Primary Care Residency Goals and Strategies:
Goals:
1. Train enough primary care providers to serve underserved CA communities
2. Increase the number of residencies to meet projected primary care provider needs in CA overall and in medically underserved geographic areas
3. Provide meaningful incentives for residency program graduates to practice primary care and sufficient numbers to do so in underserved areas
4. Provide residency training for multiple professions that includes meaningful exposure to ambulatory settings and underserved communities.
5. Provide transition to practice programs from residency programs for RN’s, MD’s, FNP’s, PA’s and other practitioners
6. Implement system for collection of data on residency placements among CA schools of medicine, available residency training slots and graduate job placement
7. Provide sufficient funding from multiple sources to support the number and location of residencies to meet the need.
Potential Strategies:
A. Hold State funded internal medicine and pediatric residency programs accountable for producing graduates in primary care. Use metrics and outcomes for funding allocation.
B. Determine current number and location of residencies. Project future need within context of health reform, medical home, Tele-health, HIT etc. Regularly update projections.
C. Identify primary care residency programs in California that currently have HRSA and or Song-Brown funding and assess their potential to expand.
D. Expand family medicine residencies
E. Sustain and advocate for increased funding for Song Brown and Thompson Loan Repayment Programs.
F. Secure additional funding from HRSA (residency programs, AHEC, Teaching Health Centers)
G. Obtain funding from National Service Corps for forgivable loans for residencies across all healthcare professions
H. Promote Teaching Health Centers to community health centers and provide technical assistance and partnership to maximize CA participation
a. CPCA, CAFP and AHEC Webinars
b. Include nurse residencies
c. Support FQHC route to THC
I. Focus on recruiting racially/ethnically diverse Californians attending medical school (in and outside Ca) into our state's PC residency programs. Priority focus on PRIME graduates. Provide strong funding incentives for PC and for practice in underserved areas.
J. Revisit and implement key provisions of the Eisenberg Bill regarding residencies
K. Increase the number of graduates from UC and private allopathic and DO medical schools entering primary care residencies (in 09 all 5 UC Med Schools graduated a total of 42 MD’s into primary care residencies). Hold UC accountable for meeting target goals.
L. Evaluate opportunities for expansion and replication of the UCLA International Medical Graduate Family Residency Program. Sustain and expand funding.
M. Advocate for Federal GME reform and increased funding for CA
N. Establish CA residency fund with ample support from health plans and other private sources
O. Expand residencies to include transition to practice programs for registered nurses
P. Implement standard residency programs for advance-practice nurses in primary care
Q. Obtain and analyze baseline data on the racial/ethnic diversity of California's medical residents to document the challenge; contact directors of residency programs that have successfully recruited diverse residents to identify the strategies they have used.
R. Increase awareness among racially and ethnically diverse students of NHSC and other scholarship and loan repayment opportunities for primary care clinicians.
S. Recruit more California students from rural or urban underserved populations with knowledge and commitment to communities into CA residency programs.
T. Target residency recruitment at priority “feeder” schools with students more likely to be from underserved CA areas, greater diversity and stronger commitment to primary care.
U. Evaluate where residents from Kaiser, Other Systems, DO programs etc go to practice.
V. Advocate for increased GME funding for California and long term GME reform
W. Develop payment source for increasing residency programs
- Fee on health plans and MediCal managed care plans
Potential Lead and Collaborating Organizations:
· CAFP, CPCA, CINHC, UCOP, CMA, AHEC, HRSA, CPAC, CHWA, Kaiser, UCLA IMG, USC, Song Brown, Health Professions Education Foundation, OSHPD, HWDC, Sen Health Committee , California Health Professions Consortium, CHA, Other?
Potential Funding Sources:
· HRSA, Teaching Health Centers, Health Plans, Song Brown, NHSC, Health Reform Health Workforce, GME, State of California, Foundations
Potential Legislative or Regulatory Changes:
· TBD
Training Program Access and Innovation Goals and Strategies
Potential Goals:
1. Ensure sufficient training and preparatory program access to meet the numbers, diversity and distribution of primary care professionals on the primary care team.
2. Develop innovative new models for delivering training programs that promote and support primary care career advancement and preparation and leverage technology and limited resources.
