Alaska Health Policy Review
comprehensive, authoritative, nonpartisan
A Publication of the Alaska Center for Public Policy
September 20, 2013 - Vol 7, Issue 20
In this Issue
Visit ACPP
Interview with Robert Sewell, SHARP Program Manager
SHARP-II Program: Applications Due September 30, 2013 at 5:00 PM
Alaska Health Workforce Coalition Report
2012 Alaska Health Workforce Vacancy Study Release Soon
Please Respect Our Copyright
Healthy Alaskans 2020 Top 25 Alaska Health Concerns Released
Commonwealth Fund Reports: Meeting the Need of Low-Income Populations
Health Systems in Transition Series Review of U.S. Health System Issued
Are You Interested in Learning More about Policy in Alaska?
Subscribe to Alaska Health Policy Review
September is Hunger Action Month
Alaska Health Policy Calendar
AHPR Staff and Contributors
Visit ACPP
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Like us on Facebook
From the Editor

Good day, dear readers,

Over the summer, Alaska Health Policy Review featured a three-part series on food and food policy issues. In August, we focused on community gardens. One of the interviews was with Lisa Sadleir-Hart, board president of the Sitka Local Foods Network. It came to my attention recently that the Sitka Local Foods Network is a finalist in the fifth annual Tom's of Maine 50 States for Good contest. 50 States for Good is a national initiative to fund grassroots community projects. The top 15 vote-getters will receive $10,000 each to further their efforts.

You have the opportunity to vote online now for the Sitka Local Foods Network. Note: In order to vote, it appears you must allow Facebook access to your public profile and friend list. If you do vote and find that access to your information is not required, feel free to let me know and I will post a correction to the ACPP website and Facebook page.

This month we move on to another topic: Health care workforce issues and some of the efforts in Alaska to address the issues.  We in Alaska are fortunate to have a community of individuals and organizations committed to building and maintaining a strong health workforce system. This month we feature three of those individuals involved. Due to her enduring interest in the topic, Kelby Murphy, ACPP executive director, organized the collection of interviews. Thank you, Kelby.

First, we have a timely interview with Robert Sewell about Alaska's SHARP program. SHARP is a tool to recruit and retain selected health care professionals in designated health care shortage areas. The current SHARP-II practitioner solicitation period ends at 5:00 PM on September 30. In his interview, Sewell explains the reasons for the program, the differences between SHARP-I and SHARP-II, and how SHARP incentivizes practitioners and health care organizations.

Next, Kathy Craft, director of the Alaska Health Workforce Coalition reports on the efforts and activities of that group. Craft shares estimates of expected job growth in a variety of health care settings, lists successes of the Coalition, and discusses the Coalition's six key initiatives for 2014.

Finally, Katy Branch, project manager for the 2012 Alaska Health Workforce Vacancy Study, participated in an email interview about the study. The final report will be published in October. In the interview, Branch shares details about this piece of the workforce issue.

Rounding out the newsletter are the 25 leading health indicators as selected by the Healthy Alaskans 2020 initiative, brief explanations about three reports issued recently that address health care quality and equity, and a health policy-related calendar of events.

And very last but not least, September is Hunger Action Month. Mary Sullivan, director of the Department of Advocacy and Agency Relation at Food Bank of Alaska compiled a list of ways you can get involved. Because it is still time-relevant, we re-run in this issue the list that was originally published in last month's issue.

I hope you enjoy reading the interviews. I welcome your thoughts and comments about the newsletter content.

Thank you for reading Alaska Health Policy Review.

Managing Editor


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Interview with Robert Sewell, Alaska's SHARP Program Manager
Robert Sewell

Robert Sewell is program manager for Alaska's SHARP program, in the Alaska Department of Health and Social Services Division of Public Health Section of Health Planning & Systems Development. Sewell is a long-time Alaskan and public health advocate. As SHARP program manager, Sewell is working to build support-for-service options for clinicians statewide.

This interview was conducted by Kelby Murphy via phone and email, and it was lightly edited for length and clarity.

basicsSHARP basics

Please tell the Alaska Health Policy Review readers a bit about who you are, who you work for, and your role with Alaska's SHARP program.

Sewell: My name is Dr. Robert Sewell. I work for the Division of Public Health in Alaska Department of Health and Social Service, serving as program manager for Alaska's SHARP program, which is a support-for-service effort that provides loan repayment, and now, direct incentive as well for selected health care clinicians throughout Alaska, particularly those providing care for underserved populations.

AHPR: Can you tell us about the key elements and outcomes of SHARP?

Sewell: There are two parts to SHARP. There is our traditional SHARP program, which receives partial funding from the federal Health Resources and Services Administration (HRSA). We have received two federal HRSA grants from a program called the "state loan repayment program" that provides 50 percent support for what we call SHARP-I. This provides support for primary care practitioners only.

To date, SHARP-I has admitted 74 clinicians to the program, of which 62 remain in field. The others have largely graduated or completed their two-year service obligation. SHARP-I practitioners serve across a range of primary care medical, behavioral health, and dental occupations. SHARP practitioners serve across all six regions of the state: Anchorage/Mat-Su, Gulf Coast, Interior, Northern, Southeast, and Southwest. They are tasked to work largely, but not exclusively, with underserved populations, meaning those who are resourced through Medicaid, Medicare, or are uninsured but are assisted [with medical care costs] through a sliding fee or charity care policy.

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flexSHARP-II offers more flexibility in support-for-service effort

AHPR: How is the SHARP program being perceived?

Sewell: From a variety of data, our impression is that the program is off to a very solid start, and it seems to be well received.

AHPR: What factors contributed to the passage in 2012 of state legislation -- HB78 Medical Provider Incentives/Loan Repayment -- for a loan repayment and direct incentives program in Alaska?         

Sewell: There is a 15-member advisory council that provides oversight for our effort; it meets roughly six times per year. The SHARP council is made up of a number of interagency members, some of those are trade associations, and some are umbrella groups. A couple are from the state bureaucracy. Examples would include the Alaska Native Tribal Health Consortium, the Alaska State Hospital and Nursing Home Association, Alaska Medical Association, Alaska Dental Society, Alaska Pharmacists Association, Alaska Primary Care Association, and others.

