HOSPITAL PREPAREDNESS PROGRAM (HPP) 3.0: RESPONSE READY. COMMUNITY DRIVEN. HEALTH CARE PREPARED. National Healthcare Coalition (HCC) Preparedness Conference Melissa Harvey December 14, 2016
Evolution of Preparedness and Response 9/11 and Anthrax Attacks SARS Pandemic Hurricanes Katrina, Rita and Wilma H1N1 Pandemic Fort Hood Shooting Haitian Earthquake Deepwater Horizon Fukushima Earthquake and Nuclear Event Joplin Tornado Hurricanes Isaac and Sandy Sandy Hook Shootings MERS-CoV Ebola Outbreak Texas Fertilizer Plant Explosion Boston Marathon Bombings Flint Water Crisis Amtrak Derailment Zika Pulse Shooting Hurricane Matthew Louisiana Flooding 2001 2002 2003 2005 2006 2009 2010 2011 2012 2013 2014 2015 2016 HPP Launched at HRSA Photo credit: FEMA.gov, CDC.gov, and HHS.gov MSCC Report HPP Relocated to ASPR Crisis Standards of Care Report HPP and PHEP Align HPP Releases Health Care Preparedness Capabilities 2 HPP Leads Ebola Response HPP Releases Health Care Preparedness & Response Capabilities
HPP s Recent Developments and Way Ahead 3
Evolution from Facility-Based Equipment to an HCC Capabilities-Based Approach 2002-2011 2012-Present Facility-based equipment purchases Personal protective equipment, mobile medical units, pharmaceutical caches, other emergency supplies and equipment Capabilities-based approach to planning HPP funding is used to enhance health care system planning and response at the state, local, regional, and territorial levels. Foundation for Health Care and Medical Readiness Health Care and Medical Response Coordination Continuity of Health Care Service Delivery Medical Surge 4
HPP s Data-Driven Innovations to Advance Health Care Preparedness Current Project Period 2012-2016 Next Project Period 2017-2022 Capabilities developed in 2012 focused on aligning the HPP and PHEP programs to better integrate medical and public health systems Refining Capabilities to distinguish between Medical and Public Health Activities and Reflect Changes in Health Care Delivery Systems Initial measures set a high bar for performance; however, they are subjective and are not easily validated Improving Performance Measurement to be Objective and Exercise-based Fostered collaboration among competitive health care entities through the establishment of regional HCCs across the country Grant alignment reduced awardee burden, eliminated federal duplication and improved federal efficiency Optimizing HCCs Through Core Member Participation to Maximize Effectiveness and Functionality Refocusing HPP Funding on Health Care Entities by Limiting Awardee-Level Direct Costs to Ensure Funds Target Medical Preparedness 5
HPP s Updated Guiding Documents Health Care Preparedness and Response Capabilities Detail the high-level objectives that the health care delivery system should achieve in order to effectively prepare for, respond to, and recover from public health emergencies that require medical surge Program Performance Measures Track program implementation to inform decision-making Objectively gauge program performance through exercises Enable better communication of program results to policy and congressional stakeholders 6 Funding Opportunity Announcement (FOA) Details program requirements for both HPP and PHEP (as well as joint requirements) for the next five-year project period of July 2017-June 2022 HPP requirements will identify those for awardees, as well as those for HCCs
Capability 1: Foundation for Health Care and Medical Readiness Define boundaries to include enough members to ensure adequate resources Establish a governance structure developed by HCC members Ensure the HCC includes core members (acute care hospitals, emergency medical services, emergency management agencies, and public health departments), and other members pertinent to their jurisdiction's preparedness and response Develop a comprehensive Preparedness Plan Conduct annual training and exercises based on identified preparedness and response gaps Engage health care executives, clinicians, and community leaders to communicate HCC value and promote sustainability 7
Capability 2: Health Care and Medical Response Coordination HCC response means: information sharing, resources management, and response strategy coordination Develop an HCC Response Plan Track members resource availability and needs, identify essential elements of information, and communicate information Develop information sharing procedures Develop an incident action plan (IAP) based on members plans and integrate plans into jurisdiction's IAP Facilitate clinical knowledge sharing among health care providers and health care organizations during responses Assist with communication to the public during emergencies 8
