Archive for the ‘health professions education’ Category

June 9, 2010

Academic health center-community health center partnerships vital to health reform

89 percent of respondents to a recent survey (Academic Health Centers and Community Health Centers: The Landscape of Current Partnerships) by the Association of Academic Health Centers reported that the academic health centerution had an established partnerhsip with one or more community health centers.  These partnerships range from providing primary and preventive care to managing centers, training students, and conducting research. More than 60 percent of the partnerships are with federally qualified health centers (FQHCs).  The FQHC label is part of a designation category designed by the Health Resources and Services Administration and the Centers for Medicare & Medicaid Services indicating that the facility serves a medically underserved or health profession shortage area.

In this era of health reform, such partnerships are vital not only to expand access to care but also to address the nation’s health workforce needs.    Because community health centers provide care to more than 20 million people, of which a vast majority live in poverty, it is important to ensure that the policies and practices associated with the establishment,  operations, and collaborations of the community health center not only facilitiate effective care but also  promote innovation in care delivery.

The academic health center-community health center partnership is one that should be encouraged but improvement in federal policy is also needed so that the partnerships can adapt to changing needs.  Policymakers will need to examine regulatory, financing, management, and governance barriers that may be preventing collaborative models of care to flourish.

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Posted in Health Reform, Uncategorized, arra, health care delivery models, health professions education, health workforce | 3 Comments »

June 2, 2010

Baby Boomer Generation and the Need to Address the Health Workforce

The Baby Boomer generation has transformed America for decades.  Next year, when so many boomers turn 65, the U.S. will again feel their power as the population dramatically shifts in age.  The number of older Americans will increase dramatically from approximately 38 million to 72 million by 2030.

 The aging population presents a microcosm of the U.S. population in terms of the intense challenges facing the health workforce.  Perhaps for no other population is there such a close relationship between health and social issues and services.  Thus, examination of ways to improve and change the health workforce environment for the aging can provide valuable lessons for the nation.  

There is general agreement among experts that existing shortages across the health professions will become more acute as the elderly population grows.  However, shortages are only one part of the crisis.  Current models of workforce education and training are not adequately preparing the next generation of health care providers to meet the needs of older Americans.  In addition, an uneven patchwork of state and federal workforce policy continues to exacerbate provider shortages and hinder the delivery of quality care to the aging population.  Health care financing is particularly troubling in the long-term care arena, hindering innovation and the emergence of new models of care.  Finally, there is a lack of adequate data, research, and analysis of political, social, and demographic trends and their impact on the health workforce.

As the health needs of the aging increase and health workforce shortages grow policymakers, educators, health professionals, providers, industry leaders, and  other concerned stakeholders must consider how best to address the health workforce in a strategic and comprehensive fashion.  Policymakers must particularly question whether appropriate and effective decision-making can occur within the existing policy framework and, if not, the most promising alternatives to ensure an effective health workforce for the nation.

To resolve these issues and prepare the nation for increased health care needs, the health workforce must be made a priority domestic policy issue. For several years, the Association of Academic Health Centers (AAHC) has focused attention on the critical need for a new coordinated national health workforce planning initiative. During the health reform debate, the AAHC urged policymakers to develop an integrated, comprehensive national health workforce policy that recognizes and compensates for the weaknesses and vulnerabilities of current decentralized multi-stakeholder decision making.  The establishment of the National Health Care Workforce Commission is a powerful step to achieve that goal.

Today, with increasing pressures to meet the diverse needs of the aging for care in the coming decades, the AAHC recommends that leaders and decision-makers in both the public and private sectors:

  • Make the health workforce a priority issue.
  • Ensure that the  National Health Care Workforce Commission has the resources to plan and develop a comprehensive national health workforce policy.
  • Ensure that the National Health Care Workforce Commission engages federal, state, public, and private stakeholders with the goal of promoting harmonization of regulations and standards and addressing the pressing workforce issues of the nation.

