Bowen Director Dr. Hannah Maxey presents the Playbook to the Indiana Commission to Combat Substance Use Disorder

by Zachary Ammerman | Aug 2, 2024 | Events, News, Playbook, Reports

Bowen Center Director Dr. Hannah Maxey

Bowen Center Director Dr. Hannah Maxey presented August 1 the Playbook for Enhancing Indiana’s Mental and Behavioral Health Workforce to the Indiana Commission to Combat Substance Use Disorder. Indiana faces an enormous challenge of recruiting and retaining a sufficient number of mental and behavioral health workers, with every county in the state meeting the criteria for a federally designated workforce shortage in these areas.

The results are staggering, with real-life implications for hundreds of thousands of Hoosiers:

Untreated mental illness costs Indiana $4.2 billion annually
345,000 Hoosiers who need mental health care go without
More than 50% of Hoosier youths with depression go untreated
Suicide is the leading cause of death among Hoosier adolescents

That’s why the Bowen Center created a roadmap to lessen that impact by powering up the mental and behavioral health workforce.

Watch Dr. Maxey’s presentation of the Playbook to the Indiana Commission to Combat Substance Use Disorder below, and read the Playbook on our dedicated site here.

What’s Happening in the 2024 Legislative Session?

by Madison Bott | Feb 1, 2024 | Policy, Topics of Interest

A

739

Total Bills introduced in Indiana’s 2024 Legislative Session

A

132

Total Bills identified with direct impact on health, health workforce or workforce included in the 2024 B4

A

32

Total bills identified with direct implications for health workforce & distinguished separately.

Full 2024 B4

Top Health Workforce Themes in the 2024 Legislative Session

Let’s cut to the chase. What health workforce legislation has been introduced in the 2024 session? There were a few major themes that arose. We have conceptualized these themes and summarized the outcomes below.

Nursing Workforce

This session has seen many legislative initiatives related to the nursing workforce. One such bill (SB 45) would establish additional training requirements in trauma-informed care for all licensed Registered Nurses (RN). One bill would modify certain licensure requirements for health facility administrators, allow NCLEX passage to satisfy English proficiency requirements for internationally-educated nurse applicants, and eliminate telehealth certification requirement for telehealth nurses and other telehealth providers (HB 132). The final nursing-focused bill making progress this session makes various changes to nurse licensing, education, and training regulations regarding requirements for clinical preceptors, and requirements for certain foreign nursing applicants (HB 1259).
Bills under this theme that were introduced but did not progress include: a bill removing the collaborative practice agreement with physicians and APRNS, and allows a APRN with prescriptive authority to prescribe a schedule II substance (HB 1059); a requirement for nurses to complete implicit bias training as part of their continuing education requirements (HB 1167); establishment of nurse staffing councils within hospitals in order to develop nurse staffing plans (HB 1015); allowing Certified Registered Nurse Anesthetists to administer anesthesia under the immediate presence of a podiatrist or dentist, which is currently only allowed under the presence of a physician (HB 1371).

EMS

There have been several bills introduced regarding Hoosier emergency medical services professionals (EMS) this session. HB 1142 would establish a program of recognition for first responders killed or injured in the line of duty. A new grant pilot program was introduced in SB 10 for the purpose of assisting in the costs of mobile integrated health care programs and mobile crisis teams across Indiana. Finally, SB 142 would require healthcare coverage for mobile integrated healthcare and emergency medical services for all state employees on the state employee health plan (and other insurers).
Bills under this theme that were introduced but did not progress include: HB 1118 would establish a program to support the mental health of first responders through the Indiana first responders mental health wellness fund and program.

Regulatory Changes

House Bill 1214 would add Indiana to the Dental and Dental Hygienist Licensure Compact.
Bills under this theme that were introduced but did not progress include: A bill proposing the expansion of eligible clinical experience supervision to include physicians, and psychologists for the Clinical Social Work Licensure and expansion of supervision through telehealth (SB 261); bills that would establish new licenses – Professional Music Therapists (HB 1103) and Naturopathic Physicians (SB 262); and a bill (SB 110) that would add Indiana as a member of the Social Work Compact.

