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REGIONAL

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BENEFITING PEOPLE AND IMPLEMENTING LOCAL HEALTH SERVICES
. Anevaluative study supported by
Department of Health, Education
and Welfare funds and conducted
by the Public Accountability

Reporting Group.
PUBLIC ACCOUNTABILITY REPORTING GROUP

305 FEDERAL WAY ¢ P.O.BOX 5796 © BOISE, IDAHO 83705

THE PUBLIC ACCOUNTABILITY REPORTING GROUP (PAR) IS A COOPERATIVE
ARRANGEMENT AMONG THE NATION’S RMPs. IT WAS FORMED TO DEVELOP NATIONAL
DESCRIPTIVE AND EVALUATIVE INFORMATION ABOUT RMP PROGRAMS. PAR OPERATES
IN COOPERATION WITH THE DIVISION OF REGIONAL MEDICAL PROGRAMS AND UNDER
THE AUSPICES OF THE COORDINATOR’S EXECUTIVE COMMITTEE.

THIS PUBLICATION WAS SUPPORTED BY FUNDS AWARDED FROM THE DEPARTMENT OF
HEALTH, EDUCATION AND WELFARE. ITS CONTENTS ARE SOLELY THE RESPONSIBILITY
OF THE PUBLIC ACCOUNTABILITY REPORTING GROUP. THE FINDINGS AND
CONCLUSIONS DO NOT NECESSARILY REPRESENT THE VIEW OF THE U.S. DEPARTMENT
OF 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 in
Regional Medical Program (RMP) activities in 1973. An estimated 12
million additional persons benefited as a direct result of the use of new
skills acquired by local health professionals in RMP training programs.
Despite a year marked by lack of clarity in health policy at the Federal
Administration level and illegal impoundments of Congressional
appropriations, the RMPs continued to record substantial
accomplishments in expanding and improving local services for people.

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

_. over 150,000 health professionals received training in quality
assurance medical audit programs, new types of health manpower roles
(e.g., nurse practitioners, physician assistants and emergency medical
technicians) and new skills (e.g., kidney tissue typing and neonatal
intensive care).

_. more than 3500 local health care facilities participated in RMP
initiated quality assurance medical audit programs designed to improve
specific acts of medical care. Programs frequently result also in
moderating costs of care.

Since July, 1971:

-__ the RMPs have initiated almost 2000 major, innovative

demonstration projects. Projects were jointly funded by RMPs ($110
million) and other organizations ($53 million).

_. over 80 per cent of the almost 1000 RMP projects not designed as
“one-time” activities were continued by local financing mechanisms at an
annual estimated level of $58 million after RMP funding support was

completed.

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

RMPs’ community-based process is shown to be an effectively
functioning model of a Federally supported, largely locally controlled
implementing agency which has major impact in strengthening local
health care services systems in preparation for meeting increased
demands and needs.
TABLE OF CONTENTS

SUMMARY i
BENEFITING PEOPLE 1
RECENT RMP HISTORY 1

Chronology 1

Comment 2
PEOPLE SERVED BY RMP DEMONSTRATION PROJECTS 2
PEOPLE SERVED BY RMP TRAINED HEALTH PROFESSIONALS 3

PEOPLE BENEFITED BY RMP INITIATED IMPROVEMENTS IN LOCAL HEALTH CARE SYSTEMS 6

Expanded Capability of Health Manpower 6
New 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 7
improvement in Local Health Care Services by Quality Assurance Programs 7
Increased Access to Care: Initiation of Needed Health Services 9
ALLOCATIONS OF RMP RESOURCES IN PEOPLE SERVICES 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 10
COMMENT 10

 

. IMPLEMENTING LOCAL HEALTH SERVICES 11

ACOMMUNITY-BASED PROCESS 11
Local Structure: Regional Advisory Groups, Volunteer Committees and Professional Staffs 11
RMP Process Components: Relative investments 14
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 19
New Health Organizations Created 19
Formalization of Sharing of Existing Resources 19
Establishment of New Training Programs 20
DEVELOPMENT OF RESOURCES FOR LOCAL SERVICES IMPROVEMENTS 23

COMMENT 25
SUMMARY

REGIONAL MEDICAL PROGRAMS:

BENEFITING PEOPLE AND IMPLEMENTING
LOCAL HEALTH SERVICES

INTRODUCTION

SECTION I: BENEFITING PEOPLE

A March, 1974 survey of the Nation’s Despite these difficult circumstances,
53 RMPs revealed that, despite a year the RMPs recorded substantial

of Federal Administration confusion

accomplishments in 1973 directly

and illegal impoundments, the RMPs _ benefiting people. Major findings

have continued to make substantial
accomplishments as local

implementing agencies which provide

major assistance in developing needed
health services for people.

This report ofthe survey isorganizedin —

two sections. Section |, “Benefiting
People,” presents evidence of RMP
accomplishments in providing health
services for people. Section Il,
“implementing Local Health
Services,” describes the RMP
community-based process, types of
local expenditures, and specific
accomplishments related to
strengthening local health services
systems in preparation for meeting
increased demands and needs for
health services.

The report clearly demonstrates the
wasteful loss of needed services to
people as a result of Federal
administration mandates to dismantle
RMPs as well as illegal Administration
impoundments of Congressional
appropriations.

 

FIGURE A

Decline and
Recovery in
Service to
People.

presented in Section | include:
. More than 6.5 million people

received direct health services
from RMP demonstration projects.

. More than 2.5 million other patients

received services from new types
of health manpower (e.g., nurse
practitioners and emergency
medical services technicians and
others) trained in RMP- initiated
projects.

. More than 12 million people were

served by health professionals
using new skills acquired in RMP
programs.

. More than 27,000 providers were

trained in quality assurance
medical audit programs.

More than 3,500 local health care
facilities participated in initial
exploration or actual
implementation of quality
assurance medical audit
programs.

 

. More than 127,000 health
professionals received training in
new Skills (e.g., kidney tissue
typing, neonatal intensive care) or
as new types of health manpower
(e.g., physician assistants, nurse
practitioners, emergency medical
technicians).

SECTION II: IMPLEMENTING
LOCAL HEALTH SERVICES

As Federally supported, largely
locally controlled implementing
agencies, RMPs have developed an
effective blend of involved, expert and
experienced volunteer boards of
directors (Regional Advisory Groups),
committee structures and professional
staffs. RMPs assist a wide variety of
local health interests to make locally
suitable improvements in health care
services for people.

Regional Advisory Groups invest RMP
resources through a community-based
process which includes two major
components: (1) Initiation of
demonstration projects (80% of RMP
awards), and (2) Non-project related
community development activities
(12% of RMP awards), such as
technical assistance and
convening/facilitating.

FIGURE B
Federal
Funding
Levels.
 

RMPs3’ administrative costs represent . .

a modest (7-8%) investment of direct
costs of the program.

RMP accomplishments which are
directly associated with the
community-based process described,
since July 1, 1971, include the
following:

. .doint Funding by other
organizations in more than 1,000
demonstration projects provided a
total amount of over $50 millionin a
three-year period for projects
which were supported by RMP
funds in a total amount of $110
million.

. Continuation of over 80% of
RMP-initiated demonstration
projects through regular financing
mechanisms in locai health care
services systems; the estimated
first year operational cost after
completion of RMP funding support
was over $58 million.

