AHECs and Implementation of the Affordable Care Act. State by State Activities

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1 AHECs and Implementation of the Affordable Care Act State by State Activities The following information reflects examples from AHEC Programs and AHEC Centers across the nation of the activities which are well aligned with the Affordable Care Act (ACA). These examples show AHEC s ability to meet the increasing demands for the health care workforce, mainly in primary care, with a focus on the distribution of health professions workforce particularly in rural and underserved urban areas. These are examples of the AHEC focus on the importance of recruiting a diverse workforce that reflects the nation s population, and how AHECs across the nations are working with their partners for the expansion of collaborative practice and team models of care. AHEC Primary Care Training AHEC Workforce: Early Identification of Diverse Students, Rotations and Placements in Underserved Areas Largest support and single funder of clinical rotations focused on primary care professions. Member of Alaska Health Workforce Coalition to promote and educate legislators on PCMH, request expansion of the State Medicaid plan to provide reimbursement for expanded provider types and services requisite to successful implementation of PCMH. Alaska AHEC Partner with Alaska s AFP to design and deliver educational series for primary care physicians working toward practice transformation Participates on task force charged with defining the emerging field of care management by identifying competencies and training/preparation required in an integrated care delivery model. Page 1 of 21

2 AHEC Primary Care Training AHEC Workforce: Early Identification of Diverse Students, Rotations and Placements in Underserved Areas GVAHEC in partnership with the Arizona Chamber Foundation and St. Luke s Health Initiatives developed a policy primer on Graduate Medical Education in Arizona and how to grow the physician pipeline to help in the demand for primary care providers. GVAHEC is participating in a Statewide Arizona Action Coalition to develop and build an infrastructure to assess healthcare workforce needs and increase the number of BSNs. Arizona AHEC Family medicine residency program via teaching health center (will be applying for THC funds) technical assistance and development (with funding from HRSA) Part of statewide network educating and advocating for/about Medicaid expansion GVAHEC is working with the University of Arizona College of Medicine Phoenix to recruit first and second year medical students to complete their rotations in rural and underserved areas within region. Page 2 of 21

3 Arkansas AHEC 5 of Family Medical Centers (FMCs) in 4 AHECs participate in the Comprehensive Primary Care Initiative, a CMS innovation program authorized by the ACA. This statewide program, involves 66 primary care practices. All major Arkansas insurers participate and pay providers a monthly case management fee for PCMH services. All 8 of AHECs FMCs are level II NCQA PCMH accredited. AHEC-West, has received a teaching health center grant to expand its family medicine residency program by 2 residents (from 8 to 10) per year in training. Division of Practice Improvement and Research, in Center for Rural Health, submitted grant to Patient Centered Outcomes Research Institute, (PCORI), focused on health literacy issues in primary care practice. AHEC network, Regional Programs, and UAMS overall are advocating for Medicaid expansion, to which will begin in 2014 if approved by legislators. This will reduce the amount of uncompensated care. Page 3 of 21

4 CA AHEC Program: Primary Care Workforce: Innovative project to support retention of NHSC loan repayment participants in HPSA sites. California AHEC played a contributing role in construction of a statewide health workforce plan. The project was initially funded by HRSA and is a joint effort of the state workforce investment board and primary care office. California AHEC North Coast AHEC, housed within North Coast Clinics Network, consortium of 4 organizations, provides training and learning opportunities to achieve PCMH recognition. Collaborate with IPA on Primary Care Renewal whereby interdisciplinary teams engage in continuous quality improvement to improve care. San Francisco AHEC: Arrange training and technical assistance to local CHCs to transform to patient-centered medical homes, e.g., panel management, complex care management. The North Coast AHEC, housed within the North Coast Clinics Network, a consortium of 4 clinic organizations, provides education and outreach about the provisions of the ACA to audiences within the community: patients, communitybased organizations, health-system entities, etc. Meet regularly with County Department of Health & Human Services and other local health care stakeholders to discuss strategies for ACA provisions, such as the development and implementation of the Low-Income Health Program, Path2Health, the transition of Healthy Families into MediCal (Medicaid), and the expansion of MediCal eligibility. San Francisco AHEC: Assist local CHCs to prepare for enrollment of newly-eligible patients into Medicaid, through training, advocacy and sharing of best practices. Page 4 of 21

