08/18/10 – Building Incentive Programs for Primary Care Providers to Care for the Underserved
by Steve HollowayDirector, Primary Care Office, Colorado Department of Public Health and Environment
Access to primary health services is an important requisite to good health. Yet assessments by the Primary Care Office of the Colorado Department of Public Health and Environment indicate that at least 1 million Coloradans live in a community with less than half of the primary health providers needed to optimally deliver care.
The role of public health is to link people to needed health services and ensure provision and access to care. To do so, there are several ways to address the problem of provider shortages in low-income and rural communities in Colorado – among the most effective is the forgiveness of educational loan debt of health professionals in exchange for a period of service in a Health Professional Shortage Area (HPSA).
Loan repayment is effective because the average debt burden of primary care physicians at the end of training can range from $150,000 to $200,000. Other health professionals, such as nurse practitioners and physician assistants, also often carry a debt load in excess of $100,000. A substantial reduction in education debt can often influence a provider to practice in an underserved community, rather than opting for higher paying sub-specialties or for private practice in a well-served area.
While the state has administered a provider loan forgiveness program for many years, in 2008 the Primary Care Office and several stakeholders resolved to do more. House Bill 09-1111 added state resources to the Primary Care Office to expand assessment activities for shortage designations and renamed the state loan repayment program the Colorado Health Service Corps. Even more important, the bill modified statutory requirements that made it easier for the Primary Care Office to form partnerships with non-governmental funders like The Colorado Trust.
As a result, the annual investment in primary care provider incentives has increased from approximately $220,000 in 2009 to $2 million in 2010. For 2011, we have been awarded $1.3 million in federal funds, and we will use a combination of private grants and a state appropriation to double that amount.
We believe that if we do a good job of matching health care providers and underserved communities, the odds improve that providers will stay on in communities after their initial contract obligation is completed. With this in mind, the goal of the Primary Care Office and the Colorado Health Service Corps Advisory Council is to refine our process for selecting candidates based on the attributes known to predict their long-term retention in underserved areas. With such an improved process, we expect to begin reporting positive results in the next 18 months.
For more information, contact Steve Holloway.
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