California:
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  • Community Health Workers (CHW): Plan focuses on CHWs or "front-line workers," as essential to primary care teams in 3 of the plan's 4 initiatives: ACOs, Health homes for complex patients, and palliative care integration into primary care.
  • The plan refers to leveraging the state's primary care office to focus on underserved communities, training for cultural competency and supporting the 4 initiatives.

Colorado:
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  • Serious workforce shortages, especially in rural and frontier areas, for primary care and behavioral health clinicians. The plan presents medically underserved shortage area data for primary care and behavioral health.
  • Community Health Workers (CHWs): references a pilot (Rocky Mountain Health Plan) that integrates Community Health Workers into Primary Care/Behavioral Health team. Work is underway by the Colorado Trust to standardize Community Health Worker training.
  • Good chart of examples of an integrated Primary Care/Behavioral Health team functions and personnel responsibilities. (p. 112-115)

Connecticut:
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  • Develop a “Connecticut Service Track” to promote population health and inter-professional teams within professional training.
  • Develop training and certification standards for Community Health Workers (CHWs) with careful attention to assuring linguistic/cultural competency and creating a career pathway for existing workers and those from underserved areas.
  • Primary Care Graduate Medical Education (GME) changes to align with transformation.
  • Develop articulation agreements between entry- and advanced level colleges to allow mobility for healthcare workers.
  • Include transformation concepts in Graduate Medical Education (GME) and residency programs.

Delaware:
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  • References roles of care coordinators (largely based in ambulatory care settings with complex patients), and Community Health Workers (CHWs) working in the Healthy Neighborhoods to promote wellness. (p. 97)
  • Very detailed plan for a “Delaware Health Professions Consortium” high-graduate school levels, emphasizing team care, flexibility, etc. Delaware does not have a medical school, therefore “opportunities for state to invest in teams.” (p. 99-104)

Hawaii:
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  • Establish career pathway for the state’s 243 school health aides to become medical assistants, Community Health Workers (CHWs), or receive their bachelor’s degree in Public Health.
  • Community Health Workers (CHWs): Currently there is a 2-yr Community Health Worker program at the University of Hawaii. Legislators are looking to increase cultural competency training and explore certification.
  • For substance abuse, certified peer specialists and substance abuse counselors can bill Medicaid for services. SIM grant would expand trainings for certified peer specialists.
  • Establish an advanced practice registered nurse educational program.

Idaho:
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  • Virtually all of Idaho is a behavioral health workforce shortage area and most is also a primary care shortage area. Key strategies are: the model of a “virtual Patient Centered Medical Home”, using Community Health Workers (CHWs) and community emergency medical personnel to perform key primary care functions.
  • Also, telemedicine for behavioral health consults.

Illinois:
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  • 4 approaches to workforce reform:
    • Create new roles, including Community Health Workers (CHWs),
    • Standardize curriculum and research to evaluate effectiveness and resulting economic development associated with Community Health Workers,
    • Enhance training for home care aides and community paramedics in chronic disease management, and
    • Plans to expedite pathway for veterans to work in civilian roles.
  • Ensure that medical professionals work at the top of their license.
  • Expand capacity training for primary care, specialists, and behavioral health.

Iowa:
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  • Workforce needs/analysis are detailed on page 47; additional information is available pages 138-143

Maryland:
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  • Community Health Workers (CHWs_ to be used in Patient Centered Medical Homes (PCMHs) and community teams.
  • Maryland will develop standardized CHW training and certification and leverage existing partnerships with community colleges.
  • Will establish an Advisory Board to draft CHW and CHW supervisor curriculum and (perhaps phased) implementation.
  • The Maryland State Health Agency will oversee all policy development and certification of CHWs and keep a registry of CHWs.

Michigan:
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  • Community Health Workers (CHWs): "Michigan’s Blueprint includes support for greater use of community health workers… " Includes, "efforts to define the roles and skill sets of community health workers...this may include development of a registry within the Health Professions Licensing Division in the Bureau of Health Care Services, at the Department of Licensing and Regulatory Affairs" (pg. 128). Also discusses CHWs as integral parts of health teams in Patient Centered Medical Homes (PCMHs) and potentially Community Health Innovation Regions.
  • Reviewing graduate medical education (GME) funding to figure out how best to address provider shortages. (pg. 130) Provides for training on team-based care. Scope of practice - Blue Print will "include identification and elimination of potential barriers that prevent health team members from practicing at the highest competency level of their license and training". (pg. 127)

New Hampshire:
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New York:
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  • Targeted health care workforce strategy – building on those of New York's Medicaid Redesign Team (MRT). Four focus areas – recruitment & retention of primary care workforce (health care workers who support delivery of primary care) and update standards and educational programs.
  • Specific workforce details - accessible entry points for most consumers – LPNs, RNs, and NPs – who then coordinate with specialists. (pg. 107 and 115)
  • Collaborative care approach that supports individuals with 2 or more chronic conditions.
  • For mild to moderate behavioral health conditions, primary care-led screening and treatment that incorporates remote psychiatric consultant support.
  • All consumers – prevention through primary care screenings & involvement of health workers focused on consumer education.