Potential Strategies:
A. Maintain proven existing Post Bac Programs and Consortia. Expand and scale as indicated by demand, distribution and diversity needs.
B. Expand post bac programs to other professions
C. Maintain PRIME Programs and ensure focus on training primary care MD’s who practice in underserved areas. Consider PRIME model for other professions.
D. Ensure sufficient access to training programs in other professions.
E. Maintain nursing program infrastructure and capacity to support projected future need
F. Develop new models for inter-professional education.
G. Create training and leadership development programs for people who will be leading delivery system re-design and infuse into health professions training programs
H. Utilize E-learning capabilities to expand access to trainings and improve affordability
I. Deepen the integration of cultural sensitivity and responsiveness into training program climate, teaching and skill development
J. Advocate for new medical school funding and focus on primary care
K. Support UCR Med School and UC Merced PRIME development and accountability for producing primary care providers who practice in their region.
L. Evaluate and apply lessons learned from USC Primary Care Training Program
M. Build leadership and mentoring into programs into training programs
N. Integrate training in public health and administration into trainings
Potential Lead and Collaborating Organizations:
· CAFP, CPCA, CINHC, UCOP, CMA, AHEC, CHWA, USC, HWDC, Senate Health, other?
Potential Funding Sources:
· TBD
Potential Legislative or Regulatory Changes:
· TBD
Increase Awareness of Primary Care Careers
Potential Goals:
1. Increase awareness and attractiveness of primary care careers to priority target groups and their advisors at each stage and continuously throughout the pathway.
2. Increase the number of quality, diverse candidates committed to primary care as a career path, interested in serving underserved CA populations and being supported to achieve their goals.
3. Increase the number of California medical graduates that choose primary care
4. Increase public and legislator awareness of the importance of primary care workforce, priority strategies and the value and urgency of supporting solutions.
5. Promote education about the new models of delivery and how the interdisciplinary primary care team fits
Potential Strategies:
A. Increase medical student exposure to community-based medical practices including community health centers across the four years of medical school training. Build on programs such as CAFP, USC etc.
B. Develop an extensive promotional campaign for Primary Care Week 2011. Prioritize CSU, post bac and med students.
C. Targeted outreach to student clubs in CSU, UC, Com. Colleges and private schools.
D. Learn from and replicate promising programs targeted at supporting student primary care awareness such as the USC Family Medicine Interest Group.
E. Develop a promotional campaign via UCTV and use of new and social media tools.
F. Promote primary care through 3 current HCOP and 3 COE programs in CA. Seek Fed, State & private $ to expand “HCOP” like programs in multiple regions.
G. Promote primary care through existing pipeline programs in CHPC, CTE programs, AHEC, HOSA etc. Work with AMSA, LMSA etc. Promote through WIB Centers & Programs.
H. Promote and increase the scale of existing internship programs for undergraduate students to gain primary care exposure (such as Health Career Connection, Health Corps, Americorps, Vista) and launch new ones in underserved regions like TCE Communities.
I. Expand the scale of programs targeted at promoting primary care to medical, nursing and other students.
J. Target youth in TCE communities, community health centers and rural areas for Primary Care Exposure
K. Develop Primary Care Speakers Bureau and promote through existing conferences- SUMMA, AMSA, etc. Develop on-line videos and other tools.
L. Infuse primary care and enhance the message in existing communications such Health Jobs Start Here, Health Pathways etc and campaigns by foundations.
M. Inform Senate Health Committee and other legislators and Administration about primary care needs and solutions
N. Develop central repository of interested students and continuous communication regarding opportunities, advising, support needs and financing options.
O. Provide extensive primary care career education to and engage advisors at all levels.
P. Utilize existing advisor meetings and electronic communication forums. Meet with CSU Deans & Advisors
Q. Partner with CHCF Health Journalism Project to promote awareness of primary care crisis and options
R. Provide career path information and advancement opportunities for CHW’s/ promotoras, medical assistants and others
S. Increase the number of CSU applicants applying to medical school and interested in primary care careers. Promote widely through CSU student clubs, advisors and internships. Support CSU recommendations to establish health career advisors and offices on each campus and promote primary care through them.
