Shcc Governors Health Policy Council Stakeholder Forum 040808


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Shcc Governors Health Policy Council Stakeholder Forum 040808

  1. 1. Stakeholder Forum Texas Health Care Policy Council Ben G. Raimer, MD, FAAP Chair, Texas Statewide Health Coordinating Council [email_address] April 8, 2008
  2. 2. “ The Perfect Storm” Border Health Issues Epidemic of Obesity Threats of Bioterrorism Low Immunization Rates Workforce Shortages Mental Health Issues Grow in Texas’ Population Growth of The Uninsured Health Disparities Increased Health Costs Health System Pressures
  3. 3. How will Texas fulfill its commitment to create a health professions workforce for the future … <ul><li>… who are able to provide culturally competent, linguistically appropriate, </li></ul><ul><li>quality health care </li></ul><ul><li>for the state’s increasingly diverse population? </li></ul>
  4. 4. Factors Affecting Workforce Supply Resulting in Shortages <ul><li>Aging workforce </li></ul><ul><li>Declining enrollments in professional schools </li></ul><ul><li>Feminization of the workforce </li></ul><ul><li>Workforce participation / lack of interest </li></ul><ul><li>Poor minority representation in health professions schools </li></ul><ul><li>Distribution of providers </li></ul><ul><li>Salary & benefits of providers </li></ul><ul><li>Working conditions of providers </li></ul><ul><li>Lack of unified state plan for workforce development </li></ul>Prepared by: Health Professions Resource Center, Center for Health Statistics, Texas Department of Health, 3/4/03; National Center for Heath Workforce Information and Analysis, 3/26/02, Marilyn Biviano.
  5. 5. Factors Affecting Workforce Demand Resulting in Shortages <ul><li>Aging population / longevity </li></ul><ul><li>Expanded scope of practice (genomics) </li></ul><ul><li>Medical advances </li></ul><ul><li>Insurance coverage </li></ul><ul><li>Insurance reimbursement – e.g., dental providers accepting Medicaid patients </li></ul><ul><li>Advances in technology </li></ul><ul><li>Population growth </li></ul><ul><li>Impact of chronic illness </li></ul>Prepared by: Health Professions Resource Center, Center for Health Statistics, Texas Department of Health, 3/4/03; National Center for Heath Workforce Information and Analysis, 3/26/02, Marilyn Biviano.
  6. 6. 2005 – 2010 State Health Plan Primary Care Recommendations <ul><li>Support of public health prevention and education programs, especially targeting chronic diseases </li></ul><ul><li>Reinstatement of general revenue funds in support of the Medicaid draw-down of federal funds for graduate medical education </li></ul><ul><li>Elimination of current outdated federal caps on funding for graduate medical education training slots </li></ul><ul><li>Restoration of funding for graduate medical education to 02-03 levels </li></ul><ul><li>Support of 300 new resident positions ($50,000 each), phased in over four years </li></ul><ul><li>Funding for Physician Education Loan Repayment Program from “all” Texas medical schools </li></ul><ul><li>Support of enrollment increases at pharmacy schools </li></ul>
  7. 7. <ul><li>Increase the number of Federally Qualified Health Centers in Texas </li></ul><ul><li>Support methodologies for development of innovative models for primary care delivery </li></ul><ul><li>Support of demonstration projects that utilize interdisciplinary teams of health professionals for prevention and management of chronic diseases </li></ul><ul><li>Track outcomes to providers </li></ul><ul><li>Include advanced practice nurses in networks </li></ul><ul><li>Support the training and use of state certified community-level health providers </li></ul><ul><li>Provide incentives to providers who use evidence-based practice guidelines </li></ul>2005 – 2010 State Health Plan Primary Care Recommendations
  8. 8. Federally Designated Primary Care Health Professional Shortage Areas as of February 1, 2007 Prepared by: Health Professions Resource Center, Center for Health Statistics, Texas Department of State Health Services, 2/1/07
