Priority Needs

Reduce and eliminate barriers to ensure equitable and optimal health for women. Reduce disparities in infant and maternal morbidity and mortality.

National Performance Measures

NPM 1 - Percent of women, ages 18 through 44, with preventive medical visits in the past year. NPM 13.1 - Percent of women who had a preventive dental visit during pregnancy.

 

For 2023, the priorities for women’s health were to reduce and eliminate barriers to ensure equitable and optimal health for women and reduce disparities in infant and maternal morbidity and mortality. Within the Women/Maternal health population domain, programs continued their work in Health Equity and Family Engagement. The Health Equity activities are identified in italics throughout this section of the report and information about Family Engagement can be found interwoven through the annual report and in the Family Partnership narrative.

Arizona identified the continued need to improve the health of women before and between pregnancies as a priority. With Title V funding, BWCH continued to support the Preconception Health Alliance in partnership with the Arizona Family Health Partnership. The Alliance met quarterly in 2023 and achieved the following: Substance Use Disorder, Opioid Use Disorder, Pregnancy, and Parenting presentation by Kate Dobbler of AHCCCS; Dr. Coonrod conducted presentations on the importance of Folic Acid to the Chief Medical Officers of FQHC networks and AHCCCS medical plans, as well as developing a Folic Acid infographic for distribution. The Alliance will continue to increase its partnering agencies.

In 2023, Title V funds were allocated to fourteen (14) out of the fifteen (15) County Health Departments through the Maternal & Child Health Healthy Arizona Families (MCH HAF) Intergovernmental Agreement (IGA). The county health departments can utilize the funds to address the women/maternal health population domain. Figure 17 provides a list of the Counties, the population-specific National Performance Measures the Counties are working to address, along with the associated strategies. The majority of the Counties utilize Title V Funds to implement the Family Planning Clinics, but Arizona has two Counties that utilize the funds to promote preventive oral health care for pregnant women. 

Figure 17. MCH HAF IGA Counties and associated National Performance Measures

County	NPM	Strategies
Apache	NPM 1	Implement a Family Planning Clinic
Cochise	NPM 1	Implement a Family Planning Clinic
Coconino	NPM 13.1	Promote preventive oral health care for pregnant women
Gila	NPM 1	Implement a Family Planning Clinic Promote dental care for pregnant women
	NPM 13.1
Graham	NPM 1	Implement a Family Planning Clinic
Greenlee	NPM 1	Implement a Family Planning Clinic
La Paz	NPM 1	Implement a Family Planning Clinic
Mohave	NPM 1	Implement a Family Planning Clinic
Navajo	NPM 1	Implement a Family Planning Clinic
Yavapai	NPM 1	Provide well-women resources to community partners
Yuma	NPM 1	Implement a Family Planning Clinic

 

Title V Family Planning Program: Within the MCH HAF IGA, nine (9) counties (Apache, Cochise, Gila, Graham, Greenlee, La Paz, Mohave, Navajo, Yuma) implemented family planning and reproductive health services to low-income and other higher need women, including those living in rural and underserved areas or without a reliable form of health insurance, and their partners. The overall goal of this program was to improve the health of women of childbearing age before, during, and after birth to promote optimal health, outcomes, and wellness for all Arizonans; in alignment with our priority to reduce and eliminate barriers to ensure equitable and optimal health for women and NPM 1: Well-Women Visits. Services provided included family planning and reproductive health education; counseling on birth control methods and provision of birth control; screening for pregnancy, sexually transmitted infections, and cervical cancer; and referrals to other clinical or social services. Additionally, the Arizona Title V Program funded Valleywise Health, a network of federally qualified health centers to provide these services in Maricopa County.

During 2023, seven out of nine counties were able to provide services to clients monthly. In the rare case that the county was not able to provide services, it was due to a lack of providers or a lack of patients scheduled. Despite this, the counties were able to provide services to 2,261 clients over the year.