Capability 3: Continuity of Health Care Service Delivery Develop an HCC Continuity of Operations Plan (COOP) Collect and coordinate information on members equipment, supplies, and pharmaceutical stores and needs Assist members with developing strategies to protect health care information systems and networks Protect responders, employees, and their families through promotion of regional PPE procurement, training and exercising, and developing health care worker resilience Coordinate the planning, exercising, and implementation of evaluation and relocation Monitor, facilitate, and coordinate health care delivery system recovery 9
Capability 4: Medical Surge Incorporate medical surge plans into an HCC Response Plan that include: Activation and notification processes to initiate medical surge response coordination Crisis standards of care plans Strategies to track identified and unidentified patients Processes for coordinated joint decision making about resource allocation Coordinate an approach to share information and resources for managing the following types of medical surge responses: In-patient medical Pediatric care Behavioral health surge Exposure management Infectious diseases Out-of-hospital medical to chemical or radiation Medical surge Burn care countermeasures Alternate care systems Trauma care 10 Mass fatalities
2017 Performance Measures The 2017 Performance Measures have been finalized There are 28 measures (6 apply only to Islands) Allow HPP to objectively track trends in engagement, coordination, communication, patient care, and continuous learning Collect baseline in the first budget period 50% of the performance measures are exercise-based 8 of the 28 measures can be captured during an approximately 4-hour Coalition Surge Test exercise 2 measures can be captured during a communications exercise, defined in forthcoming technical documentation 4 measures that apply to Islands only can be captured during the Hospital Surge Test exercise 11
HPP s Progress and Opportunities 12
Core Membership: Enabling HCC Response While HCCs should have diverse membership, there are four core members that must be present. Behavioral and Mental Health Centers and Agencies Outpatient Facilities Emergency Medical Services Home Health Agencies Health Centers Rural Health Centers Community Health Centers Emergency Management Agencies Physicians Primary Care Specialists Health Care Coalition (HCC) Long Term Care Skilled Nursing Facilities Hospice Care Community Partners Academic Institutions Non-profits Volunteers Local Government Elected Officials Fire Departments Police Departments Hospitals Public Health Departments 13
HCC Membership is Growing There are 28,055 HCC members nationwide, a 63 percent increase from BP1. HCC Core Members Hospitals - 86% Local Health Departments - 75% Emergency Management Agencies - 46% Emergency Medical Services - 23% Psychiatric Residential Treatment Facilities - 31% Skilled Nursing Facilities - 29% Federally Qualified Health Centers - 26% End Stage Renal Disease Dialysis Clinics - 16% Community Health Centers - 16% Rural Health Clinics - 14% Hospices - 11% Community Mental Health Centers - 11% Ambulatory Surgical Centers - 8% Home Health Agencies - 6% BP1 HCC Members BP2-BP4 HCC Member Change from BP1 BP4 Non-HCC Members Data as of 10/24/2016 0 5,000 10,000 15,000 20,000 14
Core Member Participation Enhances Load-Sharing During Emergencies BP1 BP2 BP3 BP4 Even after significant progress, only 58% of HCCs include all four core member types. 15
Moving From Planning Bodies To Coordinating For Response % of HCCs with 8+ HCCDA Factor Scores 100% 80% 60% 40% 20% 0% 46% Percent of HCCs with Operational Capabilities 50% Incident Management 54% 51% 60% Situational Awareness 61% 36% 45% 46% Resource Support & Coordination BP2 BP3 BP4 While a greater number of HCCs are increasing their operational readiness, more than 60% of HCCs do not considered themselves response-ready. 16
The New CMS Emergency Preparedness Rule Creates Exciting Opportunities for HCCs The new Centers for Medicare & Medicaid Services (CMS) rule offers HCCs and newly engaged providers a tremendous opportunity to achieve greater organizational and community effectiveness and financial sustainability. HPP anticipates that health care entities that have not previously engaged in community preparedness will seek to do so through participation in HCCs HCCs will function as an accessible source of preparedness and response best practices as newly engaged provider types adapt to the new requirements HPP funding may not be used by individual health care organizations to meet the requirements of the CMS rule, but may be used by HCCs to provide technical assistance to their members 17
HCC Funding and Resources 18
