REGIONALMEDICALPROGRAMS

HEALTH SERVICESAnevaluativestudy suppotted byDepartment of Health, Educationand Welfare funds and conductedby the Public AccountabilityReporting Group.

PUBLIC ACCOUNTABILITY REPORTING GROUP305 FEDERAL WAY @ P.O. BOX 5796 g BOISE, IDAHO 83705

THE PUBLIC ACCOUNTABILITY REPORTING GROUP (PAR) ISA COOPERATIVEARRANGEMENT AMONG THE NATION’S RMPs. IT WAS FORMED TO DEVELOP NATIONALDESCRIPTIVE AND EVALUATIVE INFORMATION ABOUT RMP PROGRAMS. PAR OPERATESIN COOPERATION WITH THE DIVISION OF REGIONAL MEDICAL PROGRAMS AND UNDERTHE AUSPICES OF THE COORDINATOR’S EXECUTIVE COMMITTEE.

THIS PUBLICATION WAS SUPPORTED BY FUNDS AWARDED FROM THE DEPARTMENT OFHEALTH, EDUCATION AND WELFARE, ITS CONTENTS ARE SOLELY THE RESPONSIBILITYOF THE PUBLIC ACCOUNTABILITY REPORTING GROUP. THE FINDINGS ANDCONCLUSIONS DO NOT NECESSARILY REPRESENT THE VIEW OF THE U.S. DEPARTMENTOF HEALTH, EDUCATION AND WELFARE.

12m — MAY 1974 —J.R.

ABSTRACT

REGIONAL MEDICAL PROGRAMS:

BENEFITING PEOPLE AND IMPLEMENTING LOCAL HEALTH SERVICES

More than 9 million people received direct health care services inRegionai Medical Program (RMP) activities in 1973. An estimated 12million additional persons benefited as a direct result of the use of newskills acquired by local health professionals in RMP training programs.Despite a year marked by lack of clarity in health policy at the FederalAdministration level and illegal impoundments of Congressionalappropriations, the RMPs continued to record substantialaccomplishments in expanding and improving local services for people.

Other findings of a March, 1974 national survey of the Nation’s 53RMPs revealed that in 1973:

.,. over 150,000 health professionals received training in qualityassurance medical audit programs, ne w types of health manpower roles(e.g., nurse practitioners, physician assistants and emergency medicaltechnicians) and new skil/s (e.g., kidney tissue typing and neonatalintensive care).

. . . more than 3500 local health care facilities participated in RMPinitiated quality assurance medical audit programs designed to improvespecific acts of medical care. Programs frequently result also inmoderating costs of care.

Since July, 1971:. the RMPs have initiated almost 2000 major, innovative

demonstration projects. Projects were jointly funded by RMPs ($1 10million) and other organizations ($53 million).

. . . over 80 percent of the almost 1000 RMP projects not designed as“one-time” activities were continued by local financing mechanisms at anannual estimated level of $58 million after RMP funding support wascompleted.

. RMPs provided major technical assistance in over 6000 instancesin creating new health services organizations and in securing over $350million of non-RMP funds: (1) for other health organizations for neededimprovements in local health services, and (2) for rapid, locally suitableimplementation of new Federal initiatives.

RMPs’ community-based process is shown to be an effectivelyfunctioning model of a Federally supported, largely locally controlledimplementing agency which has major impact in strengthening localhealth care services systems in preparation for meeting increaseddemands and needs.

TABLE OF CONTENTS

SUMMARY i

1. BENEFITING PEOPLE 1

RECENT RMPHISTORY 1

Chronology 1

Comment 2

PEOPLE SERVED BY RMPDEMONSTRATION PROJECTS 2

PEOPLE SERVED BY RMPTRAINED HEALTH PROFESSIONALS 3PEOPLE BENEFITEDBY RMPiNITIATED improvements lNLOCALHEALTH CARE SYSTEMS 6

Expanded Capability of Health Manpower 6New Skills of Professionals Improve Health Services 6

New Types of Health Professionals Increase Access to Needed Services 7

Persons Trained in Techniques of Quality of Care Assurance i’

Improvement in Local Health Care Services by Quality Assurance Programs 7

Increased Access to Care: Initiation of Needed Health Services !?

ALLOCATIONS OF RMP RESOURCES IN PEOPLE SEFWICES PROGRAMS 10

More Effective Use of Manpower 10

Improved Accessibility and Availability of Primary Medical Care 10

Regionalization of Secondary and Tertiary (Specialized) Care 10

Quality of Care Assurance 10COMMENT 10

11, IMPLEMENTING LOCAL HEALTH SERVICES 11A COMMUNITY-BASED PROCESS 1 I

Local Structure: Regional Advisory Groups, Volunteer Committees and Professional Staffs

RMP Process Components: Relative investments 1a

DEMONSTRATION PROJECTS: JOINT FUNDING AND CONTINUATION 15

Joint Funding 15

Continuation 17

NEW HEALTH ORGANIZATIONS AND FORMAL COOPERATIVE ARRANGEMENTS 19

Establishment of New Health Services 1g

New Health Organizations Created I g

Formalization of Sharing of Existing Resources 1g

Establishment of New Training Programs 20

DEVELOPMENT OF RESOURCES FOR LOCAL SERVICES IMPROVEMENTS 23COMMENT 25

11

SUMMARY

REGIONAL MEDICAL PROGRAMS:

f3ENEFlllNG PEOPLE AND IMPLEMENTINGLOCAL HEALTH SERVICES

INTRODUCTION SECTION 1:BENEFITING PEOPLE

A March, 1974 survey of the Nation’s Despite these difficult circumstances,53 RMPs revealed that, despite a year the RMPs recorded substantialof Federal Administration confusion accomplishments in 1973 directlyand itlegal impoundments, the RMPs benefiting people. Major findingshave continued to make substantial presented in Section I include:accomplishments as local More than 6.5 million peopleimplementing agencies which provide “ “ “ received direct health servicesmajor assistance in developing needed from RMP demonstration rxoiects.health services for people.

1.More than 2.5million other patients

This report of the survey is organized in “ ‘ “ received services from new hmestwo sections. Section /, “BenefitingPeep/e, ” presents evidence of RMPaccomplishments in providing healthservices for people. Section //,“implementing Local HealthServices, ” describes the RMPcommunity-based process, types oflocal expenditures, and specificaccomplishments related tostrengthening local health servicessystems in preparation for meetingincreased demands and needs forhealth services.

The report clearly demonstrates thewasteful loss of needed services topeople as a result of Federaladministration mandates to dismantleRMPs as well as illegal Administrationimpoundments of Congressionalappropriations.

,,of heakh manpo wer (e.g., nursepractitioners and emergencymedical services technicians andothers) trained in RMP-initiatedprojects.

. . . More than 12 million people wereserved by health professionalsusing newskiKs acquired in RMPprograms.

. . . More than 27,000 providers weretrained in qua/ity assurancemedical audit programs.

More than 3,500 local health carefacilities participated in initialexploration or actualimplementation of qua/ityassurance medical auditprograms.

