Performance of Health Care Workforce Programs — Joint Commission on Health Care, Report Document #527 (2024)
Summary
This is the Joint Commission on Health Care report Performance of Health Care Workforce Programs, Report Document #527, to the Governor and the General Assembly of Virginia, 2024. It says Virginia's General Assembly appropriated $683 million in state funds for 34 health care workforce programs in Fiscal Years 2023 and 2024, including $318 million for 24 programs exclusively focused on health care workforce and $365 million for 10 programs partially focused on it. It states that Nineteen programs have no reporting requirements and only five programs report a positive impact on measured program outcomes. The report says there are 2 policy options, one directing a review of program eligibility and one directing a plan for reporting and monitoring.
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JOINT COMMISSION ON HEALTH CARE
PERFORMANCE OF HEALTH CARE WORKFORCE PROGRAMS
REPORT TO THE GOVERNOR AND THE
GENERAL ASSEMBLY OF VIRGINIA
REPORT DOCUMENT #527
COMMONWEALTH OF VIRGINIA
RICHMOND
2024
Code of Virginia § 30-168. Joint Commission on Health Care
The Joint Commission on Health Members
Care (the Commission) is
established in the legislative branch
Chair
of state government. The purpose The Honorable Delegate Rodney T. Willett
of the Commission is to study, Vice Chair
report and make recommendations The Honorable Senator Ghazala F. Hashmi
on all areas of health care
provision, regulation, insurance,
liability, licensing, and delivery of
Delegate N. Baxter Ennis
services. In so doing, the Senator Barbara A. Favola
Commission shall endeavor to Delegate C.E. (Cliff) Hayes, Jr.
ensure that the Commonwealth as
provider, financier, and regulator Senator Christopher T. Head
adopts the most cost-effective and Delegate M. Keith Hodges
efficacious means of delivery of
Delegate Patrick A. Hope
health care services so that the
greatest number of Virginians Senator Mamie E. Locke
receive quality health care. Further, Senator L. Louise Lucas
the Commission shall encourage
the development of uniform Delegate Robert D. Orrock, Sr.
policies and services to ensure the Senator Stella G. Pekarsky
availability of quality, affordable
Senator Todd E. Pillion
and accessible health services and
provide a forum for continuing the Delegate Marcia S. Price
review and study of programs and Delegate Atoosa R. Reaser
services.
Delegate Mark D. Sickles
The Commission may make
recommendations and coordinate
Senator David R. Suetterlein
the proposals and Delegate Howard Otto Wachsmann, Jr.
recommendations of all
commissions and agencies as to Staff
legislation affecting the provision Sarah Stanton, JD, MPA
and delivery of health care. For the
Executive Director
purposes of this chapter, “health
care” shall include behavioral Jen Piver-Renna, PhD
health care. Deputy Director
Kyu Kang
Senior Health Policy Analyst
Estella Obi-Tabot, MSPH
Senior Health Policy Analyst
Emily Atkinson, MPH, CHES
Assistant Health Policy Analyst
Agnes Dymora
Executive Assistant/Office Manager
Performance of Health Care
Workforce Programs
Contents
In brief .................................................................................................................................. i
Virginia’s health care workforce programs ......................................................................... 2
Program reach, implementation quality, and impact ......................................................... 8
Reporting requirements and monitoring capacity ........................................................... 10
Appendix 1: Reports on Virginia’s Health Care Workforce ................................................ 17
Appendix 2: Study Resolution............................................................................................ 22
Appendix 3: Programs Identified for Consideration .......................................................... 23
Appendix 4: 2023 Program Inventory ................................................................................ 30
Appendix 5: Sources and Methods .................................................................................... 36
Performance of Health Care
Workforce Programs
POLICY OPTIONS IN BRIEF FINDINGS IN BRIEF
There are 2 policy options in the
report for consideration. Virginia’s General Assembly appropriated $683 million in state
funds for 34 health care workforce programs in Fiscal Years 2023
Option: Direct a review of health and 2024
care workforce programs’ eligibility, The Virginia General Assembly appropriated $318 million for 24
screening criteria, and service programs exclusively focused on health care workforce, and $365
requirements via letter to state million for 10 programs partially focused on health care workforce,
agencies. The review should among other occupational sectors. Ninety percent of state funding
identify opportunities to align supports programs intended to expand the pipeline of health care
programs with Virginia’s health care professionals in secondary, post-secondary, and post-graduate
workforce needs based on available settings. The remaining programs aim to retain health care
supply and demand data. professionals in Virginia with financial incentives or salary
(Option 1, page 10) adjustments, or by improving workforce well-being.
Option: Direct the Virginia Health State-funded programs are reaching their intended target
Workforce Development Authority, audience but lack focus on areas of most need
in collaboration with Virginia Nearly 80 percent of programs provide services to individuals for
Works, to develop a plan to whom the program was designed, but programs rarely focus on the
increase capacity for reporting and health care professional specialties, settings, or geographical areas
monitoring of health care of highest need in Virginia. Five programs require or prioritize
workforce programs while applicants who fulfill service requirements in shortage areas.
balancing the administrative burden However, expanding shortage areas in Virginia are diluting the
to state agencies. identification of areas of extreme need.
(Option 2, page 15)
Sparse, inconsistent data collection makes reporting on program
quality and impact difficult
Most programs use passive strategies to measure implementation,
and track program completion as the main outcome. Nineteen
programs have no reporting requirements and only five programs
report a positive impact on measured program outcomes, including
increased wages and retention and reduced vacancy rates. With
program monitoring responsibilities spread across two entities,
programs’ barriers to data collection and reporting are not
consistently reviewed or addressed.
Prepared by Jen Piver-Renna and Kyu Kang
jpiver-renna@jchc.virginia.gov
i
Performance of Health Care
Workforce Programs
The Commonwealth of Virginia, consistent with national trends, is facing a historic
challenge with ongoing health care workforce shortages. The COVID-19 pandemic
exacerbated pre-pandemic health care workforce concerns, with already critical shortage
areas being hit the hardest. As of July 2024, all 133 localities in Virginia are federally
designated as behavioral health shortage areas, 98 localities are federally designated as
dental health shortage areas, and 96 localities are designated as primary care shortage
areas. Strains to provide services and attract and retain health care workers have been
reported across almost every health care profession.
In response to these concerns, multiple entities in Virginia have documented the root
causes of workforce shortages in Virginia, including analyzing trend data by health care
profession and recommending strategies to address areas of need (see APPENDIX 1 for a
summary of recent reports). One strategy, among many pursued in Virginia, includes
funding programs to recruit and retain health care professionals to address specific
workforce shortages. However, as Joint Commission on Health Care (JCHC) staff reported in
November 2023, few programs have been evaluated for effectiveness.
To ensure state investments in health care workforce programs are yielding anticipated
benefits, the JCHC directed staff to monitor and report on the performance and impact of
state-funded health care workforce programs. The study resolution (APPENDIX 2) directed
staff to:
• Develop a framework for measuring the performance and impact of health care
workforce programs;
• Obtain relevant data to populate metrics measuring each program’s outputs and
outcomes;
• Develop and implement a process for reporting on the performance of programs
that is meaningful, transparent, and actionable; and
• Consider policy options through which the state may improve the performance of
state-funded health care workforce programs.
For the purposes of this study, JCHC staff define health care workforce programs as any
initiative or organized strategy that has at least one primary objective directly and
intentionally benefiting the health care workforce, including strategies to recruit or retain
health care professionals and improve workforce well-being. Consistent with the study
1
resolution, JCHC staff prioritized programs receiving state
Health care workforce programs funding (see sidebar) that have been implemented for at
funded through sources other least one year, to ensure programs had an opportunity to
than the state are a significant
report on outcomes. For a summary of program selection
part of the health care workforce
development landscape in criteria and comprehensive list of programs considered for
Virginia. In 2023, JCHC staff this study, see APPENDIX 3.
identified 44 federally or privately
funded programs focused on
recruiting, retaining, or improving Virginia’s General Assembly
the well-being of health care
professionals (see APPENDIX 4).
appropriated $683 million in state funds
for 34 health care workforce programs in
Fiscal Years 2023 and 2024
Across Fiscal Years 2023 and 2024, the Virginia General Assembly appropriated $318
million for 24 workforce programs exclusively focused on health care and $365 million for
10 workforce programs partially focused on health care, totaling a $683 million state
investment. Whereas programs exclusively focused on health care target health professions,
programs partially focused on health care address multiple high-demand occupational
sectors, such as computer science or engineering. In most cases, programs with a multi-
sector focus do not account for costs by sector, making it difficult to determine what portion
of their funding is dedicated to health care.
