Workforce & Leadership: Trends & Opportunities

1. Workforce & Leadership: Trends & Opportunities Merle Cunningham, MD, MPH, Geiger Gibson Program in Community Health Policy & Leadership

2. 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

3. Conceptual Framework for Continuum

4. Workforce & Models of Practice

5. Health Center Workforce Goals: Based on ACCESS for All American Patient Projections Current Median Provider Ratios 54,488 47,801 Full-Time Equivalent Staff 20,663 Today Range in 2015 *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.

6. Long history of “Grow your own…” • Since earliest years of OEO NHCs – late 1960s • AHEC pipeline partnerships for decades Current • 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

7. Percent of Health Centers Participating in Health Professions Training Programs, 2007 Percent Participating *Student/Resident Experiences and Rotations in Community Health ** Area Health Education Center Note: 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

8. 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)

9. 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

10. 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

11. Leadership Development

12. 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

13. Leadership Development Institutes • 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

14. 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

15. “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

16. 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.

17. 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

18. “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

19. 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

20. 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

21. Program Details Admission Requirements: • Completion of a bachelor’s degree • Three years of related experience in community health • An introductory accounting course • GRE 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 accreditation Tuition: $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

22. 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

23. 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

24. 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.