BUILDING A HEALTH CARE WORKFORCE TO ACHIEVE HEALTH EQUITY

REPORT OF THE UIC HEALTH CARE WORKFORCE DEVELOPMENT TASK FORCE

EXECUTIVE SUMMARY

The University of Illinois at Chicago (UIC) is a state, regional and national leader in the training of health care professionals. Over eighty degree and certificate programs across seven health science colleges provide undergraduate, graduate and professional training for the health care workforce (Table A10, appendix). The UIC Health Care Workforce Development Task Force (referred to as “task force”; see page 1 of appendix for membership) was charged to study emerging workforce needs and propose recommendations to inform decisions about the numbers and kinds of health care professionals UIC trains in the decade ahead as demographic factors and changes in health care delivery systems influence both demand for and supply of health care. This project follows from UIC’s mission “to train professionals in a wide range of public service disciplines, serving Illinois as the principal educator of health science professionals and as a major health care provider to underserved communities.”

Workforce planning begins with an acknowledgement of both the idiosyncrasies and uncertainties related to the financing and organization of health care and to anticipated demographic shifts. First, oversupply of and unmet demand for services often coexist. There may be high unmet demand for specific services in a community because those services are poorly reimbursed or large numbers of individuals are uninsured. For instance, there are underserved communities with a great need for basic dental care, but few professionals to meet those needs because of a lack of reimbursement. Training more dentists will not resolve the disparity. Second, a changing regulatory environment can affect demand when different job titles share overlapping skills. Demand for primary care physicians, for instance, diminishes when less costly nurse practitioners are authorized to provide primary care and bill for their services independently, based on state regulations regarding scope of practice and level of supervision, and the policies of individual health plans regarding credentialing and reimbursement for their services. Third, shifting models of health care delivery in which integrated health systems assume all financial risk while maintaining or improving quality increases demand for individuals who facilitate care coordination and outreach. Such systems should have strong incentives to keep their patients healthy and out of the hospital. Achieving these goals may call for new types of service providers such as community health workers as well as a more collaborative team based approach to care delivery. Finally, there are demographic and epidemiologic shifts, such as growth in the elderly population and in numbers of people with complex chronic disease, which, while more predictable at a national level, exhibit a great deal of local variation.

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In addition to acknowledging the vagaries of the health care marketplace, workforce planning must also acknowledge the competing priorities and constraints for academic programs seeking to respond to workforce demand. In deciding which programs to expand, contract, revise, eliminate, replace, and link to other programs, colleges must consider whether they can recruit good students at a tuition rate that covers costs, as well as competition (are other programs emerging in the region?), resources (do we have clinical training sites, faculty, lab space?), and new opportunities (federal or state grants, international interests, etc.). Some of these variables are proxies for market demand while others, such as resources, are not.

With these caveats noted, workforce development based on the best available evidence remains a valuable and essential part of planning, and is surely a responsibility for a campus that trains such a diverse and significant number of health care professionals. To that end, the task force reviewed a wide range of policy reports, commissioned its own study of job and wage growth for health care occupations, compiled college and campus level data (including survey data), and identified both state and federal funding opportunities for workforce development. Although the principal focus of the task force was on addressing emerging workforce needs in terms of the numbers and kinds of degree and certificate programs, it also became evident that the changing health care environment will require an evolving set of competencies across all disciplines and that this should be a part of the task force report as well.

Recommendations

Incorporate emerging workforce needs into strategic planning at the college level

Each college should identify and set targets for existing and new programs, informed by market trends and anticipated demands. These targets should be revisited annually with updates to the provost and VCHA. Colleges are encouraged, in particular, to use data and analysis provided in Tables 4-7 of this report, which should also be updated annually as a planning resource. Colleges should also be current about other health professions programs in the region. Data resources, such as the HRSA National Center for Health Workforce Analysis, and the Degree Program Inventory of the Illinois Board of Higher Education (IBHE) are listed with URLs in Section A16 of the appendix.

Pursue funds allocated for health care workforce developmentExplore and where feasible pursue state, federal funds and foundation funds, including those available through the Affordable Care Act and the proposed Medicaid 1115 Waiver. In particular, the Colleges of Nursing, Dentistry, and Medicine, the School of Public Health, and the University of Illinois Hospital and Health Sciences System (UI Health) should develop a plan for pursuing these initiatives. The Office of the Vice President/Vice Chancellor for Health Affairs (OVPHA/OVCHA) could play a coordinating and tracking role to assure that campus units are aware of and informed about how to capitalize on funding opportunities.

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Develop a cross-college interprofessional curriculum addressing essential core competencies

Further development of a collaborative curriculum, which would draw on strengths from each college, could become a signature program across the UIC health science colleges. The curriculum would build knowledge and skills through didactic and experiential learning activities that focus on patient centered care, quality, safety and efficacy in health systems delivery, collaborative care, and health equity. The curriculum would also include interprofessional training opportunities at community based clinical sites. This program could be developed through an Interprofessional Council that works with each health science college and that is supported through an administrative partnership between the OVPHA/OVCHA and Office of the Provost.

Build a pipeline Coordinate and track campus-wide programs that support underrepresented minorities at the secondary and post-secondary levels through STEM education into the health professions and beyond, documenting the impact of investment in disadvantaged students on developing a diverse workforce. Additionally, identify and pursue partnerships with two-year colleges and other community education programs to achieve the following:

Advance the pipeline in health professions education, particularly for underrepresented groups.

Develop curriculum for emerging mid-level occupations such as health care navigators, care coordinators and community health workers.

Develop joint programs that require both associate level and baccalaureate or master’s level training (e.g., physician assistants).

Develop programs around non-clinical emerging workforce needsInclude colleges from throughout the campus, particularly the College of Education, the School of Continuing Education, and the School of Public Health (Division of Health Policy and Administration), and the College of Business Administration in the development of online and blended professional degree and certificate programs to train health care managers, actuaries, and health systems and safety analysts.

Prioritize placement in medically underserved areas and underrepresented disciplines

Set targets in each health science college for placing graduates in medically underserved areas and in primary care or subspecialty fields that are underrepresented (for instance, pediatrics) and identify state and federal funds for scholarships and other incentives to meet those targets. Develop tracking systems to monitor performance.