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Posted in Health Reform, health care delivery models, health professions education, health workforce, jobs | 3 Comments »

November 2, 2009

More on Interprofessional Education and Practice

As we have previously noted, interprofessional education and practice is somewhat of a buzz word these days.  While there might be an informal consensus of opinion that the health care of the future needs to involve meaningful integration of various health professions into patient-care teams, we have pointed out how the rhetoric in this area is far in front of the reality (see Oct 22 post).  We are aware of many fine institutions engaging in important interprofessional activity, but not enough has been done to focus on this issue at the national level.  At a recent meeting that we convened on the topic, the following observations emerged:

  • The current approach to interprofessional education is a study in grass roots development, as opposed to top-down leadership;
  • Interprofessional education and practice sometimes operate at the periphery of the institution, and are not engrained in the institutional fabric;
  • Attaining accurate predictions and assessments of the skill sets that will be required of health professionals in the future is vital;
  • Determining whether the “education tail” wags the “practice dog” or vice versa is important in developing the content and substance of these programs;
  • The drivers of interprofessional education and practice need to move beyond “belief” and be more empirically driven; and,
  • Health care reform may create demand for interprofessional education and practice by pushing to better  align health professional education with the evolving health care needs of the public.

Health care reform holds the potential to serve as a catalyst for disruptive innovation in health care, and, in so doing, bring interprofessional health care into the mainstream.  Indeed, the drive to create value in health care may lead to team-care as a paradigm that needs to be integrated with health professions education.

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Posted in Health Reform, Uncategorized, health professions education, health workforce | 1 Comment »

October 29, 2009

Create Health Workforce Jobs for U.S. Economic Recovery

We all know that the employment picture in the U.S. continues to be dark. One in 10 Americans who wanted a job last month were unemployed. What many do not know is that private sector employment growth fell short of the number of new people entering the labor force by more than 500,00 jobs each year throughout the 1990s! The bottom line: Economists say the U.S. job creation engine has been stalled for the better part of a decade.  New enterprises are not coming on line. As older industries die, established industry and entrepreneurs are not entering the market place and using capital to create jobs.

 So where will jobs come from? Health care is an obvious choice. It’s time for a public policy to support this growth industry with a Jobs Bill for Health Care (similar to the post World War II GI bill). The bill would provide funds to train all comers – from the returning war vets to the unemployed, from the dying manufacturing industries to the recent high school graduates. This will produce not only the health workforce that the U.S. so desperately needs in the near and long term but also create a “product” that can be exported overseas – trainers for other countries’ healthcare challenges.

 In addition to direct investment, the government should ensure funding from the insurance industry and providers who do not now train health professionals but depend on the health workforce . Let’s ensure the health and economic future of the United States with a public-private partnership that makes sense.

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Posted in Health Reform, Policy, U.S. Economic Growth, health economics, health professions education, health workforce | No Comments »

October 22, 2009

Interprofessional Education and Practice: Infrastructure Needed to Go From Rhetoric

For years there is talk about interprofessional teams.  For more than 20 years, educators and policymakers have put this forth as part of the health care vision for the 21st century.  It is also directly and indirectly referred to in health reform legislation before the Congress.  Policymakers are enamored of the idea of an interprofessional team of caregivers providing patient centered care (whatever that means).

 I learned about some of the latest innovations in  interprofessional programs in academic health centers throughout the nation.  Students from two or more health professions are educated together and/or engage in practice together and, in so doing, are not only improving the learning environment but also patient care and outcomes.

 

Rural practitioners tend to embrace interprofessional practice more fully than practitioners anywhere else in the country for obvious reasons.  However, in the last decades, interprofessional education has not gone mainstream and been fully embraced by health professions schools and academic health centers.  Interprofessional activities have been person directed (by a passionate advocate), thus remaining at the margins of health professions education.  Passion on the part of institutions is not quite as evident.

 What’s the problem.  Money is always an issue.  With universities and hospitals waiting for the next budget cut, institutions are hampered from creating new programs so needed for the future.  In addition, we still don’t have enough evidence that such practices make a difference.  There has not been enough study of the long-term impact of interprofessional initiatives.  Research is needed.  And that also cost money. Regulations don’t support it.  State licensing boards and accreditation agencies often inhibit innovation within institutions. Scope of practice laws are barriers to interprofessional practice.  Faculty incentives are still based on what makes a difference to the “profession,” whichever that may be—thus making it hard to engage appropriate teachers in the process. Finally, the current health care delivery system—specifically the reimbursement system—does not support interprofessional practice—and may not support it for the future. 

 The bottom line:  Interprofessionalism lacks focus.  There is no standardization, no uniformity anywhere in the nation.  There is no framework for programs, policy or practice.  There is no infrastructure and no guidelines for establishing the infrastructure that is needed within institutions, particularly academic health centers where most of health professions education takes place.    To fill this void, leaders of academic health centers are engaging on the issue—not only to mainstream interprofessional education and practice but to educate policymakers about the best way to deliver care for the future.

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Posted in Policy, health professions education, health workforce | No Comments »