FIGURE A

Decline andRecovery inService toPeople.

. . . More than 127,000 healthprofessionals received training innew ski//s (e.g., kidney tissuetyping, neonatal intensive care) oras new types of health manpower(e.g., physician assistants, nursepractitioners, emergency medicaltechnicians).

SECTION 11:IMPLEMENTINGLOCAL HEALTH SERVICES

As Federally supported, largelylocally controlled implementingagencies, RMPs have developed aneffective blend of involved, expert andexperienced volunteer boards ofdirectors (Regional Advisory Groups),committee structures and professionalstaffs. RMPs assist a wide variety oflocal health interests to make locallysuitable improvements in health careservices for people.

Regional Advisory Groups invest RMPresources through a community-basedprocess which includes two majorcomponents: (1) /nitiation ofdemonstration projects (80!Z0of RMPawards), and (2) Non-project relatedcommunity development activities(12% of RMP awards), such astechnical assistance andconvening/facilitating.

FIGURE B

FederalFundingLevels.

RMPs’ administrative costs remesent . . . Maior, sDecific technics/a modest (7-8Yo) investment o~direct ass’kkm’ce to a wide array of localcosts of the program.

RMP accomplishments which aredirectly associated with thecommunity-based process described,since July 1, 1971, include thefollowing:

. . . Joint Funding by otherorganizations in more than 1,000 -demonstration projects provided atotal amount of over $50 million in athree-year period for projectswhich were supfxwted by RMPfunds in a total amountof$110million.

. . . Continuation of over 80% of .RMP-initiated demonstrationprojects through regular financingmechanisms in local health careservices systems; the estimatedfirst year operational cost aftercompletion of RMPfunding supporlwas over $58 million.

health interests which resulted inover 6,000 occasions where newhealth services and supportiveorganizations or formalcooperative arrangements forsharing resources were created.

. Major assistance by RMP programstaffs in developing over 1,000applications for non-RMP fundsfor other local health organizationsto support the development ofneeded health care systemsimprovements and locally suitableversions of Federal initiatives.

Major assistance in securing over“ $350 rni//ion in a three-year period

of non-RMP financial resources forother local health organizations tosupport needed community healthsystems improvements.

NEEDEDHEALTHSERVICES

COMMENT

Despite Federal Administrationvagaries of financing and programdirection, evidence reported indicatesthat the Nation’s RMPs have continuedto implement locally-needed, improvedhealth services for people.

In addition to improving services topeople, the RMPs have developed acommunity-based process which is aneffectively functioning model of afederally supported, largely locallycontrolled implementing agency, whichhas major impact on local health careservices systems.

The RMPs remain a major Nationalresource capable of prudently andeffectively assisting local communitiesto implement expanded healthservices for people.

ii

SECTIOIV /

REGIONAL MEDICAL PROGRAMS:BENEFITING PEOPLE

The Nation’s RMPs have built atangible, impressive record in assistingthe orderly development andimplementation of needed healthservices in hundreds of communitiesand areas across the Nation.

This section of the RMPevaluative study providesdocumentation of diminished, butcontinuing accomplishments despitemore than a year of Federaladministrative health policyuncertainty, phase-out directives, andunlawful impoundments ofCongressional appropriations.

The major focus of Section I is onRMP efforts leading to increased andimproved health services for people. Italso provides updated informationcorrelated with a previous evacuativereport.’

Secfion I is organized as follows:. . . A Chronology of and Comment

on Recent RMP History.People Served by RMP

Demonstration Projects.. People Served by RMP Trained

Health Professionals.People Benefited by RMP

Ini;iated Improvements in Local HealthCare Systems.

. . . Allocations of RMP Resources inPeople Services Programs.

. . . Comment.

RECENT RMP HISTORYSince January 1973, the Nation’s

RMPs have experienced a series ofcurious events which have had markedimpact on services to people.Chronology

On January 29, 1973, thePresident’s fiscal year 1974 budgetmessage to Congress recommendedzero funding for RMPs. The budgetnarrative contained a justificationwhich, to many observers, wassuperficial, inaccurate andcontradictory to previous publicstatements of Administrationspokesmen. The “justification” alsoignored the fact that many of its owncharges (e.g., “no consistent theme inRMP programs”) resulted frominconsistent and frequently changingFederal directives. Despite strongindications that the Administration’sbudget proposal was clearly contrary toCongressional intent, on February 7,1973, the Administration directed theRMPs to close down operations byJune 30, 1973,

Congressional action to continue thelegislative authorization for I?MPsfollowed in rapid sequence:

a. On March 25, 1973, the Senatepassed, by a 72-19 vote, a one-yearextension bill.

b. On May 31, the House ofRepresentatives passed, by a 372-1vote, a one-year extension.

c. On June 5, the Senate passed, bya unanimous 94-O vote, the Houseamendments to the Senate bill.

d. On June 18, the President signedinto law (PL 93-45) the bill whichextended authorization for the RMPthrough June 30,1974.

“Phase-out” orders to close downoperations were rescinded. However,many RMPs had suffered significantdisruptions of painstakingly developedcommunity relationships, as well aslosses of experienced key programand project staff.

A nominal restoration of new RMPoperations began on July 1, 1973. Therestoration was marred both bycontinuing Administrationimpoundments of RMP funds and byunclear Administration direction. In oneinstance, $6.9 million of RMP fundswere “released” with the stipulationthat the Congressionally appropriatedfunds could not be spent until a “newmission” was established for the RMPsfor the extension year.

Not until September 7,1973,however, did the Administration finallyissue a new program mission(“priorities and options”) for the yearbeginning July 1, 1973. The “prioritiesand options” sharply restricted themission of the RMPs, seemed atvariance with the legislative mandate,and required that all activities becompleted by June 30, 1974.Administration intent appeared to be torelease RMP funds: (a) at a levelconsiderably less than the full amountof the Congressional appropriation,and (b) under time schedules whichcould serve only to hinder the RMPs’capability to work effectively at the locallevel.

‘Mitchell, J., et al., “The 56 RMPs: A Special ProgressReport,” Drug Research Repotis, Vol. 16, No. 8, February21, 1973.

On September 21, 1973, theNational Association of RegionalMedical Programs initiated civil actionproceedings seeking three actionsfrom the Administration: (1) release of$115million of impounded RMPfunds,(2) relief from the restrictive missionstatement of September 7, 1973 and(3) relaxation of a June 30,1974termination date which had been set asa deadline by which RMPs musteffectively complete projects.

On February 7, 1974 a Federaldistrict court ordered release of$130million of impounded funds to theRMPs, removal of the mandatorytermination date of June 30, 1974, andlifting of the restrictive program“priorities and options.”

CommentThe following summary of RMPs’

accomplishments in developing healthservices for people unsurprisinglyreflects a consistent pattern oflessened program impact in the past 18months. The most marked effect of the“phase-out” orders is seen in the

period July to December 1973. RMPscontinued to achieve substantialresults during this time; however, onlyin a few instances are the results atlevels as high as those achieved in1972 or those approved in 1973operating schedules.