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Task Force Members

Task Force Representative Title/DepartmentSaul Weiner (Co-Chair) Vice Provost for Planning and Programs*

Surrey Walton (Co-Chair)Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy

Jonathan Art Associate Dean, Graduate College

Beth CalhounProfessor, Division of Health Policy and Administration, School of Public Health

William ChamberlinInterim Executive Director, Institute for Patient Safety Excellence, College of Medicine

Caswell EvansAssociate Dean for Prevention and Public Health Sciences, College of Dentistry

Kathy Christiansen (through 5/14)

Executive Director, Care Innovation, College of Nursing

Jorge GirottiAssociate Dean and Director, Admissions, Special Curricular Programs, College of Medicine

Cynthia Herrera LindstromCIO & Executive Director, Academic Computer & Communication Center

John HicknerProfessor of Clinical Family Medicine, College of Medicine

Nicole Kazee Senior Director, Health Policy and ProgramsMary Keehn Associate Dean, College of Applied Health SciencesRobert Kaestner Professor, Institute of Government and Public Affairs

Katherine "Kappy" LaingExecutive Director, University Office of Governmental Relations, University of Illinois

Martin MacDowell

Associate Director & Research Associate Professor, National Center for Rural Health Professions/ Dept. Family and Community Medicine, College of Medicine-Rockford

Christopher Mitchell Associate Dean, Jane Addams College of Social WorkMarieke Schoen Associate Dean, College of Pharmacy

Terry MasonChief Operating Officer, Cook County Department of Health

Cleo PappasAssociate Professor & Assistant Information Services Librarian, University Library

Lisa PitlerAssistant Vice Chancellor, Office of the Vice Chancellor for Research

Jamila Rashid Executive Director, Urban Health Program

Bernard TurnockClinical Professor, Division of Community Health Sciences, School of Public Health

Nancy Valentine (5-14- )Associate Dean for Practice, Policy and Partnerships, College of Nursing

*Laura Stempel in the Office of VPPP provided extensive support with researching and preparing report.

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PROVOST’S CHARGE TO THE HEALTH CARE WORKFORCE DEVELOPMENT TASK FORCE

November 26, 2013

Dear Colleagues:

Thank you for agreeing to serve on the Health Care Workforce Development task force, which will hold its first meeting on December 10. I appreciate your willingness to help the campus to begin thinking about how we can align future health care needs with the education and training we offer.

As the leading supplier of the state’s health care professionals, the University of Illinois at Chicago as a whole, and particularly the seven Health Science Colleges, have a fundamental investment in the future of Illinois’ health care workforce.  Changing needs, the impact of the Affordable Care Act, and predictions of increasing practitioner shortages make it crucial that we understand what we can and should do to ensure that UIC continues to produce the high quality health care workforce Illinois requires.  How will upcoming changes affect Chicago and the State?

This task force is charged with analyzing UIC’s capacity to train successful health care professionals in numbers that will meet the State’s future needs.  The Affordable Care Act mandates financial support to increase primary care providers and allied health workers through grants, scholarships, and loan repayment programs -- but how do we make the case to federal and state funders?  What academic programs or community partnerships will have to be expanded or contracted? Do we need new kinds of training? Should we consider new certificate or degree programs?

To provide strategic guidance to the campus in planning to address workforce needs and to align the campus with funding priorities to finance those needs, I ask this task force to develop answers to the following questions:

What sort of workforce will be needed to serve the citizens of Illinois, Chicago, and our catchment in five years? In ten years?

Which of these workforce needs do we view as an opportunity and responsibility for UIC to fulfill?

What will UIC need to do over the next ten years in order to meet these responsibilities and goals?

The answers to these and other questions will play an important part in UIC’s planning for the next several years. I look forward to hearing the task force’s ideas about the how to meet these new challenges as well as the opportunities the changing health care scene will offer. Sincerely,

Lon S. Kaufman

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Vice Chancellor for Academic Affairs and Provost

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I. PREPARATORY WORK OF THE TASK FORCE

The task force was convened to consider the impact of a number of anticipated changes in health care needs and delivery systems. Experts predict that an aging and increasingly diverse population and the implementation of the Affordable Care Act (ACA)1 will have significant effects on the health care workforce, increasing demand for some specialties and occupations, decreasing others, and creating a need for new ones. In addition, the rising cost of tuition and the burden of large student loans, along with decreasing state support, are likely to affect students’ decisions about which, if any, health care professions to pursue. The goal of the task force was to consider how UIC might respond to these changes by educating a workforce that meets future needs.

Task force members were selected because of their experience with the issues at hand, whether as researchers and administrators dealing directly with health care workforce issues or as representatives of UIC’s seven health science colleges. Along with staff in the Office of the Vice Provost of Planning and Programs, a small group of task force members with specific expertise in health policy, economics, and data collection identified resources and data needs and proposed priorities and hypotheses for the larger group to consider. This group accomplished the following set of tasks:

compiled datasets on numbers and types of health care programs and trainees across UIC;

compiled and reviewed national and regional reports on the health care workforce and on emerging federal and state funding opportunities to support health care workforce development;

commissioned a study to extract data from the National Bureau of Labor Statistics dataset for health care occupations for Illinois, the Midwest, and the U.S. including changes in numbers of people hired and wages; and

elicited information on health workforce education priorities and plans by surveying all seven of UIC’s health science colleges.

The resulting data is reported below and resources gathered to support the task force’s work are listed in Section A16 of the appendix. The survey of health science colleges asked the following two questions:

Are you aware of any strategic planning initiatives to adjust the numbers of trainees or to establish, revise, or eliminate programs based on assessments of emerging workforce needs? If so, can you please describe them?  

Responses: None of the colleges indicated that they plan their educational programs around workforce data, although some colleges are responsive to major trends (particularly in social work and some programs in the applied health sciences).

Can you describe the factors that do in fact determine the numbers and kinds of health professions training programs your college supports?

1 A Glossary appears in section A17 of the appendix.

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Responses: Colleges indicated that program planning in health professions education consists of determining program types, program size, curriculum, location, and partnerships. College decisions about which programs to expand, contract, revise, eliminate, replace, and link to other programs is driven by demand (can we recruit good students?), tuition rates (can we cover our costs?), competition (are other programs emerging in the region?), resources (do we have clinical training sites, faculty, and lab space?), and new opportunities (federal or state grants, international interest, etc.).