. Major, specific technical

assistance to a wide array of local
health interests which resulted in
over 6,000 occasions where new
health services and supportive
organizations or formal
cooperative arrangements for
sharing resources were created.

. Major assistance by RMP program

staffs in developing over 1,000
applications for non-RMP funds
for other local health organizations
to support the development of
needed health care systems
improvements and locally suitable
versions of Federal initiatives.

. . Major assistance in securing over
$350 million in a three-year period

of non-RMP financial resources for
other local health organizations to
support needed community health
systems improvements.

 

 

NEEDED
HEALTH
SERVICES

 

 

 

COMMENT

Despite Federal Administration
vagaries of financing and program
direction, evidence reported indicates
that the Nation's RMPs have continued
to implement locally-needed, improved
health services for people.

In addition to improving services to
people, the RMPs have developed a
community-based process which is an
effectively functioning model of a
federally supported, largely locally
controlled implementing agency, which
has major impact on local health care
services systems.

The RMPs remain a major National
resource capable of prudently and
effectively assisting local communities
to implement expanded health
services for people.

 

 

 
SECTION!

REGIONAL MEDICAL PROGRAMS:

BENEFITING PEOPLE

The Nation’s RMPs have built a
tangible, impressive recordin assisting
the orderly development and
implementation of needed health
services in hundreds of communities
and areas across the Nation.

This section of the RMP
evaluative study provides
documentation of diminished, but
continuing accomplishments despite
more than a year of Federal
administrative health policy
uncertainty, phase-out directives, and
unlawful impoundments of
Congressional appropriations.

The major focus of Section is on
RMP efforts leading to increased and
improved health services for people. It
also provides updated information
correlated with a previous evaluative
report.’

Section | is organized as follows:

... AChronology of and Comment
on Recent RMP History.

... People Served by RMP
Demonstration Projects.

... People Served by RMP Trained
Health Professionals.

... People Benefited by RMP
initiated Improvements in Local Health
Care Systems.

_.. Allocations of RMP Resources in
People Services Programs.

... Comment.

RECENT RMP HISTORY

Since January 1973, the Nation’s
RMPs have experienced a series of
curious events which have had marked
impact on services to people.
Chronology

On January 29, 1973, the
President's fiscal year 1974 budget
message to Congress recommended
zero funding for RMPs. The budget
narrative contained a justification
which, to many observers, was
superficial, inaccurate and
contradictory to previous public
statements of Administration
spokesmen. The “justification” also
ignored the fact that many of its own
charges (e.g., “no consistent theme in
RMP programs’) resulted from
inconsistent and frequently changing
Federal directives. Despite strong
indications that the Administration’s
budget proposal was clearly contrary to
Congressional intent, on February 7,
1973, the Administration directed the
RMPs to close down operations by
June 30, 1973.

Congressional action to continue the
legislative authorization for RMPs
followed in rapid sequence:

a. On March 25, 1973, the Senate
passed, by a 72-19 vote, a one-year
extension bill.

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

c. OnJune 5, the Senate passed, by
a unanimous 94-0 vote, the House
amendments to the Senate bill.

d. OnJune 18, the President signed
into law (PL 93-45) the bill which
extended authorization for the RMP
through June 30, 1974.

‘Mitchell, J., et al., “The 56 RMPs: A Special Progress
Report,” Drug Research Reports, Vol. 16, No. 8, February

21,1973.

“Phase-out” orders to close down
operations were rescinded. However,
many RMPs had suffered significant
disruptions of painstakingly developed
community relationships, as well as
losses of experienced key program
and project staff.

Anominal restoration of new RMP
operations began on July 1, 1973. The
restoration was marred both by
continuing Administration
impoundments of RMP funds and by
unclear Administration direction. In one
instance, $6.9 million of RMP funds
were “released” with the stipulation
that the Congressionally appropriated
funds could not be spent until a “new
mission” was established for the RMPs
for the extension year.

Not until September 7, 1973,
however, did the Administration finally
issue a new program mission
(‘priorities and options”) for the year
beginning July 1, 1973. The “priorities
and options” sharply restricted the
mission of the RMPs, seemed at
variance with the legislative mandate,
and required that all activities be
completed by June 30, 1974.
Administration intent appeared to be to
release RMP funds: (a) at a level
considerably less than the full amount
of the Congressional appropriation,
and (b) under time schedules which
could serve only to hinder the RMPs'
capability to work effectively at the local
level.
On September 21, 1973, the
National Association of Regional
Medical Programs initiated civil action
proceedings seeking three actions
from the Administration: (1) release of
$115 million ofimpounded RMP funds,
(2) relief from the restrictive mission
statement of September 7, 1973 and
(3) relaxation of a June 30, 1974
termination date which had been set as
a deadline by which RMPs must
effectively complete projects.

On February 7, 1974 a Federal
district court ordered release of $130
million of impounded funds to the
RMPs, removal of the mandatory
termination date of June 30, 1974, and
lifting of the restrictive program
“priorities and options.”

Comment

The following summary of RMPs’
accomplishments in developing health
services for people unsurprisingly
reflects a consistent pattern of
lessened program impact in the past 18
months. The most marked effect of the
“phase-out” orders is seen in the

TABLE |*

period July to December 1973. RMPs
continued to achieve substantial
results during this time; however, only
in a few instances are the results at
levels as high as those achieved in
1972 or those approved in 1973
operating schedules.

Based on recorded and forecasted
results from operational activities in the
current six months (January to June
1974), there is an upward trend toward
higher levels of services to people.
Carry-over of the funds released late in
1973, plus release of the additional
awards has provided a sufficient
financial base so that projections are
realistically based on scheduled
activities of operations currently in
effect.

Although buffeted in the past year,
the RMPs apparently have made
substantial, quick recoveries. As local
implementing agencies, they have
maintained organizational capability as
well as noteworthy records of
accomplishment in the development of
health services for people.

PEOPLE SERVED BY RMP
DEMONSTRATION PROJECTS

The RMPs continue to have a major
impact in serving personal health care
needs of consumers. While RMPs do
not ordinarily provide direct health
services, there are numerous
instances where direct — often highly
technical services are supported as
part of a demonstration project.
Examples include: (a) person screened
in hypertension screening projects, (b)
patients treated by project staff of a
demonstration unit for specialized
cancer care, or (c) patients seen by a
nurse practitioner or a neighborhood
clinic staff supported by an RMP. Table
| summarizes such direct services
recorded in RMP demonstration
projects.

PEOPLE RECEIVING DIRECT HEALTH SERVICES IN RMP
DEMONSTRATION PROJECTS: SUMMARY

 

 

 

ee CALENDAR CALENDAR
TYPE OF PROJECT 1970 (oes &
: (56 RMPs)
Primary Care 2,622,000
Emergency Medical
Services ~ 466,000
Regionalization of
secondary and
tertiary care 2,715,000
TOTALS 5,803,000

 

 

 

 

 

*a. The comparison cited for 1970 and 1972 was reported by the 56
RMPs then in operation. There currently exist 53 RMPs, 49 of which
responded to this survey. While direct comparisons should be made
with caution, major trends are considered valid.

b. All numbers are rounded to the nearest thousand.
Table II presents further detail about
people directly served in the course of
RMP demonstration activities. The
numbers of people who received direct
health services from RMP projects of a
categorical type generally decreased
between 1972 and 1973. In part, this
decrease was due to Federal
directives. A general decrease in
people served is due in large measure
to the decreased level of financial
resources available.

