Health Workforce Innovations to Support Delivery System Transformation Health Workforce Innovations: View from the States September 13th, 2016 Frederick Isasi, JD, MPH Director, Health Division National Governors Association Center for Best Practices

Purpose of this Session Provide a Brief Overview of NGA’s Work with Governors and their Leaders Governors’ Approaches to Health Workforce Development Current State Challenges Underlying Goals of State Health Workforce Strategy Illustrative Example: Framework for Assessing Workforce Strategy

About the National Governors Association Nation’s oldest organization serving the needs of governors and their staff (founded in 1908) Bipartisan Leadership: Chair Gov. McAuliffe (D-VA) and Vice-Chair Gov. Sandoval (R-NV) NGA Office of Federal Relations (OFR): serves as the collective voice of the nation’s governors in Washington, DC NGA Center for Best Practices: a hybrid think thank/consultancy that works to surface evidence-based practices, works directly with governors on specific policy projects, and provides support to OFR. The NGA Center divisions are: Health Education Energy, Environment, and Transportation Human Services and Workforce Homeland Security and Public Safety

About the NGA’s Health Work NGA Center Health Division: Work focuses on governors most pressing and important health care issues Typically, project-based through competitive RFA process to you and your governors Our work is provided a service, free of charge –projects funded through cooperative agreements with federal government, grants, and donations. [Read slide]

Continuum of Health Division Activities Target Audience Most Focused Most Broad Governor Healthcare Leadership Retreats In-State Policy Retreats State-specific Technical Assistance Policy Academies Convenings of States Collaboration with NGA’s Office of Federal Relations Medicaid Transformation Toolkit, Opioid Roadmap Other Publications Health Division Activities [Read slide] Done by 3:12

NGA’s Current Focus Areas in Health Six Core Focus Areas Support and Build on Each Other

Governors’ Approaches to Health Workforce Development Many Sectors of Government Affect Health Workforce Development Health Workforce Development Economic Development Access to Health Care Public Health Regulatory/ Budget Emergency Preparedness Education (K-12 and Higher) Meet Current Health Care Needs Meet Needs of Transformed Health Care System Health workforce development touches many sectors of government. Also, ensuring the health workforce is appropriately trained and utilized impacts larger health system transformation and coverage efforts, such as State Innovation Model grants and Medicaid expansion.

Current State Challenges: Siloed Workforce Efforts Recruitment and Retention Workforce Redesign/ Delivery System Regulation Integration of Population Health States are working in a number of areas; often concurrently and in some instances, in silos. Thus, greater coordination and organization is needed.

Underlying Challenges of State Health Workforce Strategy Workforce maldistribution / shortages Lack of policy and data coordination No “ownership” of statewide workforce planning efforts Siloes in heath professions Limited funding for workforce planning efforts Limited access to reliable data Limited cultural competency and diversity within the workforce Uncertainty around moving to new models of care and workforce implications Undefined roles of new and emerging health professionals Regulatory/statutory barriers to allowing professionals to practice at the top of their license  There are a number of challenges states face within workforce planning and development. Some of these challenges are in regards to access to care. For example, states experience maldistribution or shortages in particular areas, like primary care, behavioral health, or oral health. Other challenges are in regards to the lack of a governing structure to coordinate planning efforts. For example, there is no entity to coordinate data or policy, limited funding, and limited access to reliable data. Finally, other challenges relate to states that are implementing new care delivery models. Those challenges include understanding the variety of new health care professionals and their role in providing team-based care and addressing scope of practice regulations to allow for non-physician providers to deliver services.

Underlying Goals of State Health Workforce Strategy Improve access to care Improve efficiencies within the health system Ensure high quality care Increase economic development Workforce Strategy

Underlying Goals of State Health Workforce Strategy Improve access to care Address maldistribution/ shortages: Type of service(s) Geographic areas Provider participation in public programs Improve efficiencies within the health system Ensure high quality care Increase economic development Workforce Strategy

Underlying Goals of State Health Workforce Strategy Improve access to care Improve efficiencies within the health system Ensure high quality care Set a unified standard of quality that carries across: Professions Settings Patient populations, including the underserved Increase economic development Workforce Strategy

Underlying Goals of State Health Workforce Strategy Improve access to care Improve efficiencies within the health system Drive towards higher quality and lower cost care. Approaches may include: Team-based models Integration of services Care in non-clinical settings Ensure high quality care Increase economic development Workforce Strategy

Underlying Goals of State Health Workforce Strategy Improve access to care Improve efficiencies within the health system Ensure high quality care Increase economic development New roles for health professions creating economic opportunities for state residents Career ladders New career paths Workforce Strategy

Illustrative Example: Framework for Assessing Workforce Strategy Consider each lever and its impact on profession under review across each goal in the framework to determine potential policy components. Lever Access Quality Efficiencies Economic Development Potential Policy 1 Education Requirements 2 Training Requirements 3 Certification 4 Licensure 5 Continuing education requirements for certification/license renewal 6 Supervision requirements 7 Reimbursement level in state public health programs 8 Payment parity across provider types