II. WORKFORCE DEMOGRAPHICS: WHAT DO THE NUMBERS SHOW?

The task force commissioned a report on recent trends in health occupations based on data compiled by the Office of Employment Statistics in the National Bureau of Labor Statistics (BLS). Employment and wage data on health care related occupations for the five-year period from 2008 to 2012 were collated by state, region and nationally in order to track changes that indicated which occupations could be considered in demand. Occupations were identified as having increased in demand if there was an increase in both employment and wages over the five-year period; those with declines in both employment and wages were considered to have decreased in demand. The complete report, including the methodology used and tables showing additional employment and wage data, is included in the appendix to this report.

The purpose of this exercise was threefold. First, we needed to determine which among our approximately 80 degree and certificate programs in the health sciences are training students for occupations that are increasing (or decreasing) in demand as reflected in wage and job growth. Second, it was important to identify occupations that are growing in demand for which UIC is not currently providing training because these represent potential opportunities. Finally, it was useful to identify in demand occupations that do not specify particular professional degree requirements, such as “health services managers,” for which graduates of existing UIC programs would be well suited.

The following tables present the occupations in demand nationally (Table 1), in the Midwest (Table 2), and in Illinois (Table 3) between 2008 and 2012. Each of the occupations listed has shown growth in both wages and job numbers. For instance, there has been a 20% increase in the number of nursing instructors and other health science teachers at the post-secondary level, coupled with 5% wage growth adjusted for inflation.

In prognosticating about the future of the workforce, it is important to keep in mind that these labor statistics reflect past hiring and salary trends and therefore cannot predict what will happen in the future with any certainty. Health care systems and the services provided by specific occupations are in flux and it is difficult to know what impact particular changes will have. For instance, we can predict that the health care workforce will change because of the implementation of the Affordable

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Care Act (ACA). However, we cannot anticipate the extent to which that will lead to increased demand for pharmacists, nurses and physician assistants to take up responsibilities provided by physicians who work in primary care. Past data is also not inclusive of new occupations that may emerge, such as those related to coordination of care.

Table 1. In Demand Jobs in the U.S., 2008-2012

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Table 2. In Demand Jobs in the Midwest, 2008-2012

Table 3. In Demand Jobs in Illinois, 2008-2012

Pairing the data from the Occupation Codes (OCC) of the BLS in Tables 1-3 with educational programs at UIC poses several challenges. First, they do not necessarily match. On the one hand, the OCC may list multiple occupations that

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require the same degree, some of which are in demand and some of which are not. (That would certainly be true for the MD degree.) Conversely, there are a number of occupational codes that are sufficiently broad that they apply to graduates coming out of different degree programs on campus. We have attempted to address these challenges in Tables 4 and 5.

Table 4 pairs UIC’s degree and certificate programs with occupational codes from BLS data, indicating increasing demand at the state, regional and national level. Note that under some of the degrees listed, related occupational titles are indicated in italics that are taken directly from the BLS OCC codes. For instance, Social and Community Service Managers, which are in demand at both the state and regional level, is listed under Health Care Administration, and associated with both the MHA and the MPH because it seems like a relevant fit. However, it could also have been placed with our MSW degree program. For that degree, note that we paired nine different occupational titles, including Mental Health Counselors and Health Educators.

Table 4. Existing UIC health science degrees and changing demand, 2008 – 2012

DEGREES Italics identify specific occupations LEVELS

Increasing demand

Decreasing demand

State

Region

US

State

Region US

Undergraduate Degrees & MinorsHealth Information Management BS x

Medical Records and Health Information Technicians BS x xNursing BSN xNutrition BS, Minor xPublic Health BA

Community and Health Service Managers BA x

Medical and Health Services Managers BA xGraduate & Professional DegreesDental Medicine (Professional Program) DMD x x x

Oral and Maxillofacial Surgeons DMD x xHealth Informatics MS, MPH x

Health care technical occupations  MS xHealth Professions Education MHPE x x x

Health Care AdministrationMHA, MPH, DrPH x

Social and Community Service Managers MHA, MPH x xKinesiology, Nutrition, and Rehabilitation PhD x

Dieticians and Nutritionists PhD xMedical Biotechnology MS x

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Medicine (Professional Program) MD x x x xEpidemiologists MD xFamily and General Practitioners MD x xOB/Gyns MD x xPediatricians MD x xPsychiatrists MD x x x

Nursing MS, PhD x xNursing Instructors and Teachers,

Postsecondary MS, PhD x x xNursing Practice DNP x x

Nursing Instructors and Teachers, Postsecondary DNP x x xNutrition (Applied) MS x xOccupational Therapy MS, OTD x xPatient Safety Leadership MS x xPharmacy (Professional Program) PharmD x x xPhysical Therapy (Professional Program) DPT x xPsychology MA, PhD x

Health care diagnosing and treating practitioners PhD x

Industrial-Organizational Psychologists PhD x

Mental Health Counselors PhD x x xTherapists, All Other  PhD xMarriage and family therapists  PhD x

Public Health (Professional Programs)MPH, MS, PhD

Occupational Health and Safety Specialists

MPH, MS, PhD x x

Public Health MS, PhD

EpidemiologistsMPH, MS, PhD x x

Health Educators MPH, PhD xPublic Health Informatics MPH x xOccupational Health and Safety

Specialists MS, PhD x xMedical and Health Services

ManagersMS, PhD, DrPH x x

Social and Community Service Managers MS, PhD x xSocial Work (Professional Program) MSW, PhD x x

Health Care Social Workers MSW, PhD x xMental Health Counselors MSW, PhD x x xHealth Educators MSW, PhD xSocial and Community Service

Managers MSW, PhD x xChild, Family & School Social

Workers MSW, PhD xMedical and public health social

workers MSW, PhD xMental health and substance abuse

social workers MSW, PhD x x

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Marriage and family therapists MSW, PhD xSocial workers, all other MSW, PhD x

Joint DegreesIntegrated IBHE Certificate in Oral and Maxillofacial Surgery (Residency) Program (OMFS)/MD x x

NursingMBA/MS, MPH/MS x x x

Pharmacy

PharmD/MBA, PharmD/ MSCCTS, PharmDMSHM, PharmD/PhD x x x

Public Health MD/MPH xIBHE Certificate ProgramsAdministrative Nursing Leadership x

Social and Community Service Managers xAdvanced Practice Cardiometabolic Nursing x xAdvanced Practice Forensic Nursing x xAdvanced Practice Palliative Care Nursing x xAssistive Technology