Sharp upward trends in numbers of
people served in hypertension projects
reflect fulfillment of previous
projections.

PEOPLE SERVED BY RMP
TRAINED HEALTH
PROFESSIONALS

The RMP record is well known in
accomplishment of the early mission of
“bringing advances in medical
knowledge to the bedside of the

TABLE Il

PEOPLE RECEIVING DIRECT HEALTH SERVICES IN RMP
DEMONSTRATION PROJECTS: DETAIL OF
REGIONALIZATION OF SECONDARY AND TERTIARY CARE

 

 

 

 

PROJECTS

CALENDAR |. CALENDAR
TYPE OF PROJECT 1970 A972...

(56 RMPs) |. (56 RMPs)
Heart Disease 1,126,000 : 1,086,000 : :
Cancer 413,000 ~~ 623,000.
Stroke 140,000 “348,000:
Kidney 13,000 |." : 33,000:
Hypertension 135,000 “84,000.
Pulmonary Disease 300,000 “=; 307,000:
All Other 588,000 | - 1,762,000.
TOTALS 2,715,000 | 4,143,000

 

 

  

 

 

 

Health manpower training activities
of RMPs generally have resulted in (a)

patient.” Many physicians and nurses new types of health professionals

have been taught new skills for use in
coronary care units; many stroke

trained to meet the changing demands
for health care services, or in (b) the

rehabilitation teams have beentrained; acquisition of new skills by existing

and large numbers of neighborhood
health aides have been trained and
placed. As a result of RMP health
manpower training activities,
substantial numbers of people now
have ready access to improved health
services not previously available.

health manpower.
New types of health manpower is an
RMP program category which includes
all persons trained in newly defined
categories of health manpower where
no widespread, nationally recognized
training programs, certification or

licensure exist. Examples include

 

 

 

TABLE Ill
PEOPLE SERVED BY RMPs TRAINED HEALTH PROFESSIONALS:
SUMMARY
CALENDAR
TYPE OF SERVICE 1970
(56 RMPs)
Served bynew types of
health professional
manpower 969,000
Served by new skills
acquired by existing
health professionals 19,383,000
TOTALS 20,352,000

 

 

 

 

 

nurse practitioners, nurse midwives,
community health assistants, and
emergency medical technicians.

RMPs have also supported the
development of new skills in existing
health manpower. New Skills is an
RMP program category which includes
organized efforts aimed at the
acquisition of essentially new skills by
persons already educated, licensed or
certified. Examples are: (a) a
registered nurse who becomes a
coronary care unit nurse, and (b) a
physician who develops advanced
skills as a neonatal intensive care
specialist.

Table Ill summarizes the numbers of
people served in the remainder of the
year in which training occurred.

Numbers include only persons given
direct health services during the time
period indicated. For example, a
“nurse practitioner” trained in late 1972
may have served a total of 300 patients
in the remainder of 1972. In actuality,
however, the nurse practitioner may
have continued to serve increasing
numbers of persons in each year since
the completion of training. However,
the cumulative total number of persons
served is unreported.
Taking into consideration the
differences in numbers of RMPs
reporting in each of the time periods.
the following observations are
considered valid:

People served by people trained
by RMPs increased from about 20
million to over 30 million in the period
from 1970 to 1972, an increase of
roughly 50%.

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

Figure 1 is a graphic portrayal of the
sharp decline and beginning recovery
of persons served by health providers
using newly acquired skills.

 

   

 

 

 

 

 

 

FIGURE 1
PEOPLE SERVED BY VARIOUS HEALTH MANPOWER TRAINED IN
NEW SKILLS BY RMPs
3.5 me oD ARR
Legend,’ Forexamp
3,000,000 ‘pe
3.0 Medical Technicians,
Laboratory Tech- s
nicians ee |
~ 25
Qo .
Nurses
9 ——7
ao.
uu
oO
Q 20
oO
Jj
=
=
1.5
Doctors
1.0
5
July 1-72 Jan. 1-73 July 1-73 Jan. 1-74

to Dec. 31-72 to June 30-73 to Dec. 31-73 to June 30-74
Figure 2 is a graphic pattern of the
recent RMP program emphasis in
assisting the training and placement of
persons innew types of primary health
care roles. RMPs trained nurse
practitioners (563) and physician
assistants (163) who provided direct
health services to more than 650,000
patients in 1973. An additional
2,000,000 patients received direct
health services in 1973 from other
types of new health manpower trained;
for example, emergency medical
technicians, kidney tissue typing
technicians, nurse midwives, and
community health assistants.

FIGURE 2
PEOPLE SERVED BY NEW TYPES OF HEALTH MANPOWER

 

 

 

 

 

 

 

 

 

1.5
1.4 Legend: For example,
1.2 million people
1.3 were served.
1.2
x 1.1
OG 1.0
a.
7 9
O 8 Emergency
g Medical Tech-
Go 7 nicians, Community
4 Health Aides & Others
= 6 |
=
5
4 Nurse
Practitioners
3 ;
2 | Physician P_—
Assistants
a)
0 cee
July 1-72 Jan. 1-73 July 1-73

to Dec. 31-72 to June 30-73 to Dec. 31-73 to June 30-74
PEOPLE BENEFITED BY RMP
INITIATED IMPROVEMENTS IN
LOCAL HEALTH CARE SYSTEMS

Many people have gained easier
access to higher quality health care
services as aresult of RMP activities in
local communities. RMP activities
resuiting in improvements in local
health care services are reported inthe
following categories:

1. Expanded capability of the
Nation's health manpower;

2. Improvement in local health care
service through introducing quality of

3. Creation of new health services,

particularly in underserved areas.

Expanded Capability of Health
Manpower.

As reported earlier, RMPs' training

efforts have added sizable numbers of

new types of health professionals
needed to provide local services.

Training efforts also have resulted in

new Skills for large numbers of
practicing health professionals. A
summary of the numbers of health

professionals trained in new skills or in

new professional roles is presented in

 

 

   

 

 

care, medical audit programs; Table IV.
TABLE IV
NUMBERS OF HEALTH PROFESSIONALS TRAINED BY RMPs
| CALENDAR | CALENDAR :
_ TYPE OF TRAINING. 1970. 1972
(66 RMPs) | (56 RMPs)
83,361. | 107,009
7,526 | 13,825
90,887 | 120,834

 

 

 

 

 

 

 

New Skills of Professionals Improve
Health Services.

Traditionally, RMPs have provided
existing health manpower with
opportunities to acquire new skills
aimed at providing better quality care to
people served. These activities have
been weil received by the health

TABLE V

community and have been of benefit to
ever increasing numbers of health
services consumers.

A summary of the numbers of local
health providers trained in essentially
new skills is shown on Table V.

The slight increase in numbers of
doctors trained result from relative
increases in projects concerned with
hypertension, kidney disease and
other specialized services such as
neonatal intensive care.

NUMBERS OF EXISTING HEALTH PROVIDERS TRAINED IN NEW SKILLS BY RMPs

 

 

  

 

 

 

TYPES OF ee “Ae
HEALTH MANPOWER aS (56 RMPs)
Dociors 13,561
Nurses 38,159
Others Including

Medical, Laboratory

and other Technicians 34,641
TOTALS 86,361

 

 

 
New Types of Health
Professionals Increase
Access to Needed Services.