  9. 9. Health Data <ul><li>Ensure the adoption of the “Minimal Data Set” for all health profession licensing boards with availability of that data to the SHCC and the Health Professions Resource Center (HPRC) for workforce analysis. </li></ul><ul><li>Adopt a state model for projecting future health profession supply and demand to facilitate appropriate planning. </li></ul><ul><li>Ensure adequate funding for the electronic capture of this data by all licensing boards. </li></ul><ul><li>Consider the creation of a single licensing agency and workforce data center for all professions. </li></ul>
  10. 10. Health Profession Shortages <ul><li>Maintain and expand state policies that contribute to a stable medical practice environment fostering workforce retention and growth (loans, tort reform, etc) </li></ul><ul><li>Ensure adequate state and federal funding for medical school and GME necessary to support anticipated increases </li></ul><ul><ul><li>Expand the entering class size for existing medical schools </li></ul></ul><ul><ul><li>Increase the number of funded GME programs by 300 </li></ul></ul><ul><ul><li>Develop a business plan prior to the creation of new state medical schools considering best options, </li></ul></ul><ul><ul><ul><li>Expansion through regional academic center models </li></ul></ul></ul><ul><ul><ul><li>Development of new schools from “ground up” </li></ul></ul></ul><ul><ul><li>Optimize recruitment and retention of “out-of-state” and international health professional graduates </li></ul></ul>
  11. 11. Mal-distribution of Professionals <ul><li>Create economic incentives for health professionals who elect to practice in HPSAs. </li></ul><ul><ul><li>Medicare and Medicaid reimbursements </li></ul></ul><ul><ul><li>Locum tenens services (discounted) </li></ul></ul><ul><ul><li>Community development funds (ORCA) </li></ul></ul><ul><ul><li>Continuing education programs (AHEC) </li></ul></ul><ul><li>Provide economic assistance with technology applications </li></ul><ul><li>Expand loan repayment programs for practitioners who select HPSA sites </li></ul><ul><li>Increase the number of Federally Qualified Health Centers (FQHCs) </li></ul>
  12. 12. Diversity <ul><li>Emphasize the importance of cultural as well as language competency for health care providers. </li></ul><ul><li>Reward health professional programs for the recruitment of students from diverse and under-served communities. </li></ul><ul><li>Assure recruitment of students by utilizing K – 12 health career promotions. </li></ul><ul><li>Provide scholarships and loan programs that are attractive for student participants. </li></ul><ul><li>Recognize potential barriers that may adversely impact the recruitment of students from disadvantaged backgrounds, such as lack of scholarships, tuition costs, length of training programs, lack of undergraduate preparation, etc. </li></ul>
  13. 13. School of Medicine <ul><li>Under-represented Minority Students </li></ul>Class of 2011 UTMB Texas Tech UT - SA UT - SW Texas A&M UT - HOU UNT- COM UTMB Texas Tech UT - SA UT - SW Texas A&M UT - HOU UNT- COM Class of 2010
  14. 14. School of Medicine <ul><li>Number of Under-represented Minority Medical Graduates </li></ul><ul><li>03/04/05 (3YEAR TOTAL) </li></ul>1 Howard University 214 2 UMDNJ 182 3 Meharry Medical College 153 4 University of Illinois 143 5 University of Texas Medical Branch 126 6 Temple University 107 7 UTSWMS 106 8 Harvard University 104 9 Baylor College of Medicine 101 10 University of Pennsylvania 71 10 University of Southern California 71 12 Drexel University 68 13 Michigan State University 63 14 University of Kansas Medical Center 55 15 Yale University 50 #1 in US in number of Hispanic graduates
  15. 15. Aging of the Workforce <ul><li>Promote “creative” retirement options that permit health professionals to continue to work in part time positions post-retirement. </li></ul><ul><li>Provide “second career” opportunities in the health professions workforce for early retirees (i.e., military,). </li></ul><ul><li>Provide para-medical professionals to extend the healing touch using PAs, APNs, community health workers, promoters, and clinical nurse specialists who function with physicians who function in health care delivery teams. </li></ul><ul><li>Create specialized / certified programs for workers in niches such as nursing homes, correctional facilities, and state schools. </li></ul><ul><li>Create careers for certified health workers who manage chronic illness. </li></ul>