Based on recorded and forecastedresults from operational activities in thecurrent six months (January to June1974), there is an upward trend towardhigher levels of services to people.Carry-overof the funds released late in1973, plus release of the additionalawards has provided a sufficientfinancial base so that projections arerealistically based on scheduledactivities of operations currently ineffect.

Although buffeted in the past year,the RMPs apparently have madesubstantial, quick recoveries. As localimplementing agencies, they havemaintained organizational capability aswell as noteworthy records ofaccomplishment in the development ofhealth services for people.

PEOPLE SERVED BY RMP

DEMONSTRATION PROJECTS

The RMPs continue to have a majorimpact in serving personal health careneeds of consumers. While RMPs donot ordinarily provide direct healthservices, there are numerousinstances where direct —often highlytechnical services are supported aspart of a demonstration project.Examples include: (a)person screenedin hypertension screening projects, (b)patients treated by project staff of ademonstration unit for specializedcancer care, or(c) patients seen by anurse practitioner or a neighborhoodclinic staff supported by an RMP. TableI summarizes such direct servicesrecorded in RMP demonstrationprojects.

TABLE 1’

PEOPLE RECEIVING DIRECT HEALTH SERVICES IN RMPDEMONSTRATION PROJECTS: SUMMARY

TYPE OF PROJECT

Primary Care

Emergency MedicalServices

Regionalization ofsecondary andtertiary care

CALENDAR1970

(56 RMPs)

2,622,000

466,000

I 2,715,000

*a<

b.

L-222_The comparison cited for 1970 and 1972 was reported by the 56RMPsthen in operation. There currently exist 53 RMPs, 49 of whichresponded to this survey. While direct comparisons should be madewith caution, major trends are considered valid.

All numbers are rounded to the nearest thousand.

2

Table II presents further detail aboutpeople directly served in the course ofRMP demonstration activities. Thenumbers of people who received directhealth services from RMP projects of acategorical type generally decreasedbetween 1972 and 1973. In part, thisdecrease was due to Federaldirectives. A general decrease inpeople served is due in large measureto the decreased level of financialresources available.

Sharp upward trends in numbers ofpeople served in hypertension projectsreflect fulfillment of previousprojections.

PEOPLE SERVED BY RMPTRAINED HEALTHPROFESSIONALS

The RMP record is well known inaccomplishment of the early mission of“bringing advances in medicalknowledge to the bedside of thepatient.” Many physicians and nurseshave been taught new skills for use incoronary care units; many strokerehabilitation teams have been trained;and large numbers of neighborhoodhealth aides have been trained andplaced. As a result of RMP healthmanpower training activities,substantial numbers of people nowhave ready access to improved healthservices not previously available.

TABLE II

PEOPLE RECEIVING DIRECT HEALTH SERVICES IN RMPDEMONSTRATION PROJECTS: DETAIL OFREGIONALIZATION OF SECONDARY AND TERTIARY CAREPROJECTS

TYPE OF PROJECT

Heart DiseaseCancerStrokeKidneyHypertensionPulmonary DiseaseAll Other

TOTALS

CALENDAR1970

(56 RMPs)

1,126,000413,000140,000

13,000135,000300,000588,000

2,715,000

Health manpower training activities nurse practitioners, nurse midwives,of RMPs generally have res-ulted in (a)new types of health professionalstrained to meet the changing demandsfor health care services, or in (b) theacquisition of new skills by existinghealth manpower.

New types of health manpower is anRMP program category which includesall persons trained in newly definedcategories of health manpower whereno widespread, nationally recognizedtraining programs, certification orIicensure exist. Examples include

TABLE Ill

PEOPLE SERVED BY RMPs TRAINED HEALTH PROFESSIONALS:SUMMARY

TYPE OF SERVICE

Served by new types ofhealth,professionalmanpower

Served by new skillsacquired by existinghealth professionals

969,000 I

-+

19,383,000

20,352,000

community health assistants, andemergency medical technicians.

RMPs have also supported thedevelopment of new ski/Ls in existinghealth manpower. Newski/ls is anRMP program category which includesorganized efforts aimed at theacquisition of essentially new skills bypersons already educated, licensed orcertified. Examples are: (a) aregistered nurse who becomes acoronary care unit nurse, and (b) aphysician who develops advancedskills as a neonatal intensive carespecialist.

Table Ill summarizes the numbers ofpeople served in the remainder of theyear in which training occurred.

Numbers include only persons givendirect health services during the timeperiod indicated. For example, a“nurse practitioner” trained in late 1972may have served a total of 300 patientsin the remainder of 1972. In actuality,however, the nurse practitioner mayhave continued to serve increasingnumbers of persons in each year sincethe completion of training. However,the cumulative total number of personsserved is unreported.

TOTALS

Taking into consideration thedifferences in numbers of RMPsreporting in each of the time periods,the following observations areconsidered valid:

People served by people trainedby RMPs/ncreased from about 20million to over 30 million in the periodfrom 1970 to 1972, an increase ofroughly 50%.

People served by people trained byRMPs decreased from over 30 millionin 1972 to less than 15 million in 1973:a decrease of over 50Y0,

Figure 1 is a graphic portrayal of thesharp decline and beginning recoveryof persons served by health providersusing newly acquired skills.

FIGURE 1PEOPLE SERVED BY VARIOUS HEALTH MANPOWER TRAINED INNEW SKILLS BY RMPs

3.5

3.0

1.0

.5

Medical Technicians.Laboratory Tech- ‘

nicians and others

‘Urses———————

Doctors

‘1

July 1-72to Dec. 31-72

Figure 2 is a graphic pattern of therecent RMP program emphasis inassisting the training and placement ofpersons innewtypes of primary healthcare roles. RMPs trained nursepractitioners (563) and physicianassistants (163)who provided directhealth services to more than 650,000patients in 1973. An additional2,000,000 patients received directhealth services in 1973 from othertypes of new health manpower trained;for example, emergency medicaltechnicians, kidney tissue typingtechnicians, nurse midwives, andcommuniiy health assistants.

FIGURE 2PEOPLE SERVED BY NEW TYPES OF HEALTH MANPOWER

1.5

1.4

1.3

1.2

.5

.4

.3

.2

.1

EmergencyMedical Tech-

nicians, CommunityHealth Aides & Others

NursePractitioners

physician &Assistants

L.egend:For example,1.2 million people

served.

r

l— —

July 1-72to Dec. 31-72

Jan. 1-73 July l-73to June 30-73 to Dec. 31-73

Jan. 1-74to June 30-74

PEOPLE BENEFITED BY RMPINITIATED IMPROVEMENTS INLOCAL HEALTH CARE SYSTEMS

Many people have gained easieraccess to higher quality health careservices as a result of FiMPactivities inlocal communities, RMP activitiesresulting in improvements in localhealth care services are reported in thefollowing categories:

1, Expanded capability of theNation’s health manpower;

2. Improvement in local health careservice through introducing qua/ity of

3. Creation of new health services,particularly in underserved areas.

Expanded Capability of HealthManpower,

As reported earlier, RMPs’ trainingefforts have added sizable numbers ofriew types of health professionalsneeded to provide local services.Training efforts also have resulted innew ski//s for large numbers ofpracticing health professionals. Asummary of the numbers of healthprofessionals trained in new skills or innew professional roles is presented in

care, medical audit programs; Table IV,

TABLE IVNUMBERS OF HEALTH PROFESSIONALS TRAINED BY RMPs

New Skills of Professionals improveHealth Services.

