[Federal Register Volume 87, Number 122 (Monday, June 27, 2022)]
[Notices]
[Pages 38168-38170]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2022-13632]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Request for Information (RFI): HHS Initiative To Strengthen 
Primary Health Care

AGENCY: Office of the Assistant Secretary for Health, Office of the 
Secretary, Department of Health and Human Services.

ACTION: Notice of Request for Information.

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SUMMARY: U.S. Department of Health and Human Services (HHS) Office of 
the Assistant Secretary for Health (OASH) requests input from persons, 
communities, health care providers, purchasers and payers, educators, 
researchers, and other members of the public about what the federal 
government could do to strengthen primary health care in the United 
States. Improving access to health care, advancing health equity, and 
improving the health of the Nation are top priorities for the Biden-
Harris Administration and HHS. Access to high-quality primary health 
care has been shown to improve health equity and health outcomes, and 
is essential for addressing key priorities, including: the COVID-19 
pandemic; mental and substance use disorder prevention and care, 
including suicide and overdose prevention; prevention and management of 
chronic conditions; gender-based violence; and maternal and child 
health and well-being. However, our nation's primary health care 
foundation is weakening and in need of support: primary health care is 
under-resourced; the workforce is shrinking; workforce well-being is in 
peril; and many practices face reimbursement challenges that may result 
in financial instability. The HHS Initiative to Strengthen Primary 
Health Care (the Initiative) aims to establish a federal foundation for 
the provision of primary health care for all that supports improved 
health outcomes and advanced health equity. The first task is to 
develop an initial HHS plan for strengthening primary health care that 
will delineate specific actions that HHS agencies and offices may take 
to achieve the aims, within the current legislation and funding 
environment. In addition, the plan will include actions that establish 
an infrastructure in HHS to continue its focus on strengthening primary 
health, developing subsequent HHS plans that build on the initial plan, 
and monitoring progress and impact. The purpose of this RFI is to 
provide OASH with diverse perspectives, experiences, and knowledge that 
may inform the development of the initial plan for HHS, as well as 
future steps for the Initiative. OASH seeks information about 
successful approaches and innovations that improve primary health care 
payment, delivery models, service integration, access, workforce 
education, training and well-being, digital health and primary care 
measurement and research. OASH also seeks information about barriers to 
implementation of such innovations and how they could be overcome, 
including specific ideas for possible HHS action. OASH encourages 
respondents to address health equity, and is particularly interested in 
information from community-based settings, such as public housing, 
personal homes, group homes, and assisted living facilities where older 
adults and people with disabilities may live, and about populations 
traditionally underserved by current primary health care.

DATES: To be assured consideration, comments must be received at the 
email address provided below, no later than 11:59 p.m. Eastern Time 
(ET) on August 1, 2022. HHS will not reply individually to responders 
but will consider all comments submitted by the deadline.

ADDRESSES: Please submit all responses via email to 
[email protected] as a Word document attachment or in the 
body of an email. Include ``Primary Health Care RFI'' in the subject 
line of the email.

FOR FURTHER INFORMATION CONTACT: For additional information, direct 
questions to the OASH Primary Health Care Team at 
[email protected] or Sarah Boateng at (202) 401-7003.

SUPPLEMENTARY INFORMATION:
    Instructions: Response to this RFI is voluntary. Each responding 
entity (person or organization) is requested to submit only one 
response. OASH welcomes responses to inform policies and actions to 
strengthen primary health care. Respond to one or as many prompts as 
you choose. Be concise with your submissions, which must not exceed 
four pages in 12-point or larger font, with a page number provided on 
each page. Responses should include the name of the person(s) or 
organization(s) filing the comment.
    OASH invites input from members of the public representing all 
backgrounds and perspectives. In particular, OASH is interested in 
input from individuals; paid and unpaid caregivers; communities; 
community-based organizations; health care providers (please state 
discipline and specialty, as appropriate); professional societies; 
community health centers and Rural Health Clinics; state, local, 
tribal, and territorial governments and public

