Strategies for Government

Federal, state, and local governments can enact policies to align payment, programs, and regulation with health and public safety values centered on patients and communities. This includes tracking, evaluating, and regulating developing healthcare systems changes that may negatively impact worker well-being and quality of care (e.g., private equity ownership).

Resources

The U.S. Surgeon General’s Advisory recommends federal, state, local and Tribal governments should:

• Develop and invest in reimbursement models that are aligned with the goals of high-quality person-centered care, including preventions services, and coordinated care teams
• Address societal contributions to health to improve patient outcomes and decrease demand on health workers and health systems,” including expanding access, committing to improving health equity, building trust between underserved communities and health workers, and proactively addressing health misinformation
• Increase and sustain funding for public health
• Ensure and strengthen collaborative strategic planning across sectors and government agencies to improve our readiness and coordination for future public health crises

The NAM National Plan for Health Workforce Well-Being prioritizes recruiting and retaining a diverse and inclusive health workforce and identifies federal, state, and local governments as critical actors. The plan recommends:

• Ensuring health workers have the infrastructure to support their work to improve population health (e.g., integration of social determinants of health in payment policy)

Matthew Mandelberg from the U.S. Department of Justice and colleagues’ piece Reconsidering the Ban on Physician-Owned Hospitals to Combat Consolidation provides an overview of the increasing trend toward healthcare consolidation, the impact of physician owned hospital ban, and makes recommendations for Congress around removing or relaxing the ban.

Private Capital, Public Impact: An FTC Workshop on Private Equity in Health Care examines the role of private equity investments in health care. Experts highlight and discuss potential harms to patient care, as well as the health workforce, including moral injury and burnout staffing shortages and loss of professional autonomy.

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Oregon’s Health Care Market Oversight program reviews proposed business deals to ensure they will help and not hurt Oregon’s goals of health equity, lower consumer costs, increased access, and better care. Bruch, et al. found increased physician exit and clinician replacement in private equity-acquired practices across three specialties. The team’s previous work raises concerns for increased health care costs associated with private-equity acquired practices

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Diversity, equity & inclusion (DEI) for the health and public safety workforce is an ongoing challenge with significant underrepresentation in most higher paying professions and high proportions of women and people of color in low-wage occupations, such as the direct care workforce. Opportunities for federal, state, and local governments to improve workforce DEI include:

• Establishing stronger anti-discrimination protections and enforcement
• Creating targeted policies and investments to improve DEI
• Addressing DEI within the government

Resources

The U.S. Equal Employment Opportunity Commission enforces laws, including Title VII of the Civil Rights Act, the Pregnancy Discrimination Act, and the Equal Pay Act of 1963, prohibit discrimination against workers based on a number of protected statuses.  

The U.S. Surgeon General’s Advisory recommends federal, state, local and Tribal governments should recruit, expand, and retain a diverse health care and public health workforce to meet current and future health challenges. The Advisory identified the following opportunities:

• Pay health workers what they are worth, including policies to ensure living, competitive wages, equity focused career advancement opportunities, and a review of hiring, salaries, and salary caps.
• Invest in long-term programs such as the Behavioral Health Counselor Apprenticeship program and SAMHSA’s Minority Fellowship Program.
• Sustain long-term investments in programs to recruit, hire, and train health workers from underrepresented backgrounds, such as HRSA’s investment in community health workers from underserved communities.

The NAM National Plan for Health Workforce Well-Being prioritizes recruiting and retaining a diverse and inclusive health workforce and identifies federal, state, and local governments as critical actors. The plan recommends:

• Provide debt relief opportunities for students and workers
• Invest in educational pathways and programs such as pipeline programs, targeted scholarships, and professional development programs

The National Governors Association spotlights a number of state initiatives to improve health workforce diversity. Examples, include:

• California is investing in community health workers/promotores and launched an initiative to develop and support the diversity of the state’s behavioral health workforce.
• In 2022, Colorado launched the Colorado Option, with a requirement that state-based marketplace plans include a culturally responsive network that is diverse in terms of race, ethnicity, gender identity and sexual orientation to reflect the community served.
• Oregon collects and analyzes data on the diversity of its health care workforce.

Spotlights

‍In 2016, the U.S. Department of Justice Equal Employment Opportunity Commission released a report on Advancing Diversity in Law Enforcement, which examines the evidence for why diversity in law enforcement matters, barriers to diversity, promising practices, and makes key conclusions.

‍Two recent Presidential Executive Orders aim to improve DEI in the federal government:
Executive Order on Diversity, Equity, Inclusion, and Accessibility in the Federal Workforce (2021) establishes a government-wide DEIA Plan to define standards of success and strategies for DEIA, develop a comprehensive framework to address workplace harassment, promote data-driven approaches for transparency and accountability, agency reporting, and support/coordination of research and evaluation.

‍Executive Order on Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety (2022) established an interagency working group to develop a set of core policies and best practices across all Federal Law Enforcement Agencies, including assessing existing policies and identifying and sharing best practices for recruitment and hiring who are representative of the communities they serve.