Stakeholders disagree on what programs are health care workforce programs
Actual state spending on health care workforce programs may be higher or lower
depending on how health care workforce programs are defined. Virginia defines three
different types of general workforce programs in the Code of Virginia § 2.2-2036; however,
there is no definition of what a health care workforce program entails nor a centralized
inventory of existing programs. Five stakeholders interviewed for this study disagreed on
their program’s inclusion as a health care workforce program. All operated within the
education sector, where the delineation between programs designed to educate aspiring
health care professionals and programs designed to target health care professional
shortages is not always clear.
Using criteria established for this study, JCHC staff identified 19 health care workforce
programs operated by nine fiscal agents under the Education Secretariat and 15 programs
operated by three fiscal agents under the Health and Human Resources Secretariat (TABLE
1).
2
TABLE 1. Virginia health care workforce programs operate within the Education and Health
and Human Resources Secretariats
Secretariat Fiscal Agent Number of Programs
College of William and Mary 1
Eastern Virginia Medical School 1
Southern Virginia Higher Education Center 1
State Council of Higher Education for Virginia 6
University of Mary Washington 1
Education
University of Virginia 2
Virginia Commonwealth University 1
Virginia Community College System 4
Virginia Department of Education 2
Total 19
Virginia Department of Behavioral Health and 3
Developmental Services
Health and
Human Virginia Department of Health 10
Resources Virginia Department of Medical Assistance 2
Services
Total 15
SOURCE: JCHC analysis of state appropriations act, 2024.
Ninety percent of state funding for health care workforce programs focuses on
expanding the pipeline of health care professionals
Virginia’s demand for health care professions continues to rise faster than supply. Data
compiled by the Virginia Board of Workforce Development (see sidebar) indicate that the
health care and social assistance industry remains the top
employer in Virginia, comprising 13 percent of all employment The Virginia Board of
in the state, and the occupation with the highest number of job Workforce Development
openings in Virginia is registered nurses. serves as the state workforce
development board for Virginia
To address deficiencies in supply, Virginia has appropriated and advises on meeting
$618 million, or 90 percent of state funding for health care workforce development needs
in the Commonwealth through
workforce efforts, into 24 programs that seek to expand recommendation of policies
educational opportunities for aspiring health care and strategies to increase
professionals. These programs cover the spectrum of the coordination and efficiency of
workforce programs.
educational pipeline from high school through post-graduate
training (FIGURE 1).
3
FIGURE 1. Virginia funds health care workforce programs throughout the education pipeline
• Credential testing materials (VDOE)
• Vocational/technical equipment updates (VDOE)
High School
• Health science and technology dual enrollment/Blue Ridge
Partnership for Health Science Careers (VCCS)
• Workforce advancement programs (SVHEC)
• Occupational Therapy, Physical Therapy, and Surgical
Assistants programs (VCCS)
• Get Skilled, Get a Job, Get Ahead (G3) Program (VCCS)
Undergraduate • Regional education partnerships (UMW)
• FastForward/New Economy Workforce Credential Grant
(SCHEV)
• Increased degree production (SCHEV)
• Two-Year College Transfer Grant Program (SCHEV)
• Specialization in military and veterans counseling (W&M)
• Public-private partnerships for nursing (UVA & VCCS)
Graduate
• Virginia Nurse Educator Scholarship Program (VDH)
• Tuition Assistance Grant Program (SCHEV)
• Nursing Preceptor Incentive Program (VDH)
• Boost 200 (DBHDS)
• Telemental Health Initiative (DBHDS)
• Mental Health Workforce Program (SCHEV)
Post-graduate • Graduate Medical Education: High needs/specialty
residencies (DMAS)
• Gradute Medical Education/Indirect Medical Education
Supplemental Payments (DMAS)
• Family Practice Residency Programs (EVMS, UVA & VCU)
VDOE = Virginia Department of Education; VCCS = Virginia Community College System; SVHEC = Southern Virginia
Higher Education Center; UMW = University of Mary Washington; SCHEV = State Council of Higher Education for
Virginia; W&M = College of William and Mary; UVA = University of Virginia; VDH = Virginia Department of Health;
DBHDS = Department of Behavioral Health and Developmental Services; DMAS = Department of Medical
Assistance Services; EVMS = Eastern Virginia Medical School; VCU = Virginia Commonwealth University
SOURCE: JCHC staff analysis of program documentation and stakeholder interviews, 2024.
4
Ten programs fund institutions to increase health care credentials in high school
and post-secondary settings
State-funded health care workforce programs identified within the education sector are
distinct from state funds appropriated for general K-12 and post-secondary education. The
ten programs supporting credential attainment, totaling $69 million in state funds for Fiscal
Years 2023 and 2024, were intentionally created and funded to address a specific health
care workforce need or shortage area. For example, while Virginia’s Career and Technical
Education (CTE) programs are federally funded, the General Assembly appropriates general
funds each year to support necessary updates to program
equipment and bear the costs of credential testing for
students studying science, technology, engineering, math, Dual enrollment is a program
that allows high school students
and health care. Similarly, the Blue Ridge Partnership for to take college-level courses at a
Health Science Careers is an employer-led coalition to participating Virginia college or
support regional needs for health care and health science university. These courses count
towards both a high school
workers, and the General Assembly appropriates funds to
diploma and a college degree.
community colleges participating in the Partnership to
offset the costs of dual enrollment courses (see sidebar).
These programs facilitate students’ credential attainment and preparation to join the health
care workforce.
Four programs provide financial assistance for undergraduate and graduate
educational costs of aspiring health care professionals
Nearly half of state funds appropriated for health care workforce recruitment programs in
Virginia ($300 million of $618 million for Fiscal Years 2023 and 2024) are distributed to
four programs that provide financial assistance for the costs of education. Each of these
programs targets student populations at different points in their pathway toward high-
demand occupations, including health care. For example, FastForward (formerly known as
the New Economy Workforce Credential Program) provides funding for noncredit
workforce training that leads to a credential, while the Get Skilled, Get a Job, and Get Ahead
(G3) Program offers tuition assistance for students enrolled in associate degree-granting
programs. The Two-Year College Transfer Grant Program supports nursing students, among
others, who complete an associate’s degree at a Virginia two-year institution and then
transfer to a Virginia four-year institution. Finally, the Tuition Assistance Grant Program, in
part, provides payments to graduate students enrolled in health-related professional
programs at private Virginia colleges and universities.
Ten programs support opportunities for health care professionals to meet post-
graduate clinical experience requirements
Many health care professions require both a degree and additional clinical training and
experience before individuals can fully practice in their field. Virginia appropriates $249
5
million in state funds for health care workforce programs to support trainees, the teachers
and preceptors who provide instruction and supervision to the trainees, and institutions
that host and support trainees. For example, Virginia appropriates general funds to support
family medicine residencies at Eastern Virginia Medical School, Virginia Commonwealth
University, and University of Virginia. Boost 200 pays for the costs of pre-licensed counselor
and social worker supervision hours. Finally, the Virginia Department of Health’s Nursing
Preceptor Incentive Program offers financial incentives for practitioners who serve as
otherwise uncompensated preceptors for advanced practice registered nurse (APRN),
registered nurse (RN), and licensed practical nurse (LPN) students.
State-funded programs that focus on retaining health care professionals in
Virginia primarily use financial incentives
State funds dedicated to retaining health care professionals are largely channeled through
programs providing financial incentives, such as scholarships or loan repayment, to
individuals who perform a period of professional service in Virginia.