BWCH entered into another year of the Count the Kicks campaign and training in Arizona with support from Title V funding. Continuing the partnership with Count the Kicks built awareness among women in their third trimester of the importance of counting their baby’s movements with the aim of decreasing stillbirths in Arizona. To create awareness and promote the materials available for ordering, Count the Kicks provided three (3) webinars and presented at nine (9) conferences promoting Arizona’s campaign. Webinars were attended by over 70 participants and conferences by over 460 participants from specialized groups such as OBGYNs, home visitors, doulas, nurses, etc. To further create awareness, campaigns were launched throughout the year including on social media with a reach* of 48,150 and 103,189 impressions**, 5 targeted emails, 2 postcards, and 1 letter mailing to Arizona maternal health advocates. In 2023, according to Count the Kicks’ Arizona profile, Arizona loses, on average, 489 babies a year due to stillbirth, and, on average, 158 babies could be saved every year. Participating states have shown a significant decrease in stillbirth rates after a five-year investment.

*Media reach - total number of different people or households exposed to the message, at least once.

**Impressions - number of times the message was seen.

The Maternal Mortality Review Program (MMRP) funded through the CDC ERASE MM grant, aims to reduce disparities in maternal mortality through several data-related activities. Throughout 2023, the MMRP performed quantitative and qualitative analysis of data and recommendations collected during the review of 2018-2019 maternal deaths and drafted the findings for committee review and feedback. In January 2024, the final report was published, revealing the following key findings: Pregnancy-associated deaths have increased from 79.1 per 100,000 live births in 2016-2017 to 91.2 per 100,000 live births in 2018-2019. Pregnancy-related deaths (i.e., deaths that were related to pregnancy) also increased from 18.3 to 26.3 deaths per 100,000 live births. American Indian or Alaska Native persons had the highest Pregnancy-Associated Mortality Ratio at 233.9 deaths per 100,000 live births, followed by Black or African American persons at 166.8 deaths per 100,000 live births. The leading cause of death for pregnancy-related deaths was mental health conditions (32.6%), followed by cardiovascular conditions (20.9%), hemorrhage (16.3%) and infection (16.3%).

Through individual-level case reviews, the Arizona Maternal Mortality Review Committee (MMRC) determined that 90% of the 149 deaths reviewed were preventable. The MMRC’s 10 most frequently recommended strategies identified a method to prevent the death of a person under review, and call cross-sector partners to take action on the following:

1. Establish continuity of care for timely coordination among healthcare providers.
2. Adopt trauma- and culturally-informed practices for healthcare providers.
3. Increase access to high-quality mental and behavioral health services.
4. Expand insurance coverage for the range of maternal health services beyond one year postpartum.
5. Screen pregnant individuals and their partners for domestic violence, mental illness, Substance Use Disorder, and Adverse Childhood Experiences.
6. Increase in provider education about the perinatal period.
7. Enhance access to the full range of reproductive health services.
8. Ensure facilities are prepared for obstetric emergencies.
9. Address access to care barriers related to income insecurity.
10. Increase in patient education about substance use and misuse.

In March 2022, a topical report on 2016-2018 deaths related to mental health conditions and substance use disorder was published by ADHS. The report included eight (8) recommendations developed in partnership with the Maternal Mental Health Task Force that aim to reduce maternal mortality related to mental health conditions and substance use disorder. To date, at least two recommendations have been implemented: Arizona Health Care Cost Containment System expanded Medicaid coverage to one year postpartum, effective April 1, 2023, and the University of Arizona established the Arizona Perinatal Access Line (APAL) for providers to access real-time perinatal psychiatric consultation, effective June 1, 2023.

