State-Based Approaches to Reforming Medicaid-Funded Graduate Medical Education

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January 2017

Erin P. Fraher, PhD, MPP; Julie Spero, MSPH; Tom Bacon, DrPH

Conclusions and Policy Implications

1) More states were in the planning stages of GME reform than had actually implemented changes.

2) States tackled GME reform to address maldistribution of physicians by geography, specialty and setting; to respond to expansions in undergraduate medical education; to increase funding by leveraging the federal Medicaid match; and to address disparities in the amount of GME funding received by different training institutions

3) In most states, some type of oversight body had been created to bring stakeholders together, reach consensus on workforce needs, decide how funds could be targeted to needed specialties, geographies and populations; and educate the legislature. In all states interviewed, the oversight body was advisory, not authoritative.

4) Interviewees voiced a desire to increase transparency and emphasized that little or no transparency or accountability currently existed in their state.

5) Many states want to implement accountability metrics to measure ROI for state GME investments, but they need technical assistance to make tracking a reality.

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