Working Together to Strengthen Ohio's Safety Net - Dr Wymyslo, Ohio Department of Health
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Working Together to Strengthen Ohio's Safety Net - Dr Wymyslo, Ohio Department of Health, as presented at The Strengthening Ohio’s Safety Net Roundtable April 29, 2011. For more info, visit http://www.healthpathohio.org/
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Working Together to Strengthen Ohio's Safety Net - Dr Wymyslo, Ohio Department of Health
- 1. Working Together to Strengthen Ohio’s Safety Net The HealthPath Foundation of Ohio April 28, 2011 Ted Wymyslo, M.D., Director Ohio Department of Health
- 3. Public Health Partnerships Health Path Foundation of Ohio Hospitals Dental Safety Net Clinics Community Action Agencies FQHCs Office of Health Transformation Ohio Department of Health Local Health Departments Medicaid
- 10. Source: March 2011, Primary Care Office, Ohio Department of Health *Includes “Proposed for Withdrawal” and “No New Data” *Satellite sites of Comprehensive Health Centers are not listed as separate Facility HPSAs Ohio Primary Care Health Professional Shortage Areas * Geographic HPSA Special Population HPSA Correctional Facility HPSA Facility HPSA C
- 11. Source: March 2011, Primary Care Office, Ohio Department of Health *Includes “Proposed for Withdrawal” and “No New Data” *Satellite sites of Comprehensive Health Centers are not listed as separate Facility HPSAs Geographic HPSA Special Population HPSA Correctional Facility HPSA Facility HPSA C
Notas del editor
- [Welcome audience. Thank Health Path Foundation of Ohio’s Executive Director Theresa Wukusick and Board Chair Cheryl Boyce hosting the conference.] [Mention what will be talking about today]
- Together we must join forces to ensure adequate access to the health care safety net for all Ohioans.
- [Mention probably noticed OHT on last slide.] Gov. Kasich recently created the Office of Health Transformation (OHT). Function: Examine and address Medicaid spending in Ohio Determine how to efficiently administer Ohio’s Medicaid program Examine how to improve the overall health care delivery system in Ohio
- [Explain how OHT is critical partner in safety net – Medicaid.]
- HB 198 Needed to find a way to improve recruitment, retention and productivity of primary care physicians. Worked with legislature to create Ohio’s Patient-Centered Medical Home Education Pilot Project. 44 primary care practices educationally affiliated with 4 medical schools & 5 nursing schools to design and implement the PCMH model Bill addresses PCMH model curriculum reform in medical school, nursing school & primary care residency levels Bill designs a primary care scholarship process for both medical school and advanced practice nurse (APN) training levels for primary care students Hope to help correct the shortage of healthcare providers in Ohio by addressing: Cost of training Primary care curriculum in nursing and medical schools Primary care practice environment Have 68 applicants being considered for selection. (Deadline April 15 th , but may still be able to apply.)
- OACHC will help formulate the definition of a “health home.”
- Essential to the safety net, as well as central to the PCMH model, is maintaining an adequate primary care workforce. Recent workforce trends Diminishing supply and variable distribution of providers: Fewer and fewer health professional students are pursuing or are entering a career in primary care. (Dissatisfaction/retirement; Declining recruitment; Income gap) Maldistribution of providers affecting both rural and urban areas. Factors driving need for primary care Increasing demand for primary care services now and in the future: Increase in the aging of our population spurred by the baby boomer population. Chronic conditions increase with age, so with an aging population we can expect to also have an increase in the prevalence of chronic conditions which will lead to increased demand for and utilization of health care resources and services, especially in primary care. Enactment of health care reform will lead to coverage expansion, which will increase access to health care services and put increased demands on the primary care delivery system. Also need to be prepared for development of PCMH practices and Accountable Care Organizations. These trends paint a picture of a decreasing supply of providers combined with increasing demand for primary care services, leading us to the conclusion that we need to get to work on building the primary care workforce to ensure the viability of the health care safety net now and to plan for future needs!
- In order to paint a better picture of the primary care workforce, we need to be able to look at data to know, for example, how many primary care providers we have, and how much primary care is actually being provided by these providers. In Ohio we have various health care licensure systems that collect and report on selected data specific to the licensure system. From these sources, we have limited capability to extrapolate basic information to describe the current primary care workforce in Ohio. Of the estimated 34,000 active physicians in Ohio, roughly 12,000 report a primary care specialty. However, this figure may over-represent internal medicine and pediatric physicians, many of whom sub-specialize, and this figure does not indicate how much direct patient care is actually provided for primary care. We see similar issues with data sources that collect advanced practice nurse and physician assistant data. We have an estimate of the total number of licensed APNs and PAs, but we do not know how many of these providers practice primary care. As you can see, there is no single data source or coordinated system to provide a consistent and complete picture of Ohio's current or available primary care workforce, or is able to project the future primary care workforce. This makes it impossible to appropriately determine needs or identify issues that would be helpful for workforce planning efforts.
- [Discuss distribution and access issues related to Ohio.] Health professional shortage areas are designated by the federal government to identify specific health care needs for a given area, population, or facility. Currently, there are 140 health professional shortage areas designated for primary care in Ohio. 66 out of the 88 counties have some level of under-service for primary care. Need at least 344 additional physicians to reach a more acceptable population-to-physician ratio of 2000:1 , but this is a very conservative estimate. It is likely that not all areas of Ohio that may have a shortage of providers are designated as a health professional shortage area .
