1. DELAWARE HEALTH CARE COMMISSION ********** DIMER, DIDER, and State Loan Repayment Program Report 12/6/121

2. Delaware Health Care Commission Mission: To promote accessible, affordable, quality health care for all Delawareans. Key Objectives: – Access - Promote access to health care for all Delawareans. – Cost - Promote a regulatory and financial framework to manage the affordability of health care. – Quality - Promote a comprehensive health care system assuring quality care for all Delawareans. 12/6/122

3. DHCC: Promoting Access Develop an appropriate supply of health care providers to assure access to care, especially primary care physicians and other primary care providers in short supply – DHCC oversees the DIMER program, the DIDER program, and the State Loan Repayment Program – DHCC monitors the supply of Nursing providers – Conducting the Workforce Development Committee focusing on (1) identifying provider supply and demand and (2) enhancing provider recruitment and retention 12/6/123

4. DIMER, DIDER, SLRP Project Gather information on DIMER, DIDER, and SLRP Programs’ participants relative to the program objectives and DHCC objectives 12/6/124

5. DIMER Delaware Institute of Medical Education and Research Created by State law in 1969 An alternative to a state-supported medical school Provide opportunities for Delaware residents to obtain a medical education Reserve seats in nearby medical schools for qualified Delaware residents 12/6/125

6. DIMER Delaware Institute of Medical Education and Research 1970: Agreement with Jefferson Medical College at Thomas Jefferson University to accept at least 20 Delaware residents 2000: Agreement with Philadelphia College of Osteopathic Medicine (PCOM) to accept at least 6 Delaware residents (later changed to 5). 1990s: Grant/loan program for TJU tuition assistance to encourage Delaware service (In 2000, converted to the State Loan Repayment Program). 12/6/126

7. DIDER Delaware Institute for Dental Education and Research Created by State law in 1981 To support, encourage, and promote: – the dental practice residency at CCHS – expand dental education and training opportunities – strengthen factors supporting dental providers deciding to practice in Delaware including loan repayments 2006: Agreement with Temple University School of Dentistry to accept at least 5 Delaware residents 2006: Tuition assistance payments to DIDER students 12/6/127

8. SLRP Delaware State Loan Repayment Program 2000: Former DIMER loan/grant program converted to a broader loan repayment program in exchange for service in underserved areas Broadened from only students attending Jefferson through DIMER to any graduate physician 12/6/128

9. Delaware State Loan Repayment Program Private, public, governmental loans qualify Loans for undergraduate and graduate/professional education qualify Also, capital loans for equipment expenditures to establish a practice in an area of high need Funding: Combination of Federal and State – Federal/State Funds: non-profit or public facility or practice in a federally-designated HPSA (Health Professional Shortage Area) – State Only Funds: private, for profit facility or practice in a designated shortage area 9

10. SLRP Eligible Disciplines Advanced-degree PractitionersMid-level Practitioners Primary Care Physicians (MD/DO)Registered Clinical Dental Hygienists  Family Medicine Primary Care Certified Nurse Practitioners  Osteopathic PractitionersCertified Nurse Midwives  Internal MedicinePrimary Care Physicians Assistants  PediatricsLicensed Clinical Psychologists  Obstetrics & GynecologyPsychiatric Nurse Specialists  General and Pediatric PsychiatryLicensed Clinical Social Workers Medical Oncologists Licensed Prof. Counselors of Mental Health General Practice Dentists Licensed Marriage & Family Therapists 10

11. Eligibility to Apply U.S. citizen, legal resident, or a selected refugee approved by the U.S. Attorney General outstanding qualifying higher education loans (undergraduate and/or graduate) not in default valid, unrestricted license to practice in Delaware recruited/employed at a site located within an appropriately designated HPSA (primary care, dental, mental) or a State facility not have any other outstanding service obligation 11

12. Awards Advanced-Degree Practitioners – up to $70,000 for 2-year commitment (additional year for $35K) Mid-Level Practitioners – up to $35,000 for 2- year commitment (additional year for $17.5K) 12