The Virginia Department of Health operates seven state-funded scholarship and loan
repayment programs for health care professionals that require participants to practice in
Virginia following graduation for varying amounts of time (TABLE 2). Five of these
programs target the nursing profession, while the Virginia Student Loan Repayment
Program and the Behavioral Health Loan Repayment Program are available to multiple
professions. In addition, the State Council of Higher Education for Virginia operates one
scholarship program for Virginia optometry students. As there are no schools of optometry
in Virginia, the program provides funds for students to attend out-of-state schools and
colleges of optometry in exchange for a period of service in Virginia.
6
TABLE 2. Eight state-funded scholarship and loan repayment programs require periods of
service in Virginia
Maximum Financial Years of Full Time
Program Incentive Per Year Service in Virginia
Virginia Department of Health
Long-Term Facility Nursing $2,000 for LPNs or RNs One year
Scholarship $1,000 for CNAs
Mary Marshall CNA Scholarship $1,000 One year
Mary Marshall LPN Scholarship $2,000 One year
Mary Marshall RN Scholarship $2,000 One year
Virginia Behavioral Health Loan $30,000 Two years
Repayment Program
Virginia Nurse Practitioner/Nurse $20,000 One year
Midwife Scholarship Program
Virginia Student Loan Repayment $100,000 Two years
Program
State Council of Higher Education for
Virginia
Grants for students in optometry $20,000 Two years
LPN = Licensed Practical Nurses; RN = Registered Nurses; CNA = Certified Nurse Assistants
NOTE: Financial incentives represent the maximum allowable amount per year. Actual awards may vary based on
available funding and the number of qualified applicants.
SOURCE: JCHC staff analysis of program documentation and stakeholder interviews, 2024.
Programs addressing workforce salaries and well-being are not commonly state-
funded in Virginia
There are limited circumstances in which the General Assembly has direct influence on
health professionals’ salaries. However, the General
Assembly can directly influence salaries when health
Workforce well-being
professionals are state employees. For example, to address programs are typically privately
retention issues in three treatment facilities operated by funded, based on JCHC’s 2023
the Department of Behavioral Health and Developmental inventory of health care
workforce programs in Virginia.
Services, the General Assembly appropriated funds to JCHC staff identified six
increase salaries of direct care staff, including LPNs, RNs, workforce well-being programs
and nurse managers. Health professionals’ well-being in 2023, four of which were
funded by the private sector.
programs are also more commonly funded by private
employers (see sidebar) than the General Assembly.
However, the General Assembly does fund one well-being program for health professionals,
7
appropriating funds for the Southwest Virginia Graduate Medical Education Consortium to
provide educational, cultural, and social support to medical residents in Southwest Virginia.
The Consortium collects feedback from residents that is then shared with residency sites to
increase retention of physicians in Southwest Virginia following residency completion.
State-funded programs are reaching their intended target
populations but lack focus on areas of most need
Examining the alignment of participants to the program’s target population, defined as
program reach, is critical to understanding whether state-funded efforts are benefiting
their intended populations. Twenty-seven of 34 programs (or nearly 80 percent) included
in this study provide services to individuals for whom the program was designed. However,
a deeper examination of program reach indicates programs rarely focus services on the
specialties, settings, or geographical areas of highest need. Seven programs either did not
collect data on program participants or felt their program’s reach could be improved.
Programs most often use eligibility or selection criteria to ensure appropriate
participation
Twenty of the 27 programs that collect data on program participants do so initially through
an application process. For programs in the education sector, the application process for
programs may be incorporated into the institution’s existing application process. For
example, students selected for the military and veterans counseling program are students
currently enrolled in the Master of Education in Counseling program at the College of
William and Mary. For programs outside of the education sector, applications are often
reviewed by an external group to select final program participants. For example, each of the
Virginia Department of Health’s loan repayment and scholarship programs uses an
advisory committee to review applicants and rank participants for selection.
The remaining seven programs that collect data on program participants establish
eligibility criteria to target appropriate individuals and provide funding to all those who are
eligible, to the extent funding allows, without any additional selection process.
Participant selection processes could be more targeted to prioritize specific groups of
participants, but rarely do so. Three behavioral health programs place a priority on
demographic characteristics of health professionals with the goal of supporting
professionals who are culturally aligned with the individuals they serve. Boost 200 and the
Virginia Behavioral Health Loan Repayment Program prioritize persons of color during
participant selection and currently provide more than two-thirds of their programs’
funding to priority individuals. The aforementioned programs and the Virginia Telemental
Health Initiative also prioritize individuals who are multilingual. However, program staff
note the limited pool of multilingual providers is a consistent barrier.
8
Programs target some health care professions in high demand, but not all
Categorizing any health care profession as being in high demand is subject to many
considerations, including areas of specialization, practice settings, and differences in
geographic or regional employment needs. There are multiple metrics available to
determine health care workforce demand in Virginia, including the Virginia Office of
Education Economics’ (VOEE) high demand occupation list, focused on entry-level
professions, the Virginia Department of Health Professions workforce projections for
primary care and behavioral health professions, and the U.S. Department of Health and
Human Services Health Professional Shortage Areas, which are based on population-to-
provider ratios for primary care physicians, dentists, and psychiatrists.
Programs vary in the extent to which eligibility or selection criteria are aligned with
current demand metrics. Program staff interviewed for this study frequently articulated
that their programs were developed to address a specific shortage area, resulting in rigid
criteria for program eligibility with most programs targeting one health care profession
(TABLE 3). Only two programs allow flexibility in criteria to continually re-align services
with evolving high demand occupations. FastForward and the G3 Program align their
eligibility criteria with VOEE’s high demand occupation list, issued annually based on the
most recent employment data.
TABLE 3. Most programs target one type of health care profession
Target Health Care Profession Number of Programs
Programs targeting one profession 15
Nursing 8
Physicians 4
Behavioral Health 3
Programs targeting multiple professions 10
Nursing 3
Physicians 3
Behavioral Health 2
Other 2
Programs targeting general health
9
professions
Health Sciences 7
High Demand Health Care Occupations 2
SOURCE: JCHC staff analysis of program documentation and stakeholder interviews, 2024.
9
Few programs with service requirements prioritize practice settings or
geographic areas of need
Ten programs provide a financial incentive to participants who perform a period of service
in Virginia. While the collective goal of these programs is to retain providers in areas of
need, five programs do not set any parameters for where the service requirements must be
performed. The five remaining programs either require or prioritize applicants who fulfill
service requirements in health professional shortage areas or specific facilities, such as
long-term care facilities or state-operated psychiatric hospitals. No programs with service
requirements prioritize rural localities.
An additional barrier to attracting health care professionals to the highest areas of need is
the expanding number of health professional shortage areas (HPSA) in Virginia. As of July
2024, every locality in Virginia is designated as a behavioral health shortage area and more
than 70 percent of localities are also either a primary care or dental professional shortage
area. However, U.S. Health & Human Resources assigns each HPSA a score from 1 to 25 (or
26 for dental health) to assist states with determining priorities for the assignment of
clinicians. Using this gradient metric, programs could identify localities within the top
quartiles of need for additional support.
Option 1: JCHC could send letters to state agencies with fiscal oversight of health care
workforce programs requesting a review of program eligibility, screening criteria, and
service requirements. This review should identify opportunities to align programs with
Virginia’s health care workforce needs based on available supply and demand data.
Agencies should report to the Joint Commission on Health Care by October 1, 2025, any
anticipated changes to program eligibility, screening requirements, and service
requirements, or barriers to doing so.
Sparse, inconsistent data collection makes reporting on
program quality and impact difficult
Collecting data and reporting on program quality and effectiveness is one of the primary
ways in which state governments can build trust with stakeholders, increase accountability,
and improve performance. For an issue like health care workforce, where there is shared
responsibility between multiple levels of government and the private sector to address
shortages, reporting can also ensure efficient use of resources and the transparency of
effective strategies.
Passive strategies to document implementation provide limited details on
program quality
Collecting data on the extent to which agencies consistently deliver a program’s key
functions or components, known as the fidelity of program implementation, is a precursor
for determining program effectiveness. Programs that do not measure implementation
10
fidelity are unable to determine what parts of a program are most effective or ineffective,
and programs with poor implementation fidelity may unknowingly diminish the impact of
the most effective program components.
For this study, 29 of 34 programs provided documentation indicating that a process was in
place to verify that the programs’ key components were being implemented as intended.
