Workforce & Leadership: Trends & Opportunities

Merle Cunningham, MD, MPH, Geiger Gibson Program in Community Health Policy & Leadership

Session Objectives

To become familiar with evolving national trends related to CHC workforce development and changing models of practice

To understand evolving trends in CHC leadership development

To become familiar with opportunities for collaboration on workforce development and leadership development

Conceptual Framework for Continuum

CATEGORY WORKFORCE LEADERSHIP

Clinical PCPs – MD, DO, NP, PA, CNMNursing- RNs, LPNs, MAsOther medical providersOral health providers Behavioral health providersCHWs, Case managers

CMO, Site Med DirectorDental DirectorNursing DirectorOther clinical directorsOther clinical supervisors

Administrative

Front deskFiscal & billing staffHIT staffEnabling services staffOther management & support

CEO, COO, CFO, CIOSite DirectorsSupervisors

Workforce & Models of Practice

8,776

20,329 23,1737,595

17,58220,042

4,292

9,890

11,273

0

25,000

50,000

Nurses Physicians NPs/PAs/CNMs*

Health Center Workforce Goals: Based on ACCESS for All American Patient Projections

20,663

47,80154,488

*Nurse Practitioners, Physician Assistants, Certified Nurse Midwives.Source: Access Transformed: Building A Primary Care Workforce for the 21st Century. NACHC, Robert Graham Center, and GWU SPHHS. August 2008.

Ful

l-T

ime

Equ

ival

ent S

taff

Current Median Provider Ratios

Today Range in 2015

Long history of “Grow your own…” Since earliest years of OEO NHCs – late 1960s AHEC pipeline partnerships for decadesCurrent AT Still-NACHC Dental School AT Still-NACHC School Osteopathic Medicine

Arizona 1st class of 96 graduates June 3rd

Teaching Health Centers (medical & dental residencies)-THC funding 6 of 11 to CHCs, partners in 4 of 5

Future Evolving Comprehensive Workforce Continuum

Strategy

Percent of Health Centers Participating in Health Professions Training Programs, 2007

42.1%50.3%

28.1%

54.3%49.4%

0%

10%

20%

30%

40%

50%

60%

ResidencyPrograms

MedicalSchool

Programs

SEARCH*Programs

AHEC**Programs

Other

Percent Participating

*Student/Resident Experiences and Rotations in Community Health** Area Health Education CenterNote: 35% response rate. Survey responders make up a nationally representative sample of all federally-funded health centers.Source: NACHC 2007 Survey of Health Profession Training Programs in Community Health Center

NACHC Strategies - Clinical Clinical Staff

Advanced – MD, DO, NP, PA, CNM, DDS, DH, BH NHSC utilization (increase from 30%) J-1s/H-1Bs, Vets, Retirees Replicate AT Still University model (community campuses) More GME – Teaching Health Center models More Dental Residency – AEGD (Advanced Educ General

Dentistry) NP & PA academic partnerships Behavioral health academic partnerships

Entry level – RN/LPN, MA, DA, CHW, Enabling staff, Other Community college partnerships Western Governors University (WGU) – “Growing From Within” Americorps – Professional Corps model (MA, DA and CHWs)

NACHC Strategies - Administrative Administrative Staff

Advanced (Senior level positions) Leadership Development Institutes (LDI) Core Competencies – modular curriculum

components “Emerging Leader” track & networking

Entry & Mid Level – (Ops, HR, HIT, front desk, communications, fiscal, communications, etc.) Web-based modules for onsite entry level

trainings More conference content for mid-level staff

development

Evolving Models of Practice Health Care Team approaches-

Fundamental to early health centers Basic component of “Care Model” used in HDCs

Practice “transformation” – fundamental to PCMH “Working at the top of your license” Integration behavioral health Integration of oral health

Care Management (CMS Demos) “Old wine, new bottles” Reducing Care Fragmentation: Toolkit for Coordinating

Care Note: NH + VT highlights from Readiness Survey

Adoption, MU, PCMH, Registries/Clin Warehouses, Telemed

Leadership Development

NACHC Strategies Leadership Development Institutes (LDI) – to follow Core Competencies for CHC management

Identified with curriculum/ courses wrt accreditation Components can be shared via Distance Learning “mix

and match” for many different audiences and programs among PCAs and others as part of a national learning community

Emerging Leaders Geiger Gibson – Annual awards at P&I through CEO

nomination & selection by panel of GG Distinguished Visitors

NACHC – New networking sessions at P&I, CHI; planning new “track” at future conferences

