DELAWARE HEALTH CARE COMMISSION DIMER DIDER and State

DELAWARE HEALTH CARE COMMISSION ***** DIMER, DIDER, and State Loan Repayment Program Report 12/6/12 1

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. 12/6/12 2

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 (2) enhancing provider recruitment and retention 12/6/12 3

DIMER, DIDER, SLRP Project Gather information on DIMER, DIDER, and SLRP Programs’ participants relative to the program objectives and DHCC objectives 12/6/12 4

DIMER Delaware 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 12/6/12 5

DIMER Delaware 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). • 1990 s: Grant/loan program for TJU tuition assistance to encourage Delaware service (In 2000, converted to the State Loan Repayment Program). 12/6/12 6

DIDER Delaware 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 12/6/12 7

SLRP Delaware 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 12/6/12 8

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 9

SLRP Eligible Disciplines Advanced-degree Practitioners Mid-level Practitioners Primary Care Physicians (MD/DO) Registered Clinical Dental Hygienists Family Medicine Primary 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 Oncologists General Practice Dentists Licensed Prof. Counselors of Mental Health Licensed Marriage & Family Therapists 10

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 11

Awards • Advanced-Degree Practitioners – up to $70, 000 for 2 -year commitment (additional year for $35 K) • Mid-Level Practitioners – up to $35, 000 for 2 year commitment (additional year for $17. 5 K) 12

FY 2013 Budget Appropriations DIMER Jefferson Medical College Philadelphia College of Osteopathic Medicine University of Delaware Christiana Care Health System Tuition Assistance Loan Repayment TOTAL DIDER Temple University School of Dentistry General Practice Dental Residents Support Tuition Assistance Loan Repayment TOTAL 12/6/12 $1, 000 $250, 000 $200, 000 $480, 000 $150, 000 $2, 130, 000 $250, 000 $148, 000 $27, 500 $90, 000 $515, 500 13

Methodology • Data Search – Interviews • Local • Other states • Other professional education institutions – – – – 12/6/12 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 14

1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Delaware Matriculants at JMC/TJU, by Year 35 30 25 20 15 10 5 0 12/6/12 15

DIMER TJU Summary DIMER TJU 1970 to 2011 Number of DIMER Students 821 Number of DIMER Graduates 722 Number 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” 12/6/12 22. 9% 16

Delaware Matriculants at PCOM, by Year 14 12 10 8 6 4 2 0 2000 12/6/12 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 17

DIMER PCOM Summary DIMER PCOM 2000 to 2012 Number of DIMER Students Number of DIMER Graduates with GME Complete DIMER Graduates with GME in Delaware DIMER Graduates with an Active Delaware License DIMER Graduates Actively Practicing in Delaware DIMER PCOM “Return Rate” 12/6/12 102 58 37 9 9 9 24. 3% 18

DE Matriculants at TUKSOD, by Year 7 6 5 4 3 2 1 0 2006 12/6/12 2007 2008 2009 2010 2011 2012 19

DIDER Temple Summary DIDER Temple 2006 to 2012 Number of DIDER Students Number of DIDER Graduates with an Active Delaware License DIDER Graduates Actively Practicing in Delaware DIDER Temple “Return Rate” 12/6/12 31 15 5 2 13. 3% 20

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 12/6/12 21

WWAMI • Medical School 1 st year at home state university • Medical School 2 nd year at UWSOM • Medical School 3 rd and 4 th years required and elective clerkships in WWAMI states • 60% practice in WWAMI states • 50% select primary care specialties • 20% practice in HPSA areas 12/6/12 22

“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% 12/6/12 23

Delaware State Loan Repayment Program FY DELAWARE STATE LOAN REPAYMENT PROGRAM LOAN Mid-Level AWARDS* MD/DO DDS/DMD Practitioner Capital 2001 1 1 2002 1 1 2003 3 2 1 2004 2 1 1 2005 3 3 2006 5 4 1 2007 8 4 1 2008 13 7 2 4 2009 15 6 5 4 2010 11 8 1 1 1 2011 8 5 1 1 1 2012 4 3 1 TOTAL 74 44 14 13 3 12/6/12 24

Delaware State Loan Repayment Program DE SLRP Service Completion Multiple program comparison 12/6/12 93. 8% 71. 0% 25

Delaware State Loan Repayment Program Retention of SLRP Awardees after Completion of Service, FY 2001 -2012 Completed Service Stayed Left Number Percent Still in Progress 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 Physician Assistant 1 100. 0% 0 Dental Hygienist 0 0 1 49 81. 7% 11 18. 3% 14 Provider TOTAL 12/6/12 26

SUMMARY DIMER – TJU Enrollment Meets objective DIMER – PCOM Enrollment Meets objective DIDER – Temple Enrollment Below objective in last 3 years DIMER – TJU “Return Rate” Lower than WWAMI programs with home state training and GME DIMER – PCOM “Return Rate” Lower than WWAMI programs with home state training and GME DIDER – Temple “Return Rate” Very Low SLRP Service Completion Rate Higher than Comparison Study SLRP Retention Very Strong (no comparison data) 12/6/12 27