Primary Care and Prevention – Aligned Strategies Framework

1. Increase the supply, diversity and distribution of qualified workers to meet target demand **

A. Sustain and increase funding for primary care residencies (physician, NP, PA) with a priority emphasis on underserved regions and safety net settings; including teaching health centers.
B. Achieve sufficient clinical placement access to meet demand and enable target educational capacity. Implement financial incentives to expand community placements.
C. Provide sufficient funding to institutionalize and sustain current UC PRIME Programs and develop additional PRIME slots tied to increasing primary care physicians for underserved communities.
D. Support plans to grow CR Drew Medical School with accountability for producing graduates from CA in primary care with intention to practice in South LA and other underserved CA communities.
E. Sustain and grow UCR Medical School with accountability for producing graduates from CA in primary care with intention to practice in the IE and other underserved CA communities.
F. Explore branch campuses of existing medical schools in underserved communities.
G. Increase post bac training program slots. Target CA students from underserved communities.
H. Provide sufficient financial incentives (including scholarships and loan repayment) to meet target supply and distribution goals in primary care and public health.
I. CA medical, PA, NP and PH schools actively recruit, prepare, prefer and financially support qualified CA students from underserved communities; including “home town” programs.
J. Develop and expand health career outreach and advising centers on CSU. CCC and UC campuses. Integrate robust primary care and public health exposure, curriculum, opportunities.
K. Establish a public-sector matching funds pool to hire local population health/social epidemiologists to support the design, implementation, and evaluation of health improvement.
L. Increase and systematically promote paid internships in primary care and public health during undergraduate education and expand post-graduation jobs and advancement opportunities.
M. Expand and fund transition to practice programs in primary care and public health nursing and incentives for nurses to participate with potential for hire (based on the HealthImpact model).
N. Sustain and explore expansion and replication of UCLA International Medical Graduate Program
O. Invest in local and regional initiatives and infrastructure for recruitment, retention and pathway development of primary care and public health workers; target underserved regions.
P. Reinstitute a pre-med or pre-health major that incorporates the bio-psychosocial model and includes public health, behavioral medicine, social work, nutrition and exercise physiology, and IT and analytics.

2. Align education and training program content and modalities with changing roles to prepare workers with the competencies to secure and succeed in emerging roles

A. Increase integration of training and practical community experiences on social determinants of health and population health in all health professions training programs.
B. Integrate team-based, inter-professional training as core to health professions preparation.
C. Invest in faculty positions, incentives, training and advancement to support effective preparation of students in all health professions for team-based care and population health improvement.
D. Support pathways for “non-traditional” faculty, such as CHW’s and other practitioners, to support development of new models of care and integration of primary care and prevention.
E. Increase funding for and organizational infrastructure to support expanded residencies for NP and PA graduates in community ambulatory settings.
F. Increase access to public health education on-campus and on-line training programs for rural, government and safety net workers and students from URM backgrounds.
G. Document data about California’s schools of public health, including applicants; enrollment, competencies; post-graduation employment; and, demographics; understand what elements of their curricula meet the future expectations and needs of employers; track over time.
H. Standardize and strengthen CHW training models and competencies to ensure consistency, quality, and effective CHW integration into diverse settings.
I. Strengthen and expand academic-practice partnerships in nursing to increase primary care, public health and safety net training and employment.
J. Explore expansion of accelerated medical education in primary care in CA medical schools building on experience at UC Davis and schools in other states.
K. Adapt the PRIME model at schools of medicine, nursing, dentistry, public health and other professions with a focus on students from UR and underserved communities.
L. Expand public knowledge of opportunities for government public health positions, revise undergraduate and graduate curricula to build interest and streamline hiring processes.
M. Strengthen focus on pop. health/social epidemiology and cost-effectiveness analysis in BA and graduate public health programs.
N. Fund and support the development of “Academic Health Departments”, between schools of public health and health departments, to strengthen the linkages and infrastructure between academia and practice and better prepare students for the workforce.
O. Increase integration of trauma informed care and healing into education and training programs.
P. Develop a pre-med or pre-health major on UC, CSU, CCC, and private campuses with better articulation across educational levels.
Q. Support training early on and throughout educational levels for all professions regarding IT, EMR applications, health information exchange, data analytics, and digital health.

