The Virginia Health Care Workforce Implementation Grant

1. The Virginia Health Care Workforce Implementation Grant

2. Background:Establishing a Vision for the Health Care Workforce Pipeline in Virginia

3. What Are We Talking About? What do we mean when we talk about health workforce?

4. What Are We Talking About? What Do We Mean by the Healthcare Workforce Pipeline – Part I?

5. What Are We Talking About? What Do We Mean by the Healthcare Workforce Pipeline – Part II?

6. What Exists in Virginia? • Virginia’s Area Health Education Centers (1991 - Present) • Virginia SEARCH Program (2005 – 2008) • Virginia Generalist Initiative (1992 – 2001) • Southwest Virginia Graduate Medical Education Consortium (1998 – Present) • Health Workforce Advisory Committee (2000 - Present) • Virginia Department of Health (VDH) Shortage Designations and Incentive Programs (1970s? - Present) • Recruitment and Retention Collaborative Team (2003 – Present) • Rural Health Workforce Council (2008 – Present) • Department of Health Professions (DHP) Healthcare Workforce Data Center (2008 – Present) • …and more!

7. Mission: To promote health careers and access to primary care for medically underserved populations through community-academic partnerships. Structure: Virginia AHEC (VCU) Blue Ridge AHEC Eastern VA AHEC Capital AHEC Northern VA AHEC Rappahannock AHEC Southside AHEC South Central AHEC Southwest AHEC Virginia Search Program Mission: To give health professions students and residents the opportunity to train on interdisciplinary teams and acquire the skills needed to provide culturally competent care that is responsive to the needs of the underserved populations Challenges: Loss of state funding in 2008 Lack of unified vision and leadership Virginia’s Area Health Education Centers (AHECs)

8. Virginia AHECs

9. Virginia AHECs

10. Mission: To actively recruit and retain Virginia medical students with an interest in generalist medicine from medically underserved areas of the Commonwealth; and to sustain educational experiences in community settings in general, and in medically underserved communities in particular, for both medical students and generalists. Structure: Consortium (EVMS, UVA, VCU) Challenges: RWJ Grant funded – funding period has ended Virginia Generalist Initiative

11. Mission: To improve access to high quality primary care for citizens of Southwest Virginia by forming educational partnerships between communities, local physicians, and primary care residency programs in Virginia, Tennessee North Carolina, Kentucky, and West Virginia. Structure: Board of Directors Executive Director Executive Secretary Challenges: Limited in scope to one region of the State Southwest Virginia Graduate Medical Education Consortium

12. Mission: To advise on all aspects of VDH health workforce duties and responsibilities. Structure: Commissioner of Health Membership Commissioner’s Health Workforce Recognition Awards Mission: To recognize and thank individuals and organizations for making significant contributions to our communities via initiatives designed to address Virginia’s healthcare workforce shortage Challenges: Unfunded Advisory Health Workforce Advisory Committee (HWAC)

13. Purpose: To identify areas or populations having a shortage of dental, mental, and primary health care providers and to manage incentive programs to attract practitioners to serve in those areas Structure: State Health Commissioner Health Workforce Advisory Committee Office of Minority Health & Public Health Policy Division of Primary Care & Rural Health Challenges: Lack of Administrative Funding Inadequate Staffing Incentive Program Freezes Due to State Budget Shortfalls VDH Shortage Designations and Incentive Programs

14. Health Professional Shortage Area (HPSA) Designations

15. Denominators Can Get Complicated – Part 1

16. Denominators Can Get Complicated – Part 2

17. Primary Care HPSAs in 79 Localities Sources: VDH Primary Care Health Professional Shortage Areas (HPSA), http://www.vdh.state.va.us/healthpolicy/primarycare/shortagedesignations/index.htm,

18. A Closer Look - Part 1

19. A Closer Look - Part 2

20. Dental HPSAs in 61 Localities Sources: VDH Dental Health Professional Shortage Areas (DHPSA), http://www.vdh.state.va.us/healthpolicy/primarycare/shortagedesignations/index.htm, and http://bhpr.hrsa.gov/shortage/hpsaguidement.htm. Virginia Department of Health Professions (2008)*  and analyzed by the National Center for the Analysis of Healthcare Data         * These data were collected for license administration purposes only and cannot be relied upon solely to inform about actual work site location.

21. A Closer Look - Part 1

22. A Closer Look - Part 2

23. Mental HPSAs in 86 Localities Sources: Addressing Virginia’s Mental Health Workforce Shortages, VDH, Mental Health Roundtable May 20, 2009 and http://bhpr.hrsa.gov/shortage/hpsaguidement.htm

24. A Closer Look - Part 1

25. A Closer Look - Part 2

26. State Loan Repayment Programs Total funding amount $50K to $120K State funding eliminated in FY10 Individual works in an underserved area 19 individuals were provided $921,998 in State funds in FY08

27. Impact of the State Budget Crisis on Loan Repayment Awards • State funding eliminated in FY10

28. Impact of the State Economy on Healthcare

29. Mission: To establish and enhance collaborative efforts in partnership with stakeholders to deliver improvements in recruitment processes and retention systems for healthcare providers with an emphasis on medically underserved areas in Virginia. Structure: 15+ partner agencies Annual face to face meeting Bi-monthly conference calls Challenges: Lack of Administrative Funding Volunteer Staffing Recruitment and Retention Collaborative Team

30. Mission: To examine available resources and issues in order to make recommendations for improving the health care workforce in rural Virginia. Structure: One of four rural health councils State Rural Health Plan Oversight Committee Leadership by VDH and VRHA Challenges: Grant funding/sustainability Focus is limited to rural Rural Health Workforce Council