5 Colorado AHEC Member of Colorado Health Benefits Exchange (HBE) Workgroup for Marketing, Education & Outreach including exploration of AHEC as regional contact/support for HBEs across the country. Practice Transformation Support for Improving Community Health Care in Southwestern Colorado led by SWCAHEC and funded by Colorado Health Foundation. Grant supports primary care practices in transforming toward a PCMH model via quality improvement coaching and working with community based nurse navigator program to establish protocols and encourage referrals to provide support to patients. The community nurse navigators also collaborate with regional Collaborative to provide care for mutual patients. SWCAHEC provides coaching and support to rural clinics outside of aforementioned grant to help improve access to health care in rural areas, implement projects related to patient navigation and care coordination. Page 5 of 21

6 Hawaii AHEC Represented on the Governor's Healthcare Transformation Task Force Supporting continuing education on PCMH and ACOs. Started a State Loan Repayment Program. Idaho AHEC Hosted Young Invincibles for informational meeting on the ACA diverse stakeholders attended. Highlighting articles on The Affordable Care Act What does it Mean for Idaho in each issue of Newsletter, Frontier Footnotes. Presentation at Effective Practice Management Luncheon for members of Idaho Medical Group Management Association (IMGMA)... Illinois AHEC Urban Medicine and Rural Medicine students complete longitudinal clinical and non-clinical community rotations which include working across disciplines and approaching health in a wider context so as to include individual and community prevention strategies. Member of local efforts to establish a CHW training curriculum and certification. Efforts underway to establish employer-based apprenticeships. Staff one-semester CNA course that culminates in certification exam Page 6 of 21

7 Indiana AHEC East Indiana AHEC coordinates a Patient Simulation Consortium that is using simulation tools to address rural hospital quality and patient perception measures, specifically clinical core measures and HCAHPS. In determining Value-Based Purchasing enacted with the ACA, measure taken into calculation. Kentucky AHEC Focus groups and surveys, work with another agency to compile data, then work with hospital on facilitation of identifying and prioritizing strategies for each hospital and the final meeting with the hospital board to create a plan to implement the strategies. Involved with CHIP program (education and awareness). Working with statewide groups educating communities, legislators and physicians on Medicaid expansion. Working with critical access and rural hospitals and Community Needs Assessments. Introduce community health needs assessment and current IRS requirements. Chair, Kentucky Rural Health Association Legislative Committee with initiatives: monitoring Health Benefit Exchanges development, monitoring Medicaid expansion. Will take on the role of educating members about process so they can educate their communities. Developing a Community Health Needs Assessment for one of region's hospitals; service also offered to another regional hospital. The CNHA must be completed every 3 years by non-profit hospitals and is a requirement of the Affordable Care Act. Page 7 of 21

8 Louisiana AHEC Work with Department of Health and Hospitals Primary Care Office to promote loan repayment program for primary care providers in HPSAs. Develop FQHC practice site linkages with academic institutions for multi-disciplinary and interdisciplinary training. Utilize Dr. Sheila Chauvin s (LSUHSC) A Standardized Model for Creating Successful and Sustainable Academic Residency and Clinical Rotations in Community Health Centers. Model for increasing the quality and number of clinical rotations for primary care health professionals in underserved communities exposes them to multiprofessional and interdisciplinary training. Rural Scholars Track with 67 students in primary care, 13 in residency and 6 in rural practice. Serve as NHSC ambassadors for loan repayment and scholarship programs; provide technical assistance to applicants. Place primary care health professions students in community-based clinics in HPSAs. Track AHEC program participants interested in primary care careers. Encourage rotation sites to achieve a NHSC designation. Collaborate with DHH, Primary Care; provide NHSC participants/alumni with web-based health disparities and cultural competency CME/CE Provide students with service learning opportunities. Page 8 of 21