The council has been key in a couple of things: One is the visibility, advocacy, and consensus around the effort and two, in planning for the road ahead. That new road is "SHARP-II," which came to reality with the passage of HB 78 in the 27th Legislature. HB 78 -- "An Act establishing a loan repayment program and employment incentive program for certain health care professionals employed in the state; and providing for an effective date." -- passed unanimously in both houses in 2012 and was signed by the governor. It picked up numerous cosponsors. This suggests that the general idea for a support-for-service element in our system of care has arrived, has come to maturity.

There are a couple of reasons for that. One is that there are several health care occupations that Alaska simply does not train for, nor is there any plan to do so. An example is dentists. We don't have a dental school. And there is no discussion that we will. It's very expensive and complex to establish one. There are a number of other occupations that we essentially don't train for: Pharmacy would be one. There's a modest partnership program with Creighton.

We do have an excellent WWAMI medical school partnership program with the University of Washington School of Medicine. However, we need to recognize that those medical students also contract a significant amount of debt, whether or not we train them. They respond to national labor markets, and people do buy out of contracts and go elsewhere.

... there is a heck of a lot of people that have a significant amount of debt, I mean some of it is awe-inspiring: $150, $200, $250, and $300,000; I talked to a psychiatrist yesterday with $400,000 of debt.

There is also the issue of maldistribution, which I think is the third rationale for this type of support-for-service effort. It is one thing to have a particular number of practitioners. But it's another thing to ask: Are they in the right locations? Are they serving the priority populations? Those are very different questions. We believe that support-for-service is a policy tool that will help to address the maldistribution question. Which, again, is a little different than the shortage question.

HB 78 did specify that the underserved populations would be a priority for the program, not exclusively, but a tilt in that direction. It also specified a tilt toward rural and remote locations. So HB 78 was different than what we have been able to do under just SHARP-I, and we are excited about the additional flexibility that SHARP-II now has. One flexibility element is that the program is not confined exclusively to federal health professional shortages areas (HPSAs) locations. We see those as too fairly narrowly defined, and in some remarkable circumstances, way too narrowly defined. So, HB 78, and therefore now SHARP-II, provides for additional flexibility in terms of what regulation calls the "health care service shortage areas" that the state of Alaska will identify, or designate. That's exciting.

The second thing is that SHARP-II is not confined to primary care. SHARP-I is, but SHARP-II has more flexibility. Probably many of the positions (slots) will be primary care. But, it is not required by statute or regulation that those be exclusively primary care. There are some locations, there are some practitioner types that are not primary care, but may be a priority.

Third is that it does allow for hospitalists, for instance, for docs that work in the ER, and it allows for specialists. And it allows for other settings, such as long-term care. It was also determined that this can include public health nursing clinics.

This is a new day compared to SHARP-I, which is an excellent option as far as it goes. There are also other terms of contract that we are very excited about regarding increased flexibility. One is that historically, support-for-service efforts such as SHARP-I or the National Health Services Corps, or the Indian Health Services loan repayment program are almost exclusively focused on loan repayment, and that's because of two things. One is that there is a heck of a lot of people that have a significant amount of debt. I mean some of it is awe-inspiring: $150, $200, $250, and $300,000. I talked to a psychiatrist yesterday with $400,000 of debt. Those finishing dental school [have debt that is] often actually higher than physicians and many, many physicians are finishing with well over $100,000 of debt.

That's one of the reasons loan repayment has been around, but if the only policy tool regarding these issues is loan repayment, you are a bit like a child that gets a hammer for Christmas and soon learns everything needs pounding. Meaning, there are a whole bunch of people who finish school who either -- then, or later -- don't have monumental amounts of debt. Therefore, if loan repayment is all that you have for support-for-service, then you are immediately irrelevant to them. Therefore, with the guidance of people like Dr. Donald Pathman at Sheps Center at the University of North Carolina Chapel Hill, we concluded that it would be good to have more flexibility in our support-for-service effort, and thus to include direct incentives.

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repayLoan repayment and direct incentives programs

AHPR: Can you explain how loan repayment and direct incentives differ? Are the audiences different? In your mind, is one more successful at recruitment and retention?

Sewell: Direct incentives are not [intended] to repay loans; they increase interest in practicing in those high-need locations, with those high-need populations, even though the person is not saddled with educational debt. We think that has two values. One is that it vastly expands the potential recruitment pool, and by numerous-fold. This is because there are many mid-career professionals here and in the Lower 48 in particular who might consider working in the locations and populations of interest. But they are midcareer -- they are not debt-ridden.

The second important rationale besides increasing the recruitment pool is that there are some health care positions in our state, particularly in rural or remote locations, that may not be [appropriate] for those with new degrees and relatively low levels of clinical experience. Or put differently, there are jobs for which we have been with loan payment confined to the relatively young and inexperienced, simply because they are debt-ridden. There is no indication that those are [necessarily] the best people to be in those jobs. It may be that we need somebody who is more experienced, who is midcareer, and who has been there and done that and has gotten all the T-shirts.

Why? Because some of these involve a fair amount of long on-call hours, some of them involve a fair amount of personal and/or professional isolation, and some of them involve addressing a very wide range of presenting problems. In other words, experience counts. So direct incentives may allow for the state to provide support-for-service for some of those midcareer professionals for whom it is a better match. And that is now codified in regulation that was adopted and finalized. We can offer direct incentives for the more experienced clinician. So, SHARP-II involves both loan repayments and direct incentives.

What else are differences? One key difference is that it also provides a formal and budgetary nod toward very hard-to-fill positions. In other words, you can imagine that there are the default regular fill positions, lots of them in this state. And then there are those that for many reasons may be very difficult to fill, or if filled, to keep filled. Some of it has to do with an overwhelming nature of the work, either in terms of type or amount. Some of it may have to do with geographical or linguistic, cultural, or climatological barriers, or cost-of-living, and cost of travel. All these kinds of things may figure into some positions being difficult to recruit for, expensive to recruit for, and hard to maintain continuous clinical staffing. So, SHARP-II allows for regular fill and very hard to fill.