Health care technical occupations xBasic Community Public Health Practice xBioinformatics Engineering x xClinical Nurse x xEvidence-Based Mental Health Practice xHealth Environmental Health Informatics x

Occupational Health and Safety Specialists x xHealth Information Management x x xManagement and Leadership in the Nonprofit Disability Organization

Social and Community Service Managers x xNurse Practitioner/Midwifery Post-Master's x xNursing Patient Safety Organizations

Occupational Health and Safety Specialists x xPatient Safety, Error Science, and Full Disclosure xPublic Health Informatics x x xPublic Health Management x xSchool Teaching/Learning in Nursing and Health Sciences x x xSocial Work Health Informatics

Health care technical occupations xSpecialist Post-Master's Nursing x x

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Table 5 takes a different approach. Here we began with broad occupational titles that are included in the BLS dataset, such as Medical Scientists or Health Care Diagnosing and Treating Practitioners, placed them as bold headings, and then listed for each one all of the UIC degree programs that apply. For instance, under “Medical Scientists, Except Epidemiologists” we list almost two dozen educational programs, including Anatomy and Cell Biology, Biochemistry and Molecular Biology/Biochemistry and Molecular Genetics, etc., most of which have both pre-terminal (e.g., MS) and terminal (e.g., PhD) degrees. Again, we indicate the demand for these broad occupational titles at the state, regional and national levels. Because this data is less specific, i.e. programs are clustered under broad occupational titles – it may also be less accurate. Anatomy and Cell Biology, for instance, is classified as increasing in demand regionally only because it falls within a broad occupational title for which this is the case.

Table 5. Broad occupational categories with increasing demand for which multiple academic degrees may provide qualifications

OCCUPATIONS & UNITS GRANTING DEGREESIncreasing demand

MEDICAL SCIENTISTS, EXCEPT EPIDEMIOLOGISTS Degrees

State

Region

US

Anatomy and Cell Biology MS, PhD xBiochemistry and Molecular Biology/Biochemistry and Molecular Genetics MS, PhD xBioengineering MS, PhD xBioinformatics MS, PhD xBiomedical Visualization MS xBiopharmaceutical Sciences MS, PhD xClinical and Translational Science MS xKinesiology, Nutrition, and Rehabilitation PhD xMedical Biotechnology MS xMedicinal Chemistry MS, PhD xMicrobiology and Immunology MS, PhD xNeuroscience MS, PhD xNursing MS, PhD xOral Sciences MS, PhD xPathology MS, PhD xPatient Safety Leadership MS xPharmacognosy MS, PhD xPharmacology MS, PhD xPharmacy MS, PhD x

Pharmacy

PharmD/MBA, PharmD/MSCCT

S, PharmD/MSHM,

PharmD/PhD x x xPsychology MS, PhD xPhysiology and Biophysics MS, PhD xClinical and Translational Science DMD/MS x

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Clinical and Translational Science MD/MS xHEALTH DIAGNOSING AND TREATING

PRACTITIONERS, ALL OTHERSand HEALTH CARE PRACTITIONERS

Dental Medicine (Professional Program) DMD x x xMedicine (Professional Program) MD x x xNursing MS, PhD x x xNursing Practice DNP x x xOccupational Therapy MS, OTD x x xPharmacy (Professional Program) PharmD x x xPhysical Therapy (Professional Program) DPT x x xPsychology (Clinical) MA, PhD xSocial Work (Professional Program) MSW x xIntegrated IBHE Certificate in Oral and Maxillofacial Surgery (Residency) Program (OMFS)/MD xNursing MBA/MS x x x

IBHE CERTIFICATE PROGRAMSAdvanced Practice Cardiometabolic Nursing x x xAdvanced Practice Forensic Nursing x x xAdvanced Practice Palliative Care Nursing x x xClinical Nurse x xEvidence-Based Mental Health Practice xNurse Practitioner/Midwifery Post-Master's x xSpecialist Post-Master's Nursing x xCOMMUNITY AND HEALTH SERVICE MANAGERSHealth care Administration MHA, DrPH, PhD x xPublic Health BA, MS, MPH,

PhD x xSocial Work (Professional Program) MSW x xNon-health science degreesBusiness Administration BBA, MBA x xPublic Administration MPA, PhD x xUrban and Public Affairs BA x xMEDICAL AND HEALTH SERVICES MANAGERS

Public HealthBA, MS, MPH,

DrPH, PhD x x xNon-health science degreesPublic Administration MPA X x xBusiness Administration BBA, MBA x x x

Note that neither Table 4 nor 5 captures pairing of degree programs with occupational titles that may be quite specific but to which numerous potential educational pathways are available to students at UIC. For instance, students might qualify to be Community Health Workers, Industrial-Organizational Psychologists, and Medical and Health Service Managers based on skills and qualifications acquired in a variety of undergraduate and graduate degree programs. These are indicated in blue in the next table (see below).

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The purpose of Table 6 is to highlight occupations for which UIC does not have degree or certificate programs but that are in demand at the national, regional or state levels. The table also indicates if degree programs exist on the Urbana campus or, for associate degree level programs, at the City Colleges of Chicago (CCC). For each, we note in the last two columns to the right whether UIC should consider either opening a program or, for associate level degrees, finding a two-year college partner. Finally, as just noted, we highlight in blue occupations for which many of our existing degree programs likely prepare students, but who may be unaware of emerging occupations in the health section for which they are qualified.

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Table 6. In demand occupations for which UIC does not have an educational program

Blue highlighting indicates that UIC offers relevant preparation in other programs.

Increasing Demand (Blue highlighting: UIC offers related educational training that could qualify students for these occupations) US

Region

Illinois

Available at UIUC

Available at CCC

Consider UIC

Consider

finding partner

sAudiologists x √ xCardiovascular Technologists and Technicians x xCommunity Health Workers and Other x x √ √ xEmergency Medical Technicians and Paramedics x x x

√√ x

Health Technologists and Technicians, All Other x x xIndustrial-organizational psychologists x √ xMedical and Health Services Managers x x x xMedical Equipment Preparers x xMedical Records and Health Information Technicians x x x √ xOccupational Therapy Assistants x x xPharmacy Technicians x √ xPhysical Therapist Assistants x x xPhysician Assistants x x  xPodiatrists x xPsychiatric aides x x √ xRespiratory Therapists x √ xSocial and community service managers x xSpeech-Language Pathologists x x x √ xSurgical Technologists x √ x

While Table 6 lists programs that UIC does not have but should consider establishing, it does not take into account programs that the campus already has in place that may be undersized given market demand for occupations associated with the skills acquired in those programs. Hence, Table 7 below lists existing programs that granted fewer than 20 degrees in AY 2013 but prepare students for

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in demand occupations. This data is derived by cross listing occupations listed in high demand in Tables 4-5 with associated programs of relatively small size listed in Tables A11 and A12 in the Appendix, which present enrollment and degree data for UIC’s health sciences programs from 2009 to 2013. The programs in this table represent additional opportunities for UIC to capitalize on workforce demand by increasing enrollment and the number of degrees granted.