Hub & Spoke Model Hub: NACHC & Geiger Gibson Program Spokes: multiple regional programs (PCAs w/

academic partners) Mass League – Suffolk University Greater Midwest PCAs – Univ Kansas Northwest Regional PCA – Univ Washington Blue Shield Foundation of CA – UCSF Center for

Health Professions North Carolina PCA – East Carolina University Geiger Gibson Program, GW School of Public

Health & Health Services

Leadership Development Institutes

GW-NACHC Partnership Programs

“Hub” Program: Capstone in Health Policy and Leadership (3 cycles per year in Oct, Feb & June)Directors: Merle Cunningham & Becky Beauregard

Senior Advisor: Sara Rosenbaum

“Spoke” Program:Graduate Certificate in CHC Management (2 cohorts per year, starting in Fall and Spring Semesters)Director: Merle Cunningham

“Hub” Program: Capstone in Health Policy & Leadership

Program Goal To increase the number of trained CHC leaders to meet

the increasing current and future demand Learning Objectives

To gain familiarity with the federal health policymaking process and how policy influences legislation and subsequent programs

To interact with policymakers, congressional staff & Federal health program leaders

To become familiar with policy-related health services research involving health centers

GW Capstone Curriculum

Pre-Capstone Webinars (Dates scheduled in 4 week period preceding each Cycle): Four one-hour live webinars with assigned readings and online exercises

Onsite Program in DC (3 days): presentations by health policy researchers and policymakers; dialogues with Congressional staff; and informal meetings with NACHC senior leadership, HRSA staff and other Federal agency officials.

Capstone Specifics

PCA Selection Process Interested PCAs may have positions in each cycle

of 20 students Student selection is locally determined Target audience is mid-level and senior staff

interested in executive leadership careers in CHCs Cost

$1000 per student, not including travel, lodging and most meals

Timeframe 3 cycles per year in October, February and June

“Spoke” Program: Graduate Certificate in CHC Management

Designed for Working Professionals Training current and future CHC professionals for

management and executive leadership positions Offered over 3 semesters, 3 courses each

semester, 2 credits per course = 18 academic credits overall

Combines accredited academic training with practical skills that CHC managers need

Guidance and oversight provided by a GG Leadership Advisory Group of Charter members from CHCs and PCAs with students in the initial cohort

Certificate Curriculum First Semester Courses

Intro to Health Management Health Services Finance Community Health Center Policy

Second Semester Courses Quality & Performance Improvement Health Services Information Applications Health Services Marketing and Planning

Third Semester Courses Health Law for Managers Human Resources Management and

Organizational Behavior Health Services Advocacy and Communication

Online and On Campus

Executive Distance Learning Format Individual online sessions Biweekly interactive webinars and video

conferences Two group sessions: Launch with CHI, End in DC on

campus

The GW Experience A team project addressing a current local CHC

initiative Biweekly policy updates from NACHC A culminating Capstone with team presentations in

DC

Program Details

Admission Requirements:Completion of a bachelor’s degreeThree years of related experience in community healthAn introductory accounting courseGRE scores within past 5 years (waived if have any graduate degree)Transfer to Master’s Degree: Apply all 18 credits toward MHSA or MPH at GW SPHHS; credits may be transferred to another educational institution with similar accreditationTuition: $12,000 for 18 credits (savings of more than

$9000); eligible for Federal financial aid; AmeriCorps education awards recognized

Applications: due by July 1st for Fall Semester 2011

For more information, visit: www.gwumc.edu/chc

Regional Opportunities Workforce & Practice Transformation

Medical Home Pilot (VT) – potential TA sharing Care Management Project (NH) State scope of practice & licensing (NH & VT) Sharing “Community Health Team” models

Bi-State Leadership Development Program 2011-2012

Certificate Program & Seminar Series in Community Health Leadership Oct 2011 – Apr 2012

Leadership Advocacy Quality Improvement Workforce Development Budgeting Strategic Leadership

Recap Highlights 1. Reviewed evolving national trends in CHC

workforce development and changing models of practice

2. Reviewed evolving leadership development activities for CHC mid-level and senior managers

3. Identified some opportunities for regional collaboration related to workforce issues, practice transformation and emerging leadership

Take Home Messages 1. Embrace all creative variations of “grow your own”

strategies for workforce development, recognizing that short term cost are really long term investments

2. Continue aggressive work towards practice transformation, integration of services, team care coordination across all levels of care and use of regional information systems to improve population health

3. Continue to evolve a learning community with regional and national partners to share best practices and to coordinate or consolidate systems where appropriate.