-ended and take the grantee’s context into account. With better contextual data, Project Officers can help grantees explore opportunities for improvement. Project Officers ask a series of questions to help both parties understand current performance and what it would take to improve (including strategies and technical assistance). You can access the full guide at SocialSectorHero.com/Resources (see Chapter 8 resources).
5. Consistent and Effective Dialogue Leads to Measurable Improvements
The Healthy People 2030 goals provide a benchmark for national health goals. As a result of the effective dialogue between Project Officers and grantees, HRSA reports that 79 percent of BPHC health centers met or exceeded one of the Healthy People 2030 goals. 50 percent have met or exceeded five or more 2030 Healthy People goals. This success led to a campaign to have health centers recognized as patient-centered medical homes. The number of accredited health centers has increased from one percent to more than 77 percent.
Most notably, from 2009 to 2020, blood pressure control of hypertensive patients improved from 58 percent to 63.1 percent and early prenatal care of patients in the first trimester increased from 67.3 percent to 73.5 percent. The increase in performance is massive when considering the sheer size of the patient pool.
Project Officers’ analytical skills also significantly improved. Effective questions allowed BPHC to more easily gain insight into the root causes of performance data trends and tie strategies and actions back to these root causes. Program evaluation now happens annually in the application process and every three years during site visits. This has led to an overall 24 percent increase in grantee customer satisfaction between 2007-2019.
6. Jim Macrae’s Leadership and Communication Tips
If you want to get better at communicating with and analyzing grantee performance to make effective decisions, BPHC Associate Administrator Jim Macrae offers the following tips for any funder:
- Embrace having data and making it transparent
- Be OK with the good, the bad, and the ugly when looking at data
- Focus first on performance instead of compliance
- Support professional development for staff
- A focus on performance doesn’t mean focusing on negative attributes. Focus on positive building blocks
- The key is asking the right questions and being inquisitive
Focusing on the right questions is also more important than having all the answers as a leader in your organization.
7. Helpful Links
- Learn more about how to support effective dialogue with your partners.
- Access HRSA, BPHC’s Program Analysis and Recommendations (PAR) Guiding Principles.
- Download the Results-Based Accountability Guide.
- Learn more about Results-Based Accountability Training at Clear Impact.
- Set up your unified data management system with Clear Impact Scorecard.
- Get a custom, private demo of Clear Impact Scorecard.
Leave A Comment