Health Care Workforce Recommendations DRAFT

1. Health Care Workforce Recommendations DRAFT December 2012

2. Charge of the Health Care Workforce Committee • Assess Delaware’s: • Current and Future Health Care Needs • Current and Future Workforce Capacity • Anticipated Changes in the Health Care Environment • Develop Recommendations to assure adequate supply of well-trained health care professionals

3. Participants • Amelia Auner - Planned Parenthood of Delaware • John Allen - Allen Insurance Group • Theodore Becker - Delaware Health Care Commission • Traci Bolander, PsyD - Delaware Psychological Association & MidAtlantic Behavioral Health • Jamee Boone - United Way of Delaware • Lauren Brittingham - Bayhealth Medical Center • Judith Chaconas - Delaware Division of Public Health • Terri Cheek - Westside Family Healthcare • James Collins - Delaware Division of Professional Regulation • Katherine Collison - Delaware Division of Public Health • Alex Eldreth - National Multiple Sclerosis Society • Thomas Ferry - Star-Med LLC • Barbara Giardina - Delaware Psychological Association • Deborah Hamilton - Cozen O’Connor • Michele Haranin, OD - Delaware Optometric Association • Joann Hasse - General Public • Cheryl Heiks - Cozen O’Connor • Bryce Hewlett - Delaware Consumer Recovery Coalition • Kathy Janvier - Delaware Technical & Community College • Bruce Kelsey, LCSW - Delaware Guidance Services for Children and Youth, Inc. • Jonathan Kirch - American Heart Association

4. Participants (cont.) • James Lafferty - Mental Health Association in Delaware • Ruth Lytle-Barnaby - Planned Parenthood of Delaware • Kathleen Matt, PhD - University of Delaware • Bruce Matthews, DDS - Private Practice Dentist • Farzana McCormick - McCormick Executive Search, Inc. • Kathryn McKenzie - Susan G. Komen for the Cure • Linda Nemes - Delaware Department of Insurance • Janice Nevin, MD, MPH - Christiana Care Health System • Mary Nordenson - Delaware Physicians Care, Inc. • Paula Paul, PA - Delaware Academy of Physician Assistants • Ann Phillips - Delaware Family Voices • Bettina Riveros, Esq - Delaware Office of the Governor • Lisa Schieffert - Delaware Healthcare Association • Marjorie Shannon - Delaware Division of Public Health • Kim Siegel - Autism Delaware • Paul Silverman, DrPH - Delaware Division of Public Health • Denise Stypinski, SPHR - Brandywine Counseling and Community Services, Inc. • Mark Thompson, MHSA - Medical Society of Delaware • Kelly West - Delaware Department of Insurance • Betsy Wheeler - Wheeler & Associates Management Services, Inc.

5. Results of Data Collection • Delaware’s population is aging more quickly than that of the nation. • By 2030 Delaware will have the 9th oldest state population in the country • Age and chronic illness will continue to have a significant effect on health care needs • Number of diabetics age 18+ will increase by ~one-third (~60,ooo in 2010; ~78,000 in 2040); number of diabetics age 65+ will more than double (~26,000 in 2010; ~57,000 in 2040) • 80% of Americans age 65+ have >1 chronic condition; 50% have >2 chronic conditions • And on health care consumption • Average American age 85+ consumes • Twice as much health care as those age 75-84 • Three times as much health care as those age 65-74 • Projecting a number of needed health care professionals is complicated BUT…

6. Results of Data CollectionPrimary Care Providers According to HRSA, Delaware is approximately: • 7 primary care providers short of the MINIMUM needed to remove HPSA designations • 4 psychiatrists short of the MINIMUM needed to remove the HPSA designations • 31 dentists short of the MINIMUM needed to remove HPSA designations

7. Results of Data Collection Nurses • Net increase of 130 active APN (Advanced Practice Nurse) licenses in 2012 • Net increase of 1384 active RN (Registered Nurse) licenses in 2012

8. Results of Data Collection What We Don’t Know • How many FTE’s are presently practicing in which settings in Delaware across disciplines and specialties? • How many will retire within 5 years, 10 years, 15 years?