AHPR: And the three-year contract is for the loan repayment?

Sewell: Well, either route for SHARP-II, loan repayment or direct incentive, the contract is three years. Eligible practitioner categories for Tier-1 include: doctor of Allopathic Medicine (M.D.), doctor of Osteopathic Medicine (D.O.), dentist (D.D.S. or D.M.D.), and pharmacist. Tier-2 practitioners include: nurse practitioner, physician assistant, registered clinical dental hygienist, clinical or counseling psychologist (Ph.D. or equivalent), licensed clinical social worker (master's or doctorate in social work), registered nurse (R.N.), and physical therapist.

In the current Clinician Solicitation-2, there is particular emphasis on finding candidates in the above-listed "Tier-2" occupations. This emphasis is not wholly exclusive of Tier-1 candidates. Rather, the Tier-2 emphasis is due the substantial number of Tier-1 clinicians admitted to the program during Soliciation-1 (Spring 2013).

Loan repayment and/or direct incentive support will be paid up to a maximum annual benefit for the practitioner. This amount is dependent upon whether the occupation is categorized as Tier-1 or Tier-2, and whether the position is full-time or half-time, and whether it's categorized as regular-fill or very hard-to-fill.

The maximum annual benefit amounts are: Tier-1: $35,000 - $47,000 and Tier-2: $20,000 - $27,000. The program can pay a mix of loan repayment and direct incentive, but this yearly payment will not exceed the stipulated maximum annual cap. This loan repayment per se is exempt from federal personal income tax according to federal regulation governing state loan repayment programs; however, direct incentive is treated as taxable personal income. This support-for-service award is strictly in addition to, and is not supplanting of, the clinician's regular employer-provided wage and benefit.

A wide variety of health care delivery locations are anticipated to become eligible, including selected private non-profit, for-profit, and public (government) health care sites. Potential examples include, but are not limited to, community health centers, hospitals, community mental health clinics, private for-profit clinics, drug treatment facilities, long-term care facilities, and prisons, amongst others. Among the factors considered for eligibility, the site must be identified as, or being within, a state-designated health care services shortage area. An employer matching-payment is required at the rate of: 10 percent at government sites, 25 percent at private non-profit sites, and 30 percent at for-profit sites. A partial waiver of this match requirement is possible in some instances for private non-profit and for-profit sites.

In brief, both individual health care practitioners and individual health care delivery sites must apply. It's kind of a dance, or a match, or dating game.

This loan repayment per se is exempt from federal personal income tax according to federal regulation governing state loan repayment programs; however, direct incentive is treated as taxable personal income.

AHPR: So do they have to connect with one another before applying to you, or do they each apply on their own and then you match them?

Sewell: They can apply individually. We want the sites to continue to apply. And that's an open admission, that's an open application window that will be ongoing. So, a site may have the job they need filled, and we want them to fill out the application and get it in. The clinician window will close on September 30 at 5:00 PM. We believe that there will be other openings for SHARP-II. But we are now moving into more of being able to do more raw recruitment.  
It takes a while to find and to solicit and encourage people from distant locations. For example, let's say in Cincinnati there's a dentist who is sick of what he's been doing; he's thinking about life in the last frontier. It will take a while between when he first hears about this opportunity, or any opportunity in Alaska, and him moving here and getting ensconced in a job. But nonetheless, we are moving into more of the opportunity to recruit. Nonetheless, we are getting a lot of interest. What else can I tell you about it?

AHPR: Just a clarifying question, SHARP-I is a federal-state loan repayment program, and SHARP-II is a state-sponsored loan repayment and direct incentive program? Is that correct?

Sewell: Yes. I would have to say [SHARP-II] is a nonfederal sponsor, because most of the support for SHARP-II is from the state general fund, or GF. But for the first time it is required that there be an employer match. That level depends on the type of site. So public or government entities have a 10 percent match. Nonprofits have a 25 percent match. For-profits, which is another category available for the first time -- such as small privately-owned clinics -- have a 30 percent match. Both the nonprofits and for-profits have the opportunity for an application for a partial waiver of the employer match. Nonprofits get reduced to 10 percent, and for-profits could be reduced to 15 percent. That depends on documents that they would submit, but nonetheless, that opportunity is out there for those in harder straits. So, the support for SHARP-II comes mostly from the state general fund, but also required employer match.

For SHARP-I, 50 percent comes from federal HRSA-SLRP and 50 percent from non-federal -- this being state GF and the Alaska Mental Health Trust Authority, which has been very supportive of SHARP.

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recruitSHARP: Recruitment or retention tool?

AHPR: Are there any quality standards or any other standards that the site or provider has to adhere to in order to get the direct incentive or loan repayment? 

Sewell: Yes, quite a few, as a matter of fact. There is a quarterly report, which is relatively short, and it's not HIPAA-sensitive, but it does have to do with patient counts by payer type and visitation counts. It also has to do with reporting the number of days of clinical work in a quarter, and there is one attestation regarding the portion of the work week that is in direct care. That's not for administration; it's for direct care clinical employees. There are a number of things that they have to assert, [for instance,] that they will take clients with Medicaid, Medicare, and clientele on a sliding fee or charity care basis for those unable to pay.

There are a number of requirements about how the contract is maintained, for example, the kinds of records available for inspection. In terms of the application itself, we do require that the site applicant be busy developing a recruitment and retention plan. The state is very interested in doing whatever we can to support development of those site recruitment and retention plans. I think there is a lot of interest in slowing down, by whatever means, the churn and burn that happens in many health care settings. So that's required. We are in a position to work with the individual site over time, so on application day, we may be able to provide some flexibility there and support over time. But they do need to have a recruitment and retention plan.

Early on, retention candidates are by far the most likely. The longer the program is in place, and the more visibility the opportunity, the more word gets around, and the more people can be plan-ful.

AHPR: Related to that -- recruitment and retention -- do you see SHARP-I or SHARP-II as being more of a recruitment tool or a retention tool? Or can we not separate them?

