DELAWARE HEALTHCARE COMMISSION

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DIMER, DIDER, and State Loan Repayment Program Report

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Delaware Health Care Commission

• Mission: To promote accessible, affordable, quality health care for all Delawareans.

• Key Objectives: – Access - Promote access to health care for all

Delawareans. – Cost - Promote a regulatory and financial framework

to manage the affordability of health care. – Quality - Promote a comprehensive health care

system assuring quality care for all Delawareans.

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DHCC: Promoting Access

• Develop an appropriate supply of health care providers to assure access to care, especially primary care physicians and other primary care providers in short supply– DHCC oversees the DIMER program, the DIDER

program, and the State Loan Repayment Program– DHCC monitors the supply of Nursing providers– Conducting the Workforce Development Committee

focusing on (1) identifying provider supply and demand and (2) enhancing provider recruitment and retention

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DIMER, DIDER, SLRP Project

Gather information on DIMER, DIDER, and SLRP Programs’ participants relative to the program objectives and DHCC objectives

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DIMERDelaware Institute of Medical Education and Research

• Created by State law in 1969• An alternative to a state-supported medical

school• Provide opportunities for Delaware residents

to obtain a medical education• Reserve seats in nearby medical schools for

qualified Delaware residents

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DIMERDelaware Institute of Medical Education and Research

• 1970: Agreement with Jefferson Medical College at Thomas Jefferson University to accept at least 20 Delaware residents

• 2000: Agreement with Philadelphia College of Osteopathic Medicine (PCOM) to accept at least 6 Delaware residents (later changed to 5).

• 1990s: Grant/loan program for TJU tuition assistance to encourage Delaware service (In 2000, converted to the State Loan Repayment Program).

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DIDERDelaware Institute for Dental Education and Research

• Created by State law in 1981• To support, encourage, and promote:– the dental practice residency at CCHS– expand dental education and training

opportunities– strengthen factors supporting dental providers

deciding to practice in Delaware including loan repayments

• 2006: Agreement with Temple University School of Dentistry to accept at least 5 Delaware residents

• 2006: Tuition assistance payments to DIDER students

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SLRPDelaware State Loan Repayment Program

• 2000: Former DIMER loan/grant program converted to a broader loan repayment program in exchange for service in underserved areas

• Broadened from only students attending Jefferson through DIMER to any graduate physician

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Delaware State Loan Repayment Program

• Private, public, governmental loans qualify• Loans for undergraduate and

graduate/professional education qualify• Also, capital loans for equipment expenditures to

establish a practice in an area of high need• Funding: Combination of Federal and State – Federal/State Funds: non-profit or public facility or

practice in a federally-designated HPSA (Health Professional Shortage Area)

– State Only Funds: private, for profit facility or practice in a designated shortage area

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SLRP Eligible Disciplines

Advanced-degree Practitioners Mid-level Practitioners

Primary Care Physicians (MD/DO) Registered Clinical Dental Hygienists

Family MedicinePrimary Care Certified Nurse Practitioners

Osteopathic Practitioners Certified Nurse Midwives Internal Medicine Primary Care Physicians Assistants Pediatrics Licensed Clinical Psychologists Obstetrics & Gynecology Psychiatric Nurse Specialists General and Pediatric Psychiatry Licensed Clinical Social Workers

Medical OncologistsLicensed Prof. Counselors of Mental Health

General Practice DentistsLicensed Marriage & Family Therapists

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Eligibility to Apply

• U.S. citizen, legal resident, or a selected refugee approved by the U.S. Attorney General

• outstanding qualifying higher education loans (undergraduate and/or graduate) not in default

• valid, unrestricted license to practice in Delaware

• recruited/employed at a site located within an appropriately designated HPSA (primary care, dental, mental) or a State facility

• not have any other outstanding service obligation

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Awards

• Advanced-Degree Practitioners – up to $70,000 for 2-year commitment (additional year for $35K)

• Mid-Level Practitioners – up to $35,000 for 2-year commitment (additional year for $17.5K)

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FY2013 Budget AppropriationsDIMER

Jefferson Medical College $1,000,000 Philadelphia College of Osteopathic Medicine $250,000 University of Delaware $50,000 Christiana Care Health System $200,000 Tuition Assistance $480,000 Loan Repayment $150,000 TOTAL $2,130,000

