OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH
THE USPHS COMMISSIONED CORPS America’s Health Responders
ADMIRAL BRETT P. GIROIR, M.D. Assistant Secretary for Health Commissioner of Food and Drugs (Acting) U.S. PUBLIC HEALTH SERVICE COMMISSIONED CORPS
“the Commissioned Corps… a mobile, duty-bound group of health officers willing to go anywhere, at any time, to meet the nation’s most urgent public health needs.”
Craig Collins The PHS Commissioned Corps Two Centuries and Counting
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 2 USPHS COMMISSIONED CORPS ABREVIATED HISTORY
1798 Act for the Relief of Sick and Disabled Seamen 1870 Marine Hospital Service 1871 First Supervising Surgeon (later Surgeon General) Dr. John Maynard Woodworth 1878 National Quarantine Act 1889 Legislation created the Commissioned Corps 1912 Public Health Service (with broadened powers) 1930 Parker Act: Expanded Public Health Service to Non-Physicians 1955 Establishment of the Indian Health Service 1979 Department of Health and Human Services established 1999 First Dedicated Disaster Response Mission for the Commissioned Corps (20,000 Kosovo refugees)
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 3 IMPACT OF THE NATION’S DOCTOR
VADM Jerome Adams
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 4 OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 5 IMPERATIVE FOR MODERNIZATION
OMB BUDGET GUIDANCE 2018
“…the Corps’ mission assignments and functions have not evolved in step with the public health needs of the Nation. …
The specific recommendations and plans …could range from phasing out unnecessary Corps functions to re- inventing the Corps into a smaller, more targeted cadre focused on providing the most vital public health services and emergency response.”
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 6 USPHS MODERNIZATION: ASSESSMENT AND PROCESS
Independent Data-Driven Self-Assessment Cost Assessment
Initial Phase Comprehensive Phase Implementation Phase
(Jun 2018 – Sept 2018) (Mar 2018-Sept 2018) (Sept 2018 – May 2019) (Jun 2019 – Jun 2021)
• Compensation relative to f • Force size and structure • Comprehensive • Implementation of comparable civilian based on current and assessment of HQ recommendations professions projected future missions infrastructure • Improve Corps IT Systems • Complexities of retirement • Findings and preliminary • Recommendations • Ready Reserve and benefits packages modernization strategies and activities to support implementation • Training • First cost assessment • Delivered to CC: February 11 Town Hall since 1996 GAO Study • HQ improvements
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 7 MODERNIZATION: TOP LINE FINDINGS
• Increased Demand for Officers on Deployments - Deployments increased an average of 44% per year - Officers perform the majority of intra-agency deployment responses (FDA, IHS, CDC, CMS, others) - New opportunities for public health deployments
• Increased Agency Demand for Officers - Bureau of Prisons (+162%), Indian Health Service (+60%), and Department of Homeland Security (+60%) Between 2013-2019, • Costs for Officers officers deployed 7,976 times, - Overall costs for officers generally overlap with comparable contributing 135,587 federal civilians; but on average, officers are more expensive deployment-days to - Officers fill critical positions for underserved and vulnerable populations for which recruiting enough civilians is not possible 140 different missions
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 8 DEPLOYMENTS: >50 OFFICERS (2013-2019)