13. FY2013 Budget Appropriations DIMER Jefferson Medical College $1,000,000 Philadelphia College of Osteopathic Medicine $250,000 University of Delaware $50,000 Christiana Care Health System $200,000 Tuition Assistance $480,000 Loan Repayment $150,000 TOTAL$2,130,000 DIDER Temple University School of Dentistry $250,000 General Practice Dental Residents Support $148,000 Tuition Assistance $27,500 Loan Repayment $90,000 TOTAL $515,500 12/6/1213

14. Methodology Data Search – Interviews Local Other states Other professional education institutions – Health Care Commission files (2000 and after) – Christiana Care files (pre-2000) – TJU files/databases – PCOM files/databases – Temple files/databases – Division of Professional Regulation databases – DHIN participation lists – Public media/internet 12/6/1214

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16. DIMER TJU Summary DIMER TJU 1970 to 2011 Number of DIMER Students821 Number of DIMER Graduates722 Number of DIMER Graduates with GME Complete 650 DIMER Graduates with GME in Delaware166 DIMER Graduates with an Active Delaware License 173 DIMER Graduates Actively Practicing in Delaware 149 DIMER TJU “Return Rate”22.9% 12/6/1216

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18. DIMER PCOM Summary DIMER PCOM 2000 to 2012 Number of DIMER Students 102 Number of DIMER Graduates 58 Number of DIMER Graduates with GME Complete 37 DIMER Graduates with GME in Delaware 9 DIMER Graduates with an Active Delaware License 9 DIMER Graduates Actively Practicing in Delaware 9 DIMER PCOM “Return Rate” 24.3% 12/6/1218

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20. DIDER Temple Summary DIDER Temple 2006 to 2012 Number of DIDER Students31 Number of DIDER Graduates15 DIDER Graduates with an Active Delaware License5 DIDER Graduates Actively Practicing in Delaware2 DIDER Temple “Return Rate”13.3% 12/6/1220

21. WWAMI Four other states do not have a medical school (Alaska, Idaho, Montana, Wyoming) Agreements with University of Washington School of Medicine (UWSOM) to form WWAMI Each state has a specific number of seats at UWSOM Tuition paid by combination of appropriated state funds and student tuition 12/6/1221

22. WWAMI Medical School 1 st year at home state university Medical School 2 nd year at UWSOM Medical School 3 rd and 4 th years required and elective clerkships in WWAMI states 60% practice in WWAMI states 50% select primary care specialties 20% practice in HPSA areas 12/6/1222

23. “Return Rate” Comparisons DIMER – TJU:22.9% DIMER – PCOM:24.3% National (Public Medical Schools): 39.0% WWAMI States – Alaska: 45% – Idaho: 50% – Montana: 40% – Wyoming: 67% ------------------------------------ -- DIDER – Temple: 13.3% 12/6/1223

24. Delaware State Loan Repayment Program DELAWARE STATE LOAN REPAYMENT PROGRAM FY LOAN AWARDS*MD/DODDS/DMD Mid-Level PractitionerCapital 200111 20021 1 2003321 2004211 200533 2006541 200784121 200813724 200915654 2010118111 201185111 201243 1 TOTAL744414133 12/6/1224

25. Delaware State Loan Repayment Program 12/6/1225 DE SLRP Service Completion93.8% Multiple program comparison71.0%

26. Delaware State Loan Repayment Program Retention of SLRP Awardees after Completion of Service, FY2001-2012 Provider Completed Service Still in Progress StayedLeft NumberPercentNumberPercent Physician2672.2%1027.8%8 Dentist13100.0%00.0%4 Nurse Practitioner583.3%116.7%1 Nurse Midwife4100.0%00.0%0 Physician Assistant1100.0%00.0%0 Dental Hygienist0 0 1 TOTAL4981.7%1118.3%14 12/6/1226

27. SUMMARY DIMER – TJU EnrollmentMeets objective DIMER – PCOM EnrollmentMeets objective DIDER – Temple EnrollmentBelow objective in last 3 years DIMER – TJU “Return Rate”Lower than WWAMI programs with home state training and GME DIMER – PCOM “Return Rate”Lower than WWAMI programs with home state training and GME DIDER – Temple “Return Rate”Very Low SLRP Service Completion RateHigher than Comparison Study SLRP RetentionVery Strong (no comparison data) 12/6/1227