Renewed Focus on Funding for HCCs HPP has re-examined the percentage of funding awardees may retain for managing and monitoring the HPP cooperative agreement. For budget periods 3-5, the average percent retained across awardees for program management was 21% For the 2017-2022 project period, tighter restrictions will be placed on the amount of funding awardees may retain for managing and monitoring the program. Funding for the awardee s staff, fringe benefits, and travel must be limited to no more than 18% of their total HPP award By the end of BP5, this funding must account for no more than 15% of the awardee s total HPP award In the 2017-2022 project period, cooperative agreement funds must primarily support collaborative HCC development. 19
ASPR TRACIE Has Many Resources to Support HCCs Self-service collection of audience- tailored materials Subject-specific, subject matter expert (SME) reviewed Topic Collections Unpublished and SME reviewed materials highlighting Real-life tools and experiences Personalized support and responses to requests for information and training and technical assistance Accessible by toll-free number (1-844-5-TRACIE (844-587-2243)), email (askasprtracie@hhs.gov), or web form (ASPRtracie.hhs.gov) Area for password-protected discussion among vetted users in near real-time Ability to support chats and the peer- to-peer exchange of user-developed templates, plans, and other materials 20
ASPR TRACIE Provides Support for the CMS Emergency Preparedness Rule Dedicated CMS Rule page: ASPRtracie.hhs.gov/CMS rule CMS Emergency Preparedness Rule: Resources at Your Fingertips document Provides description of each of the 17 supplier and provider types affected by rule Includes requirements crosswalk table ASPR TRACIE s Topic Collections and provider- and supplier-specific resources can help organizations involved in implementing the CMS requirements with resources tailored to their specific needs Assistance Center support 21
HCC Response Leadership Course Overview Developed by the Division of National Health Care Preparedness Programs (NHPP) and FEMA s Center for Domestic Preparedness (CDP). Held at CDP in Anniston, Alabama. Three day course provides instruction and exercise opportunities to guide coalitions in preparing and responding as a HCC leadership team. Target Audience: Health care leaders, public health leaders, emergency medical service leaders, emergency management professionals and public officials. There will be 27 participants in the class representing three HCCs with 9 participants per HCC. Travel, lodging, and meals will be provided for non-federal participants who are registered through CDP for the course. 22
HCC Response Leadership Course Dates and Registration Training Week Travel To Anniston Training Return from Anniston Week 18 Monday 30 Jan Tuesday-Thursday Friday 3 Feb Week 21 Tuesday 21 Feb Wednesday-Friday Saturday 25 Feb Week 29 Monday 17 Apr Tuesday-Thursday Friday 21 Apr Week 41 Sunday 9 Jul Monday-Wednesday Thursday 13 Jul Week 51 Monday 18 Sep Tuesday-Thursday Friday 22 Sep To be considered for a course, please complete a request form (distributed via the HCC Listserv) and send to: Richard.Hunt@hhs.gov 23
Questions? 24
Appendix 25
2017-2022 Health Care Preparedness and Response Capabilities Capability Foundation for Health Care and Medical Readiness Health Care and Medical Response Coordination Continuity of Health Care Service Delivery Medical Surge Capability Goal The community s health care organizations and other stakeholders coordinated through a sustainable HCC have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources. Health care organizations, the HCC, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events. Health care organizations, with support from the HCC and the ESF-8 lead agency, provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well-educated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations. Health care organizations including hospitals, EMS, and out-of-hospital providers deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The HCC, in collaboration with the ESF-8 lead agency, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the HCC s collective resources, the HCC supports the health care delivery system s transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible. 26
Geographic Distribution and Population Coverage of HCCs in the U.S. Currently there are 476 HCCs nationwide, ranging from 1 to 60 per jurisdiction. Current HCC population coverage: 62% of HCCs cover less than 500,000 19% of HCCs cover between 500,001 1,000,000 8% of HCCs cover between 1,000,001 1,500,000 3% of HCCs cover between 1,500,001 2,000,000 8% of HCCs cover more than 2,000,000 27