1. Health Care Workforce Group VI

2. Problem Statement There is an insufficient supply of qualified primary care practitioners in the United States which limits access to primary care.

3. Problem Statement What are the dimensions of the problem you confronting? –There is a shortage of primary care practitioners which limits access to care. –The demand for primary care will increase as a reformed healthcare system focuses on chronic care management, health promotion and disease prevention. –Initiatives to improve access to nursing care have focused on hospital care rather than primary care.

4. Rationale Access to primary care can increase quality and decrease costs to the healthcare system. A reformed healthcare system will require new and innovative models of care and education.

5. Proposed Solution Increase access to advanced practice nursing care (APRN) –Modify Medical Home legislative language to include Advanced Practice Nurses under qualified providers. –Expand federal funding for Nursing Education, particularly on the Baccalaureate and Advanced Practice levels. –Support demonstration projects for new models of care.

6. Stakeholders Who will support this plan/What positions are they likely to hold? –Healthcare insurers/decreased costs –Employers/decreased cost of benefits –The Public/increased access –Consumer advocacy groups (AARP, ADA, etc.)/increased access, quality, decreased cost –Professional nursing organizations/increased access, professional autonomy

7. Stakeholders, Con’t Who will support this plan/What positions are they likely to hold? –Rural Care Advocates/increased access –Nursing Educational Institutions/increased student body –Community Health Centers (FQHC, etc.)/increased access, quality, decreased cost –Public health systems/increased access, enhanced services, quality –Long Term Care, American Healthcare Assoc/access

8. Stakeholders Who will oppose it/What positions are they likely to hold? –American Medical Association/Patient safety –Other medical groups/Patient safety –Regulatory bodies/Public safety

9. Stakeholders Whose positions are unknown? –Pharmaceutical companies –Regulatory Bodies (Boards) –Hospitals & Other Healthcare organizations

10. Plan of Action : Modify Medical Home legislative language to include Advanced Practice Nurses under qualified providers Adjust language to be inclusive of Advanced Practice Nurses under the categories of qualified providers in the proposed “Medical Home Model” in states allowing independent practice.

11. Plan of Action : Expand federal funding for Nursing Education, particularly on the Baccalaureate and Advanced Practice levels. –Establish a dedicated source of Federal funding for nursing education. –Refocus “Workforce Investment Authority” funding toward Baccalaureate & higher degree programs. –Direct funding to create incentives for primary care practice, public health & community health. –Use Graduate Medical Education funding as a model. –Support “Internship model”

12. Plan of Action: Support demonstration projects for new models of care Provide funding for demonstration projects (e.g., multidisciplinary teams, virtual visits, alternative education pathways) Provide funding for comparative effectiveness of new models of care. Address regulatory barriers to the adoption of new models of care.