Workforce & Leadership: Trends & Opportunities Merle Cunningham, MD, MPH, Geiger Gibson Program in Community Health Policy & Leadership

Session Objectives  To become familiar with evolving national trends related to CHC workforce development and changing models of practice  To understand evolving trends in CHC leadership development  To become familiar with opportunities for collaboration on workforce development and leadership development

Conceptual Framework for Continuum CATEGORYWORKFORCELEADERSHIP Clinical PCPs – MD, DO, NP, PA, CNM Nursing- RNs, LPNs, MAs Other medical providers Oral health providers Behavioral health providers CHWs, Case managers CMO, Site Med Director Dental Director Nursing Director Other clinical directors Other clinical supervisors Administrativ e Front desk Fiscal & billing staff HIT staff Enabling services staff Other management & support CEO, COO, CFO, CIO Site Directors Supervisors

Workforce & Models of Practice

Health Center Workforce Goals: Based on ACCESS for All American Patient Projections 20,663 47,801 54,488 *Nurse Practitioners, Physician Assistants, Certified Nurse Midwives. Source: Access Transformed: Building A Primary Care Workforce for the 21 st Century. NACHC, Robert Graham Center, and GWU SPHHS. August Full-Time Equivalent Staff Current Median Provider Ratios TodayRange in 2015

Long history of “Grow your own…”  Since earliest years of OEO NHCs – late 1960s  AHEC pipeline partnerships for decades Current  AT Still-NACHC Dental School  AT Still-NACHC School Osteopathic Medicine Arizona 1 st class of 96 graduates June 3 rd  Teaching Health Centers (medical & dental residencies) -THC funding 6 of 11 to CHCs, partners in 4 of 5 Future  Evolving Comprehensive Workforce Continuum Strategy

Percent of Health Centers Participating in Health Professions Training Programs, 2007 Percent Participating *Student/Resident Experiences and Rotations in Community Health ** Area Health Education Center Note: 35% response rate. Survey responders make up a nationally representative sample of all federally-funded health centers. Source: NACHC 2007 Survey of Health Profession Training Programs in Community Health Center

NACHC Strategies - Clinical  Clinical Staff  Advanced – MD, DO, NP, PA, CNM, DDS, DH, BH  NHSC utilization (increase from 30%)  J-1s/H-1Bs, Vets, Retirees  Replicate AT Still University model (community campuses)  More GME – Teaching Health Center models  More Dental Residency – AEGD (Advanced Educ General Dentistry)  NP & PA academic partnerships  Behavioral health academic partnerships  Entry level – RN/LPN, MA, DA, CHW, Enabling staff, Other  Community college partnerships  Western Governors University (WGU) – “Growing From Within”  Americorps – Professional Corps model (MA, DA and CHWs)

NACHC Strategies - Administrative  Administrative Staff  Advanced (Senior level positions)  Leadership Development Institutes (LDI)  Core Competencies – modular curriculum components  “Emerging Leader” track & networking  Entry & Mid Level – (Ops, HR, HIT, front desk, communications, fiscal, communications, etc.)  Web-based modules for onsite entry level trainings  More conference content for mid-level staff development

Evolving Models of Practice  Health Care Team approaches-  Fundamental to early health centers  Basic component of “Care Model” used in HDCs  Practice “transformation” – fundamental to PCMH  “Working at the top of your license”  Integration behavioral health  Integration of oral health  Care Management (CMS Demos)  “Old wine, new bottles”  Reducing Care Fragmentation: Toolkit for Coordinating Care  Note: NH + VT highlights from Readiness Survey  Adoption, MU, PCMH, Registries/Clin Warehouses, Telemed

Leadership Development

NACHC Strategies  Leadership Development Institutes (LDI) – to follow  Core Competencies for CHC management  Identified with curriculum/ courses wrt accreditation  Components can be shared via Distance Learning “mix and match” for many different audiences and programs among PCAs and others as part of a national learning community  Emerging Leaders  Geiger Gibson – Annual awards at P&I through CEO nomination & selection by panel of GG Distinguished Visitors  NACHC – New networking sessions at P&I, CHI; planning new “track” at future conferences