9 Cultural competence education/training sessions at UMB for faculty. Maryland AHEC Participated on selection of essential health benefit (EHB) package. Dissemination of information related to the health exchange. Community educational sessions on ACA and its timeline and how it can affect "you and your family." State workforce planning committees to address shortages especially related to ACA PCP implementation Assisting to secure keynote speaker who will discuss ACA and its implications for Aging Conference. Discussion with others to become a partner in the Navigator Program -- building on AHEC regional contacts, educational outreach experience, and knowledge of the Region to assist the Navigators in both understanding and reaching the population and ACA information and what it means to them. Page 9 of 21

10 Massachusetts AHEC Translating documents related to ACA and Massachusetts health care reform efforts to ensure the understanding of Limited English Proficient patients. MassAHEC Network plenary on health care reform planned for annual conference in June for 200+ medical interpreters so they are aware of the changes and respond to patient inquiries. Michigan AHEC Partner in HRSA grant to Michigan Department of Community Health for Advanced Practice Nurse Leader primary care model for overweight and obese patients. Project designed to improve health outcomes in two medically underserved areas and expand primary care services by with interdisciplinary clinical training opportunities for health professional students, and training current health care professionals in an Interprofessional collaborative practice model. Page 10 of 21

11 Collaborated with Primary Care Association and Federally Qualified Health Centers, to implement SEARCH program to extend the reach of NHSC. Serve as NHSC Ambassadors to promote scholarship and loan repayment programs. Collaborative oral health career recruitment efforts with Missouri School of Dentistry and Oral Health. The school will collaborate with Community Health Centers to provide clinical training experiences designed to produce dental professionals with an in-depth understanding of and a desire to serve populations in need. Missouri AHEC Participating in collaborative statewide efforts to educate communities on the potential impact of implementing Medicaid expansion in the state. Participant in efforts by the Missouri Foundation for Health and Missouri Health Advocacy Alliance to inform and educate communities about the provisions of the Affordable Care Act. Serve on the state advisory board of the Center for Patient Safety, Missouri s Patient Safety Organization under the ACA. Lead an effort to make the Team STEPPS teamwork development program available on-line to medical students and hospitals statewide. Page 11 of 21

12 Montana AHEC Collaborate with Great Falls College Montana State University on Project Homeless Connect to provide medical, dental, social, educational, behavioral and preventive services free of charge. Sponsor in partnership with the Montana Hospital Association, distance and continuing education series and webinars Partner with Robert Wood Johnson Foundation s Academic Progression in Nursing Grant Program to educate employers and academic entities about BSN education/competencies, advanced practice roles and retention rates. Host annual CME for faculty and preceptors affiliated with Montana WWAMI program; offer topics pertinent to role of teaching physician and rural/underserved care. Coordinate medical student rotations. Coordinate Montana R/UOP elective for students who have completed first year of medical school. Created referral-based Montana Connections Recruitment Program. Responsible for rotations for BSN-RN and FNP students at rural/frontier public health departments or critical access hospitals. Serve as NHSC Ambassadors to promote scholarship and loan repayment. Recruit/certify students, health professionals and others in CPR/First Aid. Conduct feasibility of CNA training. Responsible for the inception, feasibility study, and accreditation of the Western Montana Family Medicine Residency Program, a 10/10/10 family medicine program sponsored by The University of Montana and affiliated with the University of Washington Family Medicine Residency Network. Oversight of Behavioral Health Primary Care Collaboration which integrates a prelicensed clinical social worker and post-doctoral psychology graduates into primary care rural health clinics across Montana. Host Citizen Soldier interprofessional CME/CEU conference to assist primary care and mental health specialists to provide patientcentered health care for veterans. Sponsor American Indian Cultural Competency Workshop. Present information on the impact of the ACA and Medicaid expansion on the communities of Montana at Bureau of Business and Economic Development Outlook seminars. Sponsor Providers Advancing Transitions in Healthcare (PATH) that seeks to facilitate the development of organizational cultures of teamwork for physicians and midlevels. Sponsor Leadership Education and Performance Program (LEAP), focused on developing leadership and teamwork skills to build more effective management teams in order to transition into new healthcare paradigms and delivery models such as the PCMH. Partner with MT FLEX/PIN program, to sponsor on-going distance, medical education to rural providers. Topics include quality improvement, peer review, operational and financial improvement, and health system development and community engagement. Page 12 of 21

