March 12, 2018

Addressing Provider ‘Churn’: The Provider Recruitment & Retention Program

PCDC recently launched its Provider Recruitment and Retention (PR&R) Financing Program, which enables community health centers (CHCs) to either recruit new providers or retain one or more staff through alternative “loan-forgiveness/performance-incentive” financing.

Previously excluded from more traditional loan-forgiveness offerings, CHCs can now benefit from new financial incentives available through PCDC — and help create healthier, thriving communities through consistent primary care.

This week, PCDC Chief Lending Officer William O’Brien [pictured] will discuss the program in more depth at the 2018 Policy and Issues Forum in Washington, D.C., presented by the National Association of Community Health Centers.

Below are excerpts from a recent conversation about this “one-of-a-kind” financing option, according to O’Brien.


PCDC: Why is the program so unique?

O’Brien: The program is novel because of its purpose and how it’s structured.

In terms of purpose, the program is one-of-a-kind: no other financial institution is offering a workforce-focused financing product.

Specifically, the program is designed for health centers that do not qualify for more traditional loan-forgiveness programs, such as the federal National Health Service Corps (NHSC), or similarly-structured state-level programs. As such, it seeks to address the national shortage in primary care providers.

It’s also unique in its structure. Although we commonly discuss the program as a single entity, it’s actually structured as two distinct financing products, designed for different purposes.


How do they differ?

The Provider Recruitment product is structured to maximize the likelihood of a provider remaining with the health center by staggering advances made to the provider — through PCDC’s CHC client — over a period of five years.

So, the program not only offers a financial incentive to join the health center, but also incentivizes the provider to stay at the center. It thereby addresses the common issue of provider “churn” — the frequent departure of providers from health centers immediately following completion of the NHSC two-year tenure requirement.

Alternatively, the Provider Retention product is structured as a more straightforward three-year financing program that can be offered to any group of key staff, including providers, support staff, etc.

Advances are made in equal amounts over three consecutive years, thus ensuring both adequate funding in any single year, but also establishing a longer-term incentive plan at the center (and enhancing the CHC’s “competitiveness” among its area peers).

The benefit of both programs — apart from available funds for payment to key staff — is the ability of the CHCs to be able to compete for providers by having their own economic incentives.

Finally, qualifying for PCDC’s programs is relatively flexible and easy: no Health Professional Shortage Area (HPSA) scores are necessary. Rather, the center only needs to demonstrate: a.) the need for the program; and b.) its ability to repay the loans.


How would you describe the early response?

Early response has been strong interest coupled with constructive criticism: several industry leaders, including several CHCs, state primary care associations (PCAs), and NACHC have offered suggestions to strengthen the program.

These ideas include staggered advance rates to help retain specific providers beyond the traditional two-year commitment period, and a separate “retention” program to offer centers as a means of financing incentive programs to help retain key staff members.

Regions of the country also have shown strong interest, particularly more rural areas of the west coast, the Pacific Northwest, and Gulf Coast states. In addition, CHCs in certain urban areas have expressed interest, including New York, Chicago, and New Orleans — centers that might score relatively low on the HPSA scale, but still experience difficulty in attracting providers due to their areas.

While the Recruitment program has been described as innovative, the Retention program has been of particular interest as it is useful for a broader group of CHCs, including providers, support staff, and other key team members.


What is the profile of an organization that might be interested?

The Provider Recruitment financing product was designed for those centers that did not qualify for either the NHSC or state-sponsored loan forgiveness programs, but who had the same difficulty recruiting providers as those centers who did qualify. It was those centers who were cited by their respective PCAs who were lacking the economic tools — provided by the NHSC and local programs — to compete for providers. PCDC’s recruitment product was designed to help those centers compete for staff.

The Retention product was designed for any center that wanted to develop an economic incentive program to retain key staff at the CHC. Many centers already have such programs but are financing off their balance sheets (using their own cash), while others are interested in creating such a program but lack the cash to spend upfront. PCDC’s program provides both groups with a flexible financing alternative to accomplish this goal and compete with other health systems.

Learn more this Thursday, March 15, at 10:30 a.m. at the “Health Center Workforce Programs Fell Over the Cliff, Lessons Learned” session at the 2018 Policy and Issues Forum.