Additionally, the MMRP continued its partnership with Diné College and the University of Arizona to conduct an extension of the 2020 Title V Needs Assessment focused on access to prenatal, postpartum, mental, and oral healthcare in Arizona. The original assessment was completed in 2020, and the report was published in July 2021. The assessment revealed racial and residential disparities that impact maternal health outcomes in Arizona. Since then, a supplementary study was conducted to explore the findings and better understand the maternity care experiences of African American women and women residing in rural areas. In September 2022, a slide deck was published describing the supplementary analysis and results. Throughout 2023, partners at the University of Arizona reviewed these findings in greater detail and, as a result of these 2023 review efforts, a qualitative paper titled “Optimizing Postpartum Care in Rural Communities: Insights from Women in Arizona and Implications for Policy” was published in February 2024. This study concludes that postpartum care utilization is influenced by maternity care experiences and structural barriers, emphasizing the need for comprehensive person-centered postpartum care through policy interventions that increase the accessibility and affordability of community-level support and services. Findings will be used to inform future programming for MMRP, MHIP, and Title V programming.

Internally, the MMRC is addressing health disparities by increasing the diversity of the committee to ensure that populations who are disproportionately impacted by maternal mortality are represented during maternal death reviews. In 2023, the MMRC accepted 21 new members, of which, approximately 50% are people of color, and several of which have experience with community birth (e.g. midwife, doula). The MMRC is also recruiting and compensating tribal maternal health community advocates as well as those with lived experience for their time and to reduce barriers to their active participation. In February 2024, the MMRC selected a co-chair who represents tribal communities to serve alongside the co-chair who represents clinicians. The MMRP conducts an annual composition survey to evaluate current membership and identify gaps in the personal and professional experiences of the committee for ongoing opportunities to diversify membership.

MMRP has taken several opportunities to present information about the program, the latest data, and the MMRC’s recommendations to various audiences. On August 23rd and 24th of 2023, ADHS virtually hosted the 4th Maternal and Infant Mortality Summit. The theme of the Summit was Systems and Communities: Creating Change for Better Outcomes. The sub-theme for day one was Strengthening the Birth Workforce; some presentation topics included the latest maternal and infant mortality data, maternal and infant health policies, maternal health insurance coverage, and two programs that improve access to midwives and doulas. The sub-theme for day two was Optimizing Maternal and Infant Care; some presentation topics included the Arizona Alliance for Maternal Health (AIM), the Arizona High-Risk Perinatal Program, and the Maternal Early Childhood Sustained Home Visiting (MECSH) Program Pilot, Count the Kicks, infant feeding models, and the launch of the Stillbirth and Infant Mortality Action Plan (SIMAP). There were 705 registrations for the Summit, with 418 peak attendance on day one and 374 peak attendance on day two. The majority of the audience included registered nurses, home visitors, social workers, and public health professionals. For the first time, ADHS was able to offer up to eleven (11) Continuing Education Units (CEUs) to active participants.

In 2023, the CDC-funded Arizona Pregnancy Risk Assessment Monitoring System (AZ PRAMS) advocated for the utilization of PRAMS data, which offers comprehensive surveillance on the preconception health of reproductive-age individuals, enabling ADHS-funded programs to customize interventions to address the physical and mental health requirements of populations susceptible to adverse pregnancy outcomes. For FY 2023, PRAMS proposed to continue to meet the goals of the CDC to maintain 50% or more in interview maintenance at 10% per batch. AZ PRAMS complied with CDC requirements and has a compliance rate of 53.38%. Arizona has the highest response rates in the Country. Overall in 2023, nationwide, PRAMS was operating at a compliance rate of 47.39%.

In 2019, Arizona was one of nine states awarded the first Maternal Health Innovation (MHI) grant and in 2023, the ADHS applied again and was awarded an additional five years of funding. This elevates Arizona among the select few states chosen to receive MHI funds for a second time – a profound testament to its unwavering commitment to advancing maternal health. The successful reapplication for the HRSA Maternal Health Innovation funding in 2023 serves as an affirmation of Arizona's dedication to maternal health and ensures that the state can continue its trajectory of progress and innovation in maternal health initiatives over the next five years. The MHI Program is committed to ongoing improvement, collaboration, and the pursuit of addressing disparities. As a leader in maternal health innovation, Arizona is poised for even greater advancements in the years to come, ensuring the well-being of mothers and infants across the state.

