Virginia Health Care Workforce Initiatives and JCHC Review 2023

Health Care Workforce Health Care Workforce Initiatives in Virginia Initiatives in Virginia Sarah Stanton, Executive Director Sarah Stanton, Executive Director Virginia Joint Commission on Health Care Virginia Joint Commission on Health Care

Purpose of the JCHC The purpose of the Commission is to study, report and make recommendations on all areas of health care provision, regulation, insurance, liability, licensing, and delivery of services. Commission shall endeavor to ensure that the Commonwealth as provider, financier, and regulator adopts the most cost-effective and efficacious means of delivery of health care services so that the greatest number of Virginians receive quality health care. - Code of Virginia; 30-168 Joint Commission on Health Care 2

JCHC strategic objectives Quality Affordability Accessibility Equity The Commission shall encourage the development of uniform policies and services to ensure the availability of quality, affordable and accessible health services. - Code of Virginia; 30-168 Joint Commission on Health Care 3

JCHC furthers objectives by developing recommendations for legislative action JCHC members identify relevant topics and policy issues and direct staff to provide information JCHC staff conduct independent research and report findings and policy options for consideration JCHC members vote to adopt policy recommendations for legislative action Joint Commission on Health Care 4

2023 Health Care Workforce Review JCHC members directed staff to review and evaluate health care workforce development programs on a continual basis Year 1 goals: Develop an inventory of health care workforce programs, including goals, reach, funding sources, and effectiveness Elevate findings from other Virginia health care workforce studies from VHWDA and Claude Moore Foundation VHWDA = Virginia Health Workforce Development Authority Joint Commission on Health Care 5

Virginia has invested in a variety of workforce development programs Staff identified 64 health-specific workforce programs and 24 general workforce programs that include health careers 42% of health-specific workforce programs receive state funding Joint Commission on Health Care 6

Most programs focus on workforce recruitment or distribution Program Focus Area 58% 41% 19% 11% 8% Expanding recruitment efforts Improving workforce distribution Retaining the workforce Improving workforce well- being Studying the workforce SOURCE: JCHC staff analysis of stakeholder interviews and public documentation, 2023 NOTE: Percentages add to more than 100% as programs could have more than one focus area Joint Commission on Health Care 7

State-funded recruitment and distribution programs target providers and support staff VDH administers health care workforce scholarship and loan repayment programs Includes primary care, dental, and behavioral health workforce VCCS provides tuition assistance and short-term training pathways through Virginia s G3 and FastForward Programs Stackable credentials for nursing aides, medical assistants, home health aides, and pharmacy technicians, among others NOTE: VDH = Virginia Department of Health; VCCS = Virginia Community College System Joint Commission on Health Care 8

Retention and well-being programs vary based on employees needs Stakeholders described a variety of employer-sponsored programs, often in response to internal surveys Enhanced childcare programs Studies of salary/benefits competitiveness Workplace violence is associated with lower quality of patient care and decisions to exit the field State legislation in 2019 permitted enhanced penalties for threats to health care workers Joint Commission on Health Care 9

Virginia workforce studies identify common strategic recommendations Taking a phased, multi-pronged approach to address recruitment and retention Create multiple entrances and pathways to advancement Increase pay for providers and faculty/preceptors Reduce regulatory and documentation burden Support well-being and provide wraparound supports Creating centralized infrastructure with regional hubs Increasing monitoring and evaluation of program impact SOURCE: Claude Moore Charitable Foundation s Virginia Health Science & Human Services Workforce Strategic Recommendations Report (September 2023); RAND Health Care s Identifying Strategies for Strengthening the Health Care Workforce in the Commonwealth of Virginia (October 2023); JCHC staff analysis of stakeholder interviews, 2023 Joint Commission on Health Care 10

Evidence of workforce program effectiveness in Virginia is limited Virginia programs meeting this criteria: 0% Program has been evaluated and has a positive impact on the desired goal Level 4 Virginia programs meeting this criteria: 30% Program collects limited metrics on implementation or outcomes Level 3 Program is based on studies of similar programs in other states/settings Virginia programs meeting this criteria: 28% Level 2 Program is based on reasonable assumptions about how it will impact an area of need Virginia programs meeting this criteria: 42% Level 1 SOURCE: JCHC staff analysis of stakeholder interviews and public documentation, 2023 Joint Commission on Health Care 11

Barriers to evaluation include lack of available data and dedicated resources Stakeholders reported difficulties with evaluation when: Data are spread across multiple agencies or entities Longitudinal data are not available on program participants Program funding does not consider costs of evaluation activities Joint Commission on Health Care 12

2024 Study of Performance of Health Care Workforce Programs JCHC members directed staff to: Develop a framework for measuring the performance and impact of health care workforce programs Obtain relevant data to populate metrics measuring each program s outputs and outcomes Develop and implement a process for reporting on the performance of programs that is meaningful, transparent, and actionable Consider policy options through which the state may improve the performance of state-funded health care workforce programs Study resolution approved by Commission on December 6, 2023. Joint Commission on Health Care 13

Major study questions Are health care workforce programs in Virginia meeting their intended goals? How can the Commonwealth improve the performance of health care workforce programs? Joint Commission on Health Care 14

Study will focus on state-funded health care workforce programs For this study, health care workforce programs are: Any initiative or organized strategy with at least one primary objective directly and intentionally benefitting the health care workforce Funded by state general funds, in whole or in part In operation at the time of the study Beyond their initial year of implementation Joint Commission on Health Care 15

JCHC staff identified 34 programs across two Secretariates for inclusion Number of Programs Sector Agency/Organization Virginia Department of Education 2 Virginia Community College System 4 Education State Council for Higher Education in Virginia 6 Multiple institutes of higher education 7 Virginia Department of Health 10 Department of Medical Assistance Services 2 Health Department of Behavioral Health and Developmental Services 3 Joint Commission on Health Care 16

Virginia appropriated $683 million in state funds for included health care workforce programs in FY24 $318 million in state general funds supports 24 programs exclusively focused on health care workforce $365 million in state general funds supports 10 programs partially focused on health care workforce

Final report available September 2024 JCHC staff will brief members on findings of the Study of the Performance of Health Care Workforce Programs at the September JCHC meeting Final report and briefing slides will be available on the JCHC website NOTE/SOURCE: Joint Commission on Health Care 18

Joint Commission Joint Commission on on Health Health Care Care Address: 411 E. Franklin Street, Suite 505 Richmond, VA 23219 Phone: 804 786 5445 Website: http://jchc.virginia.gov