9. Recommendations • Fully implement the Institute of Medicine’s recommendation to build an infrastructure for the collection and analysis of professional health care workforce data • Support and continue to expand Delaware’s health information technology infrastructure • Support state-of-the-art health care workforce education and training programs • Ensure a supportive regulatory and policy environment for health care professionals • Ensure integrated and supportive practice environments for health care professionals • Create and implement a comprehensive health care workforce recruitment strategy

10. 1. FULLY IMPLEMENT THE INSTITUTE OF MEDICINE’S RECOMMENDATION TO BUILD AN INFRASTRUCTURE FOR THE COLLECTION AND ANALYSIS OF PROFESSIONAL HEALTH CARE WORKFORCE DATA GOAL:Routinely collect, analyze, disseminate and use health care workforce data to guide decision making and evaluate interventions at all levels. TASKS/INTERVENTIONS: • Conduct an inventory and analysis of available health care workforce data sets including • individual data elements • technical specifications of databases • collection, analysis and release protocols and practices • potential use of existing resources/infrastructure (e.g., DHIN) • potential for interoperability and analysis across data sets and functions

11. 1. FULLY IMPLEMENT THE INSTITUTE OF MEDICINE’S RECOMMENDATION TO BUILD AN INFRASTRUCTURE FOR THE COLLECTION AND ANALYSIS OF PROFESSIONAL HEALTH CARE WORKFORCE DATA (cont.) TASKS/INTERVENTIONS (cont.): • Develop and implement a strategic plan for the collection, dissemination and use of health care workforce data, leveraging the DHIN infrastructure and provider index, including: • data elements to be collected • data sources and collection methodologies • analyses to be conducted (e.g., vacancy rates, full time equivalents) • responsible entities • costs • value vs. cost of collection • timeline for completion and schedule of ongoing maintenance

12. 2. SUPPORT AND EXPAND DELAWARE’S HEALTH INFORMATION TECHNOLOGY (HIT) INFRASTRUCTURE GOAL: Continue to support, develop and enhance a comprehensive and integrated health care data collection, transfer, analysis and training infrastructure for use across all health care disciplines and among all health care organizations, leveraging the DHIN as Delaware’s state-designated Health Information Exchange (HIE).

13. 2. SUPPORT AND EXPAND DELAWARE’S HEALTH INFORMATION TECHNOLOGY (HIT) INFRASTRUCTURE (cont.) TASKS/INTERVENTIONS: • Include HIT professionals in developing, maintaining and participating in multi-disciplinary training environments • Promote development of inter-organizational HIT capabilities and programs • Promote the ongoing development of the DHIN to optimize the exchange of data among health care workforce providers and health care organizations. • Using current DHIN Health Information Exchange (HIE) infrastructure and individual provider systems, develop and implement a statewide HIT strategic plan to include: • tasks • timelines • responsible agencies • costs • potential funding sources

14. 2. SUPPORT AND EXPAND DELAWARE’S HEALTH INFORMATION TECHNOLOGY (HIT) INFRASTRUCTURE (cont.) TASKS/INTERVENTIONS (cont.): • Use “meaningful use” HIT incentives offered by the Office of the National Coordinator (ONC) as a model to develop incentives for mental health and other health care providers currently ineligible for federal incentives to expand deployment of HIT capacity within practice environments including: • participation in the Delaware Health Information Network (DHIN) • adoption of electronic medical records (EMR) with DHIN interface • Support DHIN outreach, education and technical assistance related to meaningful use to health care providers currently eligible but not participating in HIT enhancement activities • Expand use of telemedicine for consultation and direct services; consider revenue models to support telemedicine.