Sewell: I think it's a developmental and timing issue. I think it is part of the life cycle of the program. Early on, retention candidates are by far the most likely. The longer the program is in place, and the more visibility the opportunity, the more word gets around, and the more people can be plan-ful. I'm getting a bunch of contacts now from fourth-year dental students, from fourth-year pharmacy students, people still in WWAMI. Why? Because those professional associations are getting the word out while people are still in school.

You see, [the momentum] that recruitment type of effort takes a while to build. Retention is a little different. If somebody is already in one of those jobs, then they may be contacted by their employer, who you know, has to be at the dance. And their HR department, which is already in place, gets that word out in a heartbeat to everybody in the joint. So that kind of person is going to be more likely to be contacted early, and they are more likely to respond pronto; they already have licenses as an example, they are already in Alaska.

But as time goes by and we have more of a horizon -- SHARP-II allows for a significant horizon. That gives us time to build relationships with professional schools, with national trade associations, that kind of thing. So more retention today, more recruitment tomorrow. But both are necessary, people talk about it as one or the other, but that's fallacious.

For instance, if you wanted to fill a tub with water, you've got to do two things: you've got to turn on the spigot, and you have to put in the drain plug. Otherwise you're not going to fill the tub. You have to do both.

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impactPotential impacts of the Affordable Care Act on the health workforce

AHPR: What do you know about the Affordable Care Act and the measures to address the health care workforce system and shortage? Will you speak about that?

Sewell: In terms of the impact of the Affordable Care Act (ACA) on workforce, I think it's a two-edged sword. On the one hand, ACA is anticipated to identify and help to resource something like 40 million more Americans. Most of those frankly are in lower income categories, not all but a lot. It may be that 17 million more will be added to Medicaid. At least. Those people, now more enfranchised in the system will be, reasonably, looking more for health care that they can get into, that they can afford. That, by all accounts, is expected to increase demand. Or actually, present demand that has always been there. Where will those people go? A lot of them will go to places like community health centers, not exclusively, but we are expecting that the impact of the ACA per se is going to be a big case finder; it's going to increase presenting demand. And therefore, we have to be more concerned, more interested in enhancing primary care in our state, because that's happening right now, and it's going to accelerate nationally.

Apart from demographic changes or any of the other stuff, that would be an overlay, for instance, on the arrival of large numbers of people in their later years in our demography. That means more comorbidity, more polypharmacy, and more chronic conditions. So that the ACA will be a case finder piece is an overlay on other things that are already moving. That means that we need to be more focused on workforce development, recruitment and retention, and support-for-service. Second thing is, on the other side in terms of resource, the ACA made it absolutely crystal clear through its passage and attendant regulation, loan repayment at the state level is exempt from personal federal income tax. That is a tax exempt benefit, not for direct incentives but for loan repayment. That's very helpful.

Another thing is that, depending on how this current federal budget cycle goes, we expect that the augments in loan repayment programs nationally through the National Health Services Corp will continue. It won't be our stimulus money but we expect that the federal state loan repayment program (SLRP) to continue to be resourced. And it has -- we responded to it in June 2012 and now we have another cadre of 34 clinicians that we brought on board for SHARP-I in fall 2013.

So I see both: it's increasing demand and there are also other kinds of supports that the ACA has provided for. For instance, there has been a doubling -- fairly irrelevant for our state in my view -- but there has been a doubling of the national nurse education loan repayment program, now known as Nurse Corps. That translates to only a few people in our state, but nationally, it's doubled the resources available to that support. And there are many examples like that. Under the ACA, through the National Health Service Corps, we went from roughly 18 practitioners a year, in all of Alaska, to now about 60. So there has been an impact, and we expect it will continue if the federal budget is not too heavily sequestered.

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personalThe personal side of the story

AHPR: Thank you very much, that was very informative.

I have been listening to you talk about health workforce professionals and the strategies to recruit and retain them in Alaska, and it strikes me that this is more than just a job to you. Why do you care, personally, about loan repayment and direct incentives for clinicians?

Sewell: Three reasons: One is that I've spent a large portion of my career at university in teaching, advising and administration. From that experience, I am very aware that "training" per se is only one part of the workforce development system. Over decades, I have worked with thousands of upcoming students, and they have left their mark.

The second reason is that I have worked with hundreds of professionals, both through this support-for-service effort, and through organized labor. It is clear to me that the "skill set" that the individual has is only one part, and sometimes a small part, of general effectuality in the workplace and thus tendency to "stay on." Varied experts in quality management (e.g., Deming, Juran, Shewhart) have reported on this in detail.

And finally, I have known many people who have struggled mightily under large education debts, and have seen some of its pernicious side-effects. A support-for-service strategy helps to address this, and it definitely helps interested clinicians stay working with our underserved populations.

I am very excited about the growth and stability, institutionalization of support-for-service programs in Alaska.

AHPR: Alaska Health Policy Review readers probably do not know that we share a background and interest in B.F. Skinner and behavior analysis. It may be apparent to you and I (and other Skinnerians), but could you explain the connection between practitioners' behavior and the success of loan repayment and direct incentives programs? That is, what would B.F. Skinner say about the SHARP-I and SHARP-II programs?

Sewell: B.F. Skinner was one of the very preeminent psychologists of the 20th century, and has left an enduring impact. His emphasis on role of the environment on human action has been very persuasive, especially regarding the consequences of action. Though Skinner has now passed, and I certainly cannot speak for him, the behavior analytic approach to systems relies heavily on examining the "contingencies" within which people act.

When people don't see the hoped for action, such as clinicians coming to practice in, and staying in, Alaska, then Skinner would say that you must examine the contingencies of reinforcement. Are practitioners being encouraged to be somewhere else? Are they facing systematic barriers to "doing the right things with the right populations" here are in our state? Are there accidental mis-alignments in the contingencies of reinforcement that cause clinicians to work with the lesser-priority populations, and/or in low priority locations?

Careful inspection of how we can change some of the financial inducements is bearing fruit, and that experience is similar to that of several other states' experiences and federal HRSAs. 

AHPR: That's exactly what I thought Skinner would say about SHARP!