 

Throughout 2023, the MHI Program continued to address areas vital to maternal well-being. These efforts span from increasing knowledge and education for pregnant and postpartum individuals, enhancing access to care, improving data surveillance, supporting the workforce, and its capacity, and fortifying systems of care. At the core of this work is the Maternal Health Task Force, a comprehensive initiative housing sub-task force groups devoted to critical aspects such as the Maternal Health Steering Committee, Maternal Mental Health, Tribal Maternal Health, and the AIM Steering Committee. This multifaceted approach ensures a more holistic and inclusive strategy, and a commitment to address the challenges in maternal health.

 

Additionally, initiatives like prenatal telemedicine services in Cochise County extended quality care to rural populations. This collaborative effort with the Chiricahua Community Health Center and Tucson Medical Center showcased a commitment to ensuring that even the most remote communities receive the care they deserve.

 

Another impact of the MHI Program is the Arizona Maternal and Infant Mortality Summit, a vital platform organized in collaboration with the Maternal Mortality Review Program (MMRP). This summit serves as a cornerstone for stakeholders to collaboratively address health equity issues, share insights, and foster collective action in the realm of maternal and infant mortality. Its purpose is to deepen understanding of the intricate connections between a mother's health and that of her newborn, emphasizing the critical need for timely, high-quality, and non-stigmatizing care during critical periods.

 

The MHI Program focuses on the leading causes of death and severe maternal morbidity (SMM) in Arizona. This includes cardiac conditions, hypertensive disorders of pregnancy, sepsis, and mental health conditions. It was evident that education around urgent maternal warning signs was needed in Arizona. Following the 2023 Hear Her Campaign, addressing urgent maternal warning signs, there was a need expressed for an expanded focus on perinatal mood and anxiety disorders. In order to address these concerns, the MHI Program launched the Know the Signs campaign which promoted awareness of maternal mental health conditions, and the HRSA-funded national maternal mental health hotline. This approach underscored a keen awareness of the evolving landscape of maternal health and a commitment to remaining at the forefront of effective interventions.

 

With the plan of the Engaging Families and Young Adults Program (EFYAP) to incorporate advisors throughout the Bureau in each office, the EFYAP and MHI Program continued to discuss implementation. For the women and maternal health population domain, the former and then interim program manager of EFYAP and the MCH and AMCHP Family Delegate (EFYAP co-lead) continued to meet monthly with the staff who oversee the MHI program and the Office Chief for the Office of Women’s Health. Conversations involved what it would look like to incorporate family advisors into the Maternal Health Steering Committee, Tribal Maternal Health Task Force, Mental Health Task Force, and the AIM Steering Committee. The program also brainstormed recruitment ideas and strategies for the family advisors and received technical assistance about engaging with individuals with lived experience. The MHI program staff and Office Chief began drafting an activity planner for the advisor roles identified, which would be used to help with the recruitment of advisors once completed.

The Arizona AIM Collaborative continued to engage labor and delivery facilities across the state, with continued work on the Severe Hypertension in Pregnancy patient safety bundle, and the implementation of the Obstetrics Hemorrhage safety bundle in September 2023. A total of 35 hospitals statewide participated in the AIM in 2023. The MHI Program leads this work in partnership with the Arizona Hospital and Healthcare Association (AzHHA). They provide technical assistance and ongoing support to the participating birthing hospitals through monthly calls, webinars/training, and interpersonal education to share lessons learned and challenges experienced to improve implementation efforts and health outcomes.