13 New Hampshire AHEC Participating in collaborative efforts to educate those involved with ACO pilots and others about quality improvement initiatives, meaningful use, primary care medical home, care coordination, transitions of care, patient engagement, patient safety and community health workers. Specific initiatives include: Practice improvement through a structured coaching process Patient engagement through implementation of Stanford University s evidence-based Chronic Disease Self-Management Program. Supporting the development of an ACO in the North Country Page 13 of 21

14 New York AHEC Institute for Family Health/ NY Metro AHEC Region: Awarded THC grants to expand Mid-Hudson family medicine residency and establish Harlem family medicine residency. Initiated/lead Mount Sinai Department of Family Medicine and Community Health, first full dept. Manhattan medical school and hospital. Develop progressive residency curriculum focused on better coordination of primary and specialty care, emphasis on patient care transitions emergency to primary, primary to specialty. Erie Niagara AHEC coordinates rotations for HCOP students in FQHC; provides diversity training New York Metro AHECs and NY College of Osteopathic Medicine collaboration for nonclinical experience for 2 nd year medical students in medically underserved areas. Surveys indicate that students who participated in program were more likely to work in an underserved community. Institute for Family Health/NY Metro AHEC Region: Funding from New York Alliance for Careers in Healthcare and City University of New York to provide opportunity for front desk staff to become a certified Medical Assistant at no cost, thereby meeting the demands of new models of care. Optimum Physician Alliance focused on development of a community of care; physicians and patients networked in a non-medicare ACO model. Institute for Family Health/NY Metro AHEC Region: Partner in CMS Communitybased Care Transitions Project Obtained NCQA Level 3 status at 18 primary care practices; redesigning practices in more coordinated care model. Re-training staff in care management models including HIT/EHR and patient flow. Developing call center model and training staff. Institute for Family Health/NY Metro AHEC Region: Training health home partner organizations on five major chronic diseases, care planning and documentation in EHR to prepare them to act as care managers. Training staff to improve sensitivity to LGBTQ patients. Recruiting participants for a bridge to college program to augment the bilingual healthcare workforce. Erie Niagara AHEC Health Talkers Program trains community residents about health related issues and resources, a role similar to Navigators who educate residents about health insurance marketplace. Institute for Family Health/NY Metro AHEC Region: Develop actionable information to implement shared savings arrangements with managed care organizations to improve care management. Working with schools of allied health to update medical assistant curriculum to ensure graduates are familiar with/ready to work within new models of health care. Founding member Manhattan- Bronx Health Home and designated lead of Ulster County Health Home; developed care management infrastructure and hired staff to provide coordinated care management to patients. Developed curriculum and training modules for CHC staff, including PCMH models, care coordination and patient care navigation. Train all Medical/Dental Assistants in administrative procedures to serve dual role on the care team. Page 14 of 21

15 North Carolina AHEC NC AHEC s practice support and QI consultants work with 1,100 primary care practices to adopt and use EHRs effectively, use data to transform and improve care, and achieve PCMH certification. Contracts with emerging ACOs to assure practices are PCMH-certified and delivering high quality care at a reasonable cost. AHEC staff have key role in Health Care Transitions Initiative, with hospitals and primary care networks. Goal: To reduce hospital readmissions and inappropriate emergency room use, and improve health care outcomes. AHEC staff have offered numerous continuing education programs on the ACA and health care reform, and the impact reform will have on the health workforce and health care agencies in the state. Statewide Task Force on Health Care Reform: The NC Institute of Medicine convened a high level task force to do a year-long study of health care reform and its impact on the state. Senior AHEC staff have key roles on task force including chairing the subcommittees on workforce and quality, and participating in other committees. Findings of task force will help drive key policy decisions about reform in the state. Page 15 of 21