2017 Hurricanes Harvey/Irma/Maria 1819 2014 -2015 Ebola Support 800 2019 CBP Health Screening Support Mission 427 2014 Unaccompanied Children 337 2018 Hurricanes Florence/Isaac/Olivia 247 2017 58th Presidential Inauguration 216 2018 Unaccompanied Children 213 2016 IHS Great Plains Support 200 2016-2017 Major Flooding Louisiana 200 2016 Hurricane Matthew 146 2013 57th Presidential Inauguration 138 2019 Remote Area Medical - Baltimore, MD 131 2018 COA Remote Area Medical Clinic 125 2019 Remote Area Medical - Weatherford, OK 124 2019 Remote Area Medical - Operation Lone Star 122 2017 Remote Area Medical - COA Clinic 115 2017 Remote Area Medical - Idabel, OK 100 2015 Papal Mission - DC 89 Mission types (Top 4) 2018 Hurricane Michael 81 DoD Humanitarian 2016 Remote Area Medical - Durant, OK 75 - Natural disasters (2,493) Service Medal 2016 State of the Union Address 72 2016 Independence Day Celebration 66 - Public health crises (1,977) 1,136 Commissioned Corps 2013 Independence Day Celebration 65 - Diplomatic events (861) Officers awarded for 2017 2019 Remote Area Medical - Minneapolis, MN 64 2014 State of the Union Address 55 - Remote area support (856) Hurricane Response 2015 Independence Day Celebration 55 2013 State of the Union Address 54 2018 State of the Union Address 51
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 9 SUPPORTING THE CRISIS AT THE SOUTHERN BORDER
U.S. SOUTHERN BORDER UAC REUNIFICATION SUPPORT Support DHS/Coast Guard Mission Data Analysis and Case File Review
• Deployment Days: 6759 • Deployment Days: 335 - 483 Officers Deployed - 33 Officers Deployed - 30 Dec 2018 – 2 Oct 2019 - 2 May 2019 – 7 July 2019
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 10 11
VISION FOR A 21st CENTURY COMMISSIONED CORPS
ALWAYS READY MEET CRITICAL AGENCY NEEDS A highly-trained, always-ready, fully- A provider of direct healthcare, public health deployable national asset to preserve public leadership, and scientific expertise when health and national security during national specifically needed to fulfill U.S. or global public health emergencies Government requirements
CHANGE THE MAP INNOVATION ENGINE A fundamental instrument of national An innovation engine for public health response for non-emergent, yet critical, technologies, communications, systems, public health challenges within the United and systems of systems States and territories
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 11 12 MODERNIZATION PLAN: HOW TO ACHIEVE THE VISION
. Manage the Force to Meet Mission Requirements - Recruit for underserved and vulnerable missions - Expand mission-priority positions - Decrease non mission-priority positions (most by retirement, advancement or normal attrition) once Ready Reserve has been implemented
. Establish and Train a Ready Reserve Corps
. Enhance Training and Professional Development for the Regular Corps
. Improve Processes and Systems
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 12 MODERNIZATION PLAN: FORCE NUMBERS AND STRUCTURE
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 13 RECRUITMENT AND RETENTION ARE OUR TOP PRIORITIES
OFFICE OF THE 14 ASSISTANT SECRETARY FOR HEALTH 14 RECRUITMENT OF OFFICERS FOR MISSION PRIORITY POSITIONS
Underserved Difficult to Direct and Vulnerable Recruit or Retain Clinical Care Populations Categories
Hazardous Duty Leadership or Health Security or Deployment Positions Utilization
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 15 ESTABLISHING THE READY RESERVE
Guarantees Response • Ensures the Commissioned Corps has the resources to meet its mission to Capabilities respond to regional, national, and global public health emergencies.
Preserves Critical • Maintains a sufficient supply of health professionals available for deployment without jeopardizing service of clinicians with hardship, hazardous, and/or hard Clinical Care Positions to fill roles.
• Reserve Corps force composition will be optimized for deployment requirements, Tailors Force Composition not agency operations.
• Offers an opportunity to serve for mission-driven clinical and public health Broadens Recruitment professionals who cannot commit to a full-time active duty position in the Corps.
Enables Access to • Enables mechanism for access to high-cost and/or highly specialized skill sets that would be infeasible and impractical in an active duty full-time capacity (e.g., Specialized Providers critical care transport teams).
Retains High-demand • Creates an option to retain high-demand, already-trained clinical professionals Clinical Professionals (medical officers and dentists) that have the highest separation rates.