Sewell: As you asked about Skinner, and his colleagues, in some ways, if you want new ideas then read old books. Key examples for me have been: B.F. Skinner's Reflections on Behaviorism and Society, (especially the article, "The Ethics of Helping People"), his book Science and Human Behavior and more recently books from two of his later-date colleagues: Tom Gilbert's Human Competence and Aubrey Daniels Bringing Out the Best in People.

AHPR: Those are great recommendations. B.F. Skinner's Beyond Freedom and Dignity is one of my personal favorites. And it is always great advice to read old books.

Do you have any final thoughts you'd like to share with the readers of Alaska Health Policy Review?

Sewell: I have three things to say. One is to thank Larry Weiss for his having worked so long and hard in establishing the forum and the nonprofit. So, bravo! Second thing is, I am very excited about the growth and stability, institutionalization of support-for-service programs in Alaska. It is an important additional development in our system of care. And I also want to thank, particularly, all clinicians who have chosen to practice here in Alaska. It is an important thing.

AHPR: Thank you so much for your time, Robert.

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SHARP-II Program: Applications Due September 30, 2013 at 5:00 PM

The SHARP-II Program is intended to help address the shortage of health care professionals in the state by increasing the number and improving the distribution of health care professionals. SHARP-II offers loan reimbursements ranging from $20,000 to $47,000 for eligible health care providers.

The deadline to apply is 5:00 PM AKST on September 30, 2013. Help in filling out the application is available on the website. For more information, email Robert Sewell or call him at 907-465-4065.

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Alaska Health Workforce Coalition Report
Kathy Craft

Kathryn LL. Craft, L.P.C.; M.A.; BSW is the director of the Alaska Health Workforce Coalition. Prior to her current position, Craft worked in various capacities for the Department of Health and Social Services and she was the founder and executive director of Family Centered Services of Alaska, a child and family mental health center. Craft received her Bachelor of Science in Social Work from Bowling Green State University in Ohio; her Master of Arts in Community Psychology from the University of Alaska Fairbanks; and she is a Licensed [Supervisor] Professional Counselor. Craft and husband, Mike, have three sons, one daughter, two grandsons and one granddaughter all of whom live in Fairbanks or Anchorage. Upon request from Kelby Murphy, Craft quickly drafted the following report to share with Alaska Health Policy Review reader. Thank you, Kathy.

This report was lightly edited for formatting purposes.

The Alaska Health Workforce Coalition (The Coalition) is a public-private partnership that was launched to develop a coordinated, cohesive, and effective approach to addressing the critical need for health workers in Alaska. The Coalition completed the Alaska Health Workforce Plan, which was adopted by the Alaska Workforce Investment Board as well as by Coalition member organizations. The Coalition has merged with the Alaska Mental Health Trust Authority's (The Trust) Workforce Focus Area and its partners to strengthen and sustain the efforts and pledge support for an Action Agenda that will take the planned strategies forward into implementation.

The Coalition's leadership includes both industry and government entities:
  • Alaska Behavioral Health Association (ABHA)
  • Alaska Area Health Education Centers (AHECs)
  • Alaska Native Tribal Health Consortium (ANTHC)
  • Alaska Primary Care Association (APCA)
  • Alaska State Hospital and Nursing Homes Association (ASHNHA)
  • Alaska Workforce Investment Board (AWIB)
  • Alaska Mental Health Trust Authority (AMHTA)
  • State of Alaska Department of Education and Early Development (DEED)
  • State of Alaska Department of Health and Social Services (DHSS)
  • State of Alaska Department of Labor and Workforce Development (DOLWD)
  • University of Alaska (UA)
Because the number of occupations that comprise the health workforce is so large, the Coalition realized early on that not all areas of need could be addressed immediately. Therefore, the Coalition worked diligently during 2011 to identify a reasonable set of priorities that can be advanced over the next four years. The Implementation Plan focuses on six occupations and six systemic change initiatives determined by the Coalition to be in highest need of attention.

Investments in Alaska's Health Care workforce will generate tangible results, relieving pressures of providing access to seniors, reducing the demand for outside or temporary workers, and provide career ladders for the next generation of Alaskans to have secure, well-paying jobs across the state that foster community well-being.   

Alaska is expected to add 38,749 jobs between 2010 and 2020, an increase of 12 percent. Health care and social assistance, which will benefit from the needs of an aging population, is projected to grow by about 31 percent. Health care and social assistance jobs will be booming through 2020 as the population of Alaskans age 65 and up is expected to grow by 89 percent. Ambulatory health care -- which includes practitioners, outpatient care centers, and home health services -- will gain 5,860, or 28 percent, and nursing homes and community elder care facilities will also show strong growth. The aging population will also boost social assistance, adding about 2,400 jobs -- up 25 percent for the 10-year period. In all, health care and social assistance will be responsible for a third of the total added jobs over the projection period. It will also become a larger share of the state's employment, growing from 12.8 percent in 2010 to 15 percent in 2020. Unfortunately, there are unacceptably high vacancy rates in many critical fields. The Coalition is orchestrating concerted and strategic tactics to address these needs through a comprehensive statewide plan.

