RD193 - Primary Care Workforce and Health Access


Executive Summary:
Section 32.1-122.22 of the Code of Virginia requires that the State Health Commissioner submit an annual report to the Governor and to the General Assembly regarding the activities of the Virginia Department of Health (VDH) in recruiting and retaining health care providers for underserved populations and areas throughout the Commonwealth. The annual report is required to include information on:

(i) the activities and accomplishments during the reporting period;
(ii) planned activities for the coming year;
(iii) the number and type of providers who have been recruited by VDH to practice in medically underserved areas (MUAs) and health professional shortage areas (HPSAs);
(iv) the retention rate of providers practicing in these areas; and
(v) the utilization of the scholarship and loan repayment programs authorized in Article 6 (§ 32.1-122.5 et seq.), as well as other programs or activities authorized in the Appropriation Act for provider recruitment and retention.

The report is also required to include recommendations for new programs, activities and strategies for increasing the number of providers in underserved areas.

The State Health Commissioner delegated the responsibility of preparing the report to the Office of Minority Health and Public Health Policy (OMHPHP), formerly known as the Office of Health Policy and Planning (OHPP). The mission of the OMHPHP during the reporting year was to improve access to quality health care for all Virginians. To fulfill its mission, the OMHPHP partnered with communities, health professionals and providers, advocacy groups, and other stakeholders to:

• Conduct policy analyses and research concerning the cost, quality, and accessibility of health care in the Commonwealth;

• Assist medically underserved communities and populations with the development of resources, establishment of partnerships, and identification of programs; and

• Develop the health care workforce, including the management of scholarship and loan repayment programs and other initiatives aimed at the recruitment and retention of health care providers.

During the reporting period July 1, 2006 through June 30, 2007, the OMHPHP focused a great deal of its efforts on enhancing and expanding these areas. Some highlights include:

Assisting Medically Underserved Communities and Populations

Minority Health

• OMHPHP launched its 2007 Brown Bag Lunch Series, ”Expanding our Collaborative Efforts Utilizing Non-Traditional Resources,” to address the needs of Virginia’s minority populations. This initiative focuses on Virginia’s federally designated minority populations and introduces stakeholders to community resources not commonly utilized.

• The OMHPHP launched a quarterly online newsletter, titled “Virginia OMH E-News,” which highlights minority health initiatives, events, funding and resources. This initiative is closely tied to the expansion of the office’s comprehensive website: http://www.vdh.state.va.us/healthpolicy/minorityhealth/index.htm

• With the hiring of a CLAS Act (Culturally and Linguistically Appropriate Health Care Services) Coordinator within OMHPHP, the CLAS Act Initiative has been able to significantly increase its presence both within the VDH and the Commonwealth. The cornerstone project of the Initiative is the launch of the http://www.CLASActVirginia.org website: a cultural competence resource for both health providers and clients. The CLAS Act Initiative received second place in Category B (programs with budgets under $250,000) from the Association of State and Territorial Health Officials (ASTHO) for its 2007 Vision Award. This award honors outstanding creative state health programs.

Rural Health

• The Federal Office of Health Policy's Small Rural Hospital Improvement (SHIP) Grant Program provides funding to small rural hospitals to help them do any or all of the following: 1) pay for costs related to the implementation of the prospective payment system (PPS), 2) comply with provisions of Health Insurance Portability and Accountability Act (HIPAA) of 1996 and 3) reduce medical errors and support quality improvement. The OMHPHP administers the SHIP Grant Program for Virginia and through its proactive efforts this past year, doubled the number of hospitals (from 12 to 24) in Virginia who receive these funds.

• OMHPHP sponsored a rural health strategic planning meeting on June 13 and 14, 2007 in Staunton, Virginia. The purpose of this meeting was to bring together numerous rural health representatives and experts to strategically plan for the future of health care services in Virginia’s rural and remote areas. The meeting also served as the official kick-off for Virginia’s Rural Health Plan. The plan will be divided into four main areas, each with its own workgroup: access, quality, data and rural definitions, and workforce. Representation on these workgroups includes over 40 rural health stakeholders.

Health Care Access

• As the Primary Care Office for Virginia, OMHPHP is federally mandated to oversee the Health Professional Shortage Area (HPSA) designation process. In the past year, OMHPHP helped to facilitate 16 new Primary Care HPSA designations within 21 jurisdictions, 25 new dental HPSA designations affecting 28 jurisdictions, and one new mental HPSA designation impacting two jurisdictions.

• To supplement some of its own efforts in analyzing provider supply and requirements, the OMHPHP contracted with the Department of Health Administration of Virginia Commonwealth University to forecast the size of the workforce in 2010 and 2015 and to assess the probable requirements for physicians in these two future years. According to the report (Mick, Nayar & Caretta, 2007):

* Virginia is a net importer of physicians: according to the 2005 data, about 75 percent of Virginia physicians were not trained in Virginia. Although Virginia educates about the national average of medical students per population (~25 per 100,000 population), only about 36 percent of Virginia’s medical students end up practicing in Virginia.

* In Virginia, the bulk of physicians are located in the most urban places. Conversely, the smallest places in Virginia have the fewest physicians.

* That Virginia will need more physicians over the next 20 to 30 years seems not in doubt. Population growth alone will require the addition of more of them. Added to this is the increased demand that may result from the retirement of Baby Boomers and their qualification for Medicare. For Virginia, the anticipated growth in demand may be large: the general population is expected to increase by 17% between 2000 and 2020, whereas the growth among the population over 65 years of age will increase by 65% over the same period (versus 53% for the nation as a whole).