3. Strengthen the capacity, effectiveness and retention of the current workforce through changes in the roles, functions and configuration of workers and teams

A. Promote sharing promising practice and evidence to support team-based care and team members practicing at their full scope. Expand roles, training and incentives for RNs, SW, Pharmacists, MA’s, CHW’s, Navigators, behavioral health professionals, and coaches.
B. Increase career ladders and access to affordable education and training for members of primary care and prevention teams (including RN’s, MA’s, DA’s, CHW’s).
C. Develop certification for CHW’s in specific competencies and worker payment and employer reimbursement to incentivize optimal roles, utilization and impact.
D. Inventory and track the CA public health workforce re the kind of work, settings, expertise, skills, and functions; regional and population focus; and demographics.
E. Provide large scale training and funds to strengthen public health and primary care workforce capacity and competencies to effectively address the SDOH and equity.
F. Increase capacity of health care leaders and data / technology administrators to produce quality, timely data relevant to efforts to address community conditions, SDOH and inequitable procedures and outcomes and work with partners to take effective action.
G. Increase job opportunities and appropriately adjust hiring education and training requirements to support students with an undergraduate public health education to assume greater roles in public and private public health and primary care related roles.
H. Strengthen the capacity of primary care teams to provide integrated behavioral health.
I. Develop statewide and regional safety net provider retention and renewal programs funded by public and private sources; similar to the Mass League of Health Centers program.
J. Develop and strengthen provider wellness programs within and across employers to increase health and wellbeing, stress management, practice joy and control of destiny.
K. Expand roles, training and support for MA’s, scribes, CHW’s, Population Health Nurses to strengthen team capacity and effectiveness and reduce provider burnout.
L. Establish retention bonus pools for providers in underserved communities and reimbursement incentives for meeting quality, access and equity goals.
M. Develop robust program for deployment of retirees in safety net settings and via telehealth
N. Establish mechanisms to support private practice providers in underserved communities to obtain sufficient training, practice transformation support and practice management.
O. Encourage effective, large-scale integration of oral health and dental care into health home and prevention activities.

4. Accelerate innovations in technology, process, payment and collaboration to cost effectively achieve access, outcome and equity goals

A. Advance transitions to alternative payment methodologies that provide meaningful incentives to accelerate innovations in population health improvement and primary prevention, team- based services and optimizing use of all workers.
B. Make a strong statement about and take action steps to increase Medi-Cal payment rates for primary care providers; particularly in underserve communities.
C. Establish primary care and prevention spend targets/requirements for public and private payers and explore models in Oregon and Rhode Island to increase investment, infrastructure and impact which will enhance professional recruitment and retention.
D. Establish and expand sufficient public and private reimbursement mechanisms for CHWs.
E. Expand incentives, cost-effectiveness, and process improvements to enable greater integration of telehealth for primary care, behavioral health and key specialties.
F. Increase investment in practice management resources, leveraging public and private resources, to promote large scale practice transformation in primary care practice settings.
G. Create standards and expectations for health care providers and administrators to collaborate with local partner agencies outside the health care sector, to improve the community environments and systems issues that lead to inequitable health outcomes.
H. Expand “Dental Virtual Health Homes” in underserved communities and their integration with primary care and public health initiatives.
I. Increase funding for practice coaching and consultant roles to support practice and outcomes improvement.
J. Build knowledge, standards, and expectations of health care leaders to develop and implement comprehensive strategies (local procurement, hiring, co-investing in health career pathways at the regional level, investing in healthy environments, policy advocacy) that optimally leverage their capabilities to improve health and well-being in communities.
K. Build the social epidemiological capacity of local public health agencies to partner with health care providers and payers in the design, implementation, and evaluation of comprehensive health improvement strategies.
L. Leverage lessons learned, evidence, promising practices and infrastructure from CMMI practice transformation initiatives for spread and scale in CA.


** Using the Coordinated Health Workforce Pathway Model