Transcript Office of Health Policy & Planning

Maryland Rural Health
Implementation Plan (RHIP)
Michelle G. Clark, MSW, MPH
Project Director, State Office of Rural
Health
October 2, 2008
Presentation Overview
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Office of Health Policy and Planning (OHPP)
State Office of Rural Health (SORH)
Workforce Programs (Loan Assistance
Repayment Program – LARP)
Maryland Rural Health Plan
MRHA Listening Sessions
Maryland Rural Health Implementation Plan
State Office of Rural Health
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Mission:
The Maryland State Office of Rural Health (SORH) aims to
improve the health of rural Marylanders through collaboration,
networking, outreach, education, advocacy, and the
development of special programs.
Federally Funded
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Staff
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State Offices of Rural Health (50 SORHs nationwide)
Small Hospital Improvement Program (SHIP)
State Matching Funds – Area Health Education Centers (AHEC)s
Michelle Clark, Michele Pharr, Jessica McKinnie
Consultants
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Jeanette Jenkins, Director of OHPP
Liz Vaidya, Primary Care Organization (PCO) Director
Rebecca Love, OHPP Health Policy Analyst
Workforce Programs Within OHPP
Loan Assistance Repayment Program
Federal Loan Assistance Repayment Program (LARP)
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Purpose
 To provide repayment of educational loans to physicians who
agree to practice in an approved practice/underserved area for
a period of time
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Program is jointly administered by:
 Primary Care Office (PCO) in the OHHP in Family Health
Administration for DHMH
 Maryland Higher Education Commission (MHEC)
Workforce Programs Within OHPP
LARP Funding
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Funding
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Federal funds
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Competitive funding among the states
Requires state match (50:50)
State funds
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Source is physician licensure fees
Funds provided to MD Higher Education Commission
(MHEC) through legislatively mandated Janet L.
Hoffman Program
Workforce Programs Within OHPP
LARP Eligibility and Requirements
Eligibility
 Primarily for practicing physicians, but residents also allowed
 Types of health professionals eligible
 Currently only two physician specialties included –
primary care and general psychiatrists
Requirements
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Only non-profits
Federal funds for practice in a designated Health Professional
Shortage Area only
General funds may be used to fund state-only awards in state
designated shortage areas
Is LARP effective at recruiting and
retaining providers?
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Each year there are more applicants than funding
One national study found that physicians serving
obligations to state programs served in needier areas
and remained longer in their practices (Pathman,
Konrad, King, Taylor, and Koch, 2004)
Another study found that 48 percent of students would
be more likely to return to their home states if
expanded loan repayment programs were available
(Miller and Crittenden, 2001)
In Maryland, of 24 providers who completed service
between 2004 and 2006, 22 are still practicing
Workforce Programs Within OHPP
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J-1 Visa Waiver Program
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J-1 visa requires physicians with foreign nationalities to return to
their home country for two years at the end of their medical training.
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The waiver is granted in exchange for the physician’s work in an
underserved area for three years
National Health Service Corp.
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Reviews sites’ eligibility per federal criteria
Recommendations to NHSC of eligible sites for placement of
eligible health professionals, but final decision is made by the
federal government – HRSA in DHHS
Maryland Rural Health Plan
http://www.fha.state.md.us/ohpp/ruralhlth/pdf/DHMH_Rural_Health_Plan_07.pdf
Plan Goals
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Raise awareness of rural health issues and
strategies to address these issues (Vision)
Assess the health status of Maryland’s rural
residents relative to non-rural residents
(health indicators for rural areas)
Set forth an agenda to build state consensus
on the Plan to gain funding and resource
support
Rural Health Priority Areas
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Access to primary and specialty care and
pharmacy services (availability of workforce
and affordability)
Behavioral health (mental health and
addiction/substance abuse)
Lifestyle issues (nutrition, obesity, wellness)
Oral health
Priority Recommendations
1. Increase efforts to improve recruitment
and retention of rural health providers
2. Establish preventive health centers in rural
areas, especially in those areas lacking or
underserved by Federally Qualified Health
Centers
3. Increase accessibility to pharmaceuticals for
low-income rural residents
Rural Health Plan in Action
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Maryland Rural Health Association (MRHA) Listening
Sessions - 7 Total
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October 2007 – 3 on the Eastern Shore
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December 2007 – 3 in Western Maryland
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April 2008 – Southern Maryland
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Disseminated results
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Rural Health Steering Committee had 5 Meetings in last 6
months
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Rural Health Implementation Plan (RHIP)
Listening Sessions
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Recruitment & retention of rural health
providers
Comprehensive Electronic Medical Records
Provider reimbursement
Telehealth reimbursement
Increase and efficiency of Loan Repayment
for Rural Providers
Primary preventive health services
Maryland Rural Health