Increased access to primary care innovative, promising method of
services has continued to claim RMPs increasing access to needed health
attention and efforts in recent years. care services. A summary of the
The development of new types of numbers of new types of health
health professionals specifically professionals trained primarily to
trained to provide primary health care increase access to primary care is
as “mid-level practitioners” working shown in Table VI.

closely with physicians has been an

TABLE VI

NUMBERS OF HEALTH PROFESSIONALS TRAINED IN NEW ROLES BY RMPs

 

 

 

 

 

 

CALENDAR CALENDAR
TYPES OF 1970 1972
HEALTH MANPOWER (56 RMPs) (56 RMPs)
Nurse Practitioners
Physician Assistants
Community Health
Assistants, EMTs
and Others
TOTALS 7,526* 13,825*

 

 

 

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

Persons Trained in
Techniques of Quality of

improvement in Local Health
Care Services by Quality
Assurance Programs.

Care Assurance.

RMPshavetrainednumeroushealth § The numbers of persons trained in in this report, quality of care
professionals in techniques toassure quality assurance techniques assurance programs are defined as
high levels of quality care available to increased almost six-fold between systematic efforts to set standards,
patients in local health facilities and 1970 and 1972. RMP program effortin determine deficiencies in individual or
clinics. Table Vil summarizes the quality assurance techniques is collective acts of medical care, to
numbers of health professionals substantial, though it remains less than develop corrective action, and to
trained in quality of care assurance forecast for 1973. implement activities which result in
techniques. demonstrably improved quality of care.
TABLE VII

NUMBERS OF HEALTH PROFESSIONALS TRAINED IN QUALITY ASSURANCE PROGRAMS

 

CALENDAR
1970.
(56RMPs)

 

CALENDAR
1972
(56 RMPs)

 

| 6872.

 

 

 

 

 

32,394

 

 

 
Quality of care assurance activities

offer a classic RMP example of an

effective, local developmental process
which results in sustained change after

RMP support is withdrawn.
Program development typically
followed a three-stage process.

TABLE Vill

Stage 7 — Alocal need is
identified and RMP supported

professional resource persons are
assembled. Table Vill summarizes the

numbers of professional resource
persons leading RMP program
developments in quality assurance in
each of four time periods.

NUMBERS OF PROFESSIONAL RESOURCE PERSONS
INVOLVED IN QUALITY ASSURANCE PROGRAM DEVELOPMENT

 

FISCAL YEAR 1973
July-Dec. Jan.-June

 

Professional resource
persons involved as
“Trainers/Developers”

 

 

818 1,019

 

 

A sharp recovery in the last period
reflects both Federal priority and local
capability to use released funds;
however, the increase is not as great
as the level the RMPs expected to
reach in 1973.

Stage 2 — Representatives of

local health care facilities participate in

RMP-sponsored

TABLE IX

FISCAL YEAR 1974

July-D

  

ec... Jan.-June

ae

“convening/facilitating” activities to
begin exploratory development, and/or
participate in formal projects aimed at
developing skills and implementing
quality assurance mechanisms in their
facilities (e.g., medical audit systems).
Table 1X summarizes numbers of

participation.

HEALTH CARE FACILITIES INVOLVED IN RMPs’ QUALITY
ASSURANCE PROGRAM DEVELOPMENT

facilities involved in each type of

 

 

FISCAL YEAR 1973
July-Dec. Jan.-June

 

    

 

 

 

524 638
403 545
TOTALS 927 1,183

 

 

  
Stage 3 — As local health care
facilities identify specific deficiencies in
health care, corrective action is
initiated by health care providers
involved within the facility. A tabulation
of over 5,000 formal corrective

TABLE X

programs (for example, educational
experiences and organizational!
changes) following specifically
identified deficiencies is presented in
Table X.

FORMAL CORRECTIVE PROGRAMS WITHIN LOCAL HEALTH CARE
FACILITIES PARTICIPATING IN RMP QUALITY ASSURANCE PROGRAMS

 

 

Formal Corrective
Programs Initiated
by Local Facilities

 

 

 

Increased Access to Care:
initiation of Needed Health Services.
As aconsequence of RMP
dernonstration projects and substantial
technical assistance by program staffs,
major impetus to the creation of new
health service units needed in local
communities has been provided. Since
July 1, 1971, RMPs have assisted local
communities to implement more than

TABLE XI
NEW HEALTH SERVICES CREATED
(Since July 1, 1971)

1,800 new health service units needed
locally to provide services to people.
Included, for example, are
neighborhood health clinics, rural
health stations for primary emergency
care, formal agreements for
cooperative sharing of specialized
services, and ambulatory out-patient
clinics in hospitals in underserved
urban areas.

 

 

 
 
 

FISCAL YEAR 1973 |. FISCAL YEAR 4
July-Dec. Jan.-June | July-Dec. © «Jan.
1,307 1,383 3 ; \
png

New health services organizations in
whose establishment RMPs
participated, continue to provide
needed services without continuing
RMP technical or financial assistance.

Table XI summarizes the types of new
health services created in the course of
RMP projects and program staff
efforts.

 

“Type of New: Health Services Us

 

 

Primary Care (including :
_ Emergency Medical Services) .

 
 
 

_ (Secondary and -
Tertiary Care)

Specialized Services oe eae

 

1,250

 

TOTAL

 

 

 

 

 
ALLOCATIONS OF RMP
RESOURCES IN PEOPLE
SERVICES PROGRAMS

The RMPs have allocated their
operating funds into four major
program areas. Total direct costs
awards to RMPs are categorized for
three calendar years in the following
program areas.

More Effective Use of Manpower
is an RMP program category which
includes new skill development, new
types of manpower development,
efforts to implement arrangements for
shared training and service resources
in underserved areas, and efforts to
bring about improved utilization and
relevance of health manpower training
programs.

FIGURE 3

ALLOCATIONS OF RMP RESOURCES TO

PEOPLE SERVICE PROGRAMS
(Selected Calendar Years)

CALENDAR 1972 (56 RMPs)

Improved Accessibility and
Availability of Primary Medical Care
includes development of new or
improved Health care services such as
family health centers, free clinics,
hospital-based ambulatory care
centers, primary and emergency care
centers, and improvements in minority
group access to services.

Regionalization of secondary
and tertiary (specialized) care
includes RMP efforts to facilitate
general institutional sharing of scarce
resources such as radiation facilities,
shared services such as joint
purchasing, and development of
needed services for specialized care of
heart disease, cancer, stroke and other
patients.

Primary Care

   
  
  

 

  
 
   
 
  
   

Emergency) 514,413,000
Services (15%
$832,000 :

(1%)

Regionalization
$24,039,000
(32%)

 

   

   
 

Primary Care
$18,205,000
(21%)

  

 

$87,049,000

Figure 3 also reflects the overall
decrease in resources available in
1973. However, relative investments
have remained essentially stable in the
three years with the following
exceptions:

1. The investment in assisting the
development of emergency medical
services has increased, due in part to
Federal budgetary actions.

Effective Manpower Use
$24,790,000

QA.
$4,506,000
(6%)

   

 
 
  
  

   

EMS
$7,020,217
(12%)

2. Administrative costs have
decreased from an estimated 14% in
1970 to 8% in 1973, in part due to
increased efficiency of local
operations.