 Hub & Spoke Model  Hub: NACHC & Geiger Gibson Program  Spokes: multiple regional programs (PCAs w/ academic partners)  Mass League – Suffolk University  Greater Midwest PCAs – Univ Kansas  Northwest Regional PCA – Univ Washington  Blue Shield Foundation of CA – UCSF Center for Health Professions  North Carolina PCA – East Carolina University  Geiger Gibson Program, GW School of Public Health & Health Services Leadership Development Institutes

GW-NACHC Partnership Programs “Hub” Program: Capstone in Health Policy and Leadership (3 cycles per year in Oct, Feb & June) Directors: Merle Cunningham & Becky Beauregard Senior Advisor: Sara Rosenbaum “Spoke” Program: Graduate Certificate in CHC Management (2 cohorts per year, starting in Fall and Spring Semesters) Director: Merle Cunningham

“Hub” Program: Capstone in Health Policy & Leadership  Program Goal  To increase the number of trained CHC leaders to meet the increasing current and future demand  Learning Objectives  To gain familiarity with the federal health policymaking process and how policy influences legislation and subsequent programs  To interact with policymakers, congressional staff & Federal health program leaders  To become familiar with policy-related health services research involving health centers

GW Capstone Curriculum  Pre-Capstone Webinars (Dates scheduled in 4 week period preceding each Cycle): Four one-hour live webinars with assigned readings and online exercises  Onsite Program in DC (3 days): presentations by health policy researchers and policymakers; dialogues with Congressional staff; and informal meetings with NACHC senior leadership, HRSA staff and other Federal agency officials.

Capstone Specifics  PCA Selection Process  Interested PCAs may have positions in each cycle of 20 students  Student selection is locally determined  Target audience is mid-level and senior staff interested in executive leadership careers in CHCs  Cost  $1000 per student, not including travel, lodging and most meals  Timeframe  3 cycles per year in October, February and June

“Spoke” Program: Graduate Certificate in CHC Management Designed for Working Professionals  Training current and future CHC professionals for management and executive leadership positions  Offered over 3 semesters, 3 courses each semester, 2 credits per course = 18 academic credits overall  Combines accredited academic training with practical skills that CHC managers need  Guidance and oversight provided by a GG Leadership Advisory Group of Charter members from CHCs and PCAs with students in the initial cohort

Certificate Curriculum  First Semester Courses  Intro to Health Management  Health Services Finance  Community Health Center Policy  Second Semester Courses  Quality & Performance Improvement  Health Services Information Applications  Health Services Marketing and Planning  Third Semester Courses  Health Law for Managers  Human Resources Management and Organizational Behavior  Health Services Advocacy and Communication

Online and On Campus Executive Distance Learning Format  Individual online sessions  Biweekly interactive webinars and video conferences  Two group sessions: Launch with CHI, End in DC on campus The GW Experience  A team project addressing a current local CHC initiative  Biweekly policy updates from NACHC  A culminating Capstone with team presentations in DC

Program Details Admission Requirements:  Completion of a bachelor’s degree  Three years of related experience in community health  An introductory accounting course  GRE scores within past 5 years (waived if have any graduate degree) Transfer to Master’s Degree: Apply all 18 credits toward MHSA or MPH at GW SPHHS; credits may be transferred to another educational institution with similar accreditation Tuition: $12,000 for 18 credits (savings of more than $9000); eligible for Federal financial aid; AmeriCorps education awards recognized Applications: due by July 1 st for Fall Semester 2011 For more information, visit:

Regional Opportunities  Workforce & Practice Transformation  Medical Home Pilot (VT) – potential TA sharing  Care Management Project (NH)  State scope of practice & licensing (NH & VT)  Sharing “Community Health Team” models  Bi-State Leadership Development Program Certificate Program & Seminar Series in Community Health Leadership Oct 2011 – Apr 2012  Leadership  Advocacy  Quality Improvement  Workforce Development  Budgeting  Strategic Leadership

Recap Highlights  1. Reviewed evolving national trends in CHC workforce development and changing models of practice  2. Reviewed evolving leadership development activities for CHC mid-level and senior managers  3. Identified some opportunities for regional collaboration related to workforce issues, practice transformation and emerging leadership

Take Home Messages  1. Embrace all creative variations of “grow your own” strategies for workforce development, recognizing that short term cost are really long term investments  2. Continue aggressive work towards practice transformation, integration of services, team care coordination across all levels of care and use of regional information systems to improve population health  3. Continue to evolve a learning community with regional and national partners to share best practices and to coordinate or consolidate systems where appropriate.