Analyzing the Healthcare Workforce to Address Missouri

Health ShortagesState Representative Diane Franklin

Missouri’s 123rd House DistrictRural Health Care: It’s Effect on Rural Communities

Columbia, Mo. Tuesday, September 15, 2015

Where We Are NowMissouri Healthcare Workforce Registry and

Exchange (MoHWoRx) Information system developed by DHSSHelps health professionals meet state

registration requirementsProvides information on access to health care

statewide.Informs two external components:

Missouri Health Professional RegistryBureau of Narcotics and Dangerous Drugs

Registry

Where We Are NowMoHWoRx has gaps in accuracy and is not

up-to-date.Prevents early detection of limited health care

accessibility and access in terms of geography, demography and specialty care.

Hinders the ability for policy makers and health community leaders to make informed efforts to expand the medical workforce in the state. This is especially a disservice to underserved areas.

A Growing ProblemMissouri has a shortage of health professionals.

Disproportionately spread throughout the state.Missouri trains 2.7 percent of nation’s medical school

graduates. Ranks second nationally for exporting doctors to other

states.Impending physician retirements will augment the issue.

40 percent of practicing physicians in Missouri are over the age of 55 and a third of Missouri nurses are over 50 years-old.

We know the decline is coming, but the question is when and where will the impacts be felt most?

Rural Missouri Most in NeedOne in five Missourians live in an area with

limited access to primary care.Much of Rural Missouri face a medical

workforce population shortage. The overall number of licensed practicing

physicians has increased since 2011, but rural numbers have declined.

Rural Missouri Most in Need

Primary Care Health Professional Shortage Areas exist where the ration of population to physician ratio is 3,500:1

Rural Missouri Most in NeedHospitals and primary

care physicians are few and far between in rural areas.

Missouri Foundation for Health data shows rural Missouri population to primary care ratio is 1:1,776. Urban Missouri: 1:962.

Rural Missouri Most in NeedRural Missouri will soon have greater

disproportionate supply and demand for services.Aging baby boomer population is sure to

increase demand for health services across the state – both urban and rural. 18.6 percent of Rural Missourians are 65 or older. 14.4 percent of urban Missourians are 65 or older.

The ProblemThe current healthcare workforce database is

insufficient.Impedes strong impact analysis of where and how

existing and growing medical shortage.An insufficient system does not inform leaders or

stakeholders where needs for funding, specialists or primary care coverage could be improved.

The bottom line: Missouri’s approach to collecting health workforce data for licensing functions is removed from information detailing practice locations and characteristics.

Addressing the ProblemBuild on the current database to create an

updated aggregate, quantitative database Would better inform state lawmakers, policy

directors, medical institutions, training programs and recruitment on how to approach underserved areas.

A registry-based database would keep records updated and timely for fresh indicators on where physicians are and what specialties are available in certain areas.

Addressing the ProblemThe Missouri Healthcare Workforce Database Advisory Board at

the University of Missouri is testing a system to meet the need.

Solution: Aggregated DatabasePainting a vivid picture of the Missouri medical landscape:

Evaluate where health care needs are with demographic information paired with primary care and specialty physician, nurse, dentist and mental health workforce data.

Allow education and public health initiatives to be tailored to pinpointed medically underserved areas.

Open potential for federal grants to the state as a result of more solid information and understanding of true health needs.

Supplement knowledge for state and federal agencies awarding health grant funds for local medical initiatives.

Guide medical education institutions to focus, or re-focus, recruitment and training efforts in different parts of the state.

Permit early detection of an approaching health care workforce shortage or issue – geographically, demographically or sorted by specialization.

Missouri Legislation – HB 112HB 112 (2015): To provide healthcare

workforce analysis, is a crafted solution to address the problem.

Would build on MoHWoRx to supplement current data with professional license, registration and permit data.

Missouri Legislation – HB 112Authorization would be given to agencies to

enter into a contract with DHSS, a non-profit or educational institution.State Board of NursingBoard of PharmacyMissouri Dental BoardState Board of Registration for the

Healing Arts

HB 112: Private, Secure & AccurateState board with jurisdiction over the information would control

and approve data collection.Qualitative data, such as identifying data necessary for registry

or application, would be provided to the contractor. Geographic information Demographic information Practice Professional characteristics of license

Only quantifiable data would be released to public with the creation of an aggregate workforce database.

All confidential information would be closed to the public only disclosed with consent of the board/registry entity. HB 112 text: Contractors shall maintain the confidentiality of data

received or collected under this subsection and shall not use, disclose, or release any data without approval of the applicable state board.

Missouri Legislation – HB 112Would begin building health workforce data

infrastructure to facilitate endeavors to meet health needs across the state at a low cost.Short term outlook: $0 - $75,500 per year for

three years.Stakeholders involved with software and data

development predict a comprehensive information set to be ready in three years to have a full picture to inform policy decisions.

Other States’ SuccessWith the status quo, Missouri is falling

behind several states in its ability to assess the types, number, and practice locations of its own healthcare professionals.

North Carolina and Nebraska have taken steps to implement a comprehensive health care workforce database with great success.

HB 112 would push a healthcare workforce analysis application, such as the Missouri Health Professions Workforce Data System, to achieve similar successes.

Moving ForwardWhat is next for Missouri’s healthcare

workforce database initiative?Telehealth a prospect.

Broadband services need to expand to fully benefit rural areas. AT&T, CenturyLink Announcement

Project ECHO