15. 3. SUPPORT STATE-OF-THE-ART HEALTH CARE PROFESSIONAL EDUCATION AND TRAINING PROGRAMS: GOAL:Develop an adequate and integrated system of undergraduate, graduate and post-graduate clinical experiences to complement academic training programs. TASKS/INTERVENTIONS: • Support and enhance statewide use of multi-disciplinary simulated learning environments including: • develop multi-disciplinary simulation labs in each county • expand use of students and other participants to simulate patient/professional interactions as well as clinical • include HIT, fiscal and other key roles/components in the health care environment • develop full-time faculty positions in simulation training

16. 3. SUPPORT STATE-OF-THE-ART HEALTH CARE PROFESSIONAL EDUCATION AND TRAINING PROGRAMS (cont.): TASKS/INTERVENTIONS (cont.): • Enhance and formalize current connections between DIMER, DIDER, residency and fellowship programs and health care providers statewide and the Delaware Health Sciences Alliance. With special emphasis on Kent and Sussex Counties, consider: • expanded clinical rotations for professional students • expanded internships • expanded residency placements • development of teaching health centers

17. 3. SUPPORT STATE-OF-THE-ART HEALTH CARE PROFESSIONAL EDUCATION AND TRAINING PROGRAMS (cont.): TASKS/INTERVENTIONS (cont.): • Expand opportunities and incentives for health care providers to serve as graduate and post-graduate faculty, preceptors and clinical sites. Consider strategies including: • develop remote/off-site consultation via videoconferencing • third party reimbursement to supervisors for services provided by residents and other post-graduate clinicians, particularly in mental health service arena • provide incentives to offset supervisors’/preceptors’ lost revenue resulting from decreased clinical hours

18. 3. SUPPORT STATE-OF-THE-ART HEALTH CARE PROFESSIONAL EDUCATION AND TRAINING PROGRAMS (cont.): TASKS/INTERVENTIONS (cont.): • Support the use of dental education programs to expand the supply of dental providers in underserved areas. Consider strategies recommended by the Institute of Medicine including: • support and expand Delaware’s dental residency program • expand residency programs to include more experiences serving underserved and rural populations • Develop curriculum and practical experience standards for care coordination, health navigator, health coach and other emerging health care training programs

19. 4. ENSURE A SUPPORTIVE REGULATORY AND POLICY ENVIRONMENT FOR HEALTH CARE PROFESSIONALS GOAL: Attract and actively facilitate application and licensure for highly-skilled and qualified health care professionals throughout the health care system. TASKS/INTERVENTIONS: • Review licensure requirements to ensure comparability to national standards in order to facilitate mobility of licensure. • Revise and streamline licensure processes while retaining quality and standards. Consider: • review application and licensure processes from a customer service perspective • enhanced use of IT including: • videoconferencing to accomplish one-on-one interviews

20. 4. ENSURE A SUPPORTIVE REGULATORY AND POLICY ENVIRONMENT FOR HEALTH CARE PROFESSIONALS (cont.) TASKS/INTERVENTIONS (cont.): • Revise and streamline licensure processes while retaining quality and standards. Consider (cont.): • integrated licensure and credentialing models • tiered licensing for graduate and post-graduate clinicians • standards set forth in National Council of State Boards of Nursing Model Nursing Practice Act and Model Nursing Administrative Rules (Article XVIII, Chapter XI and 11) • reciprocity standards • Review scope of practice standards and revise as appropriate. Consider implementing recommendations of the Institute of Medicine and other relevant national organizations related to expanding access to care with respect to medical, nursing, mental health/substance abuse and dental care providers.

