1. 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

2. 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

3. 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

4. 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.
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5. 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
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Done by 3:12

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

7. 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.

8. 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.

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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