• The U.S. Department of Health and Human Services' Health Resources and Services Administration (HRSA) State Planning Grants Program has awarded the OMHPHP with three rounds of grant funding for a total of just under $1.18 million to collect data, conduct research, and develop plans to provide greater access to affordable health insurance coverage for uninsured Virginians. To date the Virginia State Planning Grant (SPG) has yielded seven major products which provide a foundation for advancing the goal of expanding health coverage for the working uninsured. At the time of the writing of this report, there are two options from the Virginia SPG Program under consideration by the Governor’s Health Reform Commission.

• For the past five years, the OMHPHP has led the design and development of telehealth systems in the Commonwealth through its Virginia Telehealth Network (VTN). In this reporting year, the VTN has been incorporated in the Commonwealth of Virginia and is in the process of being recognized as a 501(c)(3) not for profit organization, an industry leader in telehealth has been hired to serve as the acting executive director, a VTN website ( http://ehealthvirginia.org) has been developed, and three major grant funding proposals have been submitted.

Developing the Health Care Workforce

Recruitment and Retention Initiatives

• The OMHPHP maintains the PPOVA healthcare recruitment website (www.ppova.org). During the reporting period, the website generated 54,277 visits, averaging 141 hits per day. During the reporting period, 82 positions were posted and 179 candidates used the system to identify positions of interest. This resulted in 329 CV’s being forwarded to practice sites.

• The National Rural Recruitment and Retention Network (3RNet) is comprised of state organizations such as State Offices of Rural Health, AHECs, Cooperative Agreement Agencies and State Primary Care Associations. These not-for-profit organizations help health professionals locate practice sites in rural areas throughout the country. For many years Virginia has been a member of the 3RNet and fully participates in its activities. Virginia’s Health Workforce Manager is leading the planning committee for the 2007 conference which will be held in Richmond, Virginia.

• The OMHPHP works to identify and assist practice sites in Virginia that are eligible to recruit and place health professionals participating in the National Health Service Corps (NHSC) scholarship and/or loan repayment programs. For the reporting fiscal year, the VDH reviewed 47 applications and the NHSC approved 46 practice sites in Virginia as eligible facilities to recruit NHSC Scholars and Loan Repayment recipients.

Scholarships/Loan Repayment/Waiver Incentive Programs

• The OMHPHP administers the Virginia Physician and Virginia State Loan Repayment Programs. These Programs offer financial incentives to physicians, physician assistants and nurse practitioners who are committed to serving the needs of underserved populations and communities in the Commonwealth of Virginia. Each recipient agrees to serve full-time at medical facilities located in designated health professional shortage areas or medically underserved areas for a minimum of two years. In return for their service, each recipient is provided funds to repay qualifying educational loans. The OMHPHP received and reviewed 31 loan repayment applications and issued 25 loan repayment awards during the reporting period.

• The Mary Marshall Nursing Scholarship Program (MMNSP) provides financial incentives to students pursuing a Licensed Practical Nurse (LPN) or a Registered Nurse (RN) education. The scholarship program requires one month of service by the recipient anywhere in the state for every $100 of scholarship awarded. The OMHPHP received and reviewed 153 nursing scholarship applications and issued 134 awards during the reporting period.

• The OMHPHP piloted a new nursing scholarship program for nurse educators to increase the number of nursing faculty in Virginia’s nursing programs. Eighty-six applications were received for ten $20,000 scholarships that are renewable for one additional year.

• The OMHPHP administers Virginia’s participation in the Conrad State 30 J-1 Visa Waiver program. This program is federally authorized and permits VDH to act as “an interested state agency” to request visa waivers for American-trained foreign physicians. These waiver requests allow foreign physicians, on a J-1 visa status, to remain in the U.S. and practice in federally designated health professional shortage areas (HPSAs) and medically underserved areas (MUAs) within Virginia, rather than returning to their home country after completing residency for the required two year period. The OMHPHP assisted in placement of 14 new physicians who utilized the J-1 Visa Waiver process.

• The OMHPHP administers Virginia’s participation in the National Interest Waiver program. Physicians applying for a NIW must work full-time for a total of five years in a HPSA or MUA. The OMHPHP issued letters of support for 13 physicians requesting National Interest Waivers.

The OMHPHP is under the leadership of a new office director and is in the midst of a strategic planning process. The OMHPHP will be embracing the following expanded vision and mission for the upcoming reporting year.

Vision: Advancing health equity for all Virginians.

Mission: To identify health inequities, assess their root causes, and address them by promoting social justice, influencing policy, establishing partnerships, providing resources and educating the public.

Health inequities are differences in health status that are systematic, avoidable, and unfair. In Virginia, several racial/ethnic minority groups and low-income populations have generally poorer health status. Health inequities are strongly influenced by differential access and exposure to social determinants of health, which include economic and educational opportunities, quality housing, the physical environment, discrimination, cultural norms, transportation, and others. In order to eliminate differences in health status, thus creating health equity, strategies must focus on the social determinants of health, as well as promotion of quality health care and healthy behaviors.

Although many of the activities being planned by OMHPHP to implement this broader vision are dependent on the availability of appropriate state, federal, and private resources, the OMHPHP has recently submitted a grant proposal to the U.S. Department of Health and Human Services, Office of Minority Health, State Partnership Grant Program to Improve Minority Health and has been invited to submit a full proposal to the Robert Wood Johnson Advancing Public Health Practice and Policy Solutions Grant Program. The OMHPHP is optimistic about its ability to successfully carry out its mission.