1. Reimagining your Workforce: Using MAs as Health Coaches The Central Valley Journey

2. The Central Valley Health Network 14 Federally Qualified Health Centers Serving 21 Counties Over 145 sites Approximately 4000 employees Majority are Migrant Health Centers

3. Central Valley Health Network  Mission: CVHN’s mission is to advocate for community health centers’ strength in the marketplace and to support members’ effective delivery of high quality and accessible health care.

4. Key Strategic Initiative: Workforce Development  The Central Valley faces health care workforce shortages at a much higher concentration than other California regions.  The Valley is lacking in an adequately prepared workforce to meet the increased skill demands needed in the post health care reform health center.  Approaches to address these issues:  strengthening pipeline programs,  connecting health centers to the resources needed to up- skill their workforce, and  supporting provider recruitment and retention efforts.

5. Upskilling the Workforce – When the Conversation Started  2011 – The San Joaquin Valley Workforce Funders Collaborative  National Fund for Workforce Solutions  organize industry partnerships to develop a pipeline of skilled workers  promote improvement to business practices and public policies  act as catalysts for generating additional investments in creating industry partnerships  The California Endowment Funded Work to look at opportunities in the Central Valley

6. What Drove the Need for the Conversation?  Health Care Reform  New Patients  Payment Reforms  Health Literacy and Demographics  Maldistribution of Physicians  Patient Centered Medical Home  Team Based Care

7. Connecting the Dots

8. Crosswalking the CHW and MA Roles to Patient Centered Medical Home

9. Choosing a Path (for this effort at least) Community Health Worker Advanced MA Role

10. So, Now What is Next?  What Will the Model Look Like  What are others doing  Funding  Foundations, Workforce Development Boards, Health Plans?  Training Model  Health First, UC Davis, San Diego  Practice Readiness

11. More Dot Connecting: What are others doing  HealthForce Center at UCSF: Innovative Workforce Models of Health Care  http://healthforce.ucsf.edu/search/node/Innovative% 20Workforce%20Models%20of%20Health%20Care http://healthforce.ucsf.edu/search/node/Innovative% 20Workforce%20Models%20of%20Health%20Care  St. Luke’s Health Care Center, San Francisco  http://www.ncbi.nlm.nih.gov/pubmed/21294977 http://www.ncbi.nlm.nih.gov/pubmed/21294977

12. Taking the Dot Connecting to the Next Level  HealthForce at UCSF presented “Innovative Workforce Models in Health Care including presentations from:  North County Health Services  Union Health Center (New York)  High Plains Health Center (Colorado)  Overview of the UCSF Health Coach work and training (Tom Bodenheimer, M.D.)  Time for a Field Trip to North County Health Services

13. Funding  The Challenge is finding funding for training of INCUMBENT workers….  Our Health Centers looked to Traditional Funders  The California Endowment invested in a pilot project in Merced County  Our Health Centers looked to the Workforce Development Board  The Merced County WDB applied for and received Workforce Accelerator Funding from the California Workforce Development Board  Our Health Centers engaged in discussions with their local health plan

14. Training  Health Center that received funding looked at:  UC Davis Model  San Diego Health Workforce Initiative  http://ca-hwi.org/ http://ca-hwi.org/  Decision made to pilot UC Davis model, provided an opportunity for evaluation of two different models

15. Practice Readiness  I put this last for a reason…although, in reality it should be one of the first things done  As Dr. Witte Shared: Changing Provider Roles— BUT—  Giving up work to the team is difficult! AT FIRST:  “The responsibility is on me!”  “It’s MY license at stake!”  “No one else understands the work!”

16. Practice Readiness AND… AFTER TRAINING OF HEALTH COACHES:  “Many tasks can come off my plate!”:  Including:  Entering data-even having a scribe.  Many phone calls.  Preventive care and alerts.  Etc.!

17. Thoughts from Connecting and Collecting the Dots  Health Coaches must be Experienced Medical Assistants (or Health Educators)  There is an organizational commitment required:  Need to invest in training of health coaches and in preceptors  Need to establish a career ladder for these new roles  This will require changes in the clinic workflow – this will take CEO and CMO support  It is one thing to provide the training but organization’s leadership needs to support the operationalization  Preceptors can and should be used to help determine the implementation process and to help with implementation.

18. Additional Thoughts from Connecting and Collecting the Dots  Onboarding of New Providers to this concept is crucial (Karissa)  Through the use of preceptors there are organizational decisions that need to be made such as implementing the assessment process, supervising of charting, etc.  The Side Benefits of the Training Model our Health Centers selected  The model provides fundamental skills to staff to prepare them for an expanded role  It allows the flexibility for health centers to operationalize in a manner that best supports their practice dynamcis  Sustainability is a challenge….WDB money and foundation money will only take this so far….

19. Connecting some Dots for you  Livingston Community Health –  Rosa Pavey rpavey@visitlch.orgrpavey@visitlch.org  UC Davis Betty Irene Moore School of Nursing –  Dr. Katherine Kim  Victoria Ngo  UC San Diego Extension -  Leslie Bruce lkbruce@ucsd.edulkbruce@ucsd.edu  Health Workforce Initiative  Ann Durham (Deputy Sector Navigator – Health Care) ann.durham@gcccd.eduann.durham@gcccd.edu  Central Valley Health Network  Mary Renner mrenner@cvhnclinics.orgmrenner@cvhnclinics.org