- Currently 65 primary care health professional shortage areas in the 36-county service area of the HealthPath Foundation of Ohio.
- ODH administers a number of programs to alleviate this growing primary care workforce concern. Health Professional Shortage Area Designations ODH provides assistance to analyze areas of the state for federal designations of underservice, and facilitates the application process with the federal government through HRSA. Designations are needed for communities to participate in state and federal recruitment & retention programs and apply for some sources of CHC funding. Student development programs [SEARCH – Encourage participation] SEARCH stands for: Student/Resident Experiences and Rotations in Community Health. Administered jointly by ODH, Ohio Academy of Family Physicians Foundation & ODMH. Pipe-line program to increase the recruitment and retention of primary care providers in Ohio’s underserved areas. Works by providing participants with clinical experiences & community projects in community-based sites. Recruitment & Retention programs Through ODH recruitment & retention programs ( loan repayment, scholarship, visa waiver ), there are currently 224 primary care, oral health and mental health providers working in underserved areas of Ohio. Across the state, CHCs are sites for 124 of these participants . Health Care Workforce Planning ODH is on forefront of statewide health care workforce planning efforts.
- Ohio’s Primary Care Office, located within the Department of Health, received a grant last year to focus on primary care workforce planning for the state of Ohio. The final product of this planning process is a document that outlines a strategic plan to develop Ohio’s primary care workforce. It is important to note that there are other professionals essential to the PCMH team that are not addressed in this effort. This Primary Care Workforce Plan is intended to be a starting point for a larger workforce effort. For purposes of this workforce plan, the definition of “ primary care ” was limited to primary medical care professionals , including physicians (both allopathic and osteopathic, and limited to specialties of family practice, general pediatrics, general internal medicine and obstetrics/gynecology), and advanced practice nurses and physician assistants in similar specialties. Plan Development Process: Organized a public input process to assess current workforce data, resources, barriers and possible solutions for primary care workforce needs. Held a one-day statewide strategic planning meeting – 9/28/2010; Key stakeholders, collaborators and outside experts were invited to participate. Held a series of half-day regional forums – (4); Based on input gathered from statewide meeting. Used all input received to develop a draft primary care workforce plan. Posted the draft plan & solicited public comments. Now in the process of finalizing a primary care workforce plan to help address the state’s growing needs for primary care providers.
- Throughout the course of the Plan development process, we began to hear some consistent “themes” of concerns expressed by contributors. These are some highlights… [Can omit this slide if have time constraints.]
- Input gathered from the Plan development process focused on three main categories. The final Ohio Primary Care Workforce Plan identifies key recommendations based on these three main categories: Development of a statewide primary health care workforce data system 2) Adequate supply, distribution and diversity of the workforce 3) Widespread adoption of the PCMH practice model in Ohio
- Data In order to be able to accurately assess a situation and make good, sound decisions we need data – “to get where we want to go, we first need to know where we are.” We need this data to be timely, and also to be able to measure what it is that we want to know. For the primary care workforce, no such complete data set exists. And there is no source that collects, compiles and analyzes available workforce data. Therefore, there is no current source for comprehensive and consistent information useful for workforce planning efforts.
- Supply, Distribution and Diversity In order to ensure an adequate the supply, distribution and diversity of Ohio’s primary care workforce, efforts need to be made to attract and develop students for entry into the health professions, beginning with our youth. We need to make sure that we are providing not only adequate preparation so students have the ability to enter into health professions training tracks, but also provide opportunities for experiences in health care settings and with underserved communities to peak interest in primary care and channel these students into the primary care field. Integral factors for supply, distribution and diversity recommendations: Identify those more likely to pursue primary care Students from underserved or diverse populations, including minority, rural and low-income, are more likely to practice in underserved areas. Admissions and acceptance policies for health professional training programs need to be adapted to be inclusive of students from underserved and diverse backgrounds.
- Supply, Distribution and Diversity (continued) We need to continue supporting the pipeline of students as they further their studies throughout health professional training programs, and incentivize them to not only choose primary care, but continue to practice once they enter the primary care field. Integral factors for supply, distribution and diversity recommendations: Incentives for pursuing primary care practice Exposure to underserved areas and experience practicing in community settings – like the SEARCH program Ease of navigation within and between training programs for advancement in health care professions
- Supply, Distribution and Diversity (continued) Integral factors for supply, distribution and diversity recommendations: Focused efforts on attracting and retaining practicing health care professionals
- [Discuss PCMH & recommendations.] The SEARCH program is a great way to introduce students in training to the PCMH model.
- Building upon the preliminary work of the primary care workforce planning effort, a larger planning effort that will include a broader array of health care professionals is underway. Behavioral Health/Physical Health Integration This effort will include mental health in support of the OHT behavioral and physical health integration initiative. State Health Care Workforce Planning Grant Ohio’s Primary Care Office received a one-year grant from HRSA to initiate a health care workforce planning effort. Will lead to lead to an increase of 10-25% of Ohio’s health care workforce over the next ten years. Hope to apply for additional federal funding to continue these efforts.
- Challenge the HealthPath Foundation of Ohio to: Integrate the Ohio Primary Care Workforce Plan information into their safety net mission. Build on to current state programs, like state loan repayment programs and the SEARCH program.