31. Mission: To improve the data collection and measurement of Virginia’s healthcare workforce through regular assessment of workforce supply and demand issues among the 80 professions and 350,000 practitioners licensed in Virginia by DHP. Structure: Advisory Council Advisory Committees Challenges: One time funding/sustainability DHP Healthcare Workforce Data Center

32. Lack of Coordination and Communication Insufficient Leveraging of Resources and Collaboration Insufficient Depth and Breadth to Address all the Healthcare Workforce Needs Statewide Reactive Instead of Proactive Inadequate Emphasis on Rural Needs Inadequate Levels of Funding and Staffing Under-Representation by Minority Groups Overview of Challenges

33. Isn’t There More We Can Do?

34. Working Toward a Solution • COORDINATION • Big-Picture, Statewide Perspective • PROACTIVITY • Identify Gaps • Identify and Promote Model Programs • EMPOWERMENT • Authority to Make Decisions • Access to Resources • REPRESENTATION • All Health Professions and Regions • SUPPORT • Leverage Resources (Public and Private) • Find New Resources (Public and Private)

35. As a result of these challenges and this vision, legislation to establish a Health Workforce Authority was first submitted in 2009. The language that was submitted was re-tooled by legislative services and the changes were so great that stakeholders did not feel it could accomplish its intended purpose. The legislation was tabled and VDH was asked by the Committee Chair to study the language and report back with recommendations in November 2009 Taking Action

36. Stakeholder Input Process • Health Workforce Advisory Committee (Part 1) – June 2009 • AHEC Directors – July 2009 • Health Professions School Stakeholders – August 2009 • Southwest Virginia Health Authority – September 2009 • Health Workforce Advisory Committee (Part 2) – October 2009 • Conference Call/Webinar with Members of Health Related Associations – October 2009 • Consolidated Draft Recommendations from stakeholder input process posted on a blog site for public comment

37. The Result • Consensus reached by over 70 individuals representing 50 organizations/agencies! • Legislative study submitted to the General Assembly • House and Senate companion bills (enabling legislation for the Authority) submitted • Legislation unanimously passed by both House and Senate • Legislation signed by the Governor and enacted on July 1, 2010

38. Mission The mission of the Authority is to facilitate the development of a statewide health professions pipeline that identifies, educates, recruits, and retains a diverse, appropriately geographically distributed and culturally competent quality workforce.

39. Core Functions The mission of the Authority is accomplished through: providing the statewide infrastructure required for health workforce needs assessment and planning that maintains engagement by health professions training programs in decision making and program implementation; serving as the advisory board and setting priorities for the Virginia Area Health Education Centers Program; coordinating with and serving as a resource to relevant state, regional, and local entities including the Department of Health Professions Workforce Data Center, the Joint Legislative Audit and Review Commission, the Joint Commission on Health Care, the Southwest Virginia Health Authority, or any similar regional health authority that may be developed;

40. Core Functions informing state and local policy development as it pertains to health care delivery, training, and education; identifying and promoting evidence-based strategies for health workforce pipeline development and interdisciplinary health care service models, particularly those affecting rural and other underserved areas; supporting communities in their health workforce recruitment and retention efforts and developing partnerships and promoting models of participatory engagement with business and community-based and social organizations to foster integration of health care training and education;

41. Core Functions advocating for programs that will result in reducing the debt load of newly trained health professionals; identifying high priority target areas within each region of the Commonwealth and working toward health workforce development initiatives that improve health measurably in those areas; and fostering or creating innovative health workforce development models that provide both health and economic benefits to the regions they serve.

42. From Challenge to Opportunity! • NHSC Expansion • CHC Expansion • Health Care Reform

43. We Won! VIRGINIA AWARDED A $1.93 MILLION STATE HEALTH WORKFORCE IMPLEMENTATION GRANT

44. Partners Virginia Department of Health Professions Virginia Workforce Council (VWC) Virginia Health Care Foundation Virginia Area Health Education Centers Virginia Community Health Care Association Virginia Academy of Family Physicians 

45. Organizational Chart

46. Goal 1 To set up the statewide infrastructure required for health workforce needs assessment and planning that maintains engagement by health professions training programs in decision making and program implementation. Objective 1: To establish the VHWDA as a sustainable public-private partnership. Objective 2: To establish the Virginia Health Careers Student Registry into a comprehensive registry of all Virginia students with an interest in health careers. Grow Your Own!

47. Goal 1 To set up the statewide infrastructure required for health workforce needs assessment and planning that maintains engagement by health professions training programs in decision making and program implementation. Objective 3: To expand the scope of the annual Choose Virginia Conference to include all students and residents with an interest in primary care, helping them to “Choose Virginia! A Healthy Place to live and work!”

48. Goal 2 To encourage regional partnerships that address health workforce pipeline development needs and promote innovative health care workforce career pathway activities. Objective 1: To identify High Priority Target Areas (HPTAs) within each region of the Commonwealth.

49. Goal 2 To encourage regional partnerships that address health workforce pipeline development needs and promote innovative health care workforce career pathway activities. Objective 2: To identify and convene regional leadership to discuss opportunities to better leverage and align existing state, regional and local programs and activities to support regional health workforce pipeline development initiatives that are designed to have a measurable impact on HPTAs.

50. Goal 2 To encourage regional partnerships that address health workforce pipeline development needs and promote innovative health care workforce career pathway activities. Objective 3: To make available funds for regional planning and implementation grants to encourage leaders at the regional level to develop partnerships to address the workforce issues in HPTAs and that result in health workforce development initiatives that improve health status and outcomes in those areas.