[[Page 38169]]

health departments; educators; academic researchers; global partners; 
health insurance payers and purchasers; health technology developers; 
and policy experts. Examples of health care providers include, but are 
not limited to: family medicine, internal medicine, pediatrics, and 
obstetrics and gynecology physicians; physician assistants; nurse 
practitioners; nurse midwives; nurses; behavioral health providers; 
oral health providers; medical/surgical specialists; community health 
workers; social workers; care coordinators; telehealth navigators; peer 
recovery specialists; provider practices; and health care systems.
    Indicate which of these stakeholder types best fits you as a 
respondent, if applicable. If a comment is submitted on behalf of an 
organization, the individual respondent's role in the organization may 
also be provided. Comments containing references, studies, research, 
and other empirical data that are not widely published should include 
copies or electronic links of the referenced materials. No business 
proprietary information, copyrighted information, or personally 
identifiable information should be submitted in response to this RFI. 
Comments submitted in response to this RFI may be posted on HHS 
websites or otherwise released publicly.
    Responses to this notice are not offers and cannot be accepted by 
the Federal Government to form a binding contract. Additionally, those 
submitting responses are solely responsible for all expenses associated 
with response preparation.
    Background: The HHS Initiative to Strengthen Primary Health Care 
aims to establish a federal foundation that supports advancement toward 
a goal state of the practice of primary health care. In its goal state, 
the practice of primary health care:
     Supports health and wellness through sustained 
partnerships with patients, families, and their communities;
     Equitably provides first contact access to all, as well as 
whole person, comprehensive care over time, using interprofessional 
teams; and
     Coordinates and integrates care across systems, including 
other health care providers, public health, and community-based health 
promotion and social service organizations.
    To achieve this goal state, actions and resources addressing 
financial, legislative, workforce, public health, technology and data 
sharing, and community-based factors are required.
    The Initiative was launched in September 2021 by the Office of the 
Assistant Secretary of Health (OASH), under the leadership of Assistant 
Secretary for Health, Admiral Rachel Levine. The first task of the 
Initiative is to develop an initial Department of Health and Human 
Services (HHS) two to three year plan for strengthening primary health 
care that will delineate specific actions that HHS agencies and offices 
may take to advance toward the goal state of primary health care, 
defined above. In addition, the plan will include actions that 
establish an infrastructure in HHS to continue its focus on 
strengthening primary health, including developing subsequent HHS plans 
that build on the initial plan, and monitoring progress and impact. The 
recently released National Academies of Sciences, Engineering, and 
Medicine (NASEM) report, Implementing High-Quality Primary Care: 
Rebuilding the Foundation of Health Care,\1\ which was developed in 
part with resources provided by HHS, will inform the development of the 
HHS Plan. This report organizes recommended actions using five domains: 
payment, access, workforce, digital health, and accountability. OASH is 
working with HHS agency partners and with other federal departments to 
develop the HHS plan. These efforts will also be informed by feedback 
from external stakeholders and subject matter experts, including 
patients, families, providers, researchers, and communities, to learn 
about innovative approaches, needs and challenges, to inform the HHS 
plan. This RFI will ensure that OASH has obtained broad input, and will 
inform the initial HHS plan and subsequent plans.
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    \1\ National Academies of Sciences, Engineering, and Medicine. 
2021. Implementing High-Quality Primary Care: Rebuilding the 
Foundation of Health Care. Washington, DC: The National Academies 
Press.
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    Scope and terminology: OASH invites input from all interested 
members of the public as outlined in the instructions. OASH encourages 
input from traditionally underserved populations. Definitions are 
provided for four of the key concepts of the goal state of primary 
health care (see above) that may have variable interpretations.
     Whole person care: Whole person care requires an 
understanding of the physical, mental, emotional, and spiritual health 
and wellness goals of the individual/family served and the context in 
which they live and work, and is facilitated by goal-oriented care 
plans developed with the patient and primary health care team through 
shared decision making.
     Integrated care: Integrated care expands the health team 
by bringing primary health care together with behavioral health (mental 
health and substance use disorder services), oral health, public 
health, and social and other services and partnerships to optimize 
access, coordination of care, and health outcomes.
     Interprofessional teams: Integrated care requires the 
expertise of interprofessional teams and their coordination of care. 
Interprofessional team composition is not predetermined or fixed, 
instead personalized to meet the needs of the individual and family 
served.
     Community participation, self-reliance, and resilience: 
Primary health care practices can support communities' capacities to 
achieve self-reliance and resilience by working as a member of the 
community to strengthen the health and wellness of individuals, 
families, and the communities in which they live.
    Information Requested: Respondents may provide information for one 
or as many topics below as they choose. OASH welcomes information about 
innovations, models, solutions to barriers, and possible HHS actions 
that may strengthen primary health care to promote health equity, 
reduce health disparities, improve health care access, and improve 
health outcomes. Strengthening primary health care requires the 
coordination of many partners. Recommendations for collaboration across 
HHS and between HHS and other federal departments are welcome.
    1. Successful models or innovations that help achieve the goal 
state for primary health care, defined above: Describe models or 
example innovations that are advancing the health of individuals and 
communities through strengthened primary health care, summarize 
evidence demonstrating impact, and provide resources, as appropriate. 
OASH is interested in action steps that will produce sustainable 
change, in addition to pilot programs. Share implementation approaches 
and lessons learned. Your response may address but need not be limited 
to: examples of new payment models; actions that support the 
integration of primary health care with other elements of the health 
care systems (e.g., specialty care including behavioral health care, 
oral health, hospitals, health systems); actions that support 
integration of primary health care with prevention specialists (e.g., 
Drug-Free Communities Coalitions, Community Health Workers, Peer 
Support Specialists) in work to reduce risk factors and increase 
protective factors associated with substance use and mental conditions; 
primary health