 

To ensure representation and active participation from all 22 of Arizona's Federally Recognized Tribal Nations, the MHI Program has forged contracts with Diné College and the Inter-Tribal Council of Arizona. These partnerships are designed to bridge gaps and foster inclusivity in the implementation of maternal health initiatives, a commitment further underscored by the active engagement of the Tribal Maternal Task Force in developing a culturally relevant strategic plan to address health disparities disproportionately affecting Indigenous communities.

 

Throughout 2023, the MHI Program continued to fund the training series “Maternal Health and Family Wellness from an Indigenous Perspective”, emphasizing cultural sensitivity to enhance maternal health among Indigenous populations. These initiatives involve collaboration with elders, knowledge holders, and birth workers, exemplifying a commitment to community-driven approaches that honor diverse cultural perspectives.

 

At the heart of MHIP's initiatives lies a commitment to patient and family engagement. Patient and family advisors assume pivotal roles in committees, with a dedicated patient advocate for the AIM Steering Committee and active participation in the National Lived Experience Integration Community of Learning with Momma’s Voices. This inclusive approach ensures that the voices of those directly affected are not only heard but are instrumental in shaping policy and practice.

 

Alongside the Women/Maternal Health activities and work headed by the Office of Women’s Health team and collaborators, the Office of Oral Health (OOH) and Primary Care Office (PCO), housed within BWCH, continued their cross-cutting activities relating to Women/Maternal Health.

The OOH implements several oral health programs and initiatives to improve the oral health of Arizona's pregnant women and other high-risk populations. The fundamental principles for OOH strategies include equity-focused, evidence-empowered, data-driven, integration-centered, stakeholder engagement, and innovation-focused. Key programs and initiatives include the Fluoride Varnish Program, the Community-based Oral Health Program for Pregnant Women, and the Mission of Mercy. Each of these programs receives partial funding from Title V.

The OOH implements a Fluoride Varnish Program for pregnant women. This is in partnership with Arizona’s early childhood agency, First Things First (FTF), through the Arizona Early Childhood Development and Health Board. The program is offered at Women, Infants, and Children (WIC) Program offices, immunization clinics, obstetricians' offices, and prenatal classes throughout the state. The application of fluoride varnish, an extremely effective cavity-prevention agent, in combination with dental screenings, referrals, and other educational services, is the core of the primary prevention program. During the 2023 state fiscal year (July 1, 2022–June 30, 2023), the Fluoride Varnish Program served 315 women of childbearing age in five counties, including screenings, oral hygiene education, referrals, and case management as needed. In addition, the OOH’s role is to provide the local partner agencies with professional development on anticipatory guidance and motivational interviewing for pregnant women. During the 2022-2023 school year, OOH provided eight hours of professional development for 96 oral health providers across Arizona. The training was provided throughout the calendar year and located geographically and virtually to accommodate broad participation from all counties and to address ongoing technical assistance needs.

The OOH continued working in partnership with the Arizona Health Care Cost Containment System (AHCCCS; Arizona's Medicaid program) by collaborating on connecting pregnant women to oral health care. Accessing affordable oral health care for pregnant women continues to be a challenge as the only dental benefit for Medicaid-eligible adults includes emergency dental services for the extraction of teeth. OOH continued its partnerships with a wide range of policymakers, advocates, and other stakeholders to respond to the need for improvements in the provision of oral health services to women during pregnancy.

Oral Health Care During Pregnancy: A National Consensus Statement, was designed to help health professionals, program administrators and staff, policymakers, advocates, and other stakeholders respond to the need for improvements in the provision of oral health services to women during pregnancy. OOH developed training materials and resources for multiple audiences, including home visitors, childcare providers, health providers, pregnant women, and new mothers, to enhance their knowledge and skills in improving oral health for women and young children. These resources include e-learning modules on oral health best practices. In 2023, 26 home visitors completed the oral health best practice e-learning modules, as well as motivational interviewing modules. The oral health training resources reside on the home visitor portal, Strong Families AZ, and are available to home visitors and partners statewide. As part of the training in 2023, OOH distributed 550 oral hygiene kits to participating home visitors to provide to their clients during oral health conversations.