T. Specific pipelines to PRIME, UCR and other with primary care commitments
U. Promote Awareness of Scholarship and Loan Repayment to target groups early on and continuously.
Potential Lead and Collaborating Organizations:
· CAFP, CPCA, CINHC, UCOP, CMA, AHEC, HRSA, OSHPD, WIBS, Health Workforce Development Council, CHWA, Kaiser, USC, CSU, HCC Health Professions Education Foundation, CHA, CA Health Professions Consortium, Other?
Potential Funding Sources:
· TBD
Potential Legislative or Regulatory Changes:
· TBD
Payment & Policy Solutions
Potential Goals:
1. Increase reimbursement or other payment mechanisms to make it more attractive for medical students and students in other primary care professions to go into and be successful in primary care.
2. Develop payment mechanisms as part of new models of care and reimbursement methodologies that promote a strong role for primary care providers and sufficient corresponding payment (such as care coordination).
3. Develop payment incentives for primary care providers to practice in underserved areas
4. Support provider organizations to maximize current available primary care payments so that they can afford sufficient primary care providers
5. Establish institutionalized funding sources not linked to State budget to support adequate primary care payments and/or subsidize the cost of residencies.
6. Develop new reimbursement mechanisms for nurses, PA’s and other non-physician providers to practice at their highest levels of privilege and have sufficient payments in coordination with physicians that are also sufficiently reimbursed.
7. Explore scope of practice changes needed to ensure access to quality, affordable primary care services for all Californians at projected demand levels and in underserved geographic areas.
Strategies:
· Maintain and increase MediCal reimbursement for primary care providers
- Episodic payment
- Bundled payment
- Include promoters / clinic coaches
· Promote strategy and provide technical assistance to help non FQHC/RHC providers take advantage of higher federal reimbursement rates
· Loan repayment/scholarships
- Target certain areas – decrease award match levels.
Develop differential payments based on geography (HPSA)
· Medical Homes – putting primary care providers in the center / make sure PC provider is receiving adequate reimbursement for care coordination
· Develop plan and policies to ensure access to care and sufficient primary care provider reimbursement for undocumented Californians.
· Advocate for increasing Medicare Payments for primary care. Other payers typically follow. Mobilize nursing and other primary care professionals for advocacy.
· Advocate for changes in Medicare Payment Advisory Committee. Currently dominated by specialists and not sufficiently supportive of primary care payments.
Potential Lead and Collaborating Organizations:
· CAFP, CPCA, CINHC, UCOP, CMA, AHEC, HRSA, CHWA, Senate Health
Potential Funding Sources:
· Fees from Health Plans
Potential Legislative or Regulatory Changes:
· New payment models/adequate payment for new care models such as Tele-health and e-visits.
Primary Care Provider Recruitment Goals and Strategies
Potential Goals:
1. Redefine the roles and functions of the primary care team as an integral part of innovative new models for delivering team based primary care , managing chronic disease, improving population health and achieving the goals of health reform.
2. Determine the competencies and training required of primary care professionals to provide quality, efficient service within new models leveraging technology and team coordination.
3. Recruit sufficient numbers and geographic distribution of quality, diverse primary care professionals to meet the access, affordability, quality and health needs of our increasingly diverse California population.
4. Strengthen the ability of California health employers to hire and afford sufficient numbers of quality primary care professionals with a priority emphasis on rural and safety net providers
5. Promote and support a primary care workforce and solid pipeline that reflects the diversity and languages of California’s overall and regional population. Invest to “grow and provide opportunity to our own”.
6. Recruit sufficient numbers of out of state and international primary care professionals to meet the near and medium supply and geographic distribution needs.
7. Utilize technology, team based care and enhanced payment to enhance attractiveness and provider success and satisfaction.
Potential Strategies:
A. Ensure that workforce leaders are part of all efforts to design and implement new delivery models. Promote team based care models and functions.
B. Develop white paper on team based primary care models within the context of new delivery models and technology. Convene panels and education employers, legislators etc.
C. Project the near and long term supply and demand for all members of the primary care team on a statewide and regional basis within the context of health reform, new delivery models and use of tele-health and EHR.
D. Increase awareness of primary care as an attractive and rewarding professions starting in K-12 and continuously through residency (see primary care awareness goals and strategies). Show that primary care is in the center of new delivery models.