Most programs used passive methods for measuring implementation fidelity with very
limited participant engagement, including audit reports to verify financial disbursements
or verification reports where participants attest to completing certain requirements (e.g.,
submission of an employment verification form to demonstrate they are meeting their
service requirements). While passive methods can be used to ensure funds are distributed
correctly or program requirements are complete, they are insufficient for determining the
quality of implementation or understanding the value of program to participants.
In contrast, three programs use active strategies to monitor the quality and fidelity of
program implementation. Staff of each program described how actively monitoring
implementation facilitated rapid changes in the program’s components to address
emerging participant needs, improve effectiveness, and address sustainability:
• Boost 200 pilot tested and then provided customized licensure exam preparation
services for social workers enrolled in the program after understanding the different
rules and challenges to successfully passing exams required for full licensure;
• The State Council of Higher Education for Virginia’s Mental Health Workforce Pilot
identified misalignment between when program funding became available and
when new graduates were looking for employment, resulting in delayed recruitment
timelines; and
• The Virginia Telemental Health Initiative described needing to increase pre-licensed
counselors’ access to their clinical team more than expected given early feedback on
the complexity of clients being served.
State-funded programs track completion but rarely measure program impact
Program effectiveness is measured as the impact of a program on an individual and
considers both short-term outcomes and long-term outcomes, after a program is complete.
For this review, 23 of the 24 programs reporting short-term outcomes measured whether
participants completed all program requirements. This includes, for example, participants
in loan repayment and scholarship programs completing their service requirements, or
participants in educational programs earning a credential. While program completion rates
provide important context for effectiveness, they alone cannot speak to the value of a
program unless coupled with longer-term outcomes.
At the time of this study, seven of 34 health care workforce programs (20 percent) reported
collecting data on long-term outcomes. For two programs, data collection was not yet
11
complete and final results are pending. 1 The five remaining programs reported a positive
impact on measured program outcomes (TABLE 4).
TABLE 4. Five programs reported data on program impact
Fiscal Agent Program Name Program Impact
State Council FastForward Health care practitioner students earning a
of Higher credential increased median wages by 51%,
Education for from $17,152 to $25,860, and health care
Virginia support students earning a credential
increased their median wages by 56%, from
$14,625 to $22,887.
Virginia Family Practice The 3-year average of physicians remaining
Commonwealth Residency Program in Virginia following completion of their
University residency is 57%.
Virginia G3 Program Program completers in health care more than
Community College doubled their median wages, from $19,360 to
System $44,972.
Virginia Salary increases for direct Eighteen months after implementing salary
Department of care staff increases, vacancy rates decreased from
Behavioral Health 30.52% to 17.93% for Direct Service
and Developmental Associates, from 44.33% to 42.60% for LPNs,
Services and from 24.04% to 19.53% for RNs.
Virginia Southwest Virginia 8 of 15 physicians (53%) completing their
Department of Graduate Medical medical residencies in the last calendar year
Health Education Consortium continue to practice in rural communities.
SOURCE: JCHC staff analysis of program documentation and stakeholder interviews, 2024.
Half of state-funded programs do not require reporting by law or regulation
Nineteen of 34 health care workforce programs, totaling $38.4 million in state funds for
FY23 and FY24, have no requirement to report on program implementation or outcomes in
state law or state regulation. There is no clear pattern among programs without required
reporting: they operate within the Education and the Health and Human Services
Secretariats, across ten state agencies, and consist of legacy programs, implemented for
more than 10 years, and newer programs, implemented following elevated workforce
concerns during the COVID-19 pandemic. While not required to do so, eight of nineteen
programs without reporting requirements produce documentation on program
1
Programs with pending outcome data include Boost 200, and the occupational therapy, physical therapy,
and surgical technology assistants programs through the Virginia Community College System.
12
implementation and outcomes, either through accreditation reviews, audits, or annual
reports.
Fifteen programs have mandated reporting requirements: 11 through state appropriations
act language, three through regulation, and one program has federal reporting
requirements. As such, 23 of 34 programs were able to provide extant documentation on
their work, although the completeness of information on program implementation or
outcomes varied. With limited and variable reporting, JCHC staff spent considerable time
conducting interviews with program staff and analyzing data to further elucidate the
quality of program implementation and impact (see APPENDIX 5 for methods).
Monitoring of state-level health care workforce programs is fragmented
Virginia’s executive and legislative capacity to monitor health care workforce programs has
increased in the past two years, yet no single entity receives reports or has oversight for all
34 programs reviewed for this study.
No consistent entity receives reports on health care workforce programs
Fifteen programs that are required to submit reports do so to five different state entities. 2
Required reports are most frequently submitted to the fiscal agency or board for the
program (7 programs), to the Department of Planning and Budget (4 programs), or to the
appropriate staff on the House Appropriations and Senate Finance and Appropriations
Committees (3 programs). Less often, reports are submitted to the Governor or, broadly,
members of the General Assembly (2 programs). In addition, programs that create reports
voluntarily may not always intend to make those reports publicly available. Several
voluntary reports were created for internal purposes, such as financial audits, or for
funders other than the state. JCHC staff obtained internal reports for most programs by
request.
Multiple state entities are responsible for workforce program monitoring and
evaluation activities
In addition to the entities receiving reports, the Virginia General Assembly has tasked
multiple executive and legislative entities with various program monitoring duties. During
the 2023 legislative session, the General Assembly established a new state agency, Virginia
Works (known as the Virginia Department of Workforce Development and Advancement in
Chapter 20.2 of the Code of Virginia). The agency has several duties related to workforce
program monitoring, to include health care workforce programs, such as:
• Regularly tracking metrics related to workforce development programs; and
2
Two programs are required to report to more than one entity.
13
• Developing strategies to modify policies, procedures, or processes to ensure
effective and efficient administration of workforce development programs.
Virginia Works was officially operational at the beginning of Fiscal Year 2025 and has
already begun implementing annual evaluations of workforce development and training
programs, as required by Code of Virginia § 2.2-214.3. This effort collects six core metrics
from each program, including the number of people trained, the total number of job
placements, job retention rate, program cost per placement, starting wage, and progressed
wage. While this metric framework may align with traditional workforce development
programs, it does not completely align with anticipated outcomes for different types of
health care workforce programs. In addition, only 11 of the 34 programs identified for this
review are currently reporting data to Virginia Works. Per Virginia Works, the balance of
programs is not considered in scope because they focus on degree attainment, not
workforce development.
During the 2024 legislative session, the Virginia General Assembly also expanded
responsibilities of the Virginia Health Workforce Development Authority (VHWDA) to seek
data for program evaluation purposes and to partner with other state agencies and
institutions to help manage and analyze health workforce data. The mission of VHWDA is to
facilitate the development of a statewide health professions pipeline that identifies,
educates, recruits, and retains a diverse, appropriately geographically distributed, and
culturally competent quality workforce. VHWDA’s expanding role in Virginia and efforts to
build capacity for health care workforce needs assessments and strategic planning make it
uniquely suited to understand the context in which health care workforce programs
operate, including their challenges and strengths.
Program barriers to data collection and reporting are not consistently reviewed
or addressed
Lack of consistency in both the reporting and monitoring is a risk for timely identification
of systemic barriers and challenges to health care workforce program quality, effectiveness,
and sustainability. Indeed, program staff interviewed for this study acknowledge receiving
very little feedback on submitted reports, even when challenges to program
implementation are identified. For example, one staff person indicated that they received
no follow-up on reports that their program was not meeting its metrics, or any direction to
look further into the program shortcomings.
In interviews with program staff, stakeholders articulated multiple barriers to both
program reporting and program sustainability that have largely been unaddressed. For
example, several programs expressed frustration with program funding amounts, stating
that their funding declined during the recession and was never restored, or that they did
not understand how their funding amounts were calculated, or that they received
inconsistent funding amounts across similar types of programs. Seven programs also
14
identified the need for additional staff, either at the agency level or at the program level, for
appropriate administration and oversight.
Eight stakeholders felt limited in their ability to expand programs without additional
funding for faculty, due to either accreditation standards that set faculty-student ratios and
require smaller cohorts, or additional clinical opportunities and training placements. Two
of the programs noted there is lack of desire or incentive for clinical sites to take on
students as they may decrease overall productivity or create more work.