During 2023, OOH worked with a broad array of national, state, and local public and private partners to educate decision-makers on dental public health issues and concerns of state oral health programs that impact and reach women. One such partnership included statewide and regional oral health coalitions that were instrumental in addressing access to care issues for our most vulnerable populations. In 2023, Arizona worked on providing technical assistance to partners regarding the recently signed Dental Therapy bill, which created a new class of dental care providers in Arizona who will be able to provide primary dental care for children and underserved individuals. While employment of this provider type is still in the rules stage of development, partners are eager to move forward with implementation.

Arizona also looks at ways to reach and serve the oral health needs of the disenfranchised and underserved. As a result, the OOH partnered with the Arizona Mission of Mercy in 2012. This event is hosted annually and provides free dental care to those in most need. It is made possible through the work of hundreds of volunteers. A startling 42% of Arizona adults over 65 years have lost six or more teeth due to decay or gum disease, are less likely to visit the dentist compared to other states, and suffer from health disparities related to race, income, and chronic disease status. We know that nationally about half of people do not have dental insurance and pay for dental care out-of-pocket, and in Arizona, Medicaid recipients are covered for emergency dental care, which is capped at $1,000 per year. In 2023, the 11th Annual Mission of Mercy event held at the Arizona Fairgrounds was once again implemented. The event addressed the severe dental needs of women that resulted during and/or after the pandemic. More than 1,300 volunteers came together and provided dental care to more than 2,000 patients, with an average treatment value of over $1,500 per person, to produce over $1.6 million in dental care during this year's event.

Here are some of the results from the December 2023 event that spanned over 3 days:

There were 1,397 volunteers comprised of the following.

• 3 ACDF Staff
• 26 AZ Mom Leads
• 1 Pharmacist
• 14 Pharmacy students
• 1 Pharmacy Tech
• 3 Physician Assistants
• 67 Dental Assistants
• 56 Dental Assistant Students
• 214 Dentists
• 26 Dental Lab Staff
• 2 EMTs
• 703 General Volunteers
• 45 Dental Hygiene Students
• 24 Pre-dental Students
• 3 Faculty
• 5 Translators
• 2 X-ray Technicians
• 144 Dental Hygienists
• 37 Medical Students
• 14 Nurses
• 7 Nurse Practitioners

There were 1,071 patients served during the 3-day event and the following figures provide a breakdown of the demographics served.

Figure 18. Mission of Mercy Patients by Gender

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 19. Mission of Mercy Patients by Age Range

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 20. Mission of Mercy Patients by Ethnicity

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 21. Mission of Mercy Patients by Household Income

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 22. Mission of Mercy Costs Associated by Departments

Other relevant statistics include:

• 91% of patients were from Maricopa County
• 4% of patients were veterans
• 39% of patients receive WIC

Over the past 12 years, the Arizona Mission of Mercy has been able to provide approximately $25 million worth of dental services to thousands of patients through the help and dedication of the volunteers.

In addition to the work being done by the Office of Women’s Health, the Primary Care Office (PCO) within BWCH leads statewide efforts to improve access to care to all health services in Arizona’s rural and underserved communities. The PCO continued to lead the data evaluation and coordination of submitting for Health Professional Shortage Areas (HPSA) or Medically Underserved Areas or Populations (MUA/P) to HRSA to inform where resources can be leveraged to create the greatest impact for improving access to health care. There were 37 MUAs and 10 MUPs in the State. Residents residing in these underserved areas are less likely to receive preventative health services. As of March 2023, Arizona had 722 HPSAs: 244 primary care, 245 dental, and 233 mental health. These include facility HPSAs for Federally Qualified Health Centers and Indian Health Service sites. Arizona needs 667 primary care physicians, 485 dentists, and 228 psychiatrists to eliminate these HPSA-designated areas, which is a higher need when compared to 2022.