COMMENT

Despite Federal administration
vagaries of financing and program
direction, the evidence reported
indicates that the Nation’s RMPs

Specialized Services

Specialized Sei

Quality of Care Assurance
programs are an RMP program
category which includes efforts to
assist local hospitals, out-patient
departments, and physicians in private
practice to perform audits of care and
efforts to foster development of
standards or other mechanisms
needed to improve care provided.

Relative investments of RMP
resources in the four program areas
along with remaining administrative
costs is shown for three years in Figure
3.

CALENDAR 1970 (56 RMPs)

    
 
  

Effective Manpower Use
$24,163,000
(32%)

   
 
  

  
  
     
 

$75,575,00

CALENDAR 1973 (49 RMPs)

      

Effective
Manpower Use
$17,002,156

Primary Care.
$10,947,470

  

    
  

  

Regionaliz
$15,504

 
 

$60,945,685

have continued to assist in the
implementation of locally needed
health service programs for people.
The RMPs remain a major National
resource capable of prudently and
effectively assisting local communities
to implement expanded health
services for people.
SECTION Il

THE REGIONAL MEDICAL PROGRAMS:
IMPLEMENTING LOCAL HEALTH SERVICES

The Nation’s RMPs constitute a
major resource for implementing
professional responses to locally
identified health needs within the broad
framework of national health policy. As
currently constituted, RMPs offer an
effective model of an implementing
agency which functions at the local
level “to convene, coordinate and
correlate federal, state and local
government efforts with private
provider efforts and with others toward
improving health care services.”?

Section || of this special progress
report from the Nation’s RMPs focuses
primarily on accomplishments in local
health care systems development.
RMP accomplishments summarized
are those which are directly related to
the unique role of the RMPs as a

community-based, federally supported ..

irnplementing agency.

RMPs' impact on development of
needed health services for people is
well known and is documented
elsewhere. Improved services for

people result from operationaleffortsin ...

the areas of access to primary and
emergency health care, the
development of quality of care
assurance programs in local health
care facilities, development of new
skills in existing health manpower,
development of new types of
manpower and innovative
demonstration clinics and patient care
projects. This impact has been
uniquely effective and uniquely far
reaching.

2" Report from the Coordinators of
the Nation’s Regional Medical
Programs” (mimeographed August 6,
1973).

Less widely known are results
growing out of the RMP process of
working with a wide array of local
health agencies and organizations.
Original legislation creating the RMPs
provided a broad mandate to act as an
implementing agency to develop
innovative changes through a
community-based, locally controlled
process involving cooperative
arrangements among local health
professionals and organizations. That
process, the community structures and
effective working relationships
painstakingly developed constitute a
major strength of RMPs; they are
important reasons for RMP
accomplishments summarized as
follows:

.. ACommunity-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 PROCESS

There are two major components of
the community based RMP process:

(1) an effective blend of local boards
of directors, volunteer committees and
professional staffs;

(2) alocally determined pattern of
expenditures which includes
demonstration projects and community
development activities.

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

.. RMPs are federally supported
implementing agencies which are
largely locally controlled. Regional
Advisory Groups act as boards of
directors to study and act upon health
problems in a way that is best suited to
local situations. Volunteers serve long
hours, often at considerable personal
financial sacrifice.

The financial value alone of time
donated by volunteers in integrating
the activities of the RMPs into health
care systems in local areas is truly
impressive. For example, a detailed
analysis conducted by an RMP in the
South conservatively estimated the
value of the “man-hours” contributed
by the Regional Advisory Groups
volunteers during federal fiscal year
1973 as $450,000.
In addition to Regional Advisory
Groups, RMPs make use of numerous
important volunteer committees for
purposes such as technical review and
project development. Table XII
displays current membership of RMP
Regional Advisory Groups and of

major committees whose members
had volunteered at least one day of
service in the preceding six months.
Together, the voluntary groups and
RMP professional staffs provide a local
mechanism which constitutes the wide
range of skills, training and experience

necessary to assist communities to
develop workable solutions to complex
health problems.

Table XIIl shows the current
composition of RMP program staffs
and staffs of externally operated RMP
demonstration projects.

 

 

 

 

 

 

 

 

 

 

 

 

TABLE Xil
CURRENT RMP VOLUNTEER STRUCTURE (As of February 1, 1974) (49 RMPs)
TYPE OF VOLUNTEER ACTIVITY NUMBER OF VOLUNTEERS
REGIONAL ADVISORY GROUPS:
Doctors (e.g., MDs, DOs, DDS) 851
RNs, Allied Health 249
Health Administrators 438
Members of the Public 547
TOTAL 2085
MAJOR COMMITTEES:
Doctors (e.g., MDs, DOs, DDS) 2175
RNs, Allied Health 1004 .
Health Administrators 905
Members of the Public 1012
Others — Not Classified 278
TOTAL 5374
TABLE XIill
CURRENT RMP STAFF STRUCTURE (As of February 1, 1974) (49 RMPs)
TYPE OF STAFF STAFF
NUMBER] FTE*
RMP PROGRAM STAFFS:
Doctors (e.g., MDs, DOs, DDS) 72 56
RNs, Allied Health 48 42
Social and Behavioral Scientists 398 378
(e.g., educators, administrators)
Support Staff (secretarial & clerical) 295 278
TOTALS 813

754

 

STAFFS OF RMP DEMONSTRATION PROJECTS:

326.

 

 

 

Doctors (e.g., MDs, DOs, DDS) : :
RNs, Allied Health 642 ©
Social and Behavioral Scientists 750.
(e.g., educators, administrators) vet :
Support Staff (secretarial & clerical) 799
TOTALS 2517 1696

 

 

 

 

*FTE’s are full time equivalent staffs, rounded to nearest whole number.
The effect of a Presidential message
and subsequent DHEW directives to
“phase-out” RMPs had drastic
repercussions on the numbers of —
volunteers participating in RMP major
committees and on both program and
project staff of RMPs.

Figure 4 graphically shows the
dramatic drop in membership of
committee volunteers and staffs. The
Regional Advisory Groups, however,
maintained considerable membership
stability.

FIGURE 4

By February 1, 1974, both the
numbers of committee volunteers and
the numbers of project and program
staffs had increased, however
numbers were still at lower levels than
they had been prior to the phase-out
orders.

The recovery of RMP volunteer
structures and staffs toward
pre-phaseout levels strongly argues
that the general health community
maintains a continuing commitment to
the RMP mission as well as a beliefin
RMPs' important implementation role
in local health care services system.

RMP ADVISORY STRUCTURES AND STAFFS: EFFECTS OF
FEDERAL ADMINISTRATION PHASE-OUT ORDERS

 

 

6500 4
ey,
6000 4 0%,
64
NN, 6
5500 + Sn,
we “% mm
me Es - —_
5000 4 ft en
~ -
~ -~
4500 +
4000 +
3500 4
3000 4
2500 4>~~
~ Regional Adviso
eee: may ry] Groups
2000 + ST Se CN ee eRe ance Wecome
Alp
LA, E _—_—
1500 4 ~AiMp by ~Ser statis (TE) -——
~ Gram, i
1000 4 Starts (Py
~ LS)
“Ay
500 4 a
0
Jan. 1, 1973 July 1, 1973 Feb. 1, 1974

 

 

 

os
RMP Process Components:
Relative Investments

Funds? available for use by local
RMPs constitute a valuable community
resource for assisting and accelerating
improvements in local health care
service systems. The RMP processes
for investing locally controlled funds
are an important aspect of that
resource.