Traditionally, RMPs have provided community and have been of benefit toexisting health manpower with ever increasing numbers of healthopportunities to acquire new skills services consumers.aimed at providing better quality care to A summary of the numbers of localpeople served, These activities have health providers trained in essentiallybeen well received by the health new skills is shown on Table V.

The slight increase in numbers ofdoctors trained result from relativeincreases in projects concerned withhypertension, kidney disease andother specialized services such asneonatal intensive care.

TABLE VNUMBERS OF EXISTING HEALTH PROVIDERS TRAINED IN NEW SKILLS BY RMPs

TYPES OF CALENDAR

HEALTH MANPOWER 1970(56 RMPs)

Doctors 13)561. ..,,

Nurses 38,159.. ”’.’Others Including .,Medical, Laboratory ,::and other Technicians

“t~J,, 34,641

TOTALS : !“86,361

CALENDAR19

16

42

48

New Typesof HealthProfessionals IncreaseAccess to Needed Services,

Increased access to primary care innovative, promising method ofservices has continued to claim RMPs increasing access to needed healthattention and efforts in recent years. care services. A summary of theThe development of new types of numbers of new types of healthhealth professionals specifically professionals trained primarily totrained to provide primary health care increase access to primary care isas “mid-level practitioners” working shown in Table W.closely with physicians has been an

TABLE VINUMBERS OF HEALTH PROFESSIONALS TRAINED IN NEW ROLES BY RMPs

TYPES OFHEALTH MANPOWER

Nurse Practitioners

Physician Assistants

Community HealthAssistants, EMTsand Others

TOTALS

CALENDAR1970

(56 RMPs)

7,526*

I

13,825”

“Information is not available by profession for 1970 and 1972.

Persons Trained inTechniques of Quality ofCare Assurance.

RMPs have trained numerous health The numbers of persons trained inprofessionals in techniques to assure quality assurance techniqueshigh levels of quality care available to increased almost six-fold betweenpatients in local health facilities and 1970 and 1972. RMP program effort inclinics. Table Vll summarizes the quality assurance techniques isnumbers of health professionals substantial, though it remains less thantrained in quality of care assurance fo~ecast for 1973.techniques.

Improvement in Local HealthCare Services by QualityAssurance Programs.

In this report, qua/ity of careassurance programs are defined assystematic efforts to set standards,determine deficiencies in individual orcollective acts of medical care, todevelop corrective action, and toimplement activities which result indemonstrably improved quality of care,

TABLE VliNUMBERS OF HEALTH PROFESSIONALS TRAINED IN QUALITY ASSURANCE PROGRAMS

Quality of care assurance activities Stage 1 —A local need isoffer a classic RMP example of an identified and RMP supportedeffective, local developmental process professional resource persons arewhich results in sustained change after assembled. Table Vll I summarizes theRMP support is withdrawn. numbers of professional resource

Program development typically persons leading RMP program

followed a three-stage process. developments in quality assurance ineach of four time periods.

TABLE VillNUMBERS OF PROFESSIONAL RESOURCE PERSONSINVOLVED IN QUALITY ASSURANCE PROGRAM DEVELOPMENT

A sharp recovery in the last periodreflects both Federal priority and localcapability to use released funds;however, the increase is not as greatas the level the RMPs expected toreach in 1973.

Stage 2 — Representatives oflocal health care facilities participate inRMP-sponsored

“convening/facilitating” activities tobegin exploratory development, and/orparticipate in formal projects aimed atdeveloping skills and implementingquality assurance mechanisms in theirfacilities (e.g., medical audit systems).Table IX summarizes numbers offacilities involved in each type ofparticipation.

TABLE IXHEALTH CARE FACILITIES INVOLVED IN RMPs’ QUALITYASSURANCE PROGRAM DEVELOPMENT

Stage 3 — As local health care programs (for example, educationalfacilities identify specific deficiencies in experiences and organizationalhealth care, corrective action is changes) following specificallyinitiated by health care providers identified deficiencies is presented ininvolved within the facility. A tabulation Table X.of over 5,000 formal corrective

Increased Access to Care:initiation of Needed Health Services.

As a consequence of RMPdemonstration projects and substantialtechnical assistance by program staffs,major impetus to the creation of newhealth service units needed in localcommunities has been provided. SinceJuly 1,1971, RMPshaveassisted localcommunities to implement more than

1,800 new health service units neededlocally to provide services to people,Included, for example, areneighborhood health clinics, ruralhealth stations for primary emergencycare, formal agreements forcooperative sharing of specializedservices, and ambulatory out-patientclinics in hospitals in underservedurban areas.

New health services organizations inwhose establishment RMPsparticipated, continue to provideneeded services without continuingRMP technical or financial assistance.Table Xl summarizes the types of newhealth services created in the course ofRMP projects and program staffefforts.

TABLE XlNEW HEALTH SERVICES CREATED(Since July 1, 1971)

ALLOCATIONS OF RMPRESOURCES IN PEOPLESERVICES PROGRAMS

The RMPs have allocated theiroperating funds into four majorprogram areas. Total direct costsawards to RMPs are categorized forthree calendar years in the followingprogram areas.

More Effective Use of Manpoweris an RMP program category whichincludes new skill development, newtypes of manpower development,efforts to implement arrangements forshared training and service resourcesin underserved areas, and efforts tobring about improved utilization andrelevance of health manpower trainingprograms.

FIGURE 3

Improved Accessibility andAvailability of Primary Medical Careincludes development of new orimproved health care services such asfamily health centers, free clinics,hospital-based ambulatory carecenters, primary and emergency carecenters, and improvements in minoritygroup access to services,

Regionalization of secondaryand tertiary (specialized) careincludes RMP efforts to facilitategeneral institutional sharing of scarceresources such as radiation facilities,shared services such as jointpurchasing, and development ofneeded services for specialized care ofheart disease, cancer, stroke and otherpatients.

Primarv Care iEmergency

k

MedicalServices

ALLOCATIONS OF RMP RESOURCES TO $W~;O~

PEOPLE SERVICE PROGRAMS --4

(Selected Calendar Years)

[$2;

~ \\

CALENDAR 1972 (56 RMPs)

Quality of Care Assuranceprograms are an RMP programcategory which includes efforts toassist local hospitals, out-patientdepartments, and physicians in privatepractice to perform audits of care andefforts to foster development ofstandards or other mechanismsneeded to improve care provided.

Relative investments of RMPresources in the four program areasalong with remaining administrativecosts is shown for three years in Figure3.

