Item 12 of the 1998 Appropriation Act directs the Joint Commission on Health Care to study and develop a centralized planning and funding mechanism to ensure that the Commonwealths health workforce activities and initiatives related to improving access to care in underserved areas are designed, administered, and funded in a coordinated manner that maximizes their efficiency and effectiveness. The budget language provides that the analysis include the following health workforce activities and initiatives:

(i) the Area Health Education Centers (AHEC) program;

(ii) the Department of Health's Center for Primary Care Resource Development, including recruitment, scholarship and loan repayment programs;

(iii) those activities of the Generalist Initiative which relate to improving access to care in underserved areas; and

(iv) the role of other related private, non-profit community-based organizations.

The Primary Focus Of This Report Is To Study And Develop A Centralized Planning And Funding Mechanism For Health Workforce Initiatives; The Report Is Not Intended To Be A Comprehensive Evaluation Of The Relative Effectiveness/Value Of Each Initiative

As will be discussed in this report, the Commonwealths health workforce initiatives include a number of complex and inter-related programs and activities designed to improve access to care in underserved areas. While the process of studying a centralized planning and funding mechanism for these workforce activities inherently involves some level of assessment of each activity, this report is not intended to serve as an evaluation of the relative effectiveness or value of each initiative. Such an evaluation would require significantly greater amounts of time and resources than that available for this study. In addition to the level of resources needed for such an evaluation, a one-time evaluation of these activities provides only a "snap-shot" of the programs' effectiveness.

In an era of ever-changing health care needs, issues, and markets, the greater need is for a process that provides continuing analysis and coordination of the various workforce initiatives. While a one-time evaluation of these initiatives certainly would provide useful information, an ongoing evaluative process that is part of the centralized planning and funding mechanism would be far more valuable to the Commonwealth. Accordingly, this report focuses on establishing a process for coordinating and reviewing the health workforce initiatives, rather than on evaluating the current effectiveness/value of each individual component.

Section II of the report provides an overview of the need for and objectives of health workforce initiatives. Also, information regarding the areas of the Commonwealth designated as medically underserved and health professional shortage areas is presented. Section III identifies and discusses the various health workforce initiatives in Virginia. Section IV discusses the need for a centralized planning and funding mechanism for the Commonwealths health workforce initiatives and discusses several alternatives for establishing such a process. Section V presents a number of policy options for consideration by the Joint Commission in addressing these workforce issues.