Table 7. Programs training for in demand occupations but granted fewer than 20 degrees in AY 2013

Program Degree OccupationsHealth Professions Education MHPE Health EducatorsNursing Practice DNP Health Educators, Nursing Instructors & TeachersNursing (Research) PhD Nursing Instructors & Teachers

NutritionBS, MS (Applied) Nutritionists

Occupational Therapy OTD Occupational TherapistsOccupational Health and Safety Specialists MPH, MS, PhD

Safety technicians and specialists in occupational health

Public Health DrPH, MS, PhDCommunity Health Workers, Social & Community Service Managers

Not fully captured in any of the data from the BLS are the emerging unmet needs of health systems that are in a process of transformation in which they assume both greater financial risk for the care of large numbers of patients and concurrent accountability for maintaining or achieving measures of quality. Such needs, for instance, will likely include extensive care coordination provided by case managers (or some similar occupational title[s]) who serve as the glue linking patients and their families to complex care delivery services. Requisite skills may vary, depending on the complexity of patient illness and the range of services and providers in an integrated health system, but may include social work, nursing, information technology and health care administration expertise ranging from associate degree to graduate level skills development.

In addition, the data in Tables 4-7 do not incorporate information on UIC’s particular areas of strength for prioritizing program development. For instance, given its partnership with the College of Engineering, the College of Medicine is well positioned to develop a biomedical engineering track within the medical school curriculum to respond to regional demand for bioengineers (Table 5), many of whom need clinical expertise. And UIC is well position to provide professional development for the current workforce through additional degree or certificate programs, such as the highly successful RN to BSN program in the College of Nursing and a wide variety of IBHE certificate programs that build on current institutional strengths (see Table A10)

Finally, another limitation of the BLS data, which is an indirect driver of other variables that impact enrollment and tuition rates (see box below), is that it is

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entirely a measure of market demand rather than community need. Unfortunately, many communities and the individuals who reside within them cannot afford services they need, or are ethnically/racially or geographically isolated. Serving these communities remains a signature dimension of UIC’s mission. The university’s commitment to serving the underserved requires admissions and other policies that ensure that low-income students and those from underrepresented and underserved communities have both the access and the financial means to pursue training in the occupations of their choice. It also requires that the health care professionals educated at UIC understand the needs of underserved communities and the impact of health disparities.

III. MAJOR THEMES

In addition to compiling and analyzing workforce data, the task force conducted an environmental scan of major trends that have implications for health care

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THE ECONOMICS OF PROGRAM AND WORKFORCE DEVELOPMENT

As seen from the survey of UIC health science colleges, workforce development is not often a direct factor in program planning. However, workforce demand likely impacts the variables that influence decision-making. Specifically, when colleges make adjustments in enrollment and tuition rates those changes generally reflect changes in the workforce marketplace. When there is unmet workforce demand, wages for those job titles rise and tuition rates follow (as prospective students are willing to pay more based on anticipated higher future income). Hence, when programs increase enrollment and raise tuition they do so because the market will bear those rates and there is a pool of qualified applicants--i.e., they are responding to workforce development needs.

Workforce demand, however, should not be confused with workforce need. For instance, a community may need primary care services – services that can be provided by physicians, nurse practitioners or physician assistants. Which health care professionals may provide those services depends on state regulations regarding the scope of practice, level of supervision for each type of practitioner, and whether the non-physician provider can bill directly or under the physician’s provider number. A particular occupation is only in demand when there is both a need for the services that practitioner is trained to provide, a regulatory environment for credentialing of the job title, and reimbursement for the services provided.

However, market forces are not a substitute for social policy that assures that trainees from underrepresented minority communities or low income strata can enroll and graduate, or the special planning and investments (such as grants, incentives, and loan payback agreements) that may be required for graduates to work in underserved areas.

workforce planning that others have documented in reports prepared by government organizations, “think tanks,” and professional societies. Five themes emerged and are described below.

Significant Demographic Shifts

A recent report of the Coalition of Urban Serving Universities indicated that 20% of the US population resides in communities that are medically underserved. This problem is exacerbated by an aging population with growing health care needs. The Association of American Medical Colleges (AAMC) predicts 91,000 more physicians needed by 2020. The American Association of Colleges of Nursing anticipates 260,000 more registered nurses needed by 2025, and the Association of Schools of Public Health anticipates 250,000 additional public health workers required by 2020. Underrepresented minorities (particularly Hispanics and African Americans) comprise over one third of the population and continue to grow as a proportion of the total population yet only comprise 9% of physicians, 7% of dentists, 10% of pharmacists, and 6% of registered nurses.2

Implications: Leading educational and trade organizations project substantial shortages based on available workforce data and demographic projections, and also note a need for increased diversity among health care providers. Note that the actual shortage projections may not take into account cross-over in the services health professionals can provide. For instance, the primary care physician workforce shortage may be mitigated by the training of more nurse practitioners who can provide many of the same services. Regardless, the evidence is that we need to train a more diverse workforce and provide incentives to health care professionals to work in medically underserved communities. This will require developing a workforce pipeline that is representative of the populations they will serve, with a particular emphasis on supporting student success in the STEM fields at the secondary and post-secondary school levels.

Health Systems Assume More Risk for Excess Costs

University of Illinois Hospital and Health Sciences System (UI Health) is engaged in developing an Accountable Care Entity contractual agreement with Medicaid for a subset of patients in which the health system will receive a fixed sum of money monthly from each participant for coordination of care and will, in turn, assume increasing risk while maintaining certain benchmarks of quality. The challenge will be to increase efficiency, i.e., to provide the same or higher quality care at lower cost.