Regarding program reporting capacity, program staff indicated a lack of reporting
requirements creates an environment where agencies may devalue the importance of
documenting program effectiveness in favor of other competing priorities. In addition,
programs without reporting requirements rarely seek resources to update their reporting
infrastructure or build additional capacity for more robust data collection. One agency, for
example, stated that their current system of managing programs through a series of
disconnected Excel sheets was so time-consuming that they could not carve out any
additional resources for long-term follow-up on program participants.
Even when programs desire to collect long-term outcomes and have the capacity to do so,
four program staff indicated it is difficult to track participants after graduation and to know
where individuals are employed. Reporting is voluntary once participants have completed
their service requirements or graduated, and they are therefore no longer obligated to
provide employment verification. There are also gaps in data that are reported, making it
difficult to get a full picture of participants’ experiences. For example, FastForward tracks
changes in participants’ wages, but staff noted that the employment data only show what
industries students are going into, not the kinds of jobs they are getting within those
industries.
Option 2: JCHC could submit a Section 1 bill requiring the Virginia Health Workforce
Development Authority, in collaboration with Virginia Works, to develop a plan to increase
capacity for reporting and monitoring of health care workforce programs. The plan should
be submitted to the Joint Commission on Health Care by October 1, 2025, and consider:
• Processes required to maintain an accurate inventory of state-funded health care
workforce programs;
• Strategies to increase capacity of state agencies to design, collect, analyze, and report
data on program implementation and outcomes, as needed;
• Recommendations to align reporting requirements to meet the program monitoring
duties of VHWDA and Virginia Works while balancing the administrative burden of state
agencies to report such information.
15
16
Appendix 1: Reports on Virginia’s Health Care Workforce
Multiple organizations have released reports in the last three years to describe Virginia’s
health care workforce shortages and evidence-based strategies to address areas of need.
1. Virginia Health Care Foundation. (January 2022). Assessment of the capacity of
Virginia’s licensed behavioral health workforce. https://www.vhcf.org/wp-
content/uploads/2022/01/BH-Assessment-Final-1.11.2022.pdf
Key Findings:
While Virginia regularly ranks at the top of national scorecards as the best state for
business and a top state for public education, when it comes to availability of
behavioral health (BH) services, that is not the case. The shortage of BH professionals
is not a new problem, the severity of the shortage is, however.
• A large and disproportionate number of Virginia’s licensed BH professionals are at
or nearing retirement age (61% of Psychiatrists are aged 55 or older).
• Virginia’s BH workforce does not reflect the racial and ethnic diversity of the
Commonwealth’s population.
• 93 of Virginia’s 133 localities are federally-designated Mental Health Professional
Shortage Areas; 37% of Virginians (3.2 million) live in them. Two localities have no
licensed BH professionals; 35 have no trained BH prescriber (Psychiatrist, Psych
NP).
• In many communities with no or a few BH professionals, a large number of
households do not have broadband internet access and are unable to access tele-
health services. One-in-five Virginians (20%) live in these communities.
• Virginia localities with no or a few BH professionals have poorer outcomes on key
BH indicators than those with more BH professionals.
• Although Virginia’s 40 graduate-level BH programs, combined, graduate nearly
800 individuals annually, the number who ultimately become licensed in Virginia
is insufficient to maintain even the current inadequate supply of BH professionals.
Recommended Strategies:
There are multiple strategies to address Virginia’s significant shortage of BH
professionals. It will likely require all or most of them to be successful. It will also take
a number of years to see the results. As such, time is of the essence.
Several immediate strategies include:
• Virginia’s participation in Interstate Compacts for each licensed BH professional.
This would enable licensed BH professionals from other Compact states to practice
17
in the Commonwealth. The most productive Compacts provide full reciprocity of
licensure.
o Legislation authorizing Virginia’s participation in a Compact for Licensed
Professional Counselors is likely to be considered during the 2022 General
Assembly session. It will provide for reciprocity. (Note: HB1433 and SB802
passed during the 2023 General Assembly session, authorizing Virginia to
become a signatory to the Counseling Compact).
o Legislation approving Virginia’s participation in a Compact for Licensed
Clinical Psychologists passed in 2020. While it is helpful, it only allows LCPs
from other states to provide services in Virginia via telehealth. Given
broadband access issues in most of Virginia’s mental health professional
shortage areas, this approach provides limited relief.
o A Compact for Licensed Clinical Social Workers, which would include
reciprocity, is currently under development at the national level and will
likely be ready for the General Assembly’s consideration in the next few
years. (Note: The passage of HB326 from the 2024 General Assembly Session
authorized Virginia to become a signatory for the Social Work Licensure
Compact).
• State funding for more psychiatric residencies and Fellowships for Child and
Adolescent Psychiatrists. The data cannot be ignored. Virginia currently has a
dearth of Psychiatrists and 677 of them (61%) are at or near retirement age (55
years or older). Virginia’s psychiatric residency programs graduate only about 32
residents a year, combined. The small number of Child and Adolescent
Psychiatrists in Virginia is particularly concerning, especially with recent reports
of the traumas high numbers of children are experiencing as a result of the
pandemic.
• State payment for the clinical supervision required for licensure of Masters
prepared social workers and counselors. A pilot program would determine the
efficacy of paying these fees for pre-licensees who practice in MHPSAs or of whom
there is a disproportionately low number (e.g., bilingual, people of color). It would
also have the immediate benefit of adding more therapists in the field to help
address the tremendous current demand for services.
Longer term strategies are needed, as well. These include working with the State
Council on Higher Education of Virginia and Virginia’s BH graduate programs to
produce more of each type of licensed BH professional and prioritizing the state’s
MHPSAs for last-mile broadband development.
2. Andrew, M., Briscombe, B., Vardavas, R., Wolters, N., Qureshi, N., Nham, W., & Abir, M.
(2024). Identifying Strategies for Strengthening the Health Care Workforce in the
Commonwealth of Virginia. Rand Health Quarterly, 11(2).
18
https://acrobat.adobe.com/id/urn:aaid:sc:US:a3d2d6c1-3221-4cdc-ae91-
d3a756976b32
Key Findings:
• If current trends persist, nursing, primary care, and behavioral health workforce
shortages will worsen across Virginia.
• To reverse these trends, the Commonwealth will need to implement multiple
interventions to boost recruitment, retention, and the structural efficiency of
health care delivered by these professions.
Strategies for Increasing Retention:
• Promote team-based care through regulatory and reimbursement reform and by
creating career ladders for upward movement.
• Implement programs to address mental health and well-being among workers.
• Address underlying causes of stress and burnout, such as inappropriate patient-
provider ratios, unrealistic throughput requirements, and heavy documentation
burdens.
• Reduce license restrictions on physician assistants and nurse practitioners.
• Streamline documentation requirements by eliminating redundant and needless
paperwork.
• Create more-diverse health care workplaces.
• Increase the legal consequences of violence toward health care providers.
• Recruit local students from rural communities to bolster rural workforces.
Strategies for Increasing Recruitment:
• Increase Medicaid reimbursement for primary care and behavioral health.
• Increase residency slots and funding for primary care and psychiatry.
• Increase scholarships and loan forgiveness programs and advertise their
availability.
• Craft targeted loan forgiveness opportunities in primary care fields. For example,
repay loans for physicians practicing in settings that qualify for the Public Service
Loan Forgiveness Program.
• Enable rural applicants and first-generation students to receive loan forgiveness
up front.
• Increase wages for nursing faculty and preceptors to match those in engineering
and business.
• Reduce stringent supervision requirements for behavioral health trainees.
19
• Develop and expand programs to expose children in kindergarten through 12th
grade to health professions.
• Implement outreach strategies for youth from underrepresented communities.
• Leverage nursing and behavioral health retirees to increase the pool of licensed
supervisors.
• Shorten the duration of application for licensure in behavioral health.
Strategies for Increasing Structural Efficiency:
• Incentivize health workers to move from areas with more provider capacity to
those with less capacity.
• Increase the use of telehealth to support rural practitioners.
• Leverage technologies, such as voice recognition and artificial intelligence, to
reduce documentation burdens.