Behavioral Health Workforce

A bill proposed in the House would allow a Social Worker licensee applicant to take the social worker examination during their last term of a program that meets educational requirements, and provides a letter of good standing from the director of the academic department (HB 1138). This bill would allow a student to sit for their professional exam early if all requirements in the bill are met. House Bill 1238 would add certain physician assistants and advanced practice nurses as potentially qualifying professionals to serve as competency evaluators in criminal proceedings (previously only psychiatrists and psychologists).
Bills under this theme that were introduced but did not progress include: SB 166 which would have allowed community mental health center staff to provide social work services without a license and remove examination requirement for BHHS temporary permits; SB 261 which would have expanded the qualifications for clinical experience supervisors for clinical social workers and expanded tele-supervision.

Other health workforce themes from legislators that didn’t make it to the second chamber:

Health Workforce Incentives

There were a few bills related to health workforce specific incentives, including a bill that would establish a medical school loan forgiveness pilot program (HB 1175). Another bill would establish an Indiana rural hospital and critical health care services fund, new health workforce student loan repayment program, and associated health workforce advisory board (advisory board (HB 1196).

There’s More on the B4!

One way we monitor health workforce trends is by tracking Indiana health workforce legislation through implementation of the Bowen Bi-Weekly Bill Brief or “B4.” There are many other health and workforce/education-related bills that have been introduced this session. Check out the full B4 to learn more about those bills and keep track of the active bills as they progress through the second half of session!

Full 2024 B4

Policymakers Tapping into the Power of Indiana’s Health Workforce Data

by Becky Boustani | Jun 7, 2023 | Data, Policy, Topics of Interest

The Bowen Center believes in the power of data to support informed policy.

Workforce data provides valuable insights regarding trends in and dynamics of supply, pinpoints where shortages exist and informs emerging workforce models which aim to fill gaps. The Bowen Center supports Indiana’s efforts to collect data on licensed healthcare occupations. When health professionals renew their Indiana license, they provide supplemental information through a series of questions structured to capture data needed to inform state policy, such as: where they practice, how many hours they work, demographics, and their plans for the future. Our team partners with the state to transform these data into reports and briefs that (we hope) promote a better understanding of Indiana’s health workforce, the strengths, challenges, and where opportunities exist to fill gaps.

Recently, we were approached to provide data insights on the contraceptive care workforce – where Indiana had potential contraceptive care providers, and where there were gaps. These data were used to inform 2023 House Enrolled Act 1568. This bill expanded the role of trained pharmacists by allowing them to prescribe hormonal contraceptives to adult women, a service that was previously held by traditional prescribers – generally physicians, advanced practice registered nurses, and physician assistants. Lawmakers wanted to understand the potential impact on access to contraceptive care if pharmacists were granted the ability to contribute as prescribers.

Read the Brief Here

Leveraging workforce data, the Bowen Center generated a policy brief and map that examined the distribution of primary care and maternity care practitioners and pharmacists across Indiana. The map revealed that pharmacists were spread out more widely across the state than primary care and maternity care practitioners, with at least one pharmacist practicing in every one of Indiana’s 92 counties, including within counties that are underserved by traditional contraceptive prescribers. Supporters of the legislation used this map during debate in the statehouse, and backed by evidence, HB 1568 successfully passed through the legislature and was signed into law by the governor. More information about the methodology and findings from this research request can be found in our accompanying brief.

What makes Effective Data?

In fulfilling this data request, we realized this exercise might provide us an opportunity to share our thoughts on the “values” that a dataset might hold in order to be used most effectively to support informed policy.

1. Timeliness and Accuracy.

It is crucial to use the most up-to-date information to have a current understanding of labor market conditions. Outdated or inaccurate data can lead to decisions based on flawed information.

The supplemental data used for the Bowen Center’s primary care, maternity care, and pharmacist map were collected within the last two to three years, ensuring its relevancy. Physician and APRN data came from the 2021 license renewal cycle, while pharmacist data was sourced from the 2020 report. To identify primary care shortage areas and maternity care capacity, a trusted federal source, the Health Resources & Services Administration, was utilized.