Although not yet complete, the Office of the VPHA is conducting its own needs assessment of the local population, the University of Illinois Survey on Neighborhood Health (UNISON), which includes neighborhoods from Humboldt Park to Englewood. UNISON will draw on 1,400 interviews of residents selected from a

2 “Developing a health workforce that meets community needs,” community-wealth.org http://community-wealth.org/content/urban-universities-developing-health-workforce-meets-community-needs. Workforce distribution maps available through the HRSA National Center for Health Workforce Analysis (National Center for Health Work Analysis. http://bhpr.hrsa.gov/healthworkforce/) indicate similar workforce needs in Illinois.

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stratified probability sample to identify unmet needs for new programs and services, with a particular focus on uncontrolled hypertension, diabetes, and asthma. The goal of UNISON is to identify health disparities and the resources needed to address them so that UI Health can mobilize a data driven response. This project should provide insight into the kinds of workers and skills that support community health.

Implications: As health care systems such as UI Health are held accountable for controlling costs while maintaining quality, they will create new job descriptions (e.g., various types of community health workers and care coordinators) and redesign old ones (e.g., employing pharmacists as clinical providers for chronic care management) to increase efficiencies. This requires avoiding overuse and misuse of medical services. UI Health will need to develop improved collaborative care processes to assure, for instance, that as patients transition from inpatient to outpatient care there is detailed communication among providers and with patients and their families that will minimize preventable readmission risk. Efficiency also requires that all health professionals work “at the top of their license,” ensuring that health care services are provided by the health professional who can give safe and effective care at the lowest cost.

Emphasis on Patient Centered Care

Care that is patient centered is coordinated, comprehensive, safe and of measurably high quality, accessible, and responsive to patients’ needs and preferences. In particular it includes a proactive and personalized approach to addressing the health needs of patients who may not be optimally utilizing the resources of the health system. For instance, in patient centered medical homes, a team of providers shares responsibility for a “panel” of patients assigned to them. The team may utilize a data warehouse to identify patients in their panel with poorly controlled diabetes who are not requesting services and refer them to nutritionists, clinical pharmacists, and other providers who can assist them with chronic disease management. They may arrange for home visits by a community health worker who is trained to communicate with sensitivity to relevant cultural issues and the patient’s life context. They may also involve a home telehealth team that uses phone or internet based technology that enables the patient to provide regular reports on the diabetes control and obtain frequent feedback. Such approaches avert the need for unnecessary appointments in the doctor’s office, prevent patients from “falling through the cracks,” and make effective use of technology, all to assure that patients get the right care at the right time, with the aim of reducing the chances of complications and possible admission or other high-cost interventions later.

Implications: The education of all health care providers should prepare them to work in teams, to use technology effectively to communicate, and to address problems proactively by accessing data and reaching out to patients, rather than the traditional reactive approach in which the health care system waits for problems to occur. There appears to be a need among all who care for patients directly or indirectly for a set of shared competencies in strategies essential to providing patient centered care, including topics in health policy and planning,

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communication, the effective use of technology, and collaborative decision making.

Funding Opportunities for Educational Programs and Students in Health Sciences

The Affordable Care Act (ACA) includes public workforce provisions of relevance to UIC because they provide education and incentives for medical students, physicians in training, pharmacists, nurse practitioners and other frontline providers to work in underserved areas (details are provided in Table A13 and Section A14 of the appendix). These include the following opportunities:

ACA public workforce provisions scheduled to expand the existing National Health Service Corps program to increase scholarships to primary, dental, mental and behavioral health providers who practice in medically underserved areas. The law increases loan repayment amounts to $50K. ($710M-810M)

Title VII Health Profession expansion to support training in primary care, dentistry, physician assistants, and mental and behavioral health providers and enhance workforce diversity provisions, including Centers of Excellence, Area Health Education Centers and loan repayment and scholarship initiatives, and enhance a program to train providers in cultural competency, prevention, and working with individuals with disabilities. ($214M)

Title VIII Nursing Education Programs program expansion to support training and diversity in nursing, including student loan programs, grants and scholarships for undergraduate and graduate nursing education and retention, loan repayment for nursing faculty, a new nurse-managed health clinic program, a new demonstration program for family nurse practitioner training, and grants to help minority individuals complete associate or advanced degrees in nursing. ($223M)

Epidemiology and Laboratory Capacity Grants to expand national all-hazards preparedness for public health emergencies through a grant program to respond to infectious and chronic diseases and other conditions at state, local or tribal departments or academic centers. ($104M)

Expansion of the preventive medicine residency program at HRSA to support training at schools of public health and medicine, hospitals, and state, local or tribal health departments. ($18M)

In addition to the Affordable Care Act, another major opportunity for UIC is the Medicaid 1115 Waiver. 1115 Waivers are submitted by states to the federal government as requests to waive some of the standard requirements for how states must spend Medicaid dollars to be eligible for matching federal dollars. If approved, the waiver enables states to adopt innovative strategies to improve care delivery at a budget neutral cost as a “pilot” for, typically, a 5-year time period. Recently, in June 2014, Illinois, through its Department of Health care and Family

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Services (DHFS) submitted a 1115 Waiver proposal to the US Department of Health and Human Services (DHHS) that included requests to allot substantial Medicaid dollars to educational programs at UIC that would better prepare the workforce. Some of the funds would go towards expanding existing degree and/or professional training programs and some would establish new ones. A summary of the proposed program expansions or additions, which were drafted by each of the health science colleges, is included in Table A15 of the appendix. As the waiver review process advances, it is likely that the DHFS will negotiate with DHHS over what aspects of the waiver they are prepared to fund and, during those negotiations, UIC will be called upon to provide greater details about how the funds to campus health science training programs will ultimately advance health care and health in Illinois.

Finally, private foundations are investing resources in addressing emerging health care work force needs. For instance the John A. Hartford Foundation, which has a particular interest in the health of older Americans, is funding Interprofessional Leadership in Action, a portfolio of projects to develop collaborative skills and leadership in population-based health in an aging population.

Implications: There are funding opportunities that apply to many of the programs and students in the health sciences at UIC. These funds reflect federal and state priorities and conclusions about where investments will have the highest yield. They also provide potential resources for health science colleges and their programs and students to offset costs of education and training.

Community Engagement and Public Health

It is evident that community based prevention is an essential component of the health care delivery system. Wellness programs and a focus on healthy homes, workplaces and communities can also reduce costs and extend resources, especially in underserved communities. Community health care workers and health educators are central to the effort to engage people in promoting their own health.

