California Health Workforce Alliance (CHWA) Kick-Off Primary Care Meeting Wed, January 12, Noon – 3:00

Welcome – John Troidl

Overview of Primary Care Issues – Kevin Barnett

Kevin Barnett listed objectives for the meeting. 1) Prepare the workforce for increasingly diverse populations 2) Determine tangible element to move forward. 3) Emphasize ongoing collaboration 4) Leverage available resources. 5) Determine initial framing, and then revise and refine.

Under the “CHWA Guiding Principles,” Geographic Framework and Beyond Institutional Interests are of importance. Need to encourage institutions to look at the greater interest--to challenge them to do things differently. Providers and health systems need to work together. The definition of primary care is a starting point for how we create a team for dramatic growth.

The “Key Elements” document lists strategies for our long-term investment in recruiting, training and deploying qualified health care practitioners in primary care. Our medium-term strategies revolve around thinking strategically about how to engage future healthcare workers and expanding internships and training programs, with emphasis on primary care. Our near-term goals concentrate on retention and expansion of current programs. To achieve the goals, the focus will be on the following:

1) Conduct a gap analysis 2) Bring an urgency to expanding primary care residency 3) Encourage residents to go back and practice in underserved communities 4) Diversify dentistry programs 5) Expand telemedicine 6) Strengthen the data to better manage care (through EMR) 7) Look into team-based approaches to care

Work Session: Issue Elaboration by Participants – Jeff Oxendine

Jeff acknowledged the complexity of the issues involved in sustaining and maintaining a primary health care workforce, particularly in rural areas, and although the issues are often a moving target, they require action. Jeff presented a “Health Workforce Pathway” as a visual representation of a long-term initiative aimed at recruiting and retaining a qualified healthcare workforce. Guideposts included:

1) Primary care Outreach Enrollment Potential Utilization (OERU) 2) Utilization of veterans coming home from the wars to augment the current workforce. 3) Overcoming barriers with specialists – Currently, there are not enough primary care providers available, so patients are utilizing specialists as their primary care providers.

Need to identify assets and strengths and identify gaps.

Elements listed on the “Health Workforce Pathway” do not appear connected, since some things fall through the cracks. For example, a potential health care worker may have an interest, but there is no training available, or there is no funding for the training to be completed. Case management is one way for individuals seeking employment to have continuous support to keep them in programs, moving toward a career in primary healthcare.

Need to create health career awareness among target groups, then assess and prepare, including funding. Need to reduce barriers that prevent qualified applicants from obtaining the training they need and provide access. Once in the appropriate programs, need retention programs so those who will finish the program still want to go into primary care. Need internships, hiring and orientation, so they have a chance to thrive in a primary care environment.

Dr. Carlisle suggested targeting target medical students rather than residents, encouraging them toward primary care. Currently, 80% of medical students are going into specialty care. Need to retain pre-med students at the undergrad level, and provide formal on-the-job training and internships in clinical training. Need to send students to practice in rural areas and underserved communities and encourage them to return to practice.

For more information: http://pace.berkeley.edu/

Need to provide incentives (payment policy) for students and residents to stay in primary care. Currently, we also rely on physician assistants and nurse practitioners for preventive care, but mid-level practitioners have the same distribution issues. Need reimbursement and incentives to attract nursing students to rural areas.

“De-selection” occurs within academic preparation programs. A professor may attempt to weed out students based on poor performance in science classes. Medical schools don’t want “C” students. Culturally competence in the enabling conditions run throughout all issues.

There are also barriers to the current workforce that is ready and willing to work but become lost in the maze of HR departments and job placement boards. Some students who complete allied health are unable to find jobs and drop out of the healthcare altogether. Need to develop more marketing and recruitment and devote attention toward reducing the barriers of the current workforce.

Need to define and manage the changing role of primary care, and address the issues of the aging workforce. Get students into training with the doctors who are retiring.

The UC Merced Prime Program covers the whole curriculum of primary care and is making a long-term investment. They are sparking interest at an early age. Much can be done at low cost to increase undergraduate retention and strengthen skills for acceptance into medical school. Cited 800 million in state general funds going to CA medical schools, but less than 20% of them are primary care graduates.

Make sure planning invests in ladders for advancement of allied health professionals.

Mental health regional groups have engaged psychological academic institutions to revise curricula in a manner that addresses public mental health needs.

There is a need for regional “service centers” that provide an infrastructure, an incentive for going into primary care, where EHR and telemedicine is integrated and support – overcome barriers to entry.

Putting PCPs at the center of a tem provides a basis to increase prestige and interest. Medical homes create a sense of stability.

Need to identify and address obstacles to PCPs from other states choosing to practice in CA.

The future of nursing is about advancing health, with a concern in geriatric care.

Primary Care Career Advancement 1) County Medical Associations: Mentorship in high schools. 2) Family medicine students going to high schools to mentor students 3) Health Science Educators Institute 4) Kaiser – Hippocrates Program -expose high school students to medical careers 5) Albert Schweitzer Scholarship Program 6) Healthcare Pathways Newsletter 7) Partnership with CPCA to provide clinical training program. HSEP and premed students reached. 8) Public Awareness Campaigns – Nursing – touch upon different healthcare disciplines 9) Preceptorship – putting 40 students into primary care settings over the summer 10) Health career opportunity programs statewide 11) HOSA: A good resources for assessments 12) Summer youth program through the WIBS (see CPCA website for explanation) 13) UCOP – priorities in ramping up enrollments in primary care 14) IOM Report 15) Medicaid waiver (see Andy Bindman re preventable conditions). 16) Medical Home Model 17) Expand primary care residencies 18) AHECs in other states have relationships with FFAs and 4H which serve as resources to link folks to health career options. 19) Many potential links to TCE’s Building Health Communities Initiative 20) Feds have just appropriated $19 M to expand residency slots. 21) CA is one of 5 pilots selected by RWJ as Regional Action Committees (RACs) to explore implementation of IOM Nursing recommendations. 22) NHSC Scholarship money is appropriated through 2015. HRSA is emphasizing the benefits of working in a CHC. 23) OSHPD: Song Brown, CAL-SEARCH, Health Career Training Programs Mini- Grants, and Health Career Pathways. 24) UC Health – 16 health professions schools, large employer(s), “UC thinks about primary care”. There is no UC Primary Care Committee.

Senate Health Committee – Hearing scheduled for Jan. 26 postponed.

HRSA - Focused on identifying pipeline. Wants to expose young providers to community health centers (National Health Service Corps). Teaching clinics must be FQHC. Goal is to link primary care and public health.

Next Steps –

1) Identify priorities through yield, cost and complexity 2) Filter through potential ideas and focus based on marginal allocation rule 3) Invite payers and purchasers to the table (VA, hospitals, Kaiser) 4) Bring SoCal stakeholders into the conversation 5) Bring Public Health to the table 6) Add dental health 7) Link to other organizations 8) Compare notes electronically 9) CHWA can more systematically document and link efforts.

CHWA will have four meetings over the next six months with the next meeting focusing on long-term, medium-term and near-term strategies for expanding primary care as well as criteria for prioritization of activities within each time range. Our short-term goal is the development of a strategic plan for primary care for the State of California.

Prior to the next CHWA Primary Care Initiative Meeting (“Meeting #2”) we will:

1. Distribute meeting minutes from the first meeting 2. Make the draft workforce model available for additional comment 3. Make the Short Term, Medium Term, and Long Term document available for comment 4. Continue to solicit your good ideas!