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 16 United States Public Health Service Modernization Act of 2019
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 17 ENHANCE TRAINING
Operational Training Strategic Collaborations Training will align with response mission . Chemical, Biological, . National Guard Bureau Radiologic, Nuclear and requirements Explosive Awareness and . Remote Area Medical Response Training Natural disasters . National Defense Global infectious disease outbreaks . National Disaster University Management Systems Large scale repatriations Training . Military Engagement opportunities Drug related responses . Uniformed Services (DoD/USNS Comfort) CBRN threats University of Health Sciences Bushmaster . Veterans Administration Individual and unit based Exercise requirements
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 18 TRAINING: NATIONAL GUARD PARTNERSHIP
Ceremonial Signing June 11, 2019
Joseph Lengyel Brett P. Giroir General, USAF Admiral, USPHS Chief, National Guard Bureau HHS, Assistant Secretary for Health
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 19 20 REMOTE AREA MEDICAL MISSIONS (2019) Minneapolis, Texas Border, Oklahoma, Houston
• Officers Participating: 473 • Deployment Days: 1,886 • Patient Encounters: 9,357
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 20 USNS Comfort Mission
• 17 June – 15 November 2019 • 27 Officers Deployed • Deployment Days: 1110
Hold for PHOTO of AMA sendoff
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 21 READINESS AND DEPLOYMENT TEAMS
HEALTH AND MEDICAL SERVICES BEHAVIORAL HEALTH SERVICES • Scoped to support FEMA General Population Holding Facilities and • Support impacted citizens and deployed teams; Incident assessment and ASPR Health and Medical Treatment Facilities personnel assessment (diagnosis and treatment);. screening for suicide risk, substance abuse and mental health disorders
PUBLIC HEALTH SERVICES ASSISTANCE ACCESSING FOLLOW-ON • Augment State and Local Public Health Departments; Epidemiology/surveillance; Preventive (medical) services delivery and SERVICES Environmental public health (air, water, wastes, vectors, food, safety, • Support impacted citizens and partner OPDIVs and STAFFDIVs to shelter, etc.) coordinate patient movement of those displaced during emergency situations; Team size increased to match historic requirements
INCIDENT SUPPORT SERVICES BACKFILL AND INDIVIDUAL AUGMENTATION • Focus on Mission Generation and Incident, provide rapid assessments • All USPHS categories represented; Each member with rostered position and initial incident coordination resources and assistance to State, Tribal on a rapid deployment unit and local health authorities
INCIDENT MANAGEMENT SERVICES • Focus on Mission Execution, provide a structured, incident command USPHS DEPLOYMENT READINESS system approach to managing and coordinating response activities >95%
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 22 23
CHANGE THE MAP
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 23 PREVENTION THROUGH ACTIVE COMMUNITY ENGAGEMENT (PACE)
• Providing evidence-based education, aligned with the priorities of the Office of the Assistant Secretary for Health and the Office of the Surgeon General, to communities across the nation.
• Building relationships and trust between the Commissioned Corps and local, state, tribal, and federal partners.
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 24 PREVENTION THROUGH ACTIVE COMMUNITY ENGAGEMENT (PACE)
Operation Change the Map • Prioritize the three HHS regions that have a substantial burden of new HIV diagnoses
• Prepare urban and rural areas to quickly and successfully implement the EHE initiative in FY2020
- Developing both short and long term action plans to:
o Assess the communities’ needs in the regions RADM Sylvia Trent-Adams Principal Deputy Assistant Secretary o Assist HHS Partners in eliminating HIV for Health
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 25 OPIOID RAPID RESPONSE TEAMS USPHS Commissioned Corps and CDC in Collaboration with OIG, DEA, and DOJ
Public health experts ready to deploy on short- notice to support jurisdictions experiencing spikes in drug overdoses or the abrupt closure of clinics
- Needs assessments and resource mapping - Community response capacity-building - Community organization and coalition-building - Provider education and resource mobilization - Urgent communication and outreach - Case management and patient care
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 26 27
BEYOND THE HORIZON
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 27 CENTER FOR HEALTH INNOVATION
A new entity focusing on accelerating clinical innovation to address critical health challenges
• Promote efficiency and enhance the experience of innovators with HHS with common-sense solutions
• Develop an analytical framework capable of identifying and measuring progress toward CAPT Paul Reed, M.D. addressing Critical Innovation Targets (CITs) Deputy Assistant Secretary for Health (Medicine and Science)
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 28 GPS UAVs DARPA SERVICE CHIEF FELLOWS
Provides participants with insight into cutting edge technology and opportunity to facilitate the development REVOLUTIONIZING PROSTHETICS of future DARPA technologies
AUTONOMOUS VEHICLES
CDR Guillermo Avilés-Mendoza LCDR Gwendolyn Hudson USPHS Inaugural Fellow
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 29 In the Service of Health “In Officio Salutis”
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 30 VISIT THE USPHS COMMISSIONED CORPS BOOTH IN THE EXHIBIT HALL
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 31 BRETT P. GIROIR, M.D. WWW.HHS.GOV/ASH WWW.USPHS.GOV ADM, U.S. Public Health Service
Assistant Secretary for Health @HHS_ASH Commissioner of Food and Drugs (Acting) [email protected]
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH 32