Coalition successes:
  • 2012 Vacancy Study completed
  • Loan Repayment and Incentives (HB78) - SHARP II
  • Nurse Practitioner program funding
  • Physical Therapy / Physical Therapy Assistant program funding
  • Perioperative Nursing program funding
  • Perioperative cohort graduation
  • API funding for joint position with UAA
  • Established bi-annual meetings between School of Nursing and ASHNHA CNOs
  • Alaska Alliance for Direct Service Careers (AADSC) website revised and linked to Department of Labor and Workforce Development (DOL/WD) Job Center sites
  • Data needs and improvement opportunities determined
  • Health Program of Study framework and implementation supported by grants from DOL/WD and Alaska Workforce Investment Board (AWIB)
The Coalition is supporting six key initiatives in 2014:
  1. Board of Nursing. Reinstate the funding for the Nurse Aide Program Manager position within the Board of Nursing to fully support the CNA program and to assist in relieving the bottleneck created by under-staffing.
  2. Alaska Area Health Education Center (AHEC). The federal AHEC program model is to obtain State support within the first six years of establishing the AHEC program and its Centers. An increment is requested for the five Centers located in South Central, South East, Northwest, Yukon Kuskokwim Delta and the Interior and the Program Office.
  3. Professional Development and Training. The need for professional development and non-academic training is consistent across all health occupations in Alaska, including community based services, physical and behavioral health and social services. Non-academic training and professional development can include courses, certifications, conferences and other mechanisms that advance a provider's skills and expertise, enhance career progression and/or comply with regulatory organizations.
  4. Complex Behavior Collaborative. The Complex Behavior Collaborative provides intensive support and intervention to individuals with complex behaviors who are at risk of being sent out-of state or to in-state institutions. These individuals experience complex behaviors that present a high risk of danger to themselves or others to such a degree that their behaviors exceed the capacity or capabilities of local providers.
  5. Alaska's Career Pathway / Program of Study Initiative. The Alaska Tech Prep Consortium has successfully built career and technical course curriculum and connections between secondary and post secondary education so students in high school can earn college credit while still in high school. A coordinated effort is currently underway to build on this work and develop it into Career Pathways Programs of Study in Health careers that will provide an integrated education and workforce development system at the state and local levels. 
  6. Patient Centered Medical Home (PCMH). The State of Alaska and its residents would benefit greatly from improving access to primary care that utilize the Patient Centered Medical Home (PCMH) delivery model. This system is focused on what the industry calls the "triple aim": a) increased patient involvement and better more engaged patient experience; b) better overall population health; and, decreased system wide costs.  
For more information please contact Director Kathy Craft, Alaska Health Workforce Coalition, at or call 907-388-9417.

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2012 Alaska Health Workforce Vacancy Study Release Soon
Katy Branch

Katy (Katherine) Branch is the director of the UAA Alaska Center for Rural Health, Alaska's AHEC (Area Health Education Center) and project manager for the 2012 Alaska Health Workforce Vacancy Study. Branch also quickly and graciously responded to a last moment request by Kelby Murphy for the following information. Thank you, Katy.

The questions and answers were lightly edited for formatting purposes.

What is the 2012 vacancy study? Who/what does it measure?

Branch: The 2012 Alaska Health Workforce Vacancy Study (HWVS) is a point-in-time analysis of vacant positions existing among 157 occupations across the industries that employ health workers. A total of 897 employers were sampled and the survey achieved a 67 percent response rate which represents 79 percent of the health workers employed in Alaska.

The study provides data on the following questions:
Asked for each occupation separately:
  • How many total positions do you have? (number of positions, not FTEs)
  • Of the currently filled positions, how many are filled by travelers, locums, temporary, contract, relief or pool employees that you would prefer to have filled by a regular employee?
  • How many positions require prior work experience in addition to any training/education you require?
  • How long have you been trying to fill the position that has been open the longest?
Asked of each employer, generally:
  • What are the top two reasons for not being able to fill or hire positions at your organization?
  • What are the top two reasons for not being able to retain employees at your organization?
Furthermore, since the 2012 HWVS utilized the Alaska Standardized Health Occupations Taxonomy, which includes a crosswalk of each occupation to the Department of Labor's Standardized Occupation Classification (SOC) codes, the dataset can be used in conjunction with turnover, resident/non-resident and other statewide resources to maximize its utility.
AHPR: When will the results be published?

Branch: The report is currently being written and should be published in October 2013.

Presentations and data can be requested now for immediate needs.

AHPR: Who might benefit from the data/findings? How might they be used?

Branch: Previous Alaska HWVSs (2001, 2003, 2005, 2007, 2009) have been used by the university to redirect and develop new health programs. Data have been used by many organizations and associations to justify a need for health care services or workforce programs through grants and other funding sources. Likewise, the information is used to inform policy by legislators and other policy makers around recruitment needs, health access information and quality of care, amongst other issues. The benefits of this study are many, especially in these economic times when the level of competition for every funding source is so high.

AHPR: Who can readers contact for more information?

Branch: Email me, Katy Branch, director, Alaska Center for Rural Health, Alaska's AHEC and project manager for the 2012 Alaska HWVS or call me at 907-786-6705.

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Please Respect Our Copyright

Alaska Health Policy Review is sent to individual and group subscribers for their exclusive use. Please contact us for information regarding significant discounts for multiple subscriptions within a single organization. Distributing copies of the Alaska Health Policy Review is prohibited under copyright restrictions without written permission from the editor; however, we encourage the use of a few sentences from an issue for reviews and other "Fair Use."

We appreciate your referral of colleagues to the ACPP website in order to obtain a sample copy. The Alaska Center for Public Policy holds the copyright for Alaska Health Policy Review. Your respect for our copyright allows us to continue to provide this service to you.

For all related matters, please contact the managing editor, Jacqui Yeagle.


Healthy Alaskans 2020 Top 25 Alaska Health Concerns Released

Reducing the rates of cancer, suicide, domestic violence, and obesity are among the 25 Leading Health Indicators (LHIs) released by Healthy Alaskans 2020 this week. The indicators will guide the efforts in Alaska over the next decade to improve health and ensure health equity for all Alaskans. Target goals for each of the 25 indicators have been established. The next step will be to initiate efforts, or increase existing efforts, to reach those goals. 

Healthy Alaskans 2020 is part of the national Healthy People 2020 and is a joint effort between the state of Alaska Department of Health and Social Services and the Alaska Native Tribal Health Consortium. A group of Alaska subject matter health experts selected the indicators after months of collaboration with each other and with the input of the Alaska community via public surveys.

Full List of 25 Leading Health Indicators

Review more information about the 25 LHIs, including target goals, on the Healthy Alaskans 2020 website.