CALENDAR 1970 (56 RMPs)

K r

$87,049,000

Figure 3 also reflects the overalldecrease in resources available in1973. However, relative investmentshave remained essentially stable in thethree years with the followingexceptions:

1. The investment in assisting thedevelopment of emergency medicalservices has increased, due in part toFederal budgetary actions.

Y, ,--.. ,-

(12”/,,‘o) I

2. Administrative costs havedecreased from an estimated 14?4.in1970 to 8% in 1973, in part due toincreased efficiency of localoperations.

COMMENTDespite Federal administration

vagaries of financing and programdirection, the evidence reportedindicates that the Nation’s RMPs

$60,945,685

have continued to assist in theimplementation of locally neededhealth service programs for people.The RMPs remain a major Nationalresource capable of prudently andeffectively assisting local communitiesto implement expanded healthservices for people.

SECTION IITHE REGIONAL MEDICAL PROGRAMS:IMPLEMENTING LOCAL HEALTH SERVICES

The Nation’s RMPs constitute amajor resource for implementingprofessional responses to locallyidentified health needs within the broadframework of national health policy. Ascurrently constituted, RMPs offer aneffective model of an implementingagency which functions at the locallevel “to convene, coordinate andcorrelate federal, state and localgovernment efforts with privateprovider efforts and with others towardimproving health care services. ”z

Section II of this special progressreport from the Nation’s RMPs focusesprimarily on accomplishments in localhealth care systems development.RMP accomplishments summarizedare those which are directly related tothe unique role of the FHvWsas acommunity-based, federally supportedimplementing agency.

RMPs’ impact on development ofneeded health services for people iswell known and is documentedelsewhere. Improved services forpeople result from operational efforts inthe areas of access to primary andemergency health care, thedevelopment of quality of careassurance programs in local healthcare facilities, development of newskills in existing health manpower,development of new types ofmanpower and innovativedemonstration clinics and patient careprojects. This impact has beenuniquely effective and uniquely farreaching,

Less widely known are resultsgrowing out of the RMP process ofworking with a wide array of localhealth agencies and organizations.Original legislation creating the RMPsprovided a broad mandate to act as animplementing agency to developinnovative changes through acommunity-based, locally controlledprocess involving cooperativearrangements among local healthprofessionals and organizations. Thatprocess, the community structures andeffective working relationshipspainstakingly developed constitute amajor strength of RM Ps; they areimportant reasons for RMPaccomplishments summarized asfollows:. . . A Community-Based Process. . . Demonstration Projects: Joint

Funding and Continuation,.. New Health Organizations and

Formal Cooperative Arrangements. . . Development of Resources for

Local Services Improvements. . . Comment

A COMMUNITY BASED PROCESSThere are two major components of

the community based RMP process:(1) an effective blend of local boards

of directors, volunteer committees andprofessional staffs;

(2) a locally determined pattern ofexpenditures which includesdemonstration projects and communitydevelopment activities.

Local Structure: Regional AdvisoryGroups, Volunteer Committeesand Professional Staffs.., RMPs are federally supportedimplementing agencies which arelargely locally controlled, RegionalAdvisory Groups act as boards ofdirectors to study and act upon healthproblems in a way that is best suited tolocal situations. Volunteers serve longhours, often at considerable personalfinancial sacrifice.

The financial value alone of timedonated by volunteers in integratingthe activities of the RMPs into healthcare systems in local areas is trulyimpressive. For example, a detailedanalysis conducted by an RMP in theSouth conservatively estimated thevalue of the “man-hours” contributedby the Regional Advisory Groupsvolunteers during federal fiscal year1973 as $450,000.

‘“A Report from the Coordinators ofthe Nation’s Regional MedicalPrograms” (mimeographed August 6,1973).

In addition to Regional Advisory major committees whose members necessary to assist communities toGroups, RMPs make use of numerous had volunteered at least one day of develop workable solutions to compleximportant volunteer committees for service in the preceding six months. health problems.purposes such as technical review and Together, the voluntary groups and Table Xlll shows the currentproject deve~opment, Table X11 RMP professional staffs provide a local composition of RMP program staffsdisplays current membership of RMP mechanism which constitutes the wide and staffs of externally operated RMPRegional Advisory Groups and of range of skills, training and experience demonstration projects.

TABLE X11

CURRENT RMP VOLUNTEER STRUCTURE (As of February 1, 1974) (49 RMPs)

1 TYPE OF VOLUNTEER ACTIVITY NUMBER OF VOLUNTEERS

REGIONAL ADVISORY GROUPS:

Doctors (e.g., MDs, DOS, DDS) 851RNs, Allied Health 249Health Administrators 438Members of the Public 547

TOTAL 2085

MAJOR COMMITTEES:

Doctors (e.g., MDs, DOS, DDS) 2175RNs, Allied Health 1004Health Administrators 905Members of the Public 1012Others — Not Classified 278

TOTAL 5374r

TABLE X111CURRENT RMP STAFF STRUCTURE (As of February 1, 1974) (49 RMPs)

TYPE OF STAFF

RMP PROGRAM STAFFS:

Doctors (e.g., MDs, DOS, DDS)RNs, Allied HealthSocial and Behavioral Scientists

(e.g., educators, administrators)Support Staff (secretarial & clerical)

TOTALS

STAFFS OF RMP DEMONSTRA TiON PROJECTS:

Doctors (e.g., MDs, DOS, DDS)RNs, Allied HealthSocial and Behavioral Scientists

(e.g., educators, administrators)Support Staff (secretariat & clerical)

TOTALS

STAFF I

~NUMBEF

I7248

398

295

813

2517

5642

378

278

1696

*FTE’s are full time equivalent staffs, rounded to nearest whole number.

The effect of a Presidential messageand subsequent DHEW directives to“pha~e-ou{”RMPs had drastic

repercussions on the numbers ofvolunteers participating in RMP majorcommittees and on both program andproject staff of RMPs.

Figure 4 graphically shows thedramatic drop in membership ofcommittee volunteers and staffs. TheRegional Advisory Groups, however,maintained considerable membershipslability.

By February 1, 1974, both thenumbers of committee volunteers andthe numbers of project and programstaffs had increased, howevernumbers were still at lower levels thanthey had been prior to the phase-outorders.

The recovery of RMP volunteerstructures and staffs towardpre-phaseout levels strongly arguesthat the general health communitymaintains a continuing commitment tothe RMP mission as well as a belief inRMPs’ important implementation rolein local health care services system.

FIGURE 4RMP ADVISORY STRUCTURES AND STAFFS: E FFECTS OFFEDERAL ADMINISTRATION PHASE-OUT ORDERS

650

600(

550(

500(

450(

‘400c

350C

3000

2500

2000

1500

1000

500

0

m. 1, 1973IJuly 1,1973 eb. 1, 1974

,.; .J

RMP Process Components:Relative Investments

Funds’ available for use by localRMPs constitute a valuable communityresource for assisting and acceleratingimprovements in local health careservice systems. The RMP processesfor investing locally controlled fundsare an important aspect of thatresource.