16 UT AHECs are working with several rural primary care practices selected to be clinical training sites for PCMH through a statewide initiative. Students will receive didactic education on PCMH and clinical training. The pilot includes training of practices, clinical education and a set aside of $50 million of Choose Ohio First scholarship money for medical and APN students who commit to residency training in Ohio, practice for 5 years, institute the PCMH model and serve Medicaid patients. Lead contact on project for the College of Medicine with Board of Regents. Ohio AHEC AHEC was involved at the College of Medicine strategic level to develop an ACO. Monitored the various rollouts of ACO opportunities and advised senior leadership. In order for CAHs to maintain that status via IRS form 990, they need to do community health services assessments. UT AHEC subcontracted with the Voinovich School of Public Policy at Ohio University to do the strategic planning and health assessment process in NW region. Started in late 2011 and concluded in May 2012, with 6 CAH hospitals. Partner, with College of Nursing, in a state Medicaid grant award to Dept. of Psychiatry to pilot integrated care for Medicaid populations. Accomplished by placing psychiatrists and psych APNs in primary care settings (primarily FQHCs) and placing primary care physicians and APNs in community mental health centers. AHEC recruits sites and places medical and APN students with practitioners so that they can experience and learn integrated care. Students are screened for an interest in practicing with Medicaid populations. UT AHEC sub-contractor to regional office Ohio Health Information Program to educate primary care physicians on benefits of EHRs and assist with establishing meaningful use. Produced with UT Center for Creative Instruction, animated video on a flash drive, to explain EHR for all primary care practices in the AHEC region. Organize CME (AHEC sponsored) several regional session with an OHIP content expert to provide detailed EHR information. Page 16 of 21

17 Oklahoma AHEC Primary Care Quality Improvement via Cooperative Extension Model, as integral part of implementation of County Health Improvement Organizations (CHIO). Each center works with local community coalitions to develop their own CHIO, based on standard guidelines. Oregon AHEC Identifying core competencies and training requirements for Community Health Workers; creating training programs. Collaborating with HRSA's BHPr, Oregon's Primary Care Office, and Office of Rural Health to recruit NHSC providers and train communities to expand their provider recruitment capacity. Hosting workshops on how to use medical assistants in redesigning primary care practices into primary care medical homes. Increasing diversity of the health care workforce with innovative programs involving ASPIRE s student mentoring projects in Community Colleges and HCOP s college preparatory program in area high schools. Providing wellresearched recommendations for the state legislature, industry and education institutions to target public resources into workforce education for new systems of care. Providing the leadership for the state legislatively-created Oregon Health Care Workforce Committee, whose efforts include: Identifying the workforce needed (quantity) and the workforce competencies (quality) for new systems of care; Crafting, at the request of the state legislature, a strategic plan for Oregon to recruit primary care providers into underserved areas. Page 17 of 21

18 South Carolina AHEC Duke Endowment grant for Institute for Primary Care Education and Practice with first cohort of 48 students (advanced practice nursing, medicine, and physician assistant studies). Mission is to increase visibility and support for primary care, and help students who begin studies with desire to enter careers in primary care to graduate as primary care clinicians. Established a statewide videoconferencing resource for CE, serving needs of health professionals in rural and underserved areas. Partnering to establish a telemedicine system for specialty consultative services in rural and underserved areas. Working with others to pass legislation for increased reimbursement for and access to telemedicine services. Established a number of innovative programs designed to encourage, mentor and support underrepresented-inhealth care high school and college students who are interested in entering careers in health care. Involved with educating South Carolina s primary care clinicians about electronic health records (EHR) and how they can obtain higher reimbursement from Medicare and Medicaid through meaningful use of their EHR systems. Developed a survey instrument and administered it to a number of primary care practices to learn about their readiness to become patient centered medical homes. Working with the state Medicaid program to train and deploy community health workers for primary care practices in South Carolina. Particular emphasis is on choosing practices that are already or are preparing to become patientcentered medical homes. Helped plan a national meeting for the Association of Academic Health Centers that focused on increasing the education of health professionals about the social determinants of health. Page 18 of 21