Implementation Goals
1. Increase Recruitment and Retention of Rural Health Care Providers
2. Expand and Enhance telehealth to bring primary and specialty care to
rural areas through technology
3. Provide preventive health education and resources in rural areas
4. Increased dental access to low income rural residents, especially the
adult population
5. Establish preventive health centers in rural areas, especially those
areas lacking or underserved by a Federally Qualified Health Center
(FQHC)s
6. Improve healthcare access for the aging population through increased
services in rural areas and training of health professionals
7. Increase access to Pharmaceuticals for low income rural residents
8. Support the development of a continuous, integrated systems of care
for co-occurring disorders in rural communities
Maryland Rural Health Plan, June 2007
Priority Strategies
MRHA Statewide Listening Sessions Oct 2007- Apr 2008
Vetted in Community
Consensus Priority Goals
Rural Health Steering Committee Summer 2008
Priority Actions
Rural Health Implementation Plan (RHIP) 2009
Snapshot of Rural Health Listening
Sessions – Workforce Issues
Implementation Framework
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Goal - ONE: Rural Recruitment and Retention
Problem
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Objective
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Rationale
Action Steps
Estimated Costs
Partners
Relates To
Evaluation of Success
Rural Health Implementation Plan
Goal: Enhance Rural Recruitment and
Retention
Objectives
1.1 Increase funding and efficiency of Loan Assistance Repayment
Program (LARP)
1.2 Increase Scholarships in Maryland health professional college and
universities for rural residents who agree to practice in rural areas
1.3 Explore and promote the efficiency in portability of health care
professional licensing between regional states
1.4 Expand health professional training and education in rural areas,
through the use of new health programs and distance learning
1.5 Establish a coordinated Statewide Healthcare Workforce Center
1.6 Increase or supplement compensation packages for rural health
providers including reimbursement package
Objective 1.1
Increase funding and efficiency of Loan Assistance
Repayment Program (LARP)
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Increase state funding for LARP for at least 20 years of
additional loan repayment through legislation, physician
fees, or hospital surcharges to allow more flexibility with
the use of funds and program staff.
Assess the needs of rural Maryland workforce shortages
and identify those areas that do not qualify for a federally
designated shortage area but are in need of physicians.
Restructure Maryland physician LARP program to allow
more flexibility with state funds and repayment in rural
areas designated as Maryland Health Professional
Shortage Areas.
Objective 1.2
Increase scholarships in Maryland health
professional colleges and universities for rural
residents who agree to practice rural areas.
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Assess the number of rural Maryland students attending
Maryland Graduate Schools in health professional
programs.
Create a Rural Health Scholarship Program that includes
administrative and fiscal support for Maryland students
committed to practicing in rural areas after training.
Objective 1.3
Explore and promote the efficiency in portability of
health care professional licensing between regional
states
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Establish partnerships with other regional states adjoining
Maryland to specifically address the need to have more
portable licenses.
In coordination with neighboring states, identify the
capacity of health professionals who practice in more the
one state and serve rural populations.
Objective 1.4
Expand health professional training and education in
rural areas, through the use of new health programs
and distance learning
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Assess professional schools that have expanded to serve
rural areas and identify best practices and models for the
potential to be replicated across the state.
Explore opportunities to create new health professional
programs in rural areas.
Encourage and fund distance learning capabilities of
health professional schools to expand scope training
available for of students in rural areas. Encourage and
fund distance learning capabilities of health professional
schools to expand scope training available for of students
in rural areas.
Objective 1.5
Establish a coordinated Statewide Healthcare
Workforce Center
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Build upon workforce shortage areas to determine
specific healthcare shortages
Develop a statewide healthcare workforce center with
all agencies involvement to serve as hub for
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Healthcare workforce programs (including marketing of
programs)
AHECs
Educate healthcare providers & employers regarding
recruitment strategies
Objective 1.6
Increase or supplement compensation packages for
rural health providers including reimbursement
package
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Increase state Medicaid payments to providers in
designated health professional shortage areas similar to
the CMS Medicare incentive payment
Provide tax incentives to rural providers working within
health professional shortage areas
Questions/Comments!
Contact Information
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Michelle Clark, MSW, MPH, Project Director, State Office
of Rural Health, Office of Health Policy and Planning
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Michele Pharr, MA, Health Policy Analyst, State Office of
Rural Health, Office of Health Policy and Planning
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[email protected]; 410-767-5121
[email protected]; 410-767-3543
http://www.fha.state.md.us/ohpp/ruralhlth/
References
Miller, JB and Crittenden, RA. (2001) “The effects of
payback and loan repayment programs on medical
student career plans.” Journal of Rural Health, 17(3):
160-164.
Pathman, DE, Konrad, TR, Taylor, DH Jr., and Koch, GG.
(2004) “Outcomes of states’ scholarships, loan
repayment, and related programs for physicians.”
Medical Care, 42(6): 560-568.