Arizona Area Health Education Center System in Transition

Arizona and 47 other states have programs called Area Health Education Centers that focus on enhancing access to quality healthcare (especially particularly primary and preventive care) by improving the supply and distribution of healthcare professionals through academic-community educational partnerships in rural and urban medically underserved areas.

Arizona’s state Area Health Education Center (AzAHEC) is housed at the University of Arizona.  Like the AHECs in most other states, Arizona’s statewide AzAHEC focuses on developing health professions workforce education programs that emphasize primary care and increasing access to care in rural and underserved communities.  Many of the strategies to accomplish this include improving the supply, quality, diversity and distribution of the health professions workforce.

The state AHEC program at the UA works in collaboration with the 5 statewide Arizona AHEC regional centers which are independent non-profit organizations that work in coordination with the state program:

The 5 regional centers each have their own unique strategies to improving the supply, quality, diversity and distribution of the health professions workforce.  Many of the regional strategies include strategies to develop health professions students and health professions workforce, recruiting and retaining a health professions workforce, and inter-professional training.  The regional centers also support many health careers programs including students in medicine, nursing, pharmacy, public health, dentistry, and allied health.

As of July 1, 2019 the Central Arizona Health Education Center took over as the Area Health Education Center for Central AZ.  For many years, Empowerment Systems dba the Greater Valley Area Health Education Center had been the Central Regional AHEC.  Sean Clendaniel is busy getting the business model and systems up and running as you read this. I’ll be updating the happenings in the Central AHEC in the coming months.

The combined work of the 5 regional centers and the state program are far too wide-ranging to capture here- but you can get an idea of the particulars by reading the state program Annual Report which includes summaries of the priority programs at the state program (UA) as well as the regional AHECs.

How it’s Funded

Funding for Arizona’s AzAHEC system is voter protected. The statute authorizing and funding the state system was approved by Arizona voters as Proposition 203 (in 1996) (aka Healthy Arizona 1) which required the Arizona State Lottery to allocate funds including the state AzAHEC programs [A.R.S. §5-522(E)] when annual Lottery revenues reach a specified threshold.

The system really matured in 2000 when voters passed Proposition 204 (aka Healthy Arizona 2) which expanded eligibility for the AHCCCS to 100% of the federal poverty level guidelines…  but also included a directive to distribute $4M annually to the AzAHEC system. 

It’s rare to have a state program that has a guaranteed source of income that doesn’t require an appropriation authorization from the state legislature, which is a real source of strength and stability. Also, because the funds are voter protected, if money is still available at the end of the fiscal year the reserves aren’t swept (like they are in most other state government programs).  As a result, the system has accumulated some carry-forward funds that are available for use in future years.  FY 2016 began with an effective carry-forward balance of approximately $7.5M.  Annual reports after 2016 didn’t disclose carry forward balances- so I’m not sure what the current carry forward is.

Leadership Change at the State Level & Moving Forward

Earlier this month, Dr. Sally Reel decided to step down from her role as the head of the AzAHEC system. Dan Derksen, MD, has agreed to serve as acting director as the U of A conducts a search for a successor.  As is the case with any leadership change- this will provide an opportunity to take a fresh look at the direction and priorities of the AzAHEC system including mission priorities and allocation of the funds.

With this leadership change, the state program moved out of the administrative control of the College of Nursing where it has been for many years to the office of the Senior Vice President for Health Sciences at the UA.  This administrative change will also provide some additional opportunities to better develop cross program inter-professional training opportunities.

Another opportunity for the state AzAHEC system is the implementation of new budget items that were in this year’s state budget- especially the addition of $12.5M more for Graduate Medical Education ($7M rural and $4.5M urban) in the coming year.  Graduate Medical Education is important because Residency programs have a huge impact on retaining primary care physicians and other allied health professionals- a big leverage point for driving healthcare professionals toward rural and underserved areas of AZ.

While Arizona has some pretty robust Medicaid GME spending already, those residencies are generally distributed in urban areas.  That’s because the money used to draw down the federal matching funds comes mostly from urban area hospitals - and the residencies go to those areas.  Also, those residency slots are generally for subspecialists – not primary care (which has the greatest need).

The new state AzAHEC program will now be in a position to influence the decisions to allocate the new $12.5M in Graduate Medical Education funding- that’s great because of the expertise within the program and at the AZ Center for Rural Health at the UA.

Other opportunities for program include soliciting input from regional AzAHEC office which could result in new innovative strategies that could be implemented either by the regional AHEC offices of the statewide AzAHEC.  Perhaps this could best be accomplished by convening a statewide primary care workforce forum to get input from a cross section of Arizona Stakeholders regarding strategic planning options and use of state AzAHEC funds.  An independent entity such as AzPHA could convene the forum, which would solicit ideas presented by participants including local AzAHEC programs.

More to come.