Safety Net Workforce in the Context of Health Care Reform

In the drive by many states to craft programs to expand health coverage to reach more, if not all, of their uninsured population, the focus has been on the cornerstone implementation issues of mandates and affordability. Less attention has been paid to the question of whether there is adequate provider capacity to deliver care, especially to those who could gain coverage under state health reform. The National Academy for State Health Policy (NASHP), under a National Cooperative Agreement with the Health Resources and Services Administration (HRSA), Bureau of Primary Health Care (BPHC) is working to better inform state policy makers on how actions to expand coverage may affect the health care safety net, and particularly federally funded community health centers. This State Health Policy Briefing is intended to stimulate dialogue and promote collaboration between state government and safety net providers in addressing shared missions and goals for assuring access to care for vulnerable populations. As part of this National Cooperative Agreement, NASHP convened in May 2007 a day-long meeting of representatives from the primary care office (PCO) and primary care association (PCA) in six states, along with state policy makers who are members of NASHP steering committees. The discussion showed that there was concern about workforce shortages facing safety net providers, and how the safety net would be affected by health care reform efforts that seek to expand health coverage. Will the newly insured create a wave of new demand that will overwhelm the health care infrastructure? Is that infrastructure already overwhelmed? How will state policy makers and health centers meet this challenge? To further examine these questions, NASHP staff conducted site visits to two states that are in two very different places along the continuum of health care infrastructure and health care reform efforts – Massachusetts and New Mexico. Three lessons emerged from the discussions in each state, and these lessons are broadly applicable to how policy makers in any state might think about the role that health centers should play in the context of workforce planning and health care reform. Lesson 1: State policy makers and health center representatives need to have consistent, well-developed lines of communication, so that they can respond quickly and effectively to new issues and opportunities as they arise. Lesson 2: Health centers are now facing challenges in workforce planning at all levels, from clinicians to front-office staff to executives. States and health centers must work together with other stakeholders to coordinate and integrate planning for workforce issues affecting the health system. Lesson 3: Even in the context of efforts aimed at providing “universal” health care coverage, health centers will continue to have a role in caring for underserved communities, responding to the needs of new populations, and providing enabling services beyond medical care. Health care reform in the states is often a bold experiment. Prospects for success are uncertain. As states embark on their reform efforts, they ought to pause to think about the condition of their safety net.

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