[[Page 38170]]

care integration with other clinical services and public health; 
primary health care integration with community-based organizations to 
provide social services to patients; interprofessional education 
strategies; expanded and effective use of health information technology 
(IT); strategies to expand primary health care research and its impact; 
and measures of primary health care spending, access, quality, and 
impact.
    2. Barriers to implementing successful models or innovations: 
Describe current barriers to implementing innovations or improvements 
that would strengthen primary health care, to improve the health of 
individuals, families and communities. Also, consider barriers to 
advancing primary health care research, as well as barriers to 
inclusive services and those targeting youth. For each barrier, you may 
provide evidence-based or proposed solutions.
    3. Successful strategies to engage communities: Describe models, 
approaches or frameworks that HHS could use to obtain ongoing input 
from individuals, caregivers, and communities on HHS actions to 
strengthen primary health care and their implementation (i.e., 
community engagement strategies), acknowledging the different 
approaches necessary to obtain perspectives from youth and adults. 
Populations of focus are those traditionally underserved by health 
care, such as Black, Latino, and Indigenous and Native American 
persons, Asian Americans and Pacific Islanders and other persons of 
color; members of religious minorities; lesbian, gay, bisexual, 
transgender, and queer (LGBTQ+) persons; persons with disabilities; 
persons who live in rural areas; and persons otherwise adversely 
affected by persistent poverty or inequality. Additional populations of 
interest are people experiencing homelessness; non-US-born persons; 
individuals experiencing gender-based violence; individuals with 
chronic illness; older adults and people with disabilities; individuals 
with mental and substance use disorders; and people who have had 
interactions with the criminal justice system. Share implementation 
approaches for community engagement strategies and lessons learned.
    4. Proposed HHS actions: Identify specific actions that HHS may 
take to advance the health of individuals, families, and communities 
through strengthened primary health care. Examples include, but are not 
limited to: steps to implement and scale new payment models and 
reimbursement approaches, including revising the Physician Fee 
Schedule, Relative Value Units, and Current Procedural Terminology 
codes and advancing value-based care; increasing payer and national 
investment in primary health care and measuring/monitoring spending on 
primary care; support for service integration, including integration of 
primary health care and public health; and enabling care for complex 
needs by integrating behavioral, oral, and primary health care and 
integrating access to social services and primary health care through 
partnerships; support for primary health care workforce well-being; 
policy and programmatic proposals for health workforce programs to 
address workforce shortages, geographic maldistribution and to improve 
workforce diversity; support for primary health care workforce 
education and training; interprofessional education; new technical 
assistance needed; advancing the use of certified health IT and 
interoperability of electronic health information across the care 
continuum; primary health care research infrastructure and investment; 
and measurement and stewardship of primary health care. Specify what 
barrier the opportunity addresses, and the realistic timing for 
implementation: less than two years, two to five years, and six to 10 
years.

    Dated: June 15, 2022.
Judith Steinberg,
Senior Advisor, Office of the Assistant Secretary for Health, 
Department of Health and Human Services.
[FR Doc. 2022-13632 Filed 6-24-22; 8:45 am]
BILLING CODE 4150-28-P