RMPs invest their program
resources’ in two basic process
components:

(1) initiation of demonstration
projects, and

(2) non-project related community
development activities, primarily by
jocal professional staffs.

There are two kinds of
demonstration projects in RMPs:

(a) Pilot projects include trial efforts
or feasibility studies aimed at
evaluating the potential of the project
objectives prior to implementing a
more substantial project.

(b) Operating projects are usually
larger scale, externally operated
demonstration projects based on the
direct or indirect outcomes of pilot
projects. Funds to support operating
projects are awarded by Regional
Advisory Groups to local health

FIGURE 5
RMP DIRECT COSTS

EXPENDITURES BY FEDERAL FISCAL YEAR
PROCESS COMPONENTS 1973
(49 RMPs) $74,361,108

 
     
 

49,172,931
66.0%

Administration
$6,112,780
8.2%

Demonstration Projects
(a) “Operating” Projects

 
   

organizations to achieve specifically
defined objectives; often projects are
co-funded by other local, state and
Federal agencies. Local RMP
professional staffs maintain significant,
frequent contact with operating
projects in activities such as
inter-project coordination, monitoring,
evaluating, seeking continuation
funding, and recommending (to
Regional! Advisory Groups)
modification of objectives and
rebudgeting of project funds which are
not being expended at expected rates.

RMPs also provide other non-project
related community development
functions. The primary components of
non-project related community
development activities are:

(a) Technical Assistance activities
include consultant and program staff
time and costs used to fulfill requests
by local agencies for assistance, for
example, developing grant
applications for new Federal initiatives.
Technical assistance essentially is the
sharing of RMPs staff and volunteer
expertise with all other elements in the
health services system;

 
 
 
 

   

(b) “Pilot” Projects
$10,811,844
me 14.4%

    
   
  
 
 

Community Development
$8,263,553
11.4%

2A\l dollar figures in this report are based on

actual expenditures where figures were

available or budget allocations where such

figures were not available.

Demonstration Projects
(a) “Operating” Projects
1

Administration
$4,588,297
7.8%

(b) Convening /Facilitating® activities
include RMP efforts to assist local
groups, agencies and others to form ad
hoc and persisting cooperative
arrangements or agreements and to
develop acommon local
understanding of the implications of
new Federal programs.

Convening/Facilitating efforts are
directed toward specific results; e.g.,
continuation funding of RMP initiated
projects or implementing locally
suitable versions of new, Federal
initiatives.

Direct costs associated with
community development activities
include both project related and
non-project related activities. Figure 5
shows the relative costs of project
activities and of non-project community
development activities for each of the
last two fiscal years. Direct costs used
for local administration remain
minimal, an indication of RMPs’
organizational efficiency.

FEDERAL FISCAL YEAR
1974
$58,516,651

   
 

40,866,918

  

   
 

Pilot” Projects
$7,532,082
“42.9%

   
 

  

- Community
Development
$5,529,354
9.5%

  

 
    

Relative investments of RMP resources in local
administration and in four major program areas
(e.g., primary care, regionalization) are described
in Section I.

5One description of RMP “Convening/Facilitating”
functions is provided in anA. D. Little report, “Evaluation
of Facilitation in the Regional Medical Program,” May,
1973.
Additional RMP dollars (“indirect
costs”) are awarded to RMP grantees
to support administrative expenses of
operating in conformance with Federal
guidelines. Indirect costs are
reimbursed by DHEW to grantees on
the basis of negotiated rates; RMPs
have no direct control over indirect
costs. For the 49 RMPs, grantee
indirect costs were $7 million in Federal
Fiscal Year 1973 and $4.2 million in
1974.

FIGURE 6

TOTAL INVESTMENT IN RMP
INITIATED PROJECTS — RMP AND
NON-RMP FUNDING

(1936 Projects Since July 1, 1971)
(49 RMPs)

 

TOTAL
RMP FUNDS

$109.8 Million

 

 

DEMONSTRATION PROJECTS:
JOINT FUNDING AND
CONTINUATION |

Extensive community involvement
frequently lends two unique strengths
to RMP initiated projects:

Joint Funding
Since July 1, 1971, RMPs have
initiated and supported 1936 major

(1) dollar costs of projects are shared demonstration projects.

by other organizations, allowing an
enhanced level of operation; and (2)
worthwhile project activities are
continued through other financing
mechanisms after RMP funding is
completed, allowing reinvestment of
scarce RMP funds in other needed
health services improvements.

 

Demonstration projects result from
extensive but relatively rapid local
development and review; they are
developed in response to community
needs which are objectively verifiable.
One indication of community
commitment and participation in RMP
demonstration projects is the number
of other health orgainzations and
agencies participating as co-sponsors
and co-funders of projects. Joint
funding serves not only to secure
active involvement and financial
commitment of the other agencies to
RMP projects, but also allows an
enhanced project operation during the
time of RMP support. Joint funding
often insures continuation of the
project after RMP funding support is
discontinued.

Since July 1, 1971, the 49 RMPs
developed a total of $52.8 million of
joint funding support for RMP initiated
projects. Amounts of support by
various joint funding sources are
summarized in Figure 6.

1t
Participation by other agencies and
organizations in sharing the dollar
costs of RMP projects is substantial. Of
the 1936 major demonstration projects
initiated by RMPs since July 1, 1971, a
total of 1126 projects were

characterized 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 7

DISTRIBUTION OF JOINT FUNDING SOURCES OF RMP INITIATED

PROJECTS
(Since July 1, 1971) (49 RMPs)

 

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

ONE NON-RMP
FUNDING SOURCE
(739 Projects)
@ @ e
Rag FT wel Bh a a hw TWO NON-RMP
FUNDING SOURCES
(231 Projects)

 

e @ @
- ~ ws ~ - _ THREE NON-RMP
FUNDING SOURCES
(91 Projects)

@ e @ e
est Bt wd PT FOUR NON-RMP
FUNDING SOURCES

(65 Projects)

 

 

 

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

$52.8 Million

Figure 8 shows both the numbers of
eto

co-funded RMP projects and the
sources of funds used by the
co-sponsoring agencies.

 

FIGURE 8
RMP PROJECT FUNDING Privat
BY TYPE OF JOINT SIS6M

FUNDING SOURCE
(Since July 1, 1971) (49 RMPs)

 

29%

 

 

  
 
  

 

(496 Projects)

  
Continuation

“ _, to be maximally effective
requires that most RMP supported
endeavors make adequate provisions
for continuation support once initial
Regional Medical Programs grant
support is terminated; that is, there
generally must be assurance that
future operating costs can be absorbed
within the regular health care financing
system within a reasonable and agreed
upon period.” RMP Mission Statement
of June, 1971.

The willingness of other agencies
and organizations to invest their own
funds to continue services when RMP
financial support has been completed
is an important, concrete measure of
the long-term worth of newly
developed, expanded, or improved
health services. As in the development
of joint funding resources, the RMP
record in this regard is impressive.

FIGURE 9

NUMBER OF DEMONSTRATION
PROJECTS

RMP SUPPORT TERMINATED
(Since July 1, 1971)

FIGURE 10

NUMBER OF DEMONSTRATION
PROJECTS: CONTINUATION
SUPPORT SOUGHT AND
OBTAINED

(Since July 1, 1971)

 
  
 

974 RMP Projects
83%

Over the past three years, RMP
funding was terminated for 1732
demonstration projects, of which 557
were originally planned as “one-time”
activities. Nine hundred seventy-four,
or over 83 per cent, of the remaining
1175 projects initiated with the help of
RMP funds, were continued with other
funds following termination of RMP

support.

