used as a feedback loop? Kelly Whitener responded that a large number of demonstration projects, each with its own timeline and focus, are operating in different states. For those projects with positive preliminary feedback, Congress can make the case that those projects should be continued.

Whitener described, as an example, a demonstration project under Medicare focused on diabetes that has a component serving Native Americans. This demonstration project has worked extremely well in Montana, which has a large Native American population, but has not done so well at other sites. The Senate could therefore push to continue the project for Native Americans. What is helpful, said Whitener, is to have outside groups and experts suggest the good programs to be evaluated.

Pattie Tucker of CDC offered the REACH (Racial and Ethnic Approaches to Community Health) demonstration projects as an example of a successful community-based program that went from making changes in the lives of individuals participating in community programs to changes at the policy level. The challenge is that completion of this transition from changes in individual and community behaviors to broader policy changes during the 5-year grant cycle is difficult. If some projects receive additional funding, CDC hopes to see more dramatic changes in those communities.

Newell McElwee of Merck & Co., Inc., asked about the workforce diversity provisions included in the ACA and its tasks. Craig Martinez said that the overall goal of the workforce commission outlined in the legislation is to provide to Congress and HHS comprehensive, unbiased information on how to better align federal health care resources with national needs. Its purpose is to assess what the workforce looks like today, what the workforce needs are, what needs are unmet, and what must occur to further develop this workforce.

Anne Kubisch of the Aspen Institute asked about the federal inter-agency collaborations around place and communities that are under way. These collaborations include the Sustainable Communities Initiative that brings together HUD, the U.S. Department of Transportation, and the Environmental Protection Agency; the Promise neighborhoods funded by the U.S. Department of Education; and the Choice neighborhoods program funded by HUD. She wondered about the leadership for this work and the role that outside groups such as the Institute of Medicine Roundtable can play in making sure that these programs are implemented as effectively as possible.

Martinez described the organizational culture of federal agencies, saying that different departments are happy in their “silos” and that it can be difficult for them to interact with each other. At the same time, programs across different departments can give a “bigger bang for our buck” when they work together. One example is the Prevention Council, which ACA legislation mandated to be made up of the secretaries of the federal agencies.



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