Implications: By directly training public health professionals and health educators and partnering with community colleges to create effective curricula in other health care occupations that serve communities, UIC has an opportunity to make a wide impact on Chicago area communities.

IV. BUILDING A SET OF SHARED COMPETENCIES ACROSS THE HEALTH CARE WORKFORCE

Consensus emerged among task force members that addressing workforce needs includes developing essential competencies across all health professions programs on campus, in part because of the increasing focus on collaborative, pro-active, personalized care. Specifically, the task force identified the following four areas for curriculum development:

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1. Interprofessional Collaborative Practice (ICP)

Interprofessional collaborative practice occurs “when multiple workers from different professional backgrounds work together with patients, families, careers [sic], and communities to deliver the highest quality of care.”3 Developing the skills, knowledge and attitudes that foster ICP is the goal of interprofessional education (IPE), which the World Health Organization (WHO) describes as an experience that “occurs when students from two or more professions learn about, from, and with each other.” In May 2013, the Institute of Medicine (IOM) of the National Academy of Sciences issued a workshop report, Interprofessional Education for Collaboration: Learning How to Improve Health from Interprofessional Models across the Continuum of Education to Practice, concluding that:

Interprofessional education provides students with opportunities to learn and practice skills that improve their ability to communicate and collaborate. Through the experience of learning with and from those in other professions, students also develop leadership qualities and respect for each other, which prepares them for work on teams and in settings where collaboration is a key to success. This success is measured by better and safer patient care as well as improved population health outcomes.4

The IOM report details how IPE works as a tool for achieving the “triple aim constructed by the Institute of Health care Improvement (IHI) of . . . better patient care, better health outcomes, and more efficient and affordable educational and health care systems” (p. 26).

To date, UIC has made significant headway in introducing interprofessional education to the campus, mostly through the volunteer efforts of a group of faculty from the health science colleges who established the Collaborative for Excellence in Interprofessional Education (CEIPE). CEIPE has organized two large seven-college IPE events and raised the profile of IPE greatly on campus. In addition, the Office of the Provost has covered costs and, most recently, invested in a part-time position for a faculty member from CEIPE to advance IPE, including facilitating the development of an IPE strategic plan.

2. Patient Centered Care (PCC)

The IOM defines PCC as “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.” 5 In practice, PCC has considerable overlap with ICP, because providing patients with personalized care often requires the coordinated 3 Solaro, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice. World Health Organization, 2010. World Health Organization Discussion Paper 2. http://www.who.int/social_determinants/corner/SDHDP2.pdf4 Institute of Medicine. Interprofessional Education for Collaboration: Learning How to Improve Health from Interprofessional Models Across the Continuum of Education to Practice: Workshop Summary. Washington, DC: The National Academies Press, 2013, p. 7.5 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press, 2001, p. 6.

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effort of teams. For instance, providing patients with complex chronic health care needs with care that addresses individual barriers– e.g., financial, social, and educational – often requires the close coordination of nurses, pharmacists, social workers, physicians and an array of other members of the health care team. PCC also requires effective communication strategies, including health coaching skills, motivational interviewing, cultural competency, attention to health literacy, and shared decision making.

3. Health Systems, Policy and Finance

Health professions education often ill prepares future clinicians and health care leaders to be patient advocates in a complex health system. Effective organizations achieve meaningful measures of quality, safety and efficacy while controlling costs. Such success requires that the health care professionals within these organizations have the knowledge, skills and attitudes to advance these goals. They also need to understand the drivers of change in the larger health care environment, including Medicare, Medicaid, the Affordable Care Act, and the healthcare marketplace. Few are prepared with a foundation of knowledge to lead within their own organizations or to participate in local and national debate. There is also little formal education about the continuum of care, including home health and hospice services, skilled nursing facilities, rehabilitation settings, or non-traditional care delivery options such as telehealth or group care approaches. However, because nearly all who participate directly or indirectly in patient care have an impact on quality and patient safety, an understanding of the causes of medical error and the drivers of quality and performance is essential.

4. Health Equity

Since the IOM’s 2002 report to Congress, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,”6 there has been heightened attention to health equity, defined by WHO as “the absence of unfair and avoidable or remediable differences in health among population groups defined socially, economically, demographically or geographically.”7 The emphasis of the term “health equity” is not simply on addressing disparities but on responding to avoidable differences in health. It is a call to action across society. For healthcare professionals it calls for addressing assumptions and biases that can undermine equity, beginning in the earliest stages of their health professions education. It also requires an understanding of the barriers to establishing healthy communities and the roles health professionals can play in addressing them.

Establishing a signature UIC cross college curriculum: opportunities and challenges

Developing a set of core competencies across the health science professions in these four broad areas is integral to addressing emerging workforce needs

6 Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (full printed version). Washington, DC: The National Academies Press, 2003.7 Solaro, p. 12.

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because the increasing emphasis on team-based care and the emergence of new healthcare paraprofessionals require that all team members understand their colleagues’ roles. At a minimum, an interdisciplinary cross-college course for all graduate and professional students in the health sciences would introduce them to basic content, themes and the acquisition of competencies as listed above. In addition, for students interested in acquiring greater depth in a particular area, further training could be available to students who enroll in specific tracks through which they acquire added expertise in topics such as patient centered care or health systems management.

Establishing such a program would include considering the following:

Convening a working group that draws faculty from each of the health science colleges. Faculty would be selected who are already leading or teaching courses that address one or more of the topics in the proposed collaborative curriculum. Innovative strategies for building on existing curricular foundations would be explored. For instance, existing courses need not be eliminated but instead might be-cross listed so that students could readily participate, gaining credits towards their degree.

In addition to the classroom elements, the collaborative curriculum would provide a strong experiential learning component, primarily in the clinical or community setting, but also through simulation. All of UIC’s clinical training programs have extensive clinical practice curricula, typically following a didactic training component of one or more years. There are rich opportunities here for IPE in which, for instance, nursing, medical, pharmacy, physical therapy students and others rotate with peers, particularly during the elective time that is often available in the final phases of their training. (These IPE collaborative experiences would require addressing the enrollment and tuition issues noted below.)