1. Cancer mortality rate per 100,000 population

2. Percentage of adolescents who have not smoked cigarettes or cigars or used chewing tobacco, snuff, or dip on one or more of the past 30 days

3. Percentage of adults who currently do not smoke cigarettes

4. Percentage of adults who meet criteria for:    
  • Obesity
  • Overweight

5. Percentage of children and adolescents who meet criteria for:

  • Overweight (Adolescents)     
  • Obesity (Adolescents)     
  • Overweight (Children)     
  • Obesity (Children)    

6. Percentage of Alaskans who meet the CDC's Physical Activity Guidelines for Americans:      

  • Adults     
  • Adolescents      

7. Suicide mortality rate per 100,000 population:      

  • Among population aged 15 - 24 years     
  • Among population aged 25 years and older      

8. Percentage of adolescents who felt so sad or hopeless every day for 2 weeks or more in a row that they stopped doing some usual activities during the past 12 months      


9. Mean number of days adults aged 18 and older report being mentally unhealthy     


10. Percentage of adolescents with 3 or more adults who they feel comfortable seeking help from  


11. Rate of unique substantiated child maltreatment victims per 1,000 children 


12. Rate of rape per 100,000 population     

13. Percentage of adolescents who were ever hit, slapped, or physically hurt on purpose by their boyfriend or girlfriend during the past 12 months    

14. Alcohol induced mortality rate per 100,000 population      


15. Percentage of persons who report binge drinking in the past 30 days based on the following criteria:      

  • Adults: five or more drinks for men; 4 or more drinks for women on one occasion     
  • Adolescents: 5 or more alcoholic drinks in a row within a couple of hours, at least once in the past 30 days     

16. Unintentional injury mortality rate per 100,000 population     

17. Percentage of children aged 19-35 months who do receive the ACIP recommended vaccination series     

18. Incidence rate of Chlamydia trachomatis per 100,000 population     


19. Percentage of rural community housing units with water and sewer services

20. Percentage of the Alaskan population served by community water systems with optimally fluoridated water    

21. Percentage of women delivering live births who have not received prenatal care beginning in first trimester of pregnancy     

22. Rate of preventable hospitalizations per 1,000 adults based on the Agency for Healthcare Research and Quality     

23. Percentage of adults reporting that they could not afford to see a doctor in the last 12 months    


24. Percentage of residents living above the federal poverty level      


25. Percentage of 18-24 year olds with high school diploma or equivalency  


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Commonwealth Fund Reports: Meeting the Need of Low-Income Populations

Two new reports from the Commonwealth Fund highlight how well, or not, states are meeting the needs of their low-income populations.

Released just this week, the Commonwealth Fund's Health Care in the Two Americas: Findings from the Scorecard on State Health System Performance for Low-Income Populations, 2013 looks at the health care experiences of low-income Americans and finds that they vary greatly depending on geography.

Among the findings:
  • For low-income populations, there are wide differences across states in access, quality and safety, and health outcomes.
  • Health system performance for low-income populations in leading states is often better than the national average and the high-income populations in other states.
  • Income-related health care disparities exist within states and across all areas of health system performance.
The scorecard compares 30 key indicators in terms of access to care, prevention and quality, potentially avoidable hospital use, and health outcomes. Based on the experience of their respective low-income group, states are ranked from best to worst on each of the 30 performance indicators.

In addition to reading the full report, you can watch an interactive presentation, A Tale of Two States: The Health Care Income Divide Visualized, that visually explains some of the key findings.

An earlier report, In States Hands: How the Decision to Expand Medicaid Will Affect the Most Financially Vulnerable Americans, contends that in states where Medicaid is not expanded, a significant portion of recently uninsured, low-income adults will be unable to fully benefit from provisions in the Affordable Care Act. 

Visit Commonwealth Fund to read the study and view the infographic.

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Health Systems in Transition Series Review of U.S. Health System Issued

A large, well-trained workforce, quality specialists, robust health sector research, and some of the best medical outcomes in the world are among the U.S. health systems strengths. Its weaknesses: incomplete health care coverage, high health care expenditures, and unequal distribution of resources and outcomes across the country and among different population groups. That is the word from the European Observatory on Health Systems and Policies' Health Systems in Transition (HiT) review of the U.S. health system.

The Health Systems in Transition series is a compilation of detailed country-specific information using a common template to facilitate comparisons between the different countries. You can learn more about HiTs by visiting  the European Observatory on Health Systems and Policies. You can also visit their site to download the full U.S. report.

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Are You Interested in Learning More about Policy in Alaska?

Do you have a public policy topic you want to explore? Let us know. Alaska Center for Public Policy seeks to sponsor community-led special research projects. We may be able to provide mentoring for your project idea.

ACPP also seeks volunteers to help with organizational efforts. The following volunteer positions are available. Other ideas are also welcome.

Affordable Care Act researcher: Are you curious about what's in the new health care law? Join us to track the implementation of the ACA. Duties may include
  • Report to ACPP staff and general public on progress and changes to the law.
  • Write white papers, 3 - 5 pages in length, on aspects of the ACA of choice, in consultation with ACPP staff.
  • Attend community meetings about the ACA.
  • Update the ACPP blog and Facebook page with relevant information and promote public events.
  • Generate topic-related content for Alaska Health Policy Review (i.e., get published!).
  • Commitment: 10 hours a week.
General topics researcher: Do you need a reason to research the policy issues that matter to you? Pick a topic and start investigating! Duties may include
  • Conduct policy-related research; write articles for the ACPP blog, Facebook page, and Alaska Health Policy Review.
  • Prepare press releases.
  • Write two white papers, 3 - 5 pages in length, on policy-related topics of choice, in consultation with ACPP staff.
  • Commitment: 10 hours a week. 
Development/marketing coordinator: Do your long-term goals include being a lead researcher with several important grants under your belt? Do you have ideas for capacity building and marketing? Take the first step toward your goals as an intern at ACPP. Duties include
  • Consult with ACPP staff to research and respond to grant proposals.
  • Develop a marketing plan for ACPP.
  • Commitment: 10 hours a week.
Communications and social media coordinator: Are you an expert with fancy social media apps and technology? Do you want to use your skills to support a fun and passionate non-profit communicate the latest on hot policy topics in Alaska? Duties for this position include
  • Manage the ACPP blog and Facebook page.
  • In conjunction with ACPP staff, develop strategies to share the work of ACPP with the general public.
  • Commitment: 10 hours a week.

Do you want the skills and knowledge needed to debate the latest policy topics with your friends and colleagues? Look no further, the Alaska Center for Public Policy can help you!   


For more information contact Kelby Murphy, or visit ACPP and complete an application. 