The work conducted through the PCO is primarily funded through the State Primary Care Office Grant (federal), State Loan Repayment Program funds (includes federal funding and state match), Arizona State General Funds, and private donations. Title V provides supplemental funding to support the development of infrastructure to support the workforce programs, access to care activities, and professional development of health professional staff throughout the state. 

Title V funding also supported the changes and additional data collection needed for the new Maternity Care Target Areas (MCTAs), which are areas within existing Primary Care Health Professional Shortage Areas (HPSAs) that are experiencing a shortage of maternity healthcare professionals. MCTAs are a supplementary score given to Primary Care HPSAs.

The PCO partnered with the Arizona Alliance for Community Health Centers, Arizona’s Primary Care Association (PCA), to implement activities that educate communities about programs and resources that can help recruit healthcare professionals in areas with significant challenges with recruitment. The aim of the partnership is also to support the development of health professionals from diverse backgrounds and expose them to service in rural and underserved communities.                           

The PCO partnered with the Arizona Alliance for Community Health Centers on the health professional and student engagement activities above to build partnerships with academic training programs, employers, local and state partners, tribal entities, and providers to collectively address workforce shortages in Arizona. Examples of activities implemented this year include education and technical assistance to students and residents attending medical, dental, or behavioral health training; local and national presentations; partnering with the PCA to help students receive rotation placements in community health centers; assisting providers with finding job placements; and working on improving the coordination efforts between the PCO, PCA, and the State Office of Rural Health to recruit providers in underserved rural areas of the state.

As part of the mission of the Primary Care Office (PCO) to expand access in rural and underserved areas, we are the lead in the AzHIP Rural and Urban Underserved Health Priority. Within this capacity, our office supports four (4) diverse initiatives to expand access to care.

The PCO staff oversees a contract with the University of Arizona’s Arizona Telemedicine Program (ATP) which is focused on tribal areas and increasing broadband access for telemedicine given the health care shortages in those areas. Broadband, billing, and funding resources were identified as major concerns. ATP is active on the state broadband committees bringing a voice for all, especially tribal and rural communities.  ATP contracted with a national billing expert to offer open office hours and provide educational reimbursement events and hosted an “Intro to Funding” webinar with a Tribal Grant Module.

Another contract overseen by PCO, as part of the AzHIP, is with the University of Arizona to support the Arizona Area Health Education Centers (AzAHECs) to establish partnerships between academic institutions to develop pathway programs for underserved students, scholarships, tuition reimbursement, and training in high-need communities. It will also work to determine how to best support student health professionals beyond financials and make recommendations to support these needs.

The third contract supported by the AzHIP is with the Arizona Advisory Council on Indian Health Care (AACHIC) which has been tasked with convening the AzHIP advisory meetings beginning in 2023. The meetings are dedicated to increasing collaboration and focus on strengthening infrastructure between Tribal communities and Arizona state agencies. The advisory group includes AACIHC and the Tribal Liaisons of ADHS, the Arizona Department of Economic Security (DES), the Arizona Health Care Cost Containment System (AHCCCS), and First Things First (FTF).

The final contract that is overseen by the PCO staff for AzHIP is held by the Arizona Alliance of Community Health Centers. This contract aims to support fast-tracked training for Medical Assistants in Federally Qualified Health Centers. This supports entry-level staff in growing their skills and career development.

In 2023, the Primary Care Office implemented four (4) new workforce programs. Two of the programs focused on expanding the nursing workforce and building the infrastructure of nursing schools. The new workforce programs are listed below.