Along with the interprofessional approaches described above, individual health science programs may develop internal tracks for students interested in cultivating advanced skills in one of the core competency areas. Students could apply to or opt in to such tracks at the start of their training. These programs are already available, but could be expanded to include cross-college collaboration. Currently, students in the College of Medicine may apply to the Urban Medicine Program, which prepares them for practicing in an urban context, with an overview of the health policy, advocacy, and care planning challenges inherent in caring for underserved urban patients in their communities. More recently the COM has established a parallel program in Global Health. In addition, the Colleges of Medicine and Pharmacy have programs specifically targeted to provide practitioners in rural and urban practice at both the Rockford and Urbana campuses. Such tracks, which have generally been successful could expand and incorporate IPE.

Developing a tuition model for cross-college participation should not disadvantage colleges when students take their courses. Current policy, which provides for $150 per credit hour for cross-college participation in graduate

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level courses for credit, is intended to offset losses when an occasional student takes courses in another college. It is not designed for extensive cross-college collaboration. Facilitating enrollment in courses across colleges that assures equity will require modifications to tuition sharing within the structure of UIC’s current RCM tuition model. A working group that draws on education and finance leaders in the colleges along with staff in the Office of the Provost would develop solutions.

Although developing a tuition model for collaborative curricula is critical to the alignment of health science education at UIC, there are also other promising sources of revenue to develop the initiative. In particular, the 1115 Medicaid Waiver may provide substantial funds. The OVPHA/OVCHA has anticipated this opportunity and is developing a proposal along the lines detailed above to anticipate discussions with DHFS as it works with DHHS in finalizing the waiver.

V. RESPONSES TO THE THREE QUESTIONS IN THE CHARGE

1. What sort of workforce will be needed to serve the citizens of Illinois, Chicago, and our catchment in five years? In ten years?

Although predicting workforce needs is inexact, the current evidence indicates a need for the following:

greater numbers of primary care providers, including primary care physicians, dentists, nurses, physician assistants, and geriatricians;

increased distribution of providers to underserved areas, including rural and low-income urban communities;

professionals and mid-level providers who facilitate care coordination, including social workers, patient navigators, patient health assistants, community health workers, and telehealth technicians;

providers who are trained to work in teams to coordinate care using technology and understanding of each other’s roles and skills; and

information managers trained in medical and health informatics and health systems management who can utilize “big data” to track performance of providers and health systems, in terms of both quality metrics and costs.

2. Which of these workforce needs do we view as an opportunity and responsibility for UIC to fulfill?

As listed in Table A10 of the appendix, UIC has approximately 80 health science degree and certificate programs spanning an extraordinary range of professional and skills development from traditional clinician provider programs such as medicine, pharmacy, dentistry, nursing, occupational and physical therapy, to public health, informatics, bioengineering, clinical and translational research, management, and patient safety leadership.8

8 Some of these programs are located on the east side of the UIC campus rather than exclusively within the seven traditional health science colleges that are predominantly located on the west side of campus or at Rockford, Peoria, Urbana or the Quad Cities (Colleges of Medicine and Nursing).

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UIC has an opportunity and, according to its mission, a responsibility to do the following:

systematically incorporate data on workforce needs into decisions about which programs to expand, establish, contract or eliminate;

establish a set of core competencies, ideally through an interprofessional health science curriculum that addresses essential topics and skills development in collaborative care, achieving health equity, and performing efficiently (i.e., achieving consistently personalized, high quality care while avoiding unnecessary costs) in complex, evolving health systems; and

establish new programs that involve partnerships with two-year colleges and that extend outside of UIC’s health science colleges to include expertise in business and education, among others.

3. What will UIC need to do over the next ten years in order to meet these responsibilities and goals?

Incorporate emerging workforce needs into strategic planning at the college level

Each college should identify and set targets for existing and new programs, informed by market trends and anticipated demands. These targets should be revisited annually with updates to the provost and VCHA. Colleges are encouraged, in particular, to use data and analysis provided in Tables 4-7 of this report, which should also be updated annually as a planning resource. Colleges should also be current about health professions programs in the region. Data resources, such as the HRSA National Center for Health Workforce Analysis, and the Degree Program Inventory of the Illinois Board of Higher Education (IBHE) are listed with URLs in Section A16 of the appendix.

Pursue funds allocated for health care workforce developmentExplore and where feasible pursue state, federal funds and foundation funds, including those available through the Affordable Care Act and the proposed Medicaid 1115 Waiver. In particular, the Colleges of Nursing, Dentistry, and Medicine, the School of Public Health, and the University of Illinois Hospital and Health Sciences System (UI Health) should develop a plan for pursuing these initiatives. The Office of the Vice President/Vice Chancellor for Health Affairs (OVPHA/OVCHA) could play a coordinating and tracking role to assure that campus units are aware of and informed about how to capitalize on funding opportunities.

Develop a cross-college interprofessional curriculum addressing essential core competencies

The collaborative curriculum, which would draw on strengths from each college, could become a signature program across the UIC health science colleges. The curriculum would build knowledge and skills through didactic and experiential learning activities that focus on patient centered care, quality, safety and efficacy in health systems delivery, collaborative care, and health equity. The curriculum would also include interprofessional training opportunities at community based clinical sites. This program could be developed through an Interprofessional

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Council that works with each health science college and that is supported through an administrative partnership between the Offices of the VPHA/VCHA and the Provost.

Build a pipeline Coordinate and track campus-wide programs that support underrepresented minorities at the secondary and post-secondary levels through STEM education into the health professions and beyond, documenting the impact of investment in disadvantaged students on developing a diverse workforce. Additionally, identify and pursue partnerships with two-year colleges and other community education programs to achieve the following:

advance the pipeline in health professions education, particularly for underrepresented groups;

develop curriculum for emerging mid-level occupations such as healthcare navigators, care coordinators and community health workers; and

develop joint programs that require both associate level and baccalaureate or master’s level training (e.g., physician assistants).

Develop programs around non-clinical emerging workforce needs

Include colleges from throughout the campus, particularly the College of Education, the School of Continuing Education, and the School of Public Health (Division of Health Policy and Administration), and the College of Business Administration in the development of online and blended professional degree and certificate programs to train health care managers, actuaries, and health systems and safety analysts. Prioritize placement in medically underserved areas and underrepresented

disciplinesSet targets in each health science college for placing graduates in medically underserved areas and in primary care or subspecialty fields that are underrepresented (for instance, pediatrics) and identify state and federal funds for scholarships and other incentives to meet those targets. Develop tracking systems to monitor performance.

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