• Primary Care and Prevention
• Behavioral Health
• Healthy Aging and Care for Older Adults

Co-chairs from each subcommittee presented initial strategies to known workforce problems and asked Commissioners to provide input, especially around timing and financial constraints in development and implementation, and around identifying opportunities for additional stakeholder involvement.

Primary Care and Prevention
Among the several initial strategies presented by the subcommittee, three strategies that were discussed at length include:

• Sustaining and increasing Graduate Medical Education funding for primary care residencies (i.e. physicians, nurse practitioners, physician assistants, among others) with a priority emphasis on underserved regions and safety net settings. Specific actions for potential inclusion as part of this strategy include exploring development of a California supported GME program in primary care through Medicaid.
• Institutionalizing and expanding the Programs in Medical Education (PRIME) model across health profession schools in medicine, nursing, dentistry, and public health. The PRIME program (University of California) is an innovative training program focused on meeting the needs of California’s underserved populations in both rural communities and urban areas by combining specialized coursework, structured clinical experiences, advanced independent study and mentoring.
• Bringing engagement of community health workers (CHW) to scale. More specifically, the subcommittee suggested exploring standardization and certification of an expanded model of CHW engagement that optimizes their contributions to improve quality of care, address the social determinants of health, and serve as advocates for people and their communities.

Behavioral Health
The three strategies that the Behavioral Health subcommittee brought up include:

• Creating a standardized Peer Support Specialist certification and training process statewide. This certification would allow reimbursement by public and private payers with the ability to bill Medi-Cal.
• Increasing education, training and skills of unlicensed behavioral health staff, specifically through promoting the Certified Psychosocial Rehabilitation Practitioner (CPRP) certification that would be reimbursable by public and private payers.
• Allowing Psychiatric Mental Health Nurse practitioners to practice at the top of their license.

Healthy Aging and Care for Older Adults
The subcommittee identified an overarching strategy aimed at defining the “ideal vision” for the roles of multiple people across the care continuum and the community in caring for older adults, starting in the home. The subcommittee will generate specific strategies to support person-centered, team-based and technology-enabled care in partnership with key stakeholders. These strategies will include recruitment into the field, training and preparation, and improving work conditions and incentives. More specifically, the subcommittee suggested:

• Promoting the inclusion of competencies to care for older adults in health workforce curricula at all levels.
• Maintaining and obtaining dedicated geriatric flexible mechanisms for residency, advanced preparation training, and workforce training.
• Aligning population needs and team-based roles with necessary funding sources and regulatory structures to support the care of older adults.

Next Steps

Subcommittees and staff are now working to incorporate the Commission’s feedback into the cross-cutting strategies, infrastructure strategies, and subcommittee-specific strategies. If you or your organization is interested in reviewing the strategies and providing input, visit the Commission’s website after March 15th for more details.

What We’re Reading

California’s Current and Future Behavioral Health Workforce
Healthforce Center at UCSF
California needs an adequate supply of workers who are distributed equitably across the state and who reflect the demographic characteristics of the state’s population. These workers must also possess the skills and credentials necessary to deliver the type of behavioral health care that people need and participate in public and private health insurance plans.

Integrating Social Determinants of Health into Graduate Medical Education: A Call to Action
Academic Journal of Medicine
Social determinants of health (SDH) are the major drivers of health and disparate health outcomes across communities and populations. Given this, the authors assert that competency in recognizing and mitigating SDH should become a vital component of graduate medical education in all specialties.

Nurses with a mission: Send older ER patients home with help
Associated Press
More than 30 percent of older adults go home from a hospital stay with a minor or major health problem they picked up at the hospital. For an ER doctor, sending an elderly patient home sometimes feels risky. Early research at Northwestern and other hospitals shows care from geriatrics-trained nurses in the ER can reduce the chances of a hospital stay after a patient’s emergency visit and for a month afterward.

Region’s health care leaders partner to give Fresno County Medi-Cal patients greater access to care
Sun Gazette
Family HealthCare Network (FHCN) and Community Medical Centers are expanding services for Medi-Cal patients by providing greater access to outpatient, primary and specialty health care services in Fresno County. The valley has far fewer primary care physicians than the rest of California. There are only 39 physicians per every 100,000 Valley residents.