1. 1 VHWDA Board Dec. 4, 2013 VHHA Healthcare Workforce Development Plan

2. 2 VHHA Strategic Workforce Task Force Met for 24 months to develop recommendations to address looming workforce needs re: skills and numbers Included stakeholders from health systems, higher education and state agencies

3. 3 Incremental change or maintaining the status quo will not provide a sufficient health professional workforce to meet the core commitment of providing compassionate care to all. Our current licensure-based system, even if improved, will not be sufficient to meet our growing and evolving workforce needs. State government is a key partner, but the health care community broadly must help lead the needed change efforts. Even relatively modest changes will meet fierce stakeholder resistance in some cases, so a long-term effort is necessary. Today’s policy recommendations are important and address near- term priorities, but the conversation will need to continue. Overall Findings

4. 4 1.Launch a Troops to Healthcare Initiative to bring a younger workforce into healthcare. 2.Increase clinical training slots in Virginia and strengthen retention of medical school and advanced practice professional graduates 3. Support healthcare workforce innovation and flexibility Recommendation Themes

5. 5 Drivers of Need for Healthcare Workers Demographics –Pig in a python age wave for both patients and providers –Continued Virginia population growth, particularly in younger ages Medical Technology Advancements –Expanding demand, but also potentially labor-saving ACA coverage vs. Access to Care –ACA’s 250,000 to 400,000 potential newly insured –Access to effective primary care systems a challenge

6. 6 Virginia’s Population Will Continue to Grow

7. 7 Aging Health Workforce

8. 8 Aging of the Nursing Workforce is a Long-term Trend HRSA National Sample Survey of Registered Nurse (2006)

9. 9 We Already Rely on Older Professionals

10. 10 Virginia Has Added Substantial Medical School Capacity Over the Past Decade Plus

11. 11 Medical School Location Does Not Determine Where a Physician Practices

12. 12 Residency Site is more Determinative of Practice Site than Medical School Location

13. 13 As Our Population Has Grown Substantially Since the Federal Residency Freeze Age 55+

14. 14 Good Intentions Negative Outcomes GA increases funding to produce more graduates to address growing population. Federal freeze makes graduates go out of state for residency. MDs likely to reside in state with residency. VA becomes donor state for other states’ physician workforce. Graduates unable to practice without internship/residency.

15. 15 Virginia Has More Than 167,000 Veterans Under Age 40

16. 16 Recommendations (continued) 1. Increase clinical training slots and retention of medical school and advanced practice professionals by: Making increased retention a priority at medical/health professional schools; Supporting consortium models for adding clinical training slots; Expanding state support for residencies and other key clinical training opportunities via targeted Medicaid payments and public/private partnerships; Creating incentives for and assistance with placing students/graduates in certified training programs in geographic areas and specialties of high need; Working federally to relax the Medicare freeze on residency slots for high growth states that have expanded medical and health professional school capacity. 13 Prioritized Recommendations

17. 17 Recommendations (continued) 2. Encourage healthcare workforce innovation and effective integration: Make Virginia a best in class state in clinical team integration who collectively provide care that fulfill the IOM six aims – health care that is Safe, Timely, Effective, Efficient, Equitable and Patient-centered (STEEEP); Develop new care team approach and health professions training to embody STEEP aims Include workforce innovation research and demonstration program as part of Virginia Health Innovation Plan; Continue push for additional workforce regulatory flexibility with next Governor. 3. Recognize veterans’ competencies and speed integration of qualified veterans into the Virginia healthcare workforce Troops to healthcare health system commitment; Continued push on regulatory flexibility for qualified veterans. 4. Continue multi-stakeholder committee or commission to: Update workforce analyses, target priority areas and track progress Address the aging of the workforce 13 Prioritized Recommendations (continued)