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Subscribe to Alaska Health Policy Review
The Alaska Health Policy Review is issued electronically, weekly during the regular legislative session and monthly the rest of the year. A standard individual 12-month subscription to the Alaska Health Policy Review is available for $600. Note: Current subscribers will see the change in cost reflected in their next invoice.

During the legislative session, Alaska Health Policy Review features a bill tracking section so you can stay informed about the status of health-related bills just by opening your email! Other features include interviews with health policy makers, original and reprinted health policy research, and a calendar of health policy-related events.  

Discount rates apply for multiple recipients in the same organization, legislators, and small nonprofit organizations. 
Don't miss an issue! Direct orders, comments, and inquiries to Alaska Center for Public Policy by email or by phone at 907-276-2277.

September is Hunger Action Month

Food Bank of Alaska estimates there are around 100,000 people in Alaska who don't know where their next meal is coming from. There are numerous ways you can get involved in local anti-hunger work. Here are just a few ideas from Mary Sullivan, director of the Department of Advocacy and Agency Relations at the Alaska Food Bank.

Learn more

Visit Food Bank of Alaska's web site

Download a calendar of activities.

Visit Feeding America's Map the Meal Gap interactive map to research the level of food insecurity overall and among children in your community.

Visit a farm or community garden in your area.


Spread the news about Hunger Action Month on Facebook and/or Twitter. Tell your friends and followers why you care about hunger in Alaska.

Write a letter to the editor or Compass piece about why you care about ending hunger in Alaska.

Write your state and federal legislators and tell them why you care about anti-hunger programs and why you want them to be protected. A simple one or two paragraph note from you will go a long way.

To find your state legislators, visit the Alaska State Legislature web site.

Contact our federal delegation.

For the latest on the Farm Bill or other important food policy, email Mary Sullivan or call  907-222-3113.


Gather food as part of the United Way of Anchorage Day of Caring Food Drive. You can deliver it any time to Food Bank of Alaska, 2121 Spar Ave, Anchorage.

Volunteer at Food Bank of Alaska to bag a large donation of Valley potatoes for distribution or to sort cans from the Day of Caring Food Drive. Email Volunteer Coordinator Christy O'Brien, or call 907-222-3116.

Call 2-1-1 to find an anti-hunger organization, food pantry, soup kitchen, shelter, etc. in your area and consider donating or volunteering. Invite your friends and family to do the same.

Volunteer at one of the Thanksgiving Blessing distribution sites, November 23, in Mat-Su and November 25, in Anchorage. Email Volunteer Coordinator Christy O'Brien, or call 907-222-3116.


Enter a team in the Anchorage CROP Walk and food drive on Sunday, September 22, 2013.

Organize a virtual food drive. Food Bank of Alaska can secure five pounds of food with every $1 donated. How many virtual pounds can you collect?

More information

Check out Food Bank of Alaska Facebook Page for the latest news.

Email Mary Sullivan, director of Advocacy and Agency Relations, or call 222-3113.

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Alaska Health Policy Calendar

This calendar of health policy and related meetings is current as of August September 17, 2013.
The 8th Circumpolar Agricultural Conference & University of the Arctic Inaugural Food Summit

When: Sunday through Thursday, September 29 - October 3, 2013
Where: Alyeska Resort, Girdwood
Other information: The conference and summit will focus on advancing food security and sustainable agriculture in the circumpolar, building an integrated vision, and creating a process for sustainable food security in northern communities.
Contact: Visit the website for more information.

Sixth Annual Northwest Tribal Water Rights Conference

When: Wednesday and Thursday, October 9 and 10, 2013
Where: Alaska Native Heritage Center, 8800 Heritage Drive, Anchorage
Other information: This year's conference will focus on creating a regional dialogue that addresses Alaska Native Water Rights and water sovereignty and discusses strategies to reduce threats to instream flows, subsistence uses, human health, food security, and management of water quality and quantity passing through traditional Native lands. Keynote speaker, Gary Harrison, will discuss Tribal versus state water rights and recent legislation in Alaska.
Contact: Visit the website or email Jen Kain for more information.

Alaska Health Workforce Coalition Behavioral Health Subcommittee Meeting

When: Thursday, October 17, 2013, 8:30 AM - noon
Where: Alaska Mental Health Trust Authority Building at 3745 Community Park Loop Suite 200, Anchorage
Other information: The meeting will focus on the 2012 Vacancy Study findings.
Contact: For more information email Kathy Craft.
8th Annual School Health and Wellness Institute

When: Thursday through Saturday, October 31 to November 2, 2013
Where: Hotel Captain Cook, Anchorage
Other information: This year's theme is Healthy Students ... Successful Learners. National and state experts will be presenting on a variety of topics including school health policy development, health and academics, cyber-safety, childhood obesity, prevention strategies, new school meal guidelines, school environmental health, trauma-informed schools, healthy youth relationships, and suicide prevention and postvention. Keynote speakers include Susan Combs, J.D.; Beverly Bradley, R.N., PhD; and Gaye Lynn MacDonald, SNS. You can register online. Scholarships are available.
Contact: Visit the website or contact Tina Day.

Alaska Brain Injury Network Brain Institute

When: Tuesday through Thursday, November 5 - 7, 2013
Where: Anchorage TBA
Other information: The institute features national and Alaska experts and
focuses on community based long-term brain rehabilitation and support strategies. Application deadline is Friday, September 20. Registration is limited. Download the application.
Contact: Email Eric Boyer or call him at 907-264-6257

Alaska Public Health Association: Annual Health Summit

When: Monday through Wednesday, January 27 - 29, 2014
Where: Hotel Captain Cook, Anchorage
Other information: There are five summit tracks: policy and system changes, public health research and evaluation, behavioral health, evidence-based public health practice and program improvement tools, and social and economic determinants of health.
Contact: Visit the website for more information or email Brenda Holden

If you have knowledge of a health policy event that you think should be included in our calendar, please email Jacqui Yeagle. Thank you.

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Alaska Health Policy Review Staff and Contributors

Kelby Murphy, Contributor and proofreader
Jacqui YeagleManaging editor