Transcript Document

LEGISLATIVE HEALTH
CARE WORKFORCE
COMMISSION
Overview
Mark Schoenbaum
Minnesota Department of Health
July 22, 2014
“Many policy levers that affect the supply,
distribution and skill mix of the health workforce
are state-based, including licensure and scope of
practice regulations, state loan repayment
programs, and Medicaid reimbursement rates.
State-level decisions about whether to enact or
change policies directed at training, recruiting, and
retaining health professionals affect a wide range
of stakeholders….”
Dr. Erin Fraher, Director of the North Carolina Health Professions Data System
What makes up the Health Care
Workforce?
Current Health Care Employment; Projected Growth
Carnivale AP, Smith N, Gulish A, Beach BH. Health Care. Georgetown
University Center on Education and the Workforce, 2012.
Planning Framework
• Need X workers ( MD, RN, lab tech, etc.) per year to meet demand
• Demand factors: age, population growth, changes in coverage, etc.)
• Expect Y workers per year
• Through production (education and training)
• Relocation/in-migration
• Leaving a Gap of Z workers
• Strategies to fill the gap:
• Investments/incentives (federal, state, employer, higher ed, etc)
• Role of technology & delivery system redesign
• Regulatory changes
Health Workforce Development Pipeline
Prepare K12
students in
basic
science &
expose to
health
careers
and role
models
Recruit
traditional
& non traditional
students
Locate
education
and
training
programs
in high
need
settings &
use
relevant
curricula
Encourage
grads to
seek
employment
in high need
settings
Redesign
health
care
delivery
& health
care
jobs
5
Retain
the
health
care
workforce
Prepare
students in
math/science
& expose to
health careers
Current
Workforce
Strategies
K – 12 Career
& Technical
Education,
STEM, etc. (MN
Dept. of Ed)
Summer Health
Careers Intern
Program (MDH)
Scrubs camps –
MN St.
Colleges/
Universities
(MNSCU)
H1B and similar
workforce
development
(MN Dept. of
Employment
and Economic
Dev - DEED)
Recruit traditional &
non -traditional students
Summer
Health
Careers
Intern
Program
(MDH)
Future
Doctors
Program (U
of M)
U of M
Duluth Med
School
Campus –
rural focus
Center
of American
Indian &
Minority
Health (U of
M Duluth
Med School)
Foreigntrained
health
worker test
preparation
pilot
(DEED)
FasTRAC
(DEED)
Nursing
facility
scholarship
program
(MN Dept.
of Human
Services –
DHS)
Provide
education and
clinical training
programs in
high-need
settings
Encourage
grads to
seek
employment
in high-need
settings
MERC Clinical
training subsidy
($58 million)
(MDH)
Minnesota
Health
Professional
Loan
Forgiveness
Program
(MDH)
Greater MN Family
Medicine Grant
Program (MDH)
Clinical Dental
Education Grants
(MDH)
Rural Physician
Associate Program
(RPAP) (U of M)
Direct
appropriations to
medical schools
and other health
professions
education programs
(MN Legislature)
National
Health Service
Corps (MDH)
Visa waivers
for foreign
medical grads
(“J1”) (MDH)
Rural
Recruiting &
Retention
Network
(3RNet)
(MDH &
Rural Health
Resource
Center)
Redesign health
care system,
delivery &
health care jobs
Team care
approaches:
Health Care
Homes Program,
Medicaid ACO
demonstration
Retain the
health care
workforce
Community
retention
strategies
(AHEC – U of
M, MDH rural
health
programs)
Emerging
professions
support (MDH,
licensing boards,
Medicaid)
Long-term care
wage issues
(DHS,
Legislature)
Telehealth (rural
providers and
systems, DHS,
MDH)
Volunteer
Ambulance
Award
Program
State Innovation
Model (SIM)
grant (MDH/DHS)
Safe Patient
Handling
(DOLI)
Scope of Practice
changes (Health
Licensing Boards)
Telehealth
(rural providers
and systems,
DHS, MDH)
Types of Approaches
• Understand Impacts of Current Investments
• Commission Charge 2
• Strategies:
•
•
•
•
•
Already underway – continue as is
Revise or redirect current resources
No (direct) cost strategies - regulatory & system changes
New or expanded funding required
Provide encouragement – e.g., best practices, innovative models, etc.
• Which pipeline sections to address?
Health Workforce Analysis Framework
40
Baseline
Demand
30
20
%
Current
Pipeline
Supply
(graduates)
10
0
Demand under
Health Reform
-10
-20
-30
2010
2014
2019
2025
Current
providers effects of
retirement &
attrition
Minnesota’s Health Professional Shortage Areas
• Why Primary Care?
• Better health outcomes
• Higher patient satisfaction
• Lower health care spending.
How big a shortage in MN?
• MDH: 1,000 – 3,000 primary care physicians
• U of M: 803, all MD specialties
• Robert Graham Center – 1,187 primary care physicians
• Georgetown – 1,000 - 4,000 all MD specialties
• Assoc. of Amer. Medical Colleges: 90,000 nationally
• Shortages in long term care, lab & imaging techs, other
ancillary jobs, etc.
Related efforts
• Governor's Health Care Reform Task Force
• MMA Primary Care Task Force
• U of M report to Higher Ed Committees
• NGA Health Workforce Policy Academy
• Mental Health Workforce Summit
• Foreign-trained Physician Task Force
Mental Health Occupations
Mental Health Specialists Requiring Bachelor’s,
Professional, or Advanced Degrees
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•
•
Child, Family, and School Social Workers
Clinical, Counseling, and School Psychologists
Healthcare Social Workers
Marriage and Family Therapists
Mental Health and Substance Abuse Social Workers
Mental Health Counselors
Psychiatrists
Clinical, Counseling, and School Psychologists
Substance Abuse and Behavioral Disorder Counselors
Psychologists, All Other
Mental Health Specialists Requiring Less than a
Bachelor’s Degree
• Psychiatric Aides
• Psychiatric Technicians
Current Government-Supported Providers
State Loan Forgiveness
64 Primary Care MDs,
Midlevels, Pharmacists
Federal Loan Forgiveness
112 Primary Care providers
( + mental health & dental)
Joint State/Federal Loan
Forgiveness
7
Foreign Medical Grad MDs
89 total (52 primary care, 37
specialists)
Total obligated providers
250
Practice Re-design
Scope of Practice
Emerging
Professions
Emerging Health Professions in MN
Licensed or certified by the state
Reimbursed by Medicaid
• Community Health Workers (2007)
• Dental Therapists (2008 - 09)
• Community Paramedics (2011 -12)
• Doulas (2013)
Contact Information
Mark Schoenbaum
[email protected] , 651-201-3859