1732 PROJECTS

1175 RMP Projects
fe}

8%

  

1175 PROJECTS

 

Continuation
Support Not
Obtained

Planned as “one-time” projects

Continuation
Support
Obtained
 

18

Figure 11 summarizes the number of
single or multiple sources of one year
continuation funding of projects.

FIGURE 11

NUMBER OF SOURCES PROVIDING CONTINUATION FUNDS FOR RMP
TERMINATED PROJECTS
(Since July 1, 1971)

 

NUMBER SOURCES OF CONTINUATION FUNDS

NON-RMP FUNDS
(661 RMP Projects)

@ @ e@
wt Re ss TWO SOURCES
NON-RMP FUNDS
(222 RMP Projects)
@ e@ e@ e
west Be” wh Ba we Bh Iw THREE SOURCES
NON-RMP FUNDS
f A (59 RMP Projects)
e e e e e
et Ee od Ba ed BRS eB I FOUR SOURCES
NON-RMP FUNDS
(32 RMP Projects)

The 974 Projects had a total of 1400 sources of funding.

e e@
VT ONE SOURCE

 

 

 

In areal sense, local communities FIGURE 12
and agencies have frequently “voted” ©RMPPROJECTS AFTER RMP FINANCING COMPLETED:
with their dollars forthe maintenance of FIRST YEAR CONTINUATION FUNDING AMOUNTS

worthwhile activities of RMP initiated AND SOURCES $58.5 MILLION
projects. Continuation funds are (974 Projects Since

supplied by State and local July 1, 1971)
governments, other Federal agencies ,
or programs, and private sources,
including fee-for-services
reimbursements by insurance
companies and individuals.
Approximately one-third of the 974 Figure 12 summarizes
projects continued after termination of the relative dollar amounts
RMP funding involved several from sponsoring sources for one
sources of support. year continuation funding of projects.

  
 

Private
$17.7
30%

 
    
  

 

 
The success of RMPs in developing
continuation support for improved
services initiated as demonstration
projects is due in part to the efforts of
local RMP program staffs in planning
for, and specifically building into
projects those features that increase
the likelihood of continuation support.
In addition to rebudgeting surplus
project funds as a result of effective
fiscal monitoring, limiting the period of
the RMP support, (usually toa
maximum of three years) enables local
Regional Advisory Groups to reinvest
available funds to accelerate
development of other activities and
projects needed to improve local health
services for people.

NEW HEALTH ORGANIZATIONS
AND FORMAL COOPERATIVE
ARRANGEMENTS

Creation of needed new health
organizations or formal cooperative
arrangements is a frequent outcome of
RMP demonstration projects or
technical assistance processes.

The RMPs (47) reported a total of
over 6,000 occasions since July 1,
1971, where demonstration projects or
substantial assistance resulted in the
creation of “new health organizations”
or “new formal cooperative
arrangements” between elements in
local health services sytems.

New health organizations include
currently continuing clinics, rural health
stations, medical care foundations,
areawide planning agencies and
expansion of services to underserved
areas. New formal cooperative
arrangements include additional
needed health manpower training
programs, shared services
agreements and similar cooperative
efforts to achieve greater efficiency of
local health care systems.

Major occasions in which substantial
RMP assistance was provided to
create new health organizations or
cooperative arrangements at the local
level are described below.

Establishment of New Health
Services includes occasions where the
arrangements or organizations created
resulted in the provision of health
services not previously available on a
continuing, permanent basis; e.g., rural
health stations, neighborhood health
centers, health screening stations,
out-patient clinics, pre-paid health
service plans.

Specific examples include:

...aNortheast RMP has established
6 new ambulatory outpatientclinicsina
medically underserved metropolitan
area where the population per square
mile is almost 50,000 people; nearly
45,713 patient visits have been
recorded since the first unit was
opened on November 7, 1972. Asa
direct result of these ambulatory
clinics, utilization of hospital
emergency rooms as the place of
primary care has decreased by fifty per
cent.

...amedically underserved area,
which has only eight physicians
serving a population of almost 79,000
was given a boost by a Western RMP in
establishing a clinic, the Centro de
Salud, which has served 2,400 people
since its August, 1973, opening;

... another Western RMP supported
training and placement of 13 family
nurse practitioners who have served
9100 isolated rural patients since
completing training.

New Health Organizations
Created includes creation of new local
organizations and cooperative
arrangements for heaith planning,
manpower, and health service
development. Examples include
“area-wide comprehensive health
planning agencies”, Experimental
Health Service and Delivery Systems,
manpower training consortia, and
quality assurance organizations.

...an RMP in the South Central
United States supported the
development of six health planning
agencies with dollars, staff and
facilitating efforts; all six are currently
approved CHP (b) agencies. Four
other CHP agencies are currently in
advanced stages of development and
will complete comprehensive health
planning coverage of the entire state.

... RMPs in the Pacific Northwest
and in the South acted in primary
leadership roles to create statewide
consortia of private and public health
interests to implement coordinated,
statewide comprehensive cancer
control programs.

Formalization of Sharing of
Existing Resources includes
occasions when two or more local
health care facilities formalize
agreements to jointly support staff or
related services, common purchasing
and billing arrangements, or
regionalization of specialized health
services.

...a Midwest RMP fostered the
development of ten distinct
“Cooperative Resource Sharing
Groups” primarily to cooperate in the
provision of in-service education
programs. Sixty-eight institutions,
comprised of 60 of the state’s 110
hospitals and 8 nursing homes, are
currently participating in the program.
The estimated savings due to sharing
of audio-visual resources and
in-service instruction time amounts to
$171,200. In addition, spin-offs due to
this cooperative effort have hada
unifying effect on other areas including
shared purchasing, services and
personnel.

wd

wo
.. an RMP in the

Northeast developed agreements
among 23 of 50 hospitals in the Region
to support a coordinated tumor registry
for an investment of $184,975 (through
December of 1973) and modest
amounts of staff time. The goal of this
project is to serve cancer patients by
stimulating continuity of care and to
promote continuing physician
education and train medical records
personnel in a specialized form of
record keeping to improve patient
followup.

Establishment of New Training
Programs includes assistance to
educational institutions, health
organizations and facilities in the
development of new health manpower
training programs needed and
supported financially at the local level.

FIGURE 13

...an RMP in the West created a
statewide corporation representing all
health professions to provide needed
continuing education ona
self-supporting basis. Since its
creation, the organization has provided
planned continuing education
experiences for over 9000 health
professionals who are essentially
isolated from large medical centers or
other resources for assistance in
maintaining current competence and
developing new skills.

...an RMP in New England was
instrumental in creating and guiding
the development of a statewide
manpower training consortium. Since
its inception, the consortium has
installed 3 needed “mid-level”
practitioner training programs,
graduated 60 needed health
professionals, and moved effectively
toward the establishment of a
continuing university-based,
integrated training effort of these types
of personnel.