• Enable colocation of primary care and behavioral health services in the same
setting.
3. Claude Moore Foundation. (October 2023). Virginia Health Science & Human Services
Workforce Strategic Recommendations Report.
https://claudemoorefoundation.org/wp-content/uploads/2023/10/Strategic-
Recommendations-Report-1.pdf
Strategic Recommendations:
• Agree on a consistent framework for workforce and career development such as
the health workforce highway to enable collective impact activity amongst
stakeholders, while organizing education, training, and career development,
promoting continuous learning and upskilling, and fostering employee
engagement and career satisfaction.
• Convene and empower a multi-agency workgroup to address unnecessary and
burdensome regulatory and payment policies to comprehensively address and
align health workforce regulations, payment, and policies to positively impact
the work, workforce, education, and training.
• Immediately invest in programs to address critical shortages while developing
ongoing strategies to address future workforce needs to include pathway
development, faculty and supervision, earn-to-learn and learner support, career
awareness, and Area Health Education Center matching, with immediate funding
to meet critical needs.
• Formalize a statewide health workforce development model under the VHWDA
that is based on the Blue Ridge Partnership for Health Sciences Careers, aligns
with the nine Go Virginia regions, and is supported by a common infrastructure
20
to promote cooperation, coordination, and innovation between employers and
educators, with the goal of improving job readiness, placement, and fostering
economic development in the region. This model is unified by a common
umbrella and supported by centralized infrastructure.
• Create a data governance and management structure that coordinates siloed
health and human services workforce data to provide up to date information on
evolving employer needs as well as monitoring the potential supply of workers
on the highway.
21
Appendix 2: Study Resolution
22
Appendix 3: Programs Identified for Consideration
TABLE 5. Initiatives included and excluded from study by agency
Agency/Fiscal FY23 State FY24 State Review Rationale for
Program Name
Agent Funding Funding Outcome Exclusion
Does not
Conditional grants
Board of receive/will not
for certain dental Excluded
Health receive ongoing
students
state funding
Does not
Dentist Loan
Board of receive/will not
Repayment Excluded
Health receive ongoing
Program
state funding
Does not
Physician Loan
Board of receive/will not
Repayment Excluded
Health receive ongoing
Program
state funding
Does not
Conditional grants
Board of receive/will not
for certain dental Excluded
Health receive ongoing
hygiene students
state funding
Does not
Conditional grants
Board of receive/will not
for certain medical Excluded
Health receive ongoing
students
state funding
Conditional grants
Does not
for certain medical
Board of receive/will not
students Excluded
Health receive ongoing
(Southwest
state funding
Virginia)
Conditional grants Does not
Board of for certain receive/will not
Excluded
Health physician assistant receive ongoing
students state funding
Does not meet
Board of Facility staffing criteria for health
Excluded
Health standards care workforce
program
Does not meet
Recruitment and
Board of criteria for health
retention of health Excluded
Health care workforce
care providers
program
Boards within
Does not
the
Nurse Licensure receive/will not
Department of Excluded
Compact receive ongoing
Health
state funding
Professions
23
Agency/Fiscal FY23 State FY24 State Review Rationale for
Program Name
Agent Funding Funding Outcome Exclusion
Boards within
Does not
the
Physical Therapy receive/will not
Department of Excluded
Licensure Compact receive ongoing
Health
state funding
Professions
Boards within
Does not
the Psychology
receive/will not
Department of Interjurisdictional Excluded
receive ongoing
Health Compact
state funding
Professions
Boards within Is not
Audiology and
the operational/
Speech-Language
Department of Excluded beyond initial
Pathology
Health year of
Interstate Compact
Professions implementation
Boards within Is not
the operational/
Counseling
Department of Excluded beyond initial
Compact
Health year of
Professions implementation
Boards within Is not
Occupational
the operational/
therapy
Department of Excluded beyond initial
interjurisdictional
Health year of
licensure compact
Professions implementation
Boards within
Does not meet
the Collection of nurse
criteria for health
Department of workforce Excluded
care workforce
Health information
program
Professions
Specialization in
College of military and
$287,850 $287,850 Included Meets criteria
William & Mary veterans
counseling
Behavioral health Does not meet
Compensation case managers and criteria for health
$7,332,246 $9,835,820 Excluded
Board medical treatment care workforce
positions program
Department of
Pilot to remove
Behavioral
barriers to the
Health and $3,012,750 $0 Included Meets criteria
mental health
Developmental
workforce
Services
24
Agency/Fiscal FY23 State FY24 State Review Rationale for
Program Name
Agent Funding Funding Outcome Exclusion
Department of
Behavioral
Telemental Health
Health and $1,100,000 $1,100,000 Included Meets criteria
Initiative
Developmental
Services
Department of
Behavioral
Salary increases
Health and $0 $54,593,304 Included Meets criteria
for direct care staff
Developmental
Services
Graduate Medical
Department of
Education/Indirect
Medical
Medical Education $109,729,111 $106,116,848 Included Meets criteria
Assistance
supplemental
Services
payments
Department of Graduate medical
Medical education: High-
$4,350,000 $4,350,000 Included Meets criteria
Assistance needs/specialty
Services residencies
Does not meet
Eastern Eastern Virginia
criteria for health
Virginia Area Health $60,620 $60,620 Excluded
care workforce
Medical School Education Center
program
Does not meet
Eastern
criteria for health
Virginia Financial aid $875,500 $1,225,700 Excluded
care workforce
Medical School
program
Eastern Family Practice
Virginia Residency $658,597 $658,597 Included Meets criteria
Medical School Program
Does not meet
Health Workforce
Office of the criteria for health
Development Excluded
Governor care workforce
Advisor
program
Virginia
Public Colleges Does not target
Guaranteed
and $722,698,444 $841,087,944 Excluded health care
Assistance
Universities professions
Program
Is not
Public Colleges operational/
Compensation for
and $0 $5,750,000 Excluded beyond initial
nursing faculty
Universities year of
implementation
Southern
Workforce
Virginia Higher
advancement $731,250 $731,250 Included Meets criteria
Education
programs
Center
25
Agency/Fiscal FY23 State FY24 State Review Rationale for
Program Name
Agent Funding Funding Outcome Exclusion
State Council of
Higher Tuition Assistance
$90,813,320 $100,325,881 Included Meets criteria
Education for Grant Program
Virginia
State Council of
Higher Grants for students
$20,000 $20,000 Included Meets criteria
Education for in optometry
Virginia
State Council of
Two-Year College
Higher
Transfer Grant $3,885,256 $3,885,256 Included Meets criteria
Education for
Program
Virginia
FastForward
State Council of
Program (New
Higher
Economy $13,500,000 $18,500,000 Included Meets criteria
Education for
Workforce
Virginia
Credential Grant)