21. 4. ENSURE A SUPPORTIVE REGULATORY AND POLICY ENVIRONMENT FOR HEALTH CARE PROFESSIONALS (cont.) TASKS/INTERVENTIONS (cont.): • Enhance Delaware’s existing State Loan Repayment Program. Consider: • eligibility for additional disciplines • additional loan repayment/service opportunities for targeted disciplines • expanded/enhanced loan repayment opportunities for participants in Delaware residency/post-doctoral experiences • Revise and streamline third party payer credentialing processes including: • using dental and medical provider models, provide reimbursement for services provided by post-doctoral mental health/substance abuse professionals under supervision • develop and implement a unified credentialing process for each discipline across all payers

22. 4. ENSURE A SUPPORTIVE REGULATORY AND POLICY ENVIRONMENT FOR HEALTH CARE PROFESSIONALS (cont.) TASKS/INTERVENTIONS (cont.): • Create or adopt certification and licensure standards for emerging health care roles including: • care coordinator • health navigator • health coach • Consider changes to payment policies including: • payment model pilot or cost comparison study of adult dental preventive care and acute medical dental emergency care • feasibility of expansion of Medicaid to include coverage for adult dental services • Inclusion of dental insurance coverage products on Delaware’s Health Benefits Exchange

23. 5. ENSURE SUPPORTIVE AND INTEGRATED PRACTICE ENVIRONMENTS FOR HEALTH CARE PROFESSIONALS GOAL: Health care providers will contribute to and use professional, community and personal support systems to deliver integrated and efficient care. TASKS/INTERVENTIONS: • Create professional support systems to include • access to remote/off-site peer and specialist consultation via • one-on-one videoconferencing • grand rounds • online access to standard of practice literature and decision support tools • mentoring and learning collaborative opportunities • assistance during development of and transition to Patient Centered Medical Home approaches to care

24. 5. ENSURE SUPPORTIVE AND INTEGRATED PRACTICE ENVIRONMENTS FOR HEALTH CARE PROFESSIONALS (cont.) TASKS/INTERVENTIONS (cont.): • Create and support personal, community and family support systems • Connect newly-licensed health care professionals with professional organizations • Create and support mechanisms to collate and link comprehensive information, prevention strategies and services to the practice setting to support coordinated care (e.g. cancer, diabetes, equipment and supplies for children with special health care needs) • Provide technical assistance to providers for practice redesign including adoption of new roles for existing and new staff to achieve greater efficiency and assure quality/continuity of care

25. 6. CREATE AND IMPLEMENT A COMPREHENSIVE INTEGRATED HEALTH CARE WORKFORCE RECRUITMENT STRATEGY GOAL: Highly qualified health care professionals will choose to practice in Delaware. TASKS/INTERVENTIONS: • Use data from a variety of sources to identify educational institutions and provider types and profiles for recruitment

26. 6. CREATE AND IMPLEMENT A COMPREHENSIVE INTEGRATED HEALTH CARE WORKFORCE RECRUITMENT STRATEGY (cont.) TASKS/INTERVENTIONS (cont.): • Create a statewide health care professional recruitment clearinghouse to coordinate and promote recruitment activities • Develop and implement recruitment strategies and materials that highlight Delaware as a health care and health technology innovation hub, highlight Delaware’s assets (DHSA, CCHS Value Institute, DHIN, Delaware Bio Science Association, UD STAR Campus) and incent relocation of health care providers to Delaware. Consider: • research and grant opportunities • significant accomplishments in areas such as • reduction/elimination of health disparities • national leadership in cancer prevention, early detection and treatment • reduction in cancer incidence and mortality • small business support strategies

27. 6. CREATE AND IMPLEMENT A COMPREHENSIVE INTEGRATED HEALTH CARE WORKFORCE RECRUITMENT STRATEGY (cont.) TASKS/INTERVENTIONS (cont.): • Create a statewide health care professional recruitment clearinghouse to coordinate and promote recruitment activities (cont.) • relocation services/toolkits including connections to • realtors • builders • schools • health care providers (personal and family) • Market availability of innovations previously described (e.g., simulation center; availability of trained support staff and of technologic infrastructure and support; streamlined licensure / credentialing process) • Provide formal linkages to small business support services for health care providers