Connecting the Dots:
Interagency &
Intergovernmental
Collaborations Related to
Health Care
Merle Cunningham, MD MPH
Learning Objectives
At the end of this session, participants will be able to:
1. Better understand the key Federal players and
collaboration among Federal Executive Branch
agencies with respect to health care & CHCs
2. Better appreciate the role of key State and Local
government players who relate to health care &
CHCs and their collaboration with Federal
agencies
Session Overview
• Federal level: Executive Branch
– Administrative agencies related to health care
• State and local (county/city) level
– Administrative agencies related to health care
• Examples of collaboration among key players
Collaboration among Key Players
• Childhood & Adolescent life cycles
– Early childhood development
– Immunization registries
-Asthma
-Obesity
• Women’s Health life cycles
– Family planning & prenatal care (reproductive health)
– Screening & prevention (breast & cervical CA, HTN)
• Adult life cycles
– Diabetes
– Heart disease
– Depression
-Obesity
-Cancer
Federal Executive Branch
• Key Powers related to Health Care
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Agenda setting
Interact with legislative & budget process
Issue/promulgate regulations within statutes
Provide oversight and monitoring
Financing – grants, contracts, health insurance
Federal Executive Branch
Key Health Care Players (Cabinet level)
– Administrative Agencies (Direct healthcare roles)
• DHHS (HRSA, CDC, SAMHSA, AHRQ, ONC, NIH,
AoA, FDA, OGC, CMS)
– Administrative Agencies (Indirect healthcare roles)
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USDA (WIC, Food Stamps, Coop Extension Service)
Education (Health Educ Curriculum, School Health)
DVA (Veterans Health Administration)
Defense (Tri-Care: Military Health Service)
Note: for underlined agencies Organizational Chart provided
HHS Organizational Chart
CDC
Bureau of Primary Health Care
Administers Health Center programs
• Policies: Policy Information Notices (PINs) and
Program Assistance Letters (PALs)
• Program requirements, grants management
• Technical Assistance
• UDS data
• FTCA deeming
State Government
• Key Health Care Players
– Variable agency structure & authority related to State
constitutions
– Typical players in some variation or combination:
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State Health Department
State Mental Health Department
State Medicaid Office
State Office: licensing & regulation of insurance companies
State Office: licensing & regulation of facilities (CON, etc)
State Education Department (staff licensing)
• Complex relationship with Federal Agencies
– Varying levels of federal intervention over time
Local Government (County or City)
• Local Public Health Agencies (LPHA):
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Created by referendum or legislation
Part of state network with shared responsibilities
Usually formed and managed by local government
May share oversight or directly operate health services
• Typical Players/Structures
– County health and or mental health departments
– City health or mental health departments
Collaboration among Key Players
• Childhood & Adolescent life cycles
– Early childhood development
– Immunization registries
-Asthma
-Obesity
• Women’s Health life cycles
– Family planning & prenatal care (reproductive health)
– Screening & prevention (breast & cervical CA, HTN)
• Adult life cycles
– Diabetes
– Heart disease
– Depression
-Obesity
-Cancer
Questions?