State Council of
Higher Mental Health
$500,000 $500,000 Included Meets criteria
Education for Workforce Pilot
Virginia
State Council of
Higher Increased degree
$28,400,000 $28,400,000 Included Meets criteria
Education for production
Virginia
State Council of Does not meet
Higher Southern Regional criteria for health
$170,000 $170,000 Excluded
Education for Education Board care workforce
Virginia program
State Council of Does not
Grants for high
Higher receive/will not
school teachers' $100,000 $100,000 Excluded
Education for receive ongoing
credentials
Virginia state funding
University of Regional
Mary educational $119,839 $108,844 Included Meets criteria
Washington partnerships
Family Practice
University of
Residency $1,393,959 $1,393,959 Included Meets criteria
Virginia
Program
Public-private
University of
partnerships for $250,000 $250,000 Included Meets criteria
Virginia
nursing
Virginia Family Practice
Commonwealth Residency $4,336,607 $4,336,607 Included Meets criteria
University Program
Virginia Public-private
Community partnerships for $191,884 $191,884 Included Meets criteria
College System nursing
26
Agency/Fiscal FY23 State FY24 State Review Rationale for
Program Name
Agent Funding Funding Outcome Exclusion
Occupational
therapy, physical
Virginia therapy, and
Community surgical $413,689 $1,413,689 Included Meets criteria
College System technology
assistants
programs
Certified Does not
Virginia
sonographer receive/will not
Community $475,000 $475,000 Excluded
education and receive ongoing
College System
training program state funding
Career and
Technical
Virginia Does not target
Education at
Community $104,950 $104,950 Excluded health care
Laurel Ridge
College System professions
Community
College
Health science and
technology dual
Virginia
enrollment/Blue
Community $1,000,000 $1,000,000 Included Meets criteria
Ridge Partnership
College System
for Health Science
Careers
Virginia Get Skilled, Get a
Community Job, Get Ahead $34,500,000 $34,500,000 Included Meets criteria
College System (G3) Program
Is not
Virginia operational/
Community Network2Work $2,000,000 $2,000,000 Excluded beyond initial
College System year of
implementation
Scholarships for
Virginia Does not target
high school
Department of $250,000 $250,000 Excluded health care
teachers'
Education professions
credentials
Vocational/
Virginia
technical
Department of $2,000,000 $2,000,000 Included Meets criteria
equipment
Education
updates
Virginia
Credential testing
Department of $500,000 $500,000 Included Meets criteria
materials
Education
Does not
Virginia Path to Industry
receive/will not
Department of Certification Excluded
receive ongoing
Education Program
state funding
27
Agency/Fiscal FY23 State FY24 State Review Rationale for
Program Name
Agent Funding Funding Outcome Exclusion
Virginia School
Does not
Virginia Mental Health
receive/will not
Department of Providers Excluded
receive ongoing
Education Recruitment and
state funding
Retention
Child Health Does not meet
Virginia
Investment criteria for health
Department of $24,679 $24,679 Excluded
Partnership of care workforce
Health
Roanoke program
Virginia Virginia Student
Department of Loan Repayment $1,500,000 $1,500,000 Included Meets criteria
Health Program
Does not meet
Virginia
Virginia Health criteria for health
Department of $2,000,571 $2,000,571 Excluded
Care Foundation care workforce
Health
program
Does not
Virginia Public-private
receive/will not
Department of partnerships for Excluded
receive ongoing
Health dental services
state funding
Virginia Behavioral
Virginia
Health Loan
Department of $1,600,000 $3,100,000 Included Meets criteria
Repayment
Health
Program
Virginia
Nursing Preceptor
Department of $500,000 $3,500,000 Included Meets criteria
Incentive Program
Health
Mary Marshall
Virginia
Nursing
Department of $35,000 $35,000 Included Meets criteria
Scholarships
Health
(CNA)
Virginia Long-Term Facility
Department of Nursing $64,000 $64,000 Included Meets criteria
Health Scholarship
Virginia Nurse
Virginia Practitioner/Nurse
Department of Midwife $936,000 $936,000 Included Meets criteria
Health Scholarship
Program
Virginia Nurse
Virginia
Educator
Department of $936,000 $936,000 Included Meets criteria
Scholarship
Health
Program
Virginia Mary Marshall
Department of Nursing $1,001,000 $1,001,000 Included Meets criteria
Health Scholarships (LPN)
28
Agency/Fiscal FY23 State FY24 State Review Rationale for
Program Name
Agent Funding Funding Outcome Exclusion
Virginia Mary Marshall
Department of Nursing $1,001,000 $1,001,000 Included Meets criteria
Health Scholarships (RN)
Southwest Virginia
Virginia
Graduate Medical
Department of $164,758 $164,758 Included Meets criteria
Education
Health
Consortium
Virginia Health Does not meet
Virginia
Workforce criteria for health
Department of $300,000 $300,000 Excluded
Development care workforce
Health
Authority program
Virginia Health Does not meet
Virginia
Workforce criteria for health
Department of $600,000 $600,000 Excluded
Development care workforce
Health
Authority program
Is not
Earn to Learn
Virginia operational/
Nursing Education
Department of $0 $5,000,000 Excluded beyond initial
Acceleration
Health year of
Program
implementation
29
Appendix 4: 2023 Health Care Workforce Program Inventory
JCHC staff compiled a program inventory in 2023 to document health workforce initiatives
operating in Virginia (TABLE 6). This inventory is not a comprehensive list but is
representative of the spectrum of programs available across different funding sources,
types of organizations, and geographical areas of focus. JCHC staff identified programs
through document review, agency website review, and stakeholder interviews. Based on
available information, JCHC staff categorized programs into five different focal areas:
1. Efforts to expand the workforce;
2. Efforts to improve distribution of the workforce;
3. Efforts to retain the workforce;
4. Efforts to improve workforce wellbeing; and
5. Efforts to study the workforce.
Table 6. Virginia health care workforce programs by focus area
Program
Sponsoring Agency/Organization Program Name Focus Area
Appalachian Regional Commission Appalachian Regional Commission J-1
1, 2
Waiver Program
Appalachian Regional Commission POWER Initiative 2021 Request for
1, 2
Proposals
Appalachian Regional Commission, Delta Workforce Opportunity for Rural
Regional Authority, Employment and Communities: Grant Initiative for the
1, 2
Training Administration, U.S. Department of Appalachian, Delta, and Northern Border
Labor Regions
Ballad Health and Lee County Public Schools School-Based Telehealth Program in Lee
2
County, Virginia
Blue Ridge Partnership for Health Science Health Sciences Education and Workforce
1, 2
Careers Development Collaboration
Central Virginia Community College Central Virginia Community College
1
Career and Technical Education Academy
Claude Moore Foundation Claude Moore Scholars 1
Claude Moore Foundation Healthcare Highways 1
Delta Dental of Virginia Foundation and Virginia Dental Loan Repayment Program
2
Virginia Department of Health
30
Program
Sponsoring Agency/Organization Program Name Focus Area
George Mason University, James Madison 4-VA Initiative
University, University of Virginia, Virginia
Tech, Old Dominion University, Virginia
1
Military Institute, Virginia Commonwealth
University, the College of William and Mary,
and CISCO Systems, Inc.