  16. 16. Mental Health Professionals <ul><li>Increase awareness of the opportunities within the mental health profession. </li></ul><ul><li>Address service reimbursement inequities in private, state and federal insurance programs. </li></ul><ul><li>Utilize telemedicine technology to address access in under-served areas as well as to provide mental health sub-specialty services such as geriatrics and child/adolescent services. </li></ul>
  17. 17. Impact of Technology <ul><li>Education </li></ul><ul><ul><li>Shortages of educators in nursing and other critical fields demand that Texas’ colleges and universities exploit the tools of technology to provide access to courses for students. </li></ul></ul><ul><ul><li>Distance learning, web-based courses, and tutorials should be available to learners as applicable. </li></ul></ul><ul><li>Clinical Services </li></ul><ul><ul><li>HPSAs should have ready access to telemedicine, electronic records, and other tools that improve patient access and improve workforce efficiency. </li></ul></ul><ul><ul><li>Payor systems should encourage the use of technology through their reimbursement programs. </li></ul></ul><ul><ul><li>Licensure rules should support such programs. </li></ul></ul><ul><ul><li>Implement the recommendations of HITAC. </li></ul></ul>
  18. 18. Education <ul><li>Restore Medicaid GME funding with viable funding process to FY 02-03 levels </li></ul><ul><li>Ensure equitable federal Medicare GME funding for Texas teaching hospitals </li></ul><ul><ul><li>Texas base rates are lower than most programs in northeastern U.S. </li></ul></ul><ul><ul><li>Eliminate federal caps on GME funding </li></ul></ul><ul><li>Support 300 new resident positions over next 4 years </li></ul><ul><li>Restore and stabilize Title VII GME start-up programs and HHS Children’s Hospital GME </li></ul><ul><li>Continue to identify innovative practice incentives to improve physician ratios in medically underserved areas </li></ul>
  19. 19. UTMB School of Medicine Match Day <ul><li>2008 </li></ul><ul><li>94% Matched </li></ul><ul><li>56% in Texas </li></ul><ul><li>36% at UT-System </li></ul><ul><li>Programs </li></ul><ul><li>22% UTMB, </li></ul><ul><li>including 6 in Austin </li></ul>
  20. 20. Education <ul><li>Consider adoption of a state model for projecting future physician supply/demand to facilitate responsible state health professions planning in collaboration with SHCC, TMB, TMA, BNE and other health professional societies. </li></ul><ul><li>Examine the impact of the proliferation of advanced health profession degree programs (such as pharmacy, nursing, PT, OT, etc) upon the cost of education, years required for training, availability of practitioners, and recruitment of students from disadvantaged populations. </li></ul><ul><li>Support public health prevention and education programs, especially those that target chronic illness. </li></ul>
  21. 21. Education <ul><li>Expand programs that promote K-12 student interest and preparation for careers in the health sciences (AHEC). </li></ul><ul><li>Fund pilot educational programs that utilize multi-disciplinary teams and technology to maximize educational resources. </li></ul><ul><ul><li>Combined PA-ANP programs with common faculty. </li></ul></ul><ul><ul><li>Basic science courses that combine students from medical school, allied health science schools, and nursing schools on the same campus, or from remote campuses utilizing distance education technologies. </li></ul></ul><ul><li>Increase specific funding for BSN programs that are associated with superior patient outcomes. </li></ul>
  22. 22. UTMB School of Medicine USMLE Step 1 Results PASS RATE UTMB NATIONAL MEAN SCORE
  23. 23. UTMB SOM Student Performance (Step 1 +2) % Passing (Step 1& Step 2 Combined) Data from THECB – 03-12-08 UTMB UTSWMS TAMU UTHSC-SA Tx.Tech UTHSC-H 88% 90% 92% 94% 96% 98% 100% 2005 2006 2007
  24. 25. A Healthy Texas is a Productive Texas