Primary Care Initiative
Meeting Four
Thursday, April 14
Working Draft- Immediate Priority Strategies,
and Action Plans (5/5/11)
Theme I: Primary Care Career Awareness
Immediate Priority Strategies
A. Develop curriculum content and build educational capacity to provide knowledge on the full spectrum of primary care-related health careers. Content should encompass all levels of K-12 education for use by educators and parents. Develop a repository of content and strategies that is broadly accessible.
Action Plan
1. Develop compendium of educational materials on primary care careers and pathways (include traditional and boundary pushing options).
2. Assess current status of primary care content integration in K-12 and post-secondary education.
3. Document options (including existing tools) to introduce and integrate primary care content.
4. ID partners and potential implementation strategies
5. Develop legislation and associated funding strategies
Measurable Objective
1. Develop concept paper for action plan and present to potential funders – July 31, 2011
B. Develop and implement a marketing strategy to increase awareness of primary care job opportunities, with particular emphasis in low income communities and populations under-represented in the health professions.
C. Advocate for public and institutional policy reforms that increase awareness and support for early and ongoing education on the importance of primary care and prevention.
Theme II: Training Program Access and Innovation
Immediate Priority Strategies
A. Assess current program capacity and geographic distribution to establish baseline relative to current and projected needs.
Action Plan
1. Define parameters and criteria for gap analysis (spatial and temporal).
2. Compile current data/info from existing sources (eg OSHPD) on program capacity and distribution.
3. Compile existing information and recommendations associated with continuity support in primary care pathways.
4. Compile structure and document existing programmatic innovations.
5. Develop/disseminate summary report.
6. Engage policy makers/opinion leaders-advocate.
Measurable Objective
1. Produce and disseminate a strategic plan based upon FDRS from Gap Analysis – April 30, 2012
B. Assess relative cost-effectiveness of current program entry points (cost, time to degree) for all primary care career tracks, and identify regulatory impediments to innovation.
C. Develop strategies to track practice patterns after training for all primary care career tracks.
D. Build support for programs that produce the most significant increase in primary care capacity and diversity.
Theme III: Primary Care Residencies
Immediate Priority Strategies
A. Develop incentives for residency programs to increase diversity and yield professionals who are committed to practice in underserved communities.
B. Increase residency opportunities and transition to practice programs for multiple provider types in areas of unmet needs.
C. Develop task force to review current funding streams and develop strategies to increase funding for increase primary care residencies.
Action Plan
1. Secure staff to facilitate this effort – Mid May 2011
2. Identify and convene taskforce members who have expertise or interest related to this issue – Mid July
3. Identify and Assign tasks - Mid July
4. Draft report/peer review January 2012
5. Final report/recommendations disseminate April 2012
Measurable Objective
1. Complete a report that outlines findings and provides recommendations for primary care resource allocation strategies.
D. Sustain and advocate for increased funding for Song Brown and LRP (Hernandez Bill)
E. Evaluate opportunity for expansion and/or replication of model programs such as the UCLA IMG program, UC Prime, and post baccalaureate programs.
Theme IV: Recruitment and Retention
Immediate Priority Strategies
A. Increase loan repayment programs and funding for primary care in California.
Action Plan
1. Explore status of waiver opportunity and barriers to approval (April 25 David)
2. Waiver: advocate for CMS approval for federal match funds for state loan repayment programs (Medicaid 15 waiver) (June 1 -David, Angela Minniefield, Steve, Callie)
3. Prepare summary of issues and sample letter to submit to CMS to advocate for approval May 10) (David and Steve)
B. Propose solutions to increase participation in loan repayment programs by streamlining and simplifying process.
Action Plan
1. Identify barriers and solutions to present to loan repayment programs. Determine level of evidence required by HRSA and HPEF (June 15)
2. Propose solutions to increase participation to HRSA, HPEF (August 1)
3. Present Solutions (Sept 1)
4. Advocate for prioritized solutions (TBD)
C. Increase awareness and participation by sites to facilitate student participation.
Action Plan
1. ID non-participating sites in USA, in CA (May 31 – Caryn, Angela, Gary)
2. Target sites in underserved areas and assist with application (Sept 30 – Caryn, Angela, Gary)
3. ID strategies to meet matching fund requirements and program requirements (June 30 – Caryn, Gary Angela)
4. Future action: Evaluate student participation
D. Reduce barriers to recruitment of primary care delivery team members in underserved areas.
Initial list: Loan repayment, cost of education, access to specialists, access to technology, rural isolation, awareness of primary care, value of primary care among health professionals, quality of life, quality of practice.
E. Increase use of SLRP funds and matching of sites.
Action Plan
1. Develop waiver language to encourage CMS to approve federal match to SLRP.
2. Develop talking points.
3. Expand disciplines eligible for LRP awareness of LRP/Scholars
4. Add information to awareness campaign to students, families, counselors
5. Assist sites with access to HPSA/NHSC programs
6. Develop toolkit for enrolling in a program
7. Rubio – GME funding – Managed care contribute to GME
F. Develop partnerships between training programs and employers to better align education with employer needs.
Action Plan
1. Develop curriculum advisory council for health professions education programs that includes health care employers
2. Expand clinical training sites to include full spectrum of HC employers.
3. Facilitate the development of affiliation agreements at organization level among IPAs, regional associations, and licensing boards.
Theme V: Payment and Policy
Immediate Priority Strategies
A. Maintain government funding (fed+state+local)
B. Establish more teaching health centers in CA (in partnership with providers) and CBOs (primary care)
C. Provide loan repayment & jobs primary care in areas of need
D. Structure payment mechanism for full scope of practice in new models of care
Action Plan
1. Explore scope of practice changes to ensure access to quality, affordable primary care services for all CA at projected demand levels and in underserved geographic areas.
2. Support legislation to promote level of PC health home @ proper payment
3. Advocate to increase Medicare payments for primary care. Other payers typically follow. Mobilize nursing and other primary care professionals for advocacy
4. 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 coordinators)
5. Medical homes – put primary care providers in the center/make sure PC provider is receiving adequate reimbursement for care coordination.
6. Secure payment for alternative delivery system, MH, payment for full scope of practice
7. Educate policy makers - policy makers and constituents
Measurable Objectives
Establish advisory group, payment and advocacy model
June 1: Create group, leader, staff
Sept 1: Literature review/document evidence
Nov 1: Select Payment mechanism
Feb 1: ID opportunities to expand demonstration model (eg CMMI)
April 1: Craft Advocacy Plan (Target: Supporters, Opponents, and local, state and federal policy makers)
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