Health Resources & Services Administration Nurse Corps Loan Repayment Program 1, 2
Health Resources & Services Administration Pediatric Specialty Loan Repayment
2
Program
Lynchburg Beacon of Hope Future Centers 1
Lynchburg Beacon of Hope Stay Close, Go Far 1, 2
Mary Washington and Germana Community Earn While You Learn
1
College
Mason Center for Health Workforce Integration and Innovation 5
Mason Center for Health Workforce Education and Training 1, 3
Medical Society of Virginia Advocacy: Expanding telehealth and
1, 2, 3, 4
telemedicine
Medical Society of Virginia SafeHaven 3, 4
National Health Service Corps Loan Repayment Program 2
National Health Service Corps Rural Community Loan Repayment
2
Program
National Health Service Corps Students to Service Loan Repayment
2
Program
National Health Service Corps Substance Use Disorder Workforce Loan
2
Repayment Program
Piedmont Virginia Community College Network2Work 1
Sentara Health Project CHOICE 1
Sentara Health Sentara Scholars Program 1
State Council of Higher Education for The Virginia Longitudinal Data System
5
Virginia
31
Program
Sponsoring Agency/Organization Program Name Focus Area
State Council of Higher Education for Tuition Assistance Grant Program
1
Virginia
United Way of Southwest Virginia Ignite Internship Program 1, 2
United Way of Southwest Virginia Educators in Industry 1, 2
United Way of Southwest Virginia Major Clarity 1, 2
United Way of Southwest Virginia 5 C's Workshop 1, 2
University of Virginia and Piedmont Earn While You Learn
1
Community College
US Department of Health and Human Exchange Visitor Program
2, 4, 5
Services
US Veterans Health Administration Cross Sector Partnership Pilot Program:
Expanding Telehealth Services for Rural 2
Veterans in Martinsville, VA
Virginia Career Works New Economy Workforce Credential Grant
1
Program
Virginia Commonwealth University Pathways Connect 1
Virginia Commonwealth University Pathways to Health Care Workforce 1
Virginia Community College System FastForward Initiative 1
Virginia Community College System Virginia Get Skilled, Get a Job, Get Ahead
1
(G3) Program
Virginia Community College System Virginia Career Coach Program 1, 2
Virginia Community Healthcare Association Advocacy, education, and professional
3, 4
development programs
Virginia Community Healthcare Association, Community Health Center University
University of Richmond, and Virginia 3
Association of Free and Charitable Clinics
Virginia Department of Behavioral Health SystemLEAD
3
and Developmental Services
Virginia Department of Behavioral Health Direct Support Career Pathways Program
1, 3
and Developmental Services
32
Program
Sponsoring Agency/Organization Program Name Focus Area
Virginia Department of Education Strengthening Career and Technical
1
Education (Perkins V)
Virginia Department of Health Mary Marshall Nursing Scholarship for
1
Certified Nurses Assistants
Virginia Department of Health Mary Marshall Nursing Scholarship for
1
Licensed Practical Nurses
Virginia Department of Health Mary Marshall Nursing Scholarship for
1
Registered Nurses
Virginia Department of Health Nurse Educator Scholarship Program 1
Virginia Department of Health Nursing Preceptor Incentive Program 1
Virginia Department of Health Physician Assistant Scholarships 1
Virginia Department of Health Virginia State Loan Repayment Program 2
Virginia Department of Health Virginia Behavioral Health Student Loan
2
Repayment Program
Virginia Department of Health Virginia Nurse Practitioner/Nurse
2
Midwife Scholarship Program
Virginia Department of Health Long-Term Care Facility Scholarship
1, 2
Program
Virginia Department of Health National Interest Waiver Program 1, 2
Virginia Department of Health Virginia Conrad 30 Waiver Program 1, 2
Virginia Department of Health Virginia Emergency Medical Service
1, 2
Scholarship
Virginia Department of Health Virginia Physician Loan Repayment
1, 2
Program
Virginia Department of Health Innovative Programming Awards 2
Virginia Department of Health Primary Care Office 5
Virginia Department of Health Workforce Development Training Team 3
Virginia Department of Health Professions Behavioral Health Dashboard 5
Virginia Department of Health Professions Healthcare Workforce Data Center 5
33
Program
Sponsoring Agency/Organization Program Name Focus Area
Virginia Department of Medical Assistance Indirect Medical Education Supplemental
1
Services Payments
Virginia Department of Medical Assistance Nurse Aide Training and Competency
1
Services Evaluation Program
Virginia Department of Medical Assistance High Demand Specialty Graduate Medical
1, 2
Services Education Program
Virginia Department of Medical Assistance Graduate Medical Education Program
1, 3
Services
Virginia Employment Commission Veterans Program 1
Virginia Foundation for Community College Rural Virginia Horseshoe Initiative
1, 2
Education
Virginia Health Care Foundation Boost 200 2, 3
Virginia Health Care Foundation Grant funding to health safety net
1
organizations to hire providers
Virginia Health Care Foundation Behavioral Health Hub 4
Virginia Health Care Foundation Psychiatric Nurse Practitioner Scholarship
1, 2
Program
Virginia Health Care Foundation and State Mental Health Workforce Pilot
1
Council of Higher Education for Virginia
Virginia Health Care Foundation and Delta Sign Up, Pay Down
1
Dental of Virginia
Virginia Health Workforce Development Virginia Area Health Education Centers
2, 3
Authority Scholars Program
Virginia Health Workforce Development Health Workforce Study
5
Authority
Virginia Health Workforce Development Virginia Area Health Education Centers
1, 2, 3
Authority
Virginia Hospital and Healthcare Association On Board Virginia 1
Virginia Hospital and Healthcare Association Workplace Violence Prevention Toolkit 3, 4
Virginia Hospital and Healthcare Association Workplace Safety Task Force 4, 5
Virginia Ready Credential Achievement Award 1
34
Program
Sponsoring Agency/Organization Program Name Focus Area
Virginia Tech Virginia Public Sector Leader Program 3
Virginia Tech Developing a Destination for Talent 1, 3
Virginia Tobacco Region Revitalization Talent Attraction Program: Student Loan
2
Commission Repayment
35
Appendix 5: Sources and Methods
JCHC staff conducted their review of state-funded health care workforce programs in three
steps: (1) program identification; (2) program review; and (3) program assessment.
Program identification
To identify state-funded health care workforce programs, JCHC staff developed a list of key
words to search multiple sources for possible programs (TABLE 7).
TABLE 7. Key word list and program sources
Key Word List
Health / healthcare
Workforce
Career / career and technical / vocation / credential
Industry
Nurs* / Physician / midwi* / doctor
Medic* / clinic*
Behavioral / counselor / psych*/ mental / therap* / social worker
Practitioner / Provider / Professional
Shortage
Medical education / residency / preceptor
Program Sources
2022 Appropriation Act
2023 Special Session I Amendments to the 2023 Appropriation Act
2024 Appropriation Act
Code of Virginia Titles 22.1, 23.1, 32.1, 37.2, 40.1, 51.5, 53.1, 54.1, and 66
State agency websites
The initial keyword search identified 69 possible health care workforce programs. Two
JCHC staff independently reviewed public information on each program and applied
inclusion and exclusion criteria established for the study to refine the list of programs for
review (TABLE 8). Staff discussed any differences in their determination of program
inclusion or exclusion until consensus was reached. Of the 69 programs initially identified,
31 did not meet inclusion criteria. Thirty-eight programs moved on to the next step in the
process.
36
TABLE 8. Study inclusion and exclusion criteria
Inclusion Criteria
• Met the definition of a health care workforce program and target a health care
profession, as defined for this study
• Received state funding, in part or in whole, in Fiscal Year 2023 and Fiscal Year
2024
• Implemented for at least one year
Exclusion Criteria
• One-time or short-duration program with no continuing state funds
• Primarily focused on strategic planning, research activities, or data analysis
Program review
JCHC staff met with agency leadership and interviewed program staff, as needed, for each of
the 38 programs identified for review. Programs were asked to provide data to document
the five program elements of the RE-AIM framework. RE-AIM was originally developed as a
framework for consistent reporting of research results and later used to organize reviews
of the existing literature on health promotion and disease management in different settings.
More recently, RE-AIM has been used to translate research into practice and to help plan
programs and improve their chances of working in “real-world” settings. 1 The acronym
stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance:
• Reach – representativeness of individuals participating, compared to identified
target population and/or state shortages
• Effectiveness – impact of the program on key outcomes (e.g., increased
recruitment, increased retention)
• Adoption – organizational value of program and capacity, resources, expertise to
deliver the program
• Implementation – fidelity to program protocol for delivery, time, and costs
• Maintenance – extent to which program is part of routine organizational
practices and policies
During the process of interviewing program staff and collecting data, JCHC staff withdrew
six programs from review for not meeting the inclusion criteria, and added two additional
programs that were not identified through the key word search but did meet criteria. This
adjustment brought the total programs for review to 34 programs. All programs responded
to JCHC’s request for information.
37
Program assessment
JCHC staff developed a standardized rubric to determine how programs fared on each of the
five RE-AIM framework dimensions. Staff reviewed program documentation and notes from
interviews with program staff to determine whether the program collected data on each
dimension, used the data to determine their performance on that dimension, and whether
the data provided positive results (TABLE 9). JCHC staff then reviewed programs’
performance on each of the dimensions to identify areas of strength and opportunity across
all programs.
TABLE 9. Rubric for applying the RE-AIM framework to health care workforce programs
Dimension Data Collection Data Use Data Results
Reach Does the program collect Does the program use data Are program participants
data on program collected to determine aligned with the intended
participants and the participants’ alignment target audience?
program’s target audience? with the intended target
audience?
Effectiveness Does the program collect Does the program use data Does the program have a
data on outcome measures? collected to determine positive impact on
program impact? measured outcomes?
Adoption Does the program collect Does the program use data Are participating sites
data on sites participating collected to determine representative of all eligible
and eligible to participate? sites’ representativeness? sites?
Implementation Does the program collect Does the program use data Is implementation
data on implementation collected to determine consistent across
fidelity? consistency of program participating
implementation? sites/settings/subgroups?
Maintenance Does the program collect Does the program use data Does the program have a
data on long-term (≥ 6 collected to determine the positive impact on
months) outcomes? long-term impact? measured long-term
outcomes?
1
https://re-aim.org/
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JOINT COMMISSION ON HEALTH CARE
411 EAST FRANKLIN STREET, SUITE 505
RICHMOND, VIRGINIA 23219
804-786-5445
http://jchc.virginia.gov
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