Community Health Center Workforce Investment Simulation Tool
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Aim: As community health center (CHC) leaders continue to explore ways to prepare for a transition to value-based payment that rewards quality, the Mullan Institute is pleased to offer a new CHC health workforce simulation tool. Its purpose is to support deliberations within and across individual CHCs about alternative staffing approaches.
Specifically, the tool allows users to simulate alternative workforce and capital investment (suggested amount $1 million dollars) to increase some combination of quality, visits, and revenue. The tool recognizes that there are tradeoffs between these three goals. In other words, the most cost-effective investment in specific types of staff to increase quality may look very different than the most cost-effective investment to increase visits or to increase revenues.
Data and outcomes measures: The tool is based on a study conducted by the Mullan Institute that explored the relationships among CHC workforce categories, capital expenses, and quality outcomes. The study used data reported in the Uniform Data System (UDS) on two quality outcomes relating to common chronic diseases: percent of hypertensive and percent of diabetic patient adequately controlled. For more information on the data and the analytic of this model, click here [add methods sheet].
Administrative and enabling staff: Surprisingly, our original analysis did not find evidence that enabling staff and community health workers improve quality. We believe this may be because one of the roles of enabling staff, such as community health workers, is to identify high need patients in the community and bring them to the CHC. Thus, they are drawing more complex patients to the CHC, potentially negatively impacting quality scores in the short term. In the long term, however, other studies [Add citation of a couple of CHW RCTs and Quality] suggest these staff contribute to quality. We also found that administrative staff also do not contribute to quality. For this reason, we chose to combine administrative and enabling staff in this preliminary version of this tool. For the purposes of this tool, therefore, they are important to account for in the baseline staffing configuration, but do not appear to be part of the optimized staffing investments.
Comments and suggestions on this preliminary tool may be sent to [email protected].
Specifically, the tool allows users to simulate alternative workforce and capital investment (suggested amount $1 million dollars) to increase some combination of quality, visits, and revenue. The tool recognizes that there are tradeoffs between these three goals. In other words, the most cost-effective investment in specific types of staff to increase quality may look very different than the most cost-effective investment to increase visits or to increase revenues.
Data and outcomes measures: The tool is based on a study conducted by the Mullan Institute that explored the relationships among CHC workforce categories, capital expenses, and quality outcomes. The study used data reported in the Uniform Data System (UDS) on two quality outcomes relating to common chronic diseases: percent of hypertensive and percent of diabetic patient adequately controlled. For more information on the data and the analytic of this model, click here [add methods sheet].
Administrative and enabling staff: Surprisingly, our original analysis did not find evidence that enabling staff and community health workers improve quality. We believe this may be because one of the roles of enabling staff, such as community health workers, is to identify high need patients in the community and bring them to the CHC. Thus, they are drawing more complex patients to the CHC, potentially negatively impacting quality scores in the short term. In the long term, however, other studies [Add citation of a couple of CHW RCTs and Quality] suggest these staff contribute to quality. We also found that administrative staff also do not contribute to quality. For this reason, we chose to combine administrative and enabling staff in this preliminary version of this tool. For the purposes of this tool, therefore, they are important to account for in the baseline staffing configuration, but do not appear to be part of the optimized staffing investments.
Comments and suggestions on this preliminary tool may be sent to [email protected].
Instructions |
To use this tool, CHC leaders should enter their own data in four steps as detailed below. Note that the question mark next to each box title also explains each measure. Also, there is prepopulated data on a hypothetical CHC in each cell. Simply type over these numbers with your own data. (DOWNLOAD INSTRUCTIONS)
Users will find that most of the variability relates to the choice of primary care physician or advanced practice clinicians. Nurses, administration, and capital also appear to be important under certain scenarios.
We reiterate that the purpose of this tool is to provide input into deliberations about new workforce investments that can improve quality of care. The purpose is NOT to determine how to adjust existing staff, and certainly not to determine if any staff should be terminated.
- ENTER POTENTIAL NEW FUNDING: To set the context for the simulation, you may enter any potential new funding level as the amount that will be used to calculate the most cost effective investment.
- ENTER CHC QUALITY, VISITS, & REVENUE: Enter your most recent data for quality: the percent of patients with diabetes and hypertension well controlled (a measure reported in UDS), for visits (in thousands) per year, and for revenue (in millions) per year.
- ADJUST RELATIVE AIMS: Select the relative weight of 2 goals for your CHC: increasing quality and visits. You must increase values on the sliding scale for at least two of these goals to activate the weighting calculations.
- ENTER CURRENT STAFF, SALARIES, & CAPITAL: Enter your CHC’s baseline information on current staff, average salary by staff category, and total capital. Capital is a broad category reported to the IRS, including medical equipment, physical workspace, information technology, etc. For capital, enter the change in Part X Line 10a from last year to this year, plus the Part IX Line 16 in this year.
Users will find that most of the variability relates to the choice of primary care physician or advanced practice clinicians. Nurses, administration, and capital also appear to be important under certain scenarios.
We reiterate that the purpose of this tool is to provide input into deliberations about new workforce investments that can improve quality of care. The purpose is NOT to determine how to adjust existing staff, and certainly not to determine if any staff should be terminated.
ACKNOWLEDGMENT: The Community Health Center Workforce Investment Simulation Tool is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $450,000 with zero percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.
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