2. Relevance.

Workforce data analysis should align with the strategic goals and priorities of the inquiry and should provide actionable insights that can help improve stakeholder understanding without the addition of extraneous data points. This means that the data should be sufficient to provide an understanding of the workforce’s capacity and capabilities with the minimum amount of information needed to answer the research question.

In the case of the policy relevant inquiry related to contraception prescribing, the quick turnaround map was created to gain a better understanding of the issue. The map included only relevant data, designed to be easily comprehensible “at a glance.” Each data element in the map contributed to answering the central question: Might access to contraceptives be impacted if pharmacists were permitted contraceptive prescribing privileges?

3. Comprehensiveness.

To maximize the utilization of data, it is ideal to have a complete picture of the workforce that addresses the initial query. It’s important to consider all the necessary information that contributes to an accurate understanding of workforce distribution.

Indiana’s practice of collecting supplemental data during the licensure renewal process provides essential workforce information that would not be gleaned from the license renewal data alone. Without this additional data, Indiana would be unable to identify such elements as practice location, FTE and practitioner specialty, severely hampering a comprehensive understanding of the workforce in Indiana. From this valuable supplemental data, we were able to incorporate both primary care and maternity care capacity as separate mapped elements since both groups can prescribe hormonal contraceptives. By including all significant workforces, we assure that the take-away is a comprehensive depiction of the current state of relevant healthcare in Indiana.

4. Balance of Granularity and Aggregation

Data should strike a balance between being detailed enough to capture the nuances of the workforce landscape and providing an overview of the bigger picture.

The policy map achieved this balance by using both granular and aggregate data in a user-friendly format. Indiana Primary Care Health Professional Shortage Areas and Maternity Care Practitioner capacity were aggregated across counties using two different visual tools, while pharmacist data was presented more granularly with individual pinpoints for each practice location. This allowed for a quick understanding of workforce capacity in specific areas without losing sight of the broader workforce gaps.

Research and data analysis are vital components of the policy and legislative process. Data analysis that is carefully considered and displayed in a user-friendly way can play an important supporting role in policymaking by providing actionable, evidence-based insights. The successful passage of House Enrolled Act 1568-2023 in Indiana demonstrates that data-driven approaches can help policymakers make informed decisions that can positively impact the health and well-being of people in the state. Ultimately, it contributes to the delivery of comprehensive, high-quality healthcare. At the Bowen Center, we are honored to be able to provide data that empowers Indiana policymakers.

Through My Eyes: Work Experience in Diversity

by Chelsea Sparks | May 24, 2023 | Data, Policy, Topics of Interest

Often, I have heard that you learn more by way of experience than from school. I found this to be true as during the past year and a half that I have worked with the Bowen Center. I have learned valuable information that has made me a well-rounded public health professional and have gained an abundance of skills. The Bowen Center has taught me about the importance of access to care, diversity in our health workforce, and expanding care through policy implications such as health workforce training programs, loan repayment programs, and other means to retaining our health workforce.

Diversity in the health workforce is important for creating a thriving and successful work environment and work culture for all health professions. Moreover, diversity in the health workforce is crucial for both better access to care and higher quality of care for underserved communities (Walker, et al, 2012).[1] Recruitment of a diverse staff can lead to the removal of barriers to health-care access in these underserved communities. A workforce that is diverse in race, ethnicity, sex, and age can lead to delivering the best possible care to diverse patient populations (Stanford, 2020).[2] Higher quality of care in these areas then leads to increased patient satisfaction, which can also improve the overall health outcomes of Indiana (Gomez, 2019) (Harker, 2020)[3], [4]. Considering this impact, it is no wonder that recruiting and retaining a diverse health workforce has become a top priority at the state and federal levels.