RMPs invest their programresources4 in two basic processcomponents:

(1) initiation of demonstrationprojects, and

(2) non-project related communitydevelopment activities, primarily bylocal professional staffs.

There are two kinds ofdemonstration projects in RMPs:

(a) Pi/et projects include trial effortsor feasibility studies aimed atevaluating the potential of the projectobjectives prior to implementing amore substantial project.

(b) Operating projects are usuallylarger scale, externally operateddemonstration projects based on thedirect or indirect outcomes of pilotprojects. Funds to support operatingprojects are awarded by RegionalAdvisory Groups to local health

organizations to achieve specificallydefined objectives; often projects areco-funded by other local, state andFederal agencies, Local RMPprofessional staffs maintain significant,frequent contact with operatingprojects in activities such asinter-project coordination, monitoring,evaluating, seeking continuationfunding, and recommending (toRegional Advisory Groups)modification of objectives andrebudgeting of project funds which arenot being expended at expected rates.

RMPs also provide other non-projectrelated community developmentfunctions. The primary components ofnon-project re/ated communitydeve/opn7ent activities are:

(a) Technics/ Assistance activitiesinclude consultant and program stafftime and costs used to fulfill requestsby local agencies for assistance, forexample, developing grantapplications for new Federal initiatives.Technical assistance essentially is thesharing of RMPs staff and volunteerexpertise with all other elements in thehealth services system;

(b) Corwening/Faci/itating5 activitiesinclude RMP efforts to assist localgroups, agencies and others to form adhoc and persisting cooperativearrangements or agreements and todevelop a common localunderstanding of the implications ofnew Federal programs.

Convening/Facilitating efforts aredirected toward specific results; e.g.,continuation funding of RMP initiatedprojects or implementing locallysuitable versions of new, Federalinitiatives.

Direct costs associated withcommunity development activitiesinclude both project related andnon-project related activities. Figure 5shows the relative costs of projectactivities and of non-project communitydevelopment activities for each of thelast two fiscal vears. Direct costs usedfor local admi~istration remainminimal, an indication of RMPs’organizational efficiency.

FIGURE 5RMP DIRECT COSTSEXPENDITURES BYPROCESS COMPONENTS

FEDERAL FISCAL YEAR1973

(49 RMPs) $74,361,108

(a) “ODeratina” Proiects

FEDERAL FISCAL YEAR1974$58,516,651

-———— — -1

3AIIdollar figures in this report are based onactual expenditures where figures wereavailable or budget allocations where suchfigures were not available.4Relative investments of RMP resources in local ‘One description of RMP “Convening/Facilitating”administration and in four major program areas functions is provided in an A. D. Little report, “Evaluation(e.g,, primary care, regionalization) are described of Facilitation in the Regional Medical Program, ” May,in Section I. 1973.

Additional RMP dollars (“indirectcosts”) are awarded to RMP granteesto support administrative expenses ofoperating in conformance with Federalguidelines. Indirect costs arereimbursed by DHEW to grantees onthe basis of negotiated rates; RMPshave no direct control over indirectcosts. For the 49 RMPs, granteeindirect costs were $7 million in FederalFiscal Year 1973 and $4.2 million in1974.

FIGURE 6TOTAL INVESTMENT IN RMPINITIATED PROJECTS— RMP ANDNON-RMP FUNDING(1936 Projects Since July 1, 1971)(49 RMPs)

TOTALRMP FUNDS$109.8 Million

DEMONSTRATION PROJECTS:JOINT FUNDING ANDCONTINUATION

Extensive community involvementfrequently lends two unique strengthsto RMP initiated projects:

(1) dollar costs of projects are sharedby other organizations, allowing anenhanced level of operation; and (2)worthwhile project activities arecontinued through other financingmechanisms after RMP funding iscompleted, allowing reinvestment ofscarce RMP funds in other neededhealth services improvements.

Joint FundingSince July 1, 1971, RMPs have

initiated and supported 1936 majordemonstration projects,Demonstration projects result fromextensive but relatively rapid localdevelopment and review; they aredeveloped in response to communityneeds which are objectively verifiable.One indication of communitycommitment and participation in RMPdemonstration projects is the numberof other health orgainzations andagencies participating as co-sponsorsand co-funders of projects, Jointfunding serves not only to secureactive involvement and financialcommitment of the other agencies toRMP projects, but also allows anenhanced project operation during thetime of RMP support. Joint fundingoften insures continuation of theproject after RMP funding support isdiscontinued.

Since July 1, 1971, the 49 RMPsdeveloped a total of $52.8 million ofjoint funding support for RMP initiatedprojects. Amounts of supporl byvarious joint funding sources aresummarized in Figure 6.

Participation by other agencies andorganizations in sharing the dollarcosts of RM P projects is substantial. Ofthe 1936 major demonstration projectsinitiated by RMPs since July 1, 1971, atotal of1126 projects werecharacterized by participation of one, Figure 7 shows the total number of

two, or as many as four other sponsors which, singly or in concert,community agencies. co-funded RMP projects.

FIGURE 7DISTRIBUTION OF JOINT FUNDING SOURCES OF RMP INITIATEDPROJECTS(Since July 1, 1971) (49 RMPs)

NUMBER OF RMP PROJECTS WITH ONE, TWO,THREE OR MORE JOINT FUNDING SOURCES

ONE NON-RMPFUNDING SOURCE(739 Projects)

TWO NON-RMPFUNDING SOURCES(231 Projects)

THREE NON-RMPFUNDING SOURCES(91 Pro}ects)

‘l-wiw”l-vl””lvw’-s

The 1126 projects had a total of 1734 agencies which co-funded the projects with RMP.

Fiaure 8 shows both the numbers of $52.8 Million

Continuation“. . . to be maximally effective

requires that most RMP supportedendeavors make adequate provisionsfor continuation support once initialRegional Medical Programs grantsupport is terminated; that is, theregenerally must be assurance thatfuture operating costs can be absorbedwithin the regular health care financingsystem within a reasonable and agreedupon period. ” F?MPMission Statementof June, 1971.

The willingness of other agenciesand organizations to invest their ownfunds to continue services when RMPfinancial support has been completedis an important, concrete measure ofthe long-term worth of newlydeveloped, expanded, or improvedhealth services. As in the developmentof joint funding resources, the RMPrecord in this regard is impressive.

FIGURE 9NUMBER OF DEMONSTRATIONPROJECTSRMP SUPPORT TERMINATED(Since July 1, 1971)

FIGURE 10NUMBER OF DEMONSTRATIONPROJECTS: CONTINUATIONSUPPORT SOUGHT ANDOBTAINED(Since July 1, 1971)

Over the past three years, RMPfunding was terminated for 1732demonstration projects, of which 557were originally planned as “one-time”activities. Nine hundred seventy-four,or over 83 per cent, of the remaining1175 projects initiated with the help ofRMP funds, were continued with otherfunds following termination of RMPsupport.

