Q&A with Tom Rauner, Director of Nebraska’s Primary Care Office
Kicking off a new health workforce initiative is just one step in addressing an ongoing workforce need. A long-term impact calls for a long-term strategy of sustainability. In this interview with Tom Rauner, Director of Nebraska’s Primary Care Office, we hear about the funders and collaborators involved in Nebraska’s Health Professions Tracking Service, and how they’ve built a system that can meet changing needs while paying its own way. In addition to his role as PCO director, Rauner also serves as the HPSA and NHSC contact for the Nebraska Office of Rural Health.
Could you tell us about the driving force behind health workforce data collection in Nebraska?
Health care workforce initiatives in Nebraska have been born from the need, as in many states, to address access to health care services. There is a continual need to be proactive to meet requests by various health care professions and policy-driven questions to assess the availability of health care providers to serve the needs of people within the state. Accurate data on health care practitioners is needed by various training programs, policymakers and incentive programs.
Please tell us a little about the history of the Health Professions Tracking Service and the funding streams that came to support it.
The desire to have better information on health care provider practice status for both federal and state shortage areas led to the creation of an annual Nebraska statewide survey of health care professionals. In seeking out various health care survey methods, it was noted that the state Health Department effort to conduct surveys with licensure renewals, previously funded by the federal government, could not be sustained once federal resources were no longer available. At the time, only the National Health Service Corps program was significantly using the information in developing federal shortage areas. For a data collection program to be sustainable in Nebraska it needed to be much more robust and diversified in its usage.
The Robert Wood Johnson Foundation funds were available and we saw an opportunity to address the need for a statewide workforce database. A change in the Chancellor at the University of Nebraska Medical Center was filled by a person who previously worked at the University of Iowa Carver College of Medicine and experienced the value of having an accurate and up-to-date database of health care providers and clinics. After several meetings there was an agreement between the Nebraska Department of Health and Human Services and the University of Nebraska Medical Center to create a system to collect and maintain information on various health care providers based on a similar model to the database in Iowa.
The funding for the Health Professions Tracking Service started with some minimal funding from the Robert Wood Johnson Foundation, as part of the Practice Sights Program 1994-1998, matched by federal Primary Care Office funds and a significant contribution from the University of Nebraska Medical Center. It continues to be maintained with funding from federal grants at the Nebraska Department of Health and Human Services and private and public institutions who request this data.
How did you determine the needs for your system and what factors did you consider in looking at existing models?
There were a number of factors we reviewed in determining the best option for establishing a system to determine who, what, when, where and how many active health care providers are serving in Nebraska. We wanted to continue with the data set of information which was collected in the past and then incorporate some temporal components which would allow us to better monitor activities over time. We learned from Iowa that building the program as part of the Chancellor’s Office would create a more inclusive situation and avoid any one college being perceived as owning the data. The Health Professions Tracking Service program has recently been moved from the Chancellor’s Office to the new College of Public Health where it is anticipated to continue its’ tradition of being the best source of health workforce data in the state.
We reviewed other state efforts on collecting health care provider data and determined that what they were doing in Iowa had been sustained for a number of years and was flexible enough to accommodate a number of our long term needs. We were able to model the Iowa program by creating our own Health Professions Tracking Service, which collects and maintains high quality information on health care providers. By collaborating with the Iowa Office of Statewide Clinical Education Programs, we were able to share overlapping information on providers practicing in both of our states.
What types of collaboration, partnerships and networking make the project possible? How do participants work together to support this shared system?
In Nebraska we have focused our health care workforce data collection efforts in a partnership between the state’s Department of Health and the University of Nebraska Medical Center, Health Professions Tracking Service. UNMC is the only public medical center in the state and has primary responsibility for training individuals to provide health care services in Nebraska and surrounding states.
The survey data collected by the Health Professions Tracking Service is intended to be available at cost, and fees are used to cover expenses for data maintenance. When additional questions are added by an organization, this data belongs to that funding entity and the Health Professions Tracking Service, and is not released without the consent of the partnering entity. The collection of health workforce data is maintained in a centralized location and the minimum dataset of information is available to anyone for a standardized rate, based on the number of data elements requested. This approach makes the information fairly available to everyone, which is essential to creating an environment to encourage full participation of those for whom data is requested.
How is the data being used?
The use of the data to assess and evaluate training programs has been limited only by the capacity of those programs to utilize the information available. Programs which have used this information include the University of Nebraska Medical Center (UNMC) and various Divisions within the Department of Health and Human Services. Some recent examples using the Health Professions Tracking Service data are the UNMC Rural Health Opportunities Program, Family Physician Survey Report, Nebraska’s Health Workforce Planning Project, Nebraska’s Behavioral Health Workforce – 2000 to 2010 Report , the Health Alert Network and a current multi-state project in coordination with the Sheps Center to assess and evaluate the retention of federal and state loan repayment program participants.
How has the existence of this tracking service impacted workforce efforts in Nebraska?
The primary impact of the tracking service from my perspective continues to be one of addressing health care provider access issues. It is a helpful tool to keep interested parties working together and to provide an unbiased data source for making programmatic and policy decisions. I believe it helps bring together various entities with sometimes opposing viewpoints to address evolving healthcare access issues. The ability to have accurate information on health care provider activity is a fundamental tool to make decisions based on data and to temper anecdotal information.
There are nearly limitless possibilities for the use of this information. As an example, we even found it to be very valuable to assist with the redistribution of vaccines where they were most needed by quickly contacting clinics to determine sites willing to share any excess reserves.
What do you see as the future for the Health Professions Tracking Service?
I would hope that the Health Professions Tracking Service will continue to provide the basic information to monitor trends in health care provider workforce, aid in policy development to improve access to care and the evaluation of program impacts. In addition, I hope that it is utilized more frequently to help assess and incorporate health care reform components, such as electronic health record utilization, patient centered medical homes, accountable care organizations or any other number of activities which may occur. It is important to have historical and current trend information to keep everyone informed and create the best possible outcome.
The tracking service data collection system is flexible enough to address the changing environment of health care workforce needs and has resulted in a very valuable resource within the state. We hope to be able to maintain it for many years to come.
Tom Rauner can be reached at email@example.com or 402-471-0148.
Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.