The Accelerated Nursing Program provides scholarships for tuition and fees for students in programs that take eighteen (18) months or less to complete. After graduation, scholarship recipients are required to serve four (4) years as a nurse in Arizona. Five universities were awarded funding through a Request for Proposal to implement the scholarship program. Arizona State University received $5.6 million for 104 scholarships, Creighton University received $5.9 million for 80 scholarships, Grand Canyon University received $16 million for 300 scholarships, Northern Arizona University received $7.2 million for 226 scholarships, and the University of Arizona received $9.2 million for 158 scholarships. As of December 31, 2023, the universities awarded a total of 439 scholarships.

The Nurse Education Investment Pilot Program is targeted to support university and community colleges with nursing programs to increase the number of faculty available and infrastructure to expand program capacity, thus increasing the number of spots available for students to seek nursing careers. The Program provides $45 million to be awarded over three years to the Arizona Board of Regents to be distributed to Arizona State University, Northern Arizona University, the University of Arizona, and the ten community college districts within Arizona. During the first year of the program, the participating universities and colleges added 84 new positions to support the growth of nursing programs and enrolled an additional 812 nursing students.

The other two workforce programs support multiple provider types.

The Preceptorship Grant Program provides stipends to healthcare providers who precept a student within the same field for at least 4 weeks. Eligible providers include osteopathic and allopathic physicians, advanced practice registered nurses, physician assistants, and dentists. The annual stipend is geared to increase the availability of preceptors in the state, prioritizing primary care and rural area providers. A total of 341 preceptors received a grant during the program’s first year.

The Behavioral Health Care Provider Loan Repayment Program provides funding to pay off portions of educational loans for behavioral health care providers and nurses, including behavioral health technicians, behavioral health nurse practitioners, psychiatric nurse practitioners and licensed practical nurses, physicians, psychiatrists, and psychologists who serve in behavioral health facilities, including the Arizona State Hospital, behavioral health residential facilities, and secure behavioral health residential facilities. The PCO established emergency rules to implement the program and begin receiving applications. In December 2022, 23 applications were received and 18 applicants were approved for participation. The awarded participants included 13 registered nurses, 2 nurse practitioners, 1 licensed clinical social worker, 1 psychologist, and a behavioral health technician. Initial feedback about the program is that it is helping improve retention at the Arizona State Hospital, which has historically struggled to retain providers.

In 2023, Title V funded the Arizona Workforce Recruitment and Retention Conference which was held on September 28-29, 2023. The conference was widely attended with 94 participants from Federally Qualified Community Health Centers, NHSC sites, tribal entities, and other healthcare organizations in rural and underserved communities of Arizona. The meeting included various topics addressing recruitment and retention. Strategies discussed were how to develop diverse staff, methods for increasing flexibility, and how to provide incentives to promote retention. The conference also covered information about the Community Health Workers (CHWs), a voluntary certification in Arizona, and reimbursement updates for these providers. There were presentations regarding establishing an Organizational Culture of Wellness. During this conference, there were also opportunities to establish partnerships and collaborations throughout the state for organizations experiencing high turnover which causes decreased access to care in the already vulnerable areas of Arizona. Feedback from attendees shared that the conference was helpful and increased their knowledge of how to recruit and retain providers.

In April of 2023, the PCO together with the Primary Care Association held the Arizona Annual NHSC Scholars Conference. The conference was well attended and attended by multiple Primary Care Scholars including students studying to be a doctor (2), physician assistants (6), dentists (9), nurse practitioners (2), and nurse-midwifery (1). During the conference, the scholars got to hear from NHSC staff and learn about PCO programs and HPSAs. A Q&A panel session was held with NHSC Alumni, which included one physician, one dentist, and two physician assistants. NHSC also had the opportunity to speak to leaders from Federally Qualified Health Centers about opportunities to fulfill their scholarship obligations.

In 2023, the PCO provided 16 presentations to diverse stakeholder meetings, outreach events, or educational opportunities, and estimates approximately 601 people were reached during these events. The stakeholders that were reached included students interested in health professions, graduate students in health professions, workforce specialists at sites from underserved areas, and leaders in rural areas.