1732 PROJECTS

1175 PROJECTS

Continuation

Obtained

.——

Figure 11 summarizes the number ofsingle or multiple sources of one yearcontinuation funding of projects.

FIGUREIINUMBER OF SOURCES PROVIDING CONTINUATION FUNDS FOR RMPTERMINATED PROJECTS(Since July 1, 1971)

NUMBER SOURCES OF CONTINUATION FUNDS

ONE SOURCENON-RMP FUNDS(661 RMP Projects)

TWO SOURCESNON-RMP FUNDS(222 RMP Projects)

‘ni”n-!””rTHREE SOURCESNON-RMP FUNDS(59 RMP Projects)

-n--n-~--”-wg,,,z,,z

-,-, ----- .,, ... ,.. AA.- —ri. .— -l!--1ne Y/4 rro]ecw naa a [olal OT14UU sources OTmrnalrlg.

In a real sense. local communities FIGURE 12and aaencies have frewentlv “voted” RMP PROJECTS AHER RMP FINANCING COMPLETED:with t~eir dollars for the “main~enance ofworthwhile activities of RMP initiatedprojects. Continuation funds aresupplied by State and localgovernments, other Federal agenciesor programs, and private sources,including fee-for-servicesreimbursements by insurancecompanies and individuals.Approximately one-third of the 974projects continued after termination ofRMP funding hwo/ved severs/sources of support.

FIRST YEAR CONTINUATION FUNDING AMOUNTSAND SOURCES $58.5 MILLION

(974 Projects SinceJuly 1, 1971) A

Figure 12 summarizes Ithe relative dollar amounts =from sr30nsorinq sources for one-year continuati& funding of projects.

18

The success of RMPs in developingcontinuation suppori for improvedservices initiated as demonstrationprojects is due in part to the efforts oflocal RMP program staffs in planningfor, and specifically building intoprojects those features that increasethe likelihood of continuation support.In addition to rebudgeting surplusproject funds as a result of effectivefiscal monitoring, limiting the period ofthe RMP support, (usually to amaximum of three years) enables localRegional Advisory Groups to reinvestavailable funds to acceleratedevelopment of other activities andprojects needed to improve local healthservices for people.

NEW HEALTH ORGANIZATIONSAND FORMAL COOPERATIVEARRANGEMENTS

Creation of needed new healthorganizations or formal cooperativearrangements is a frequent outcome ofRMP demonstration projects ortechnical assistance processes.

The RMPs (47) reported a total ofover 6,000 occasions since July 1,1971, where demonstration projects orsubstantial assistance resulted in thecreation of “new health organizations”or “new formal cooperativearrangements” between elements inlocal health services sytems.

New hea/th organizations includecurrently continuing clinics, rural healthstations, medical care foundations,areawide planning agencies andexpansion of setvices to underservedareas. New formal cooperativearrangements include additionalneeded health manpower trainingprograms, shared servicesagreements and similar cooperativeefforts to achieve greater efficiency oflocal health care systems.

Major occasions in which substantialRMP assistance was provided tocreate new health organizations orcooperative arrangements at the locallevel are described below.

Establishment of New HealthServices includes occasions where thearrangements or organizations createdresulted in the provision of healthservices not previously available on acontinuing, permanent basis; e.g., ruralhealth stations, neighborhood healthcenters, health screening stations,out-patient clinics, pre-paid healthservice plans.

Specific examples include:. . . a Northeast RMP has established

6 new ambulatory outpatient clinics in amedically underserved metropolitanarea where the population per squaremile is almost 50,000 people; nearly45,713 patient visits have beenrecorded since the first unit wasopened on November 7, 1972. As adirect result of these ambulatoryclinics, utilization of hospitalemergency rooms as the place ofprimary care has decreased by fifty percent.

. . . a medically underserved area,which has onlyeight physiciansserving a population of almost 19,000was given a boost by a Western RMP inestablishing a clinic, the Centro deSa/ud, which has served 2,400 peoplesince its August, 1973, opening;

. . . another Western RMP supportedtraining and placement of 13 familynurse practitioners who have served9100 isolated rural patients sincecompleting training.

New Health OrganizationsCreated includes creation of new localorganizations and cooperativearrangements for health planning,manpower, and health servicedevelopment, Examples include“area-wide comprehensive healthplanning agencies”, ExperimentalHealth Service and Delivery Systems,manpower training consortia, andquality assurance organizations.

an RMP in the South CentralUnited States supported thedevelopment of six health planningagencies with dollars, staff andfacilitating efforts; all six are currentlyapproved CHP (b) agencies. Fourother CHP agencies are currently inadvanced stages of development andwill complete comprehensive healthplanning coverage of the entire state.

. . . RMPs in the Pacific Northwestand in the South acted in primaryleadership roles to create statewideconsortia of private and public healthinterests to implement coordinated,statewide comprehensive cancercontrol programs.

Formalization of Sharing ofExisting Resources includesoccasions when two or more localhealth care facilities formalizeagreements to jointly support staff orrelated services, common purchasingand billing arrangements, orregionalization of specialized healthservices,

a Midwest RM P fostered thedevelopment often distinct“Cooperative Resource SharingGroups” primarily to cooperate in theprovision of in-service educationprograms. Sixty-eight institutions,comprised of 60 of the state’s 110hospitals and 8 nursing homes, arecurrently participating in the program.The estimated savings due to sharingof audio-visual resources andin-service instruction time amounts to$171,200. In addition, spin-offs due tothis cooperative effort have had aunifying effect on other areas includingshared purchasing, services andpersonnel,

an RMP in theNortheast developed agreementsamong 23 of 50 hospitals in the Regiontosupporl acoordinated tumor regist~for an investmentof$184,975 (throughDecember of 1973) and modestamounts of staff time. The goal of thisproject is to serve cancer patients bystimulating continuity of care and topromote continuing physicianeducation and train medical recordspersonnel in a specialized form ofrecord keeping to improve patientfollowup.

Establishment of New TrainingPrograms includes assistance toeducational institutions, healthorganizations and facilities in thedevelopment of new health manpowertraining programs needed andsupported financially at the local level.

an RMP in the West created astatewide corporation representing allhealth professions to provide neededcontinuing education on aself-supporting basis, Since itscreation, the organization has providedplanned continuing educationexperiences for over 9000 healthprofessionals who are essentiallyisolated from large medical centers orother resources for assistance inmaintaining current competence anddeveloping new skills.

. . . an RMP in New England wasinstrumental in creating and guidingthe development of a statewidemanpower training consortium. Sinceits inception, the consortium hasinstalled 3 needed “mid-level”practitioner training programs,graduated 60 needed healthprofessionals, and moved effectivelytoward the establishment of acontinuing university-based,integrated training effort of these typesof personnel.

FIGURE 13NEW ORGANIZATIONS OR FORMALCOOPERATIVE ARRANGEMENTS CREATED:RMP TECHNICAL ASSISTANCE OCCASIONS(Since July 1, 1971)(47 RMPsj

Number ofOccasions

1676

NEWHEALTH

ORGANIZA-TIONS

Figure 13 summarizes the occasionsthat RMPs provided substantialassistance to local communities increating new health services orsupportive organizations and formalcooperative arrangements describedabove.