19 Texas AHECs South Texas AHEC and West Texas AHEC: Coordinate 3 rd and 4 th year medical student rotations and primary care training in their respective regions. West Texas AHEC coordinates clinical training support for PA and advanced practice nursing. Texas AHEC East: GEC collaboration preparing next generation of elder care providers. Primary care clinical training support for PA and advanced practice nursing. Family medicine rural residency training support. South Texas AHEC, West Texas AHEC and Texas AHEC East: Serve as NHSC Ambassadors to recruit students and health professionals to work in NHSC eligible sites, FQHCs and rural communities. South Texas AHEC: Identify/place minority students from PA, pharmacy, nursing and public health programs to rotate and train in underserved areas. Texas AHEC East: Medical student clinical education support for practice in underserved areas. Focus on underrepresented minority students in health careers promotion and preparation. West Texas AHEC: Works with the Hispanic Center of Excellence to identify minority students to train in underserved areas. South Texas AHEC: Evaluation expertise for efficiency/quality improvement for ACOs and PCMHs. PCMH pilot at hospitals via training resources for Promotores. South Texas AHEC and West Texas AHEC: Train CHWs and Promotores as essential to ACOs and PCMHs. Texas AHEC East: CHW training in health literacy, patient navigation, case management. CHW behavioral health curriculum development. Disseminate mental health best practices. Technical assistance to FQHCs/CHCs for NHSC retention. South Texas AHEC: Conducted rural county health workforce economic impact analysis. Advanced Cardiac Life Support certification training. Train health professionals about veterans mental health. West Texas AHEC: Community assessments in all 105 counties. Conference on ACA and health care changes. Texas AHEC East: Community health assessment for Medicaid Waiver planning. Rural county health workforce economic impact for 99 counties. South Texas AHEC: Collaborate in the Texas Medicaid 1115 Waiver Program to expand and transform primary care practice in south Texas. Texas AHEC East: Practice recruitment as clients for regional extension program electronic health record implementation technical assistance. Educating geriatric providers in communities on expansion of services outlined in ACA. Provided master s health policy course discussion on ACA. West Texas AHEC: Collaborate with HIT Regional Extension Center to implement electronic health record implementation Worked extensively with Texas Medicaid 1115 Waiver Program hospital leads on community DSRIP projects. Page 19 of 21

20 Vermont AHEC Provide continuing education programs targeted toward primary care practitioners, including a Rural Health Symposium, a Geriatrics Conference and a Behavioral Health/Primary Care Integrated Care Statewide Collaborative Conference. Provide activities to support goal of encouraging more practitioners to enter primary care, including: summer rotations for medical students; monthly Primary Care Education lunch series for medical students; Vermont and New York Recruitment Days when residents/health care students can meet with state and regional hospital representatives to learn about rotation and job opportunities; and Educational Loan Repayment Program to assist primary care practitioners with educational debt repayment in exchange for service in Vermont. Developing, in collaboration with a wide variety of stakeholders, a panel manager curriculum to assist primary care practices transform into Advanced Primary Care Practices as recommended in the Act. This effort will help advance the triple aim of improving quality and patient experience while controlling health care costs Washington AHEC Partnering with the Office of Rural Health, Medicaid, Office of the Insurance Commissioner and the Health Care Authority to provide technical assistance to rural communities regarding the ACA. Page 20 of 21

21 Central Counties AHEC is planning a series of Care Management Workshops for the WV Primary Care Association in anticipation of increased patient numbers. West Virginia AHEC AHEC Program Director participates in Health Care Implementation Coalition with representation from consumer advocate organizations, faith-based community, African-American community, state agencies and provider organizations. Provide education within communities to health care providers and consumers. AHEC Program Director participates in Consumer Advocate workgroup meetings of the Office of the Insurance Commissioner s (OIC) Insurance Exchange, a marketplace that offers buyers of health insurance different plans from which to choose. Central Counties AHEC is contacting participants in the WV Connect Program, a program designed to fund primary and preventative health services and expand access to care for the working uninsured. Southeastern AHEC plans to collaboratively support educational activities in region. In association with the WV School of Osteopathic Medicine, local Primary Care Centers, and the AHEC s Advisory Board, the SEAHEC will work with other community organizations to encourage and assist with efforts to increase enrollments for Medicaid expansion, and increase coverage. Page 21 of 21

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