Ohio:
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  • Coordinate health sector workforce & training – provider training programs to reinforce PCMH and episode based care delivery; build education opportunities for new providers; align incentives to encourage participation in education & training opportunities; enhance workforce infrastructure; enable workforce changes through regulatory policy
  • To support these models, Ohio will increase its number of primary care providers, improve the effectiveness of its interdisciplinary heath care teams and build its health care workforce in underserved areas. The new model will also require support from the entire health care community.

Pennsylvania:
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  • More extensive educational and training programs for clinicians and providers.
  • Obtaining an adequate supply of primary care providers and behavioral health providers – to do so:
    • Enhanced loan forgiveness for primary care and behavioral health (physician and non-physician) and dentists
    • More robust medical home training through Transformation Support Center
    • Redesign of medical school curriculum to focus on evidence-based practices, team-based delivery models, and creation of Pennsylvania Health Learning Network using telemedicine infrastructure
    • Detailed Plan (pg. 129)
  • Redefining roles for Medical Assistants (MAs), community health workers (CHWs) and Licensed Practical Nurses (LPNs) will be essential to achieve practice transformation. (pg. 132)

Rhode Island:
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  • Community Health Workers (CHWs) under-recognized (however, plan noted a successful program within the Department of Health), but awareness and function low among providers.
  • The Rhode Island Care Transformation and Innovation Center (RICTIC) will focus on workforce development
    • develop uniform credentials and requirements for CHWs. (pg. 71)
    • conduct a workforce assessment
    • develop curricula for in-service training for professionals as well as students

Tennessee:
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  • Tennessee may require additional care coordination or primary care capacity. Reforms will also create the need for new skills and behaviors in the existing workforce, particularly around health information technology/health information exchange (HIT/HIE) and care coordination. To meet these needs, Tennessee will focus on strategic levers including education, recruitment, training, and regulation.
  • More details on pg. 68

Texas:
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  • Health Innovation Learning Network (Model 3, Innovation 1) ( pg. 157, pg. 180)
  • Establishment of the Texas Institute for Health Care Quality and Efficiency (Institute) (pg. 18)
  • Numerous delivery system reform incentive programs to improve health care delivery systems (pg. 183) Table on pg. 184 of projects
  • Recent state legislation created several new programs to support medical and graduate medical education designed to bolster the primary care provider pipeline (pg. 195)
  • SIM initiatives to improve workforce efficiencies without physician workforce expansion (pg.186-187) and create a statewide Learning Exchange for disseminating best practices on health care delivery system and payment reforms linked with state and federal Medicaid and public health initiatives (pg. 130)

Utah:
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  • Aim 4 will create community-clinical linkages through increasing the use of community health workers within health systems and plans. The Plan envisions training programs for community health workers which will teach them to incorporate general healthy behaviors in patient interactions with emphasis on tobacco cessation, diabetes control and management and overall weight and nutrition training.
  • The Plan outlines how providers will be assisted and trained in adapting and performing well in a value-based payment (VBP) environment. Such an environment has multiple characteristics of practice delivery that may be new to current practitioners. Practicing well in a VBP environment requires such skills as care coordination and coaching, care management, population management, use of information technology, motivational interviewing, behavioral health screening, collecting and reporting quality metrics, providing medical homes for geriatric populations, the chronically ill or those with complex medical conditions, and team collaboration.
  • Subaim 1.4: Align supply/demand workforce projection methodologies with a value-based purchasing environment.
  • Subaim 1.5: Prepare/train providers to perform in a VBP environment.
  • Using current and new training methods, providers will be taught to serve in a value-based purchasing environment utilizing care management training and care coordinators to facilitate the use of quality measures and health information technology. Improving access to behavioral health services and integrating them with primary care particularly in rural areas will require more advanced and regular use of technologies such as telehealth and advanced practice providers whenever possible.
  • The strategy to create a common wellness agenda (CWA) at the community level will help to develop community awareness and engagement in state efforts to achieve better health, better care, and lower cost through improvement of all segments of the population. This will be accomplished by demonstrating how a community can come together to tackle health disparities within their community. (pg. 64-65)
  • Encompassed within the CWA aim is the charge to develop a community coalition, a community-level CWA, develop and implement effective community-based initiatives to improve health outcomes and develop effective reporting mechanisms for these outcomes. The focus of the CWA will be created by reviewing state and local-level data and considering national and state plans (e.g., Health People 2020, National Prevention Strategy,National Quality Strategy, Million Hearts Campaign). This will enable the final CWA to align with national and state health objectives.

Washington:
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  • Increase workforce capacity and flexibility (pg. 37)
  • "Work in teams to engage individuals and families and provide care effectively for those with complex and chronic conditions. Provide education and practice support for team-based and coordinated care, and extend workforce capacity through telehealth and telemonitoring.” (pg. 39)
  • Encourage workforce capacity for the transformed system by building educational and career progression opportunities.
  • Expand model testing sites and build on successful methods for Community Health Workers. (pg. 38)
  • Washington will convene a specific workforce team to focus on CHWs and develop a timeline outlining the steps each stakeholder must take to establish an effective CHW workforce for Washington State.
  • Train primary care and behavioral health providers to address the needs of whole person. (pg. 39)
  • Build and Expand Primary Care Residencies in Washington. (pg. 40)
  • Leverage Washington State’s Progressive Scope of Practice Laws to Improve Patient Management and Mitigate the Shortage of Primary Care Providers. (pg. 4)