I participated in an examination of diversity in Indiana’s health workforce, and the first examination used historical data specific to Indiana physicians gathered during license renewal. This data shows much growth in diversity among physicians over the last 25 years. In 1997, less than 20% of physicians identified as non-white. In 2021, nearly one-third of fell into this group. Likewise, gender diversity has also increased, with women making up 18% in Indiana physicians 1997 and 32% in 2021.

More than looking at the numbers, I also examined the multitude of programs and initiatives which address workforce diversity and aim to support early recruitment of health professionals from underrepresented communities. Elements of these programs and initiatives may include incentive programs, such as scholarships and loan repayment options. It is essential to understand how important programs like these are and their roles in increasing the amount of diversity in the health workforce in Indiana.

Chelsea Sparks

Graduate Research Assistant

I utilized this experience in my graduate work by creating a pilot program for one of my master’s degree courses with guidance from the Bowen Center. This program was named “Better Together in the Physician Workforce” and aimed to promote culturally inclusive, and diversity driven workplace environments, starting with 3 program implementation locations. This program promotes change in diversity at these three locations through increased educational opportunities on the importance of workplace diversity, increased culturally sensitive materials, and opportunities for scholarship. The intended outcome of this program is that physicians working in these implementation locations will feel a better sense of belonging in their work environment, workplace culture will harbor diversity and inclusion overall, and physicians could further their education from funding opportunities such as scholarships or grants. It is important to me that I have contributed in some way to achieving health equity and the better representation of underrepresented minority group members and I feel as though I have done just that by building this program. This program has not been implemented; however, it is important to me that the entire program structure be built in hopes of one day launching a similar program and increasing diversity rates among the health workforce.

From this position, I now have several useful skills and even publications that I possess and can take with me to my future career. I currently have been working on a diversity report series that encompasses 11 different health professions for about a year now. This report series provides longitudinal trends in health workforce diversity in hopes of informing existing programs which aim to diversify the health workforce. I understand that I have contributed not only to public health, but also population health. Throughout this working experience I have been able to learn about higher level concepts regarding healthcare and how these concepts are tied to specific policies and impact public health overall. Not only did this graduate employment opportunity allow me to build public health skills, but it also gave me a deeper understanding of how the health workforce and other issues impact health equity. I now understand what racial concordance means and how healthcare workers reflect the populations that they serve

My colleagues at the Bowen Center have not only been the best mentors but have also given some of the best guidance and life advice to help me on my way. The Bowen Center also provides a space where I have maintained close relationships with my mentors and other coworkers. I understand that the next individual welcomed to the team as a graduate research assistant will gain a large amount of knowledge and plentiful experiences. I am thankful for this opportunity and am excited for the future.

If you would have asked me if I would have thought that at the start of my college career I would be in school for 7 years, I would have laughed. So, as for me, I am not sure what my future holds, but I am sure that I am prepared for my next adventure as this team has helped me prepare a foundation for the career that I will pursue.

References

[1] Walker, K. O., Moreno, G., & Grumbach, K. (2012). The Association Among Specialty, Race, Ethnicity, and Practice Location Among California Physicians in Diverse Specialties. Journal of the National Medical Association, 104(1-2), 46–52. https://doi.org/10.1016/s0027-9684(15)30126-7

[2] Stanford FC. The Importance of Diversity and Inclusion in the Healthcare Workforce. J Natl Med Assoc. 2020 Jun;112(3):247-249. doi: 10.1016/j.jnma.2020.03.014. Epub 2020 Apr 23. PMID: 32336480; PMCID: PMC7387183.

[3] Harker, L. (2020, January 15). Unlocking the Benefits of an Inclusive Health Workforce. Georgia Budget and Policy Institute. Retrieved November 14, 2022, from https://gbpi.org/unlocking-benefits-diverse-health-workforce/

[4] Gomez LE, Bernet P. Diversity Improves Performance and Outcomes. J Natl Med Assoc. 2019 Aug;111(4):383-392. doi: 10.1016/j.jnma.2019.01.006. Epub 2019 Feb 11. PMID: 30765101.

Indiana’s 2023 Legislative Session Wrap Up: Health Workforce Takeaways

by Cleveland Dietz | May 4, 2023 | Policy, Topics of Interest

What is the B4?

