Healthcare Workforce ARRA and Healthcare Reform

1. Healthcare Workforce ARRA and Healthcare Reform Kristin Juliar, Director Montana ORH/AHEC NOSORH Webinar, July 7, 2009

2. ARRA Issues (Some we know, some we don�t know) Community Health Centers Expansions, equipment, construction projects HIT acquisition Primary Healthcare Workforce $500 million to foster a skilled workforce and boost capacity to deliver services Expanded slots in NHSC $200 million through Title VII and VIII training program grants Funds to increase health professions literacy with HIT

3. Other ARRA Provisions of Rural Interest � Comparative Effectiveness Research Support research efforts and demonstration projects Prevention and Wellness Fund Details to be specified � for prevention and wellness , including clinical and community based prevention and wellness efforts HIT Adoption of HIT through reimbursements to providers Development of HIE HIT workforce development HIT instruction incorporated into health professions training Tele-health Broadband Technology Opportunities Program for distance learning, telemedicine and broadband Indian Health Service HIT activities �

4. Healthcare Reform � Senate Finance (What may be) Reforming the Healthcare Delivery system Strengthening primary care and chronic care management Refocus payments towards quality Promoting collaboration and accountability Comparative effectiveness HIT Healthcare workforce � focus on primary care, strengthening GME, increasing diversity, faculty, support for Title VII and Title VIII, pipeline programs

5. Health, Education, Labor and Pensions (HELP) Committee (What may be) Training in Family Medicine, General Internal Medicine, General Pediatrics and PA Through several provisions, expand the availability of primary care training, including community based programs, faculty, expansion of PA program, new competencies such as medical home Expand training for direct care workers �Training in general, pediatric and public health dentistry

6. AHEC Changes Simplifies language describing programs Expands on-going funding of long term centers to $250,000 year and envisions a national network of centers Innovative opportunities may be funded for curriculum development related to primary care, CBPR, and to address identified workforce needs 10% of medical studies in rural/underserved 10% of nursing students in rural/underserved Restructures match to allow half of match to be in-kind

7. Other Provisions Continuing Education � grants to eligible entities � Geriatric Education � Geriatric Education Centers Improving Geriatric Training for Physicians, Dentists and Behavioral/Mental Health Professionals, other incentives for geriatric careers Special Oral Health Needs Education Centers � primarily related to DD and geriatric

8. Health Workforce Information and Analysis National Center for Health Workforce Analysis State and Regional Centers for Health Workforce Analysis Research Technical assistance Eligibility �a state, a state workforce commission, a public health health professions school, an academic health center, or an appropriate public or private nonprofit or partnership of above (comments changing this language have been submitted to focus on a collaborative model) Includes grants for longitudinal tracking systems of funded health professionals/students, NHSC and other measurements. Grants would be about $75,000 per center it appears ($4.5 million total for all components)

9. More! � National Health Service Corps � expanded funding Public Health Service Commissioned Corps Ready Reserve Corps Youth Public Health Program Public Health Workforce Development � Grants for state and local programs, including scholarships, retention program, loan repayment program Nursing Workforce Development � Continuation and expansion of programs for nursing education retention, diversity, curriculum, student loans, nursing faculty loans Nurse managed health clinics providing primary care and wellness services � Mental and Behavioral Health Education and training, loan repayments, scholarships, focus on youth, research grants, community based programs of excellence grants

10. Primary Care Extension Program Primary Care Extension Program � establishes a program similar to the current Extension Service. To �provide support and assistance to primary care providers to education providers about preventive medicine, health promotion, chronic disease management, MH, evidence based practice and incorporate them into their practice and improve community health� by using �Health Extension Agents. Primary Care Extension Program � establishes a program similar to the current Extension Service. To �provide support and assistance to primary care providers to education providers about preventive medicine, health promotion, chronic disease management, MH, evidence based practice and incorporate them into their practice and improve community health� by using �Health Extension Agents.

11. Primary Care Extension Centers Competitive grants to states to establish �hubs� that consist of the state health department, Medicare program, health professions schools that train primary care, hospital associations, societies, PCAs consumer groups Required to submit a plan to coordinate with QIOs and AHECs if they aren�t part of the Hub Contracts with a county or local entity to serve as the Health Extension Agency Duties: Assist with implementing medical homes, training and deployment of community care teams; TA, training and organizational support for community care teams, support primary care learning communities Competitive grants to states to establish �hubs� that consist of the state health department, Medicare program, health professions schools that train primary care, hospital associations, societies, PCAs consumer groups Required to submit a plan to coordinate with QIOs and AHECs if they aren�t part of the Hub Contracts with a county or local entity to serve as the Health Extension Agency Duties: Assist with implementing medical homes, training and deployment of community care teams; TA, training and organizational support for community care teams, support primary care learning communities �

12. Dental, CHW Dental Care Facilities in HPSAs - grants for capital expenditures Alternative Dental Healthcare Providers Demonstration Project Community Health Workers Grants to promote positive health behaviors and outcomes using CHWs, providing training and support Collaborate with academic institutions

13. GME (Residency) In House: A redistribution of unused graduate medical education (GME) training slots, the preservation and redistribution of Medicare-funded GME training slots when teaching hospitals close, and the elimination of regulatory barriers to placing residents in non-hospital settings for portions of their training Senate Finance supporting GME expansion and redistribution to support primary care expansion

14. HRSA and ARRA In February, Congress passed the ARRA, which set aside $500 million to strengthen the nation's health care workforce. The ARRA gave $300 million of the $500 million to the National Health Services Corps, or NHSC, and $200 million to programs authorized by Titles VII and VIII of the Public Health Service Act. These sections of the Act include primary care medicine and dentistry programs, public health and preventive medicine programs, and scholarship and loan repayment programs. The AARA also gave the Health Resources and Services Administration, or HRSA, discretion regarding how to allocate the $200 million. According to Marcia Brand, Ph.D., deputy administrator for HRSA, the agency has decided to set aside about a quarter of that money for programs aimed at training primary care physicians under Title VII.

15. Questions?