1. Overview of the Workforce Provisions in the Affordable Care Act The Health Workforce Dream Team: Who Will Provide the Care? Alliance for Health Reform Policy Briefing December 2, 2010 Joel Teitelbaum, J.D., LL.M. Associate Professor & Vice Chair for Academic Affairs GW Department of Health Policy

2. Presentation Outline I.Background and Context II.Brief Overview of ACA Workforce Provisions a. Innovations b. Increasing Supply c. Education, Training, and Other Supports d. Strengthening Primary Care III.Key Implementation Questions

3. Background and Context Strengthening/modernizing the health workforce was a major goal in passing ACA ACA seeks to alleviate shortages, uneven geographic and specialty distribution, and lack of diversity in the health professions ACAs workforce provisions: market tinkering with no clear vision, or a new era of national policy promoting experimentation & professional collaboration? Health Reform GPS, a project of GWs Hirsh Health Law and Policy Program and RWJF (healthreformgps.org)

4. ACA: Innovations Prior to ACA, no national approach to analyzing/making policy recommendations about the health workforce ACA created: 1)National Health Care Workforce Commission (encourage innovation, identify barriers to improved coordination, make recommendations to Congress and the Administration) 2)National Center for Health Care Workforce Analysis (comprehensive assessments, create data reporting system, develop performance measures) 3)State Health Care Workforce Development Grants (to enable state and local partnerships)

5. ACA: Increasing/Redistributing Supply Considerable agreement that U.S. needs more health professionals and a more strategic distribution of them Four main areas of change in ACA: 1)Amendments to existing educational loan programs 2)Authorizes educational loan repayments in various programs (e.g., for pediatric specialists and public health workers) 3)Authorizes grants to establish and operate nurse- managed health centers 4)Amends the Commissioned Corps program by eliminating the 2,800-person cap on the number of commissioned officers, and by establishing the Ready Reserve Corps

6. ACA: Education, Training, and Other Supports Improving the quality, type, and number of education and training programs may help relieve workforce problems such as geographic and specialty distribution, lack of diversity, and stovepiping among disciplines ACA introduced: 1)Grant programs aimed at education and training for: primary care, direct care, oral health specialists, geriatric education centers, behavioral health, cultural competency, nursing, nurse practitioners, public health, underrepresented minorities, and more 2)The U.S. Public Health Sciences Track, to train physicians, dentists, nurses, PAs, mental and behavioral health specialists, and public health professionals by emphasizing team-based service, public health, epidemiology, and emergency preparedness and response

7. ACA: Primary Care The countrys primary care services are strained, in part because fewer health professionals are choosing to practice primary care Four main areas of change in ACA: 1)Financial incentives for providers to practice in primary care specialties (e.g., a 10 percent boost in Medicare Part B payments) 2)Revisions to GME, in the form of a redistribution of unused residency positions and a new program under which HHS can fund teaching health centers to expand and establish residency training programs 3)A new Primary Care Extension Program (to provide support and education to PCPs around preventative medicine, evidence- based medicine, and more), and grants to states to create Primary Care Extension Program State Hubs 4)New grant programs (e.g., grants for state demonstration projects to develop core training competencies and certification programs for personal or home care aides)

8. Key Implementation Questions Will the authorized/necessary funds be appropriated? Will the necessary data/information infrastructure be developed? What performance measures will be developed to measure the success of workforce programs? How will these be coordinated with current HRSA monitoring and evaluation strategies? What standards will be used in the awarding of workforce grants?

9. Key Implementation Questions What affect will policy and cultural differences at the state level have on implementation of the workforce provisions? (MDs Health Care Reform Coordinating Council already making recommendations to the Governor, including around workforce issues) Will the ACA affect the discussion around scope of practice? If so, how? Will the ACA lead to truly national health workforce policy? Will the ACA alleviate the twin problems of workforce shortages and uneven distribution?