The Bowen Center is committed to providing relevant and timely data to inform health workforce policy. A few years ago, we realized the best way to fulfill that commitment was to keep close tabs on the topics of interest by Indiana stakeholders. One way we monitor this is by tracking Indiana health workforce legislation through implementation of the Bowen Bi-Weekly Bill Brief or “B4.” When we first developed the B4, we kept it as an internal tracker to keep our team up-to-date on health workforce happenings. We quickly realized that this tracker could serve additional audiences and we could pivot its dissemination to a forward-facing tool.

Now in its fifth iteration, the B4 experienced a re-design in 2022 to enhance accessibility of customized information for users through the use of an interactive table hosted on the Bowen Portal. Users can now search for keywords of interest and filter by topic area. Below are this year’s topical categories for health workforce-related legislation: (Note: in the instance a bill may fall under multiple categories, it was assigned to a primary topic. We are already making plans for 2024’s B4 to allow for tagging of multiple topical areas.)

Topic Areas

Behavioral Health (substance use and mental health),
Corrections
Direct Care Workforce
Maternal/Child Health
Nursing Workforce
Oral health
Other
Physician Workforce
Prevention & awareness (public health, infrastructure, and healthy and active living)
Regulatory (Agency, Boards, PLA)
Safety net (Medicaid, SNAP, TANF, SNAP, etc.)
School Health
Workforce Pipeline (Education)
Workforce Incentive Program

What else did we do new in 2023?

In addition to making the B4 more interactive, we expanded its reach. Before 2023, we focused almost exclusively on bills with a primary focus on the health workforce. Think health workforce incentive program development, new license types, educational policy changes, etc. While planning for 2023, we realized that there are many instances where the bills that impact health care professionals the most are broader bills that impact both the health workforce and other sectors. In 2023, we developed a new structure that monitors bills with a primary focus on the health workforce (of course), but we began including bills that also impact health or workforce/education. These major category areas can be found within the 2023 B4.

Top Health Workforce Themes in the 2023 Legislative Session

Let’s cut to the chase. What health workforce legislation passed in the 2023 session? There were a few major themes that arose. We have conceptualized these themes, and summarized the outcomes below.

Long-term Supports and Services Workforce

Outlines that a home health agency is not required to conduct a preemployment physical on prospective staff prior to patient contact; Allows home health aides to administer g- or j-tube feedings if certain criteria are met (Senate Enrolled Act 474)
Outlines requirements for a direct support professional registry which direct support professionals must be on in order to provide direct support services, and describes requirements for the creation of a training curriculum and growth opportunities for direct support professionals (House Enrolled Act 1342)

Provides that the Family and Social Services Agency Division of Aging may hire a dementia care coordinator to establish a “dementia care specialist” program to establish training requirements for dementia care specialists employed by area agencies (House Enrolled Act 1422)
Sets the professional requirements for an individual to serve as a residential care facility administrator and creates notification requirements to the Indiana department of health when there is a vacancy or new hire of a residential care administrator. (House Enrolled Act 1461)

Licensure Compacts 

Establishes Indiana’s participation in Occupational Therapy Licensure Compact to allow occupational therapists and occupational therapy assistants to practice in Indiana under an out-of-state license if certain criteria are met (Senate Enrolled Act 73)
Professional Counselors Licensure Compact to allow professional counselors to practice in Indiana under an out-of-state license if certain criteria are met (Senate Enrolled Act 160)
Recommendation for interim study committee to study whether Indiana should adopt an interstate mobility to allow individuals with licenses in another state to practice in Indiana (Senate Enrolled Act 400)

Removal or Reduction of Noncompetitive Agreements: 

Beginning July 1, 2023, primary care physicians and employers may not enter into a noncompete agreement. This legislation also outlines procedures for eligible physicians to purchase a release from a noncompete agreement for agreements entered into after July 1, 2023. The legislation also establishes circumstances under which an agreement is not enforceable (Senate Enrolled Act 7)