DIDERTemple University School of Dentistry $250,000 General Practice Dental Residents Support $148,000 Tuition Assistance $27,500 Loan Repayment $90,000 TOTAL $515,500

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Methodology• Data Search– Interviews

• Local• Other states• Other professional education institutions

– Health Care Commission files (2000 and after)– Christiana Care files (pre-2000)– TJU files/databases– PCOM files/databases– Temple files/databases– Division of Professional Regulation databases– DHIN participation lists– Public media/internet

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DIMER TJU Summary

DIMER TJU 1970 to 2011

Number of DIMER Students 821Number of DIMER Graduates 722Number of DIMER Graduates with GME Complete

650

DIMER Graduates with GME in Delaware

166

DIMER Graduates with an Active Delaware License

173

DIMER Graduates Actively Practicing in Delaware

149

DIMER TJU “Return Rate” 22.9%12/6/12 16

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DIMER PCOM Summary

DIMER PCOM 2000 to 2012

Number of DIMER Students 102Number of DIMER Graduates 58Number of DIMER Graduates with GME Complete

37

DIMER Graduates with GME in Delaware 9DIMER Graduates with an Active Delaware License

9

DIMER Graduates Actively Practicing in Delaware

9

DIMER PCOM “Return Rate” 24.3%

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DIDER Temple Summary

DIDER Temple 2006 to 2012Number of DIDER Students 31Number of DIDER Graduates 15DIDER Graduates with an Active Delaware License 5DIDER Graduates Actively Practicing in Delaware 2DIDER Temple “Return Rate” 13.3%

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WWAMI

• Four other states do not have a medical school (Alaska, Idaho, Montana, Wyoming)

• Agreements with University of Washington School of Medicine (UWSOM) to form WWAMI

• Each state has a specific number of seats at UWSOM• Tuition paid by combination of appropriated state

funds and student tuition

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WWAMI

• Medical School 1st year at home state university• Medical School 2nd year at UWSOM• Medical School 3rd and 4th years required and

elective clerkships in WWAMI states

• 60% practice in WWAMI states• 50% select primary care specialties• 20% practice in HPSA areas

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“Return Rate” Comparisons

• DIMER – TJU: 22.9%• DIMER – PCOM: 24.3%• National (Public Medical Schools): 39.0%• WWAMI States– Alaska: 45%– Idaho: 50%– Montana: 40%– Wyoming: 67% --------------------------------------

• DIDER – Temple: 13.3%

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Delaware State Loan Repayment ProgramDELAWARE STATE LOAN REPAYMENT PROGRAM

FYLOAN

AWARDS* MD/DO DDS/DMDMid-Level

Practitioner Capital2001 1 1      2002 1   1    2003 3 2 1    2004 2 1 1    2005 3 3      2006 5 4 1    2007 8 4 1 2 12008 13 7 2 4  2009 15 6 5 4  2010 11 8 1 1 12011 8 5 1 1 12012 4 3   1  

TOTAL 74 44 14 13 3

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Delaware State Loan Repayment Program

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DE SLRP Service Completion 93.8%Multiple program comparison 71.0%

Delaware State Loan Repayment Program

Retention of SLRP Awardees after Completion of Service, FY2001-2012

Provider

Completed Service

Still in Progress

Stayed Left

Number Percent Number Percent

Physician 26 72.2% 10 27.8% 8

Dentist 13 100.0% 0 0.0% 4

Nurse Practitioner 5 83.3% 1 16.7% 1

Nurse Midwife 4 100.0% 0 0.0% 0

Physician Assistant 1 100.0% 0 0.0% 0

Dental Hygienist 0   0   1

TOTAL 49 81.7% 11 18.3% 14

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SUMMARY

DIMER – TJU Enrollment Meets objectiveDIMER – PCOM Enrollment Meets objectiveDIDER – Temple Enrollment Below objective in last 3 yearsDIMER – TJU “Return Rate” Lower than WWAMI programs with home

state training and GMEDIMER – PCOM “Return Rate” Lower than WWAMI programs with home

state training and GMEDIDER – Temple “Return Rate” Very LowSLRP Service Completion Rate Higher than Comparison StudySLRP Retention Very Strong (no comparison data)

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