1305

RMPs described several specificmethods and activities used inproviding assistance in creating neworganizations and formal agreements.Included are:

— Provision of direct RMP financialassistance;

— Assistance in securing non-RMPfinancial suppoti;

— Assistance by “loaning” or“detailing” RMP program staff for ashort period of time;

— Provision of specialized stafftechnical expertise and/or externalconsultants;

The numbers of occasions RMPs

— Assuming leadership in providing used these specific methods while

the initiative to convene interested andassisting in the creation of four kinds of

necessary principals.new health organizations and

— Securing the cooperation andcooperative arrangements are

SUppOrt of others.summarized in Table XIV.

TABLE XIVUSE OF TYPES OF RMP ASSISTANCE IN CREATINGNEW HEALTH ORGANIZATIONS & FORMALCOOPERATIVE ARRANGEMENTS(Since July 1, 1971)(47 RMPs)

Totals

5713

3282

3024

1827

1105

851

21

RMPs assisted a wide array of localagencies and professionalassociations in joint efforts to developnewhealth organizations, services andagreements,

The number of occasions other localagencies received substantialassistance in developing suchresources are summarized in Tablexv,

TABLE XVOCCASIONS OF TECHNICAL ASSISTANCE PROVIDEDOTHER AGENCIES IN DEVELOPING NEW ORGANIZATIONSAND FORMAL ARRANGEMENTS

(Since July 1, 1971)(47 RMPs)

.J.. (,”:l”~ ,.!

New~#;;jt.AGENCIES ASSISTED New Health Health /@! Shar

Organizations SerJiceZ,.! “!,,,’}.1,.!.,,,.,,.;~,~

137

287

403

151

DEVELOPMENT OF RESOURCES RMPs provided substantial technical Application requests totaled over

FOFI LOCAL SERVICES assistance in preparation of $368 million, a sum whose magnitudeIMPROVEMENTS applications for non-RMP funds to a is indicative of a major development

Another major outgrowth of RMPs’ wide array of local agencies and effort, Figure 14 summarizes thecommunity-based process has organizations. From July 1, 1971, to amounts requested from each

sometimes been described as a January, 1974, the RMPs assisted non-RMP funding source.

“broker” role. RMPs’ carefully local agencies and organizations inconstructed, effective working preparing a total of 1,135 applicationsrelationships with major segments of for funds for health servicesthe private and public sectors provide a improvements from (non-RMP)basis of confidence which underlies Federal, State, local and privatenumerous requests for technical funding sources.assistance to develop applications forfunds to support implementation oflocally appropriate improvements inhealth care services systems.

Local $ .8 M ~

FIGURE 14TOTAL DOLLAR REQUESTS ANDSOURCESRMP Assisted Atxdications for Non-RMPSupporl ‘(49 RMPs)

TOTAL $109.8 Million

TOTAL $88.7 Million

Federal $76.5 M Federal $77,7 M

FISCAL YEAR 1972 FISCAL YEAR 1973

TOTAL $169.9 Million

Federal $113.2 M

FISCAL YEAR 1974

One indirect measure of the worth ofRMP technical assistance is the dollaramount of the non-RMP awardsactually made to local agencies andorganizations assisted in thepreparation of applications. Figure 15is a summary of the total dollars innon-RM P awards received by localhealth organizations in cases whenRMPs provided substantial technicalassistance in developing theapplication.

FIGURE 15TOTAL DOLLARS RECEIVED ANDSOURCES:RMP Assisted Applications for Non-RMPsupport(49 RMPs)

TOTAL $65.2 Million

TOTAL $47.2 Million

Local $ ,9 M-

Federal $36,5 M

Local $2.8 M

Federal $40.4 M

TOTAL $116.5 Million

Local $3 M

Federal $70.7 M

FISCAL YEAR 1972 FISCAL YEAR 1973 FISCAL YEAR 1974

While the specific purposes forwhich non-RMP funding was soughthave not been enumerated, in manycases, applications were for funds tosupport continuation of RMP projectsor for the creation of new local healthcare services organizations or formalcooperative agreements previouslydescribed.

Total dollar volume of applicationsdoes not, in itself, adequately describeRMP assisted improvements in localhealth care services or the RMPscommunity development role.However, inferences about the dollarvolume may be drawn from threeperspectives:

(1) The cornrnurrityperspective:RMPs have provided substantialassistance ineffective project planningand review, and have successfullyplayed a major role in developingneeded additional financial resourcesfor local health improvements.

(2) The Federal perspective: Thenecessity has been reducedsignificantly for creating newbureaucracies to implement newprograms in a locally acceptable andvalid manner.

(3) The RMP perspective: Provisionof technical assistance to developapplications for other agencies insuresthe continuation of RMP initiatedimprovements, enhances RMPprogram operations throughcoordinated community efforts andestablishes a mechanism formaintaining effective workingrelationships with the widest array oflocal health interests.

COMMENT

In addition to improving services topeople the RMPs have developed acommunity-based process which is aneffectively functioning model of afederally supported, largely locallycontrolled implementing agency whichhas major impact on local health careservices systems.

The RMPs remain a major Nationalresource capable of prudently andeffectively assisting local communitiesto implement expanded healthservices for people.

.,.5

COORDINATORS’EXECUTIVE COMMllTEE

Donal R. Sparkman, M. D., Chairman Arthur E. Rikli, M.D.Washington/Alaska RMP Missouri RMP

Morton C. Creditor, M.D. Mr. Robert MurphyIllinois RMP Tri-State RMP -

Robert W. Brown, M.D. Mr. Paul D. WardKansas RMP California RMP

J. S. Reinschmidt, M.D. John R. F. Ingall, MOregon RMP Lakes Area RMP

D.

Granville W. Larimore, M.D. J. Gordon Barrow, M.D.Florida RMP Georgia RMP

Manu Chatterjee, M.D. Mr. Robert YoungermanMaine RMP Southeast RMPs

PAR GROUP COUNCIL

C. E. Smith, Ph. D., ChairmanMountain States RMP

John D. Cambareri, Ph.D.Project AdministratorMountain States RMP

Mr. Harry AuerbachNorth Central RMPsIllinois RMP

Mr. Robert MillerNortheast RMPsLakes Area RMP

Mr. Roger WarnerSouth Central RMPsArkansas RMP

Gordon Engebretson, Ph.D.Southeast RMPsFlorida RMP

Charles H. White, Ph.D.Western RMPsCalifornia RMP

John A. Mitchell, M.D. — ex officioCalifornia RMPChairman, Ad Hoc Evaluation Committee

J. Gordon Barrow, M.D. — ex officioGeorgia RMPChairman, Government Information Committee

Donal R, Sparkman, M.D.Washington/Alaska RMPChairman, Executive Committee

Mr. Roland Peterson — ex officioDRMPRockvilie, Maryland

w