Figure 13 summarizes the occasions
that RMPs provided substantial
assistance to local communities in
creating new health services or

NEW ORGANIZATIONS OR FORMAL
COOPERATIVE ARRANGEMENTS CREATED:
RMP TECHNICAL ASSISTANCE OCCASIONS
(Since July 1, 1971)

(47 RMPs)

Number of
Occasions

   

1830

1676

 

NEW
HEALTH
ORGANIZA-
TIONS

 

 

 

 

supportive organizations and formal
cooperative arrangements described
above.

 
RMPs described several specific
methods and activities used in
providing assistance in creating new
organizations and formal agreements.
Included are:

__ Provision of direct RMP financial
assistance;

— Assistance in securing non-RMP
financial support;

— Assistance by “loaning” or
“detailing” RMP program staff fora
short period of time;

— Provision of specialized staff
technical expertise and/or external
consultants;

— Assuming leadership in providing
the initiative to convene interested and
necessary principals.

— Securing the cooperation and
support of others.

TABLE XIV
USE OF TYPES OF RMP ASSISTANCE IN CREATING
NEW HEALTH ORGANIZATIONS & FORMAL
COOPERATIVE ARRANGEMENTS
(Since July 1, 1971)

(47 RMPs)

The numbers of occasions RMPs
used these specific methods while
assisting in the creation of four kinds of
new health organizations and
cooperative arrangements are
summarized in Table XIV.

 

Totals

5713

3282

3024

1827

1105

851

 

21
RMPs assisted a wide array of local
agencies and professional
associations in joint efforts to develop
new health organizations, services and
agreements.

The number of occasions other local
agencies received substantial
assistance in developing such
resources are summarized in Table
XV.

TABLE XV

OCCASIONS OF TECHNICAL ASSISTANCE PROVIDED
OTHER AGENCIES IN DEVELOPING NEW ORGANIZATIONS
AND FORMAL ARRANGEMENTS

(Since July 1, 1971)

(47 RMPs)

 

 

 

 

 

 

 

 

 

 

New
AGENCIES ASSISTED 4} New Health Sharing Training. - Totals
Organizations Resources Programs ‘
State and Local
Medical Societies 306 109 871
Other Professional
Associations 246 137 842
Volunteer Health
Associations 238 287 1048
State and Local
Health Departments 306 403 1457
Comprehensive Health
Planning Agencies
(A and b) 308 151 907
Educational —
Institutions 370 261 1474
All Others — 371 852 2191

 

 
DEVELOPMENT OF RESOURCES RMPs provided substantialtechnical Application requests totaled over

FOR LOCAL SERVICES assistance in preparation of $368 million, a sum whose magnitude

IMPROVEMENTS applications for non-RMP funds toa —_ isindicative ofa major development
Another major outgrowth of RMPs’ wide array of local agencies and effort. Figure 14 summarizes the

community-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 in

constructed, effective working preparing a total of 1,135 applications

relationships with major segments of for funds for health services

the private and public sectors provide a improvements from (non-RMP)
basis of confidence which underlies — Federal, State, local and private
numerous requests for technical funding sources.

assistance to develop applications for

funds to support implementation of TOTAL $169.9 Million
locally appropriate improvements in .

health care services systems.

   
  
 

Local $3.2 M

 

FIGURE 14

TOTAL DOLLAR REQUESTS AND
SOURCES

RMP Assisted Applications for Non-RMP Stale $35.3 M
Support

(49 RMPs)

 

 

TOTAL $109.8 Million

TOTAL $88.7 Million
ws Private $2.5: Mites ais

 

      

 

 

Local$ .8M—

 

 

Federal $76.5 M Federal $77.7M Federal $113.2M

 

 

 

 

 

 

 

 

 

FISCAL YEAR 1972 FISCAL YEAR 1973 FISCAL YEAR 1974 ©
One indirect measure of the worth of
RMP technical assistance is the dollar
amount of the non-RMP awards
actually made to local agencies and
organizations assisted in the
preparation of applications. Figure 15
is asummary of the total dollars in
non-RMP awards received by local
health organizations in cases when
RMPs provided substantial technical
assistance in developing the
application.

FIGURE 15

TOTAL DOLLARS RECEIVED AND
SOURCES:

RMP Assisted Applications for Non-RMP

Support
(49 RMPs)

TOTAL $65.2 Million

TOTAL $47.2 Million

Local .9M

 

 

 

 

TOTAL $116.5 Million

 

 

Federal $36.5 M Federal $40.4 M

 

 

Local $3 M

 

Federal $70.7 M

 

 

FISCAL YEAR 1972 FISCAL YEAR 1973

FISCAL YEAR 1974

 
While the specific purposes for
which non-RMP funding was sought
have not been enumerated, in many
cases, applications were for funds to
support continuation of RMP projects
or for the creation of new local health
care services organizations or formal
cooperative agreements previously
described.

Total dollar volume of applications
dogs not, in itself, adequately describe
RMP assisted improvements in local
health care services or the RMPs
community development role.
However, inferences about the dollar
volume may be drawn from three
perspectives:

(1) The community perspective:
RMPs have provided substantial
assistance in effective project planning
and review, and have successfully
played a major role in developing
needed additional fincancial resources
for local health improvements.

COMMENT

In addition to improving services to
people the RMPs have developed a
community-based process which is an
effectively functioning model of a
federally supported, largely locally
controlled implementing agency which
has major impact on local health care
services systems.

The RMPs remain a major National
resource capable of prudently and
effectively assisting local communities
to implement expanded health
services for people.

(2) The Federal perspective: The
necessity has been reduced
significantly for creating new
bureaucracies to implement new
programs ina locally acceptable and
valid manner.

(3) The RMP perspective: Provision
of technical assistance to develop
applications for other agencies insures
the continuation of RMP initiated
improvements, enhances RMP
program operations through
coordinated community efforts and
establishes a mechanism for
maintaining effective working
relationships with the widest array of
local health interests.

 
COORDINATORS’
EXECUTIVE COMMITTEE

Donal R. Sparkman, M.D., Chairman
Washington/Alaska RMP

Morton C. Creditor, M.D.
lilinois RMP

Robert W. Brown, M.D.
Kansas RMP

J. S. Reinschmidt, M.D.
Oregon RMP

Granville W. Larimore, M.D.
Florida RMP

Manu Chatterjee, M.D.
Maine RMP

Arthur E. Rikli, M.D.
Missouri RMP

Mr. Robert Murphy
Tri-State RMP

Mr. Paul D. Ward
California RMP

John R. F. Ingall, M.D.
Lakes Area RMP

J. Gordon Barrow, M.D.
Georgia RMP

Mr. Robert Youngerman
Southeast RMPs .

 

PAR GROUP COUNCIL

C.£. Smith, Ph.D., Chairman
Mountain States RMP

John D. Cambareri, Ph.D.
Project Administrator
Mountain States RMP

Mr. Harry Auerbach
North Central RMPs
Illinois RMP

Mr. Robert Miller
Northeast RMPs
Lakes Area RMP

Mr. Roger Warner
South Central RMPs
Arkansas RMP

Mr. Roland Peterson — ex officio
DRMP
Rockville, Maryland

Gordon Engebretson, Ph.D.
Southeast RMPs
Florida RMP

Charles H. White, Ph.D.
Western RMPs
California RMP

John A. Mitchell, M.D. — ex officio
California RMP
Chairman, Ad Hoc Evaluation Committee

J. Gordon Barrow, M.D. — ex officio

Georgia RMP
Chairman, Government Information Committee

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