Healthcare Workforce ARRA and Healthcare Reform

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Healthcare Workforce ARRA and Healthcare Reform

• Kristin Juliar, Director
• Montana ORH/AHEC
• NOSORH Webinar, July 7, 2009

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ARRA Issues (Some we know, some we dont 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

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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

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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

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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

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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

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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)

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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

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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.

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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 arent 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 arent 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
•  

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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

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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

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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.

"For those of you who have been following this
200 million and trying to figure out where it is
going to go, it has been kind of interesting
because there were several different iterations
of ARRA dollars for health professions education
in earlier versions of the proposed legislation,"
said Brand.
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Questions?