Dr. William Hazel, CEO of Claude Moore Opportunities: Building Virginia’s Workforce Highway

Van Ton-Quinlivan

Hello, I’m  Van Ton-Quinlivan, CEO of Futuro Health, welcoming you to WorkforceRx, where I interview leaders and innovators for insights into creating a future-ready workforce.

Today, we’re going to learn about an interesting approach to expanding the healthcare workforce in Virginia that involves raising and distributing philanthropic funds to support regional training programs. The organization at the center of this effort, Claude Moore Opportunities, was launched just last year and its CEO, Dr. Bill Hazel, is here to tell us all about it.

Dr. Hazel is not new to leading innovation in the healthcare space. As Virginia’s Secretary of Health and Human Resources for eight years, he led efforts to move the needle on difficult issues such as homelessness, mental health, and the opioid epidemic. He previously served as a senior leader in the Claude Moore Foundation, as president of the Virginia Medical Society, and as a trustee of the American Medical Association.

Thanks very much for joining us today, Bill.

Dr. Bill Hazel

Van, thank you for inviting me. I appreciate it.

Van

Absolutely. Why don’t we set the table here…it might be helpful to our audience to understand what the Claude Moore Foundation is all about because the work that you’re doing now builds on the foundation’s long-term involvement in education and workforce development.

Dr. Hazel

Yes. Claude Moore Charitable Foundation is about thirty-four years old. It started off largely with some real estate and it took a few years to have any capital to do investments, but around 2005, 2006, the group decided that the best way we could help young people is to make them aware of career opportunities that they would not otherwise know about and then try to help them get into those opportunities. That led to a program called Claude Moore Scholars.

By the time I joined in 2020, they were supporting programs that touched about seventeen school districts. We aren’t talking doctors and nurses. We’re talking about all of those careers that you don’t know about if you’re only watching Grey’s Anatomy. So, it’s the x-ray techs and the EMTs and the informaticists and the nurse aides and the medical assistants and so forth. And the sense was this is really working and this needs to be statewide.

So, we really started looking and saying okay, do we have data that shows whether it works or not? And if so, what’s working and where could we improve? So we started a process of exploration, looking back at that fourteen years of history and we realized a couple of things.

One is that while working in the K-12 space through Career and Technical Ed — primarily 9th to 12th grade — was necessary, it wasn’t really sufficient. We realized you have to start earlier. People don’t know about career opportunities. We know that if you don’t have the math in seventh and eighth grade, a science course in ninth grade may not be possible, which then gets you behind if you want to go into STEM-related careers. We saw variability in the quality of the education, and we saw courses that would be taken in high school that wouldn’t necessarily count towards a certificate or credits transferring. You’ve seen all this, I’m sure, and I feel confident that it’s not unique to Virginia.

So, we learned these things and we also learned, I think importantly, that what we were aiming to do at that point was get that first certificate out of high school recognizing that some people just needed to able to go to work. If you were going to get higher education, you needed a place to start, you needed an income. What we know, though, is that when you’re talking to folks who are younger, parents in particular, they might say, “What’s after that first job? What comes next?” So we began to think in terms of, okay, how do we lay out career tracks?

In Virginia, we had this thing called the Tech Talent Pipeline, which the General Assembly had funded $30 million to create all these people with tech expertise. It was part of business development, economic development. We didn’t like the idea of a pipeline because people don’t go into healthcare that way. They don’t go in one end and come out the other with something that qualifies them to work for the rest of their life. It’s a journey. We liked the idea of a highway, so we conceived of this model of a workforce highway with off ramps and on ramps with some pretty basic things, such as rigorous education and training with it so credits can transfer. We want to think about credential stacking. want to think about good jobs that actually pay well and attract people and keep people.

So, this really was the first idea that we had in Claude Moore Opportunities.

Van

This is such important work and I agree with your observation that career exploration needs to happen a lot earlier than high school. That was also an observation in California when I was with the community colleges. So much exposure has to be done early in order to get the education sequence correct.

Dr. Hazel

Absolutely, and also dealing with parents who have expectations. Parents might think, you have to go to college and that may be true, but maybe you don’t need to go as soon as you graduate from high school. Maybe there are things to do. There are families that may have experienced college that aren’t aware of other options like community college or Career and Technical Ed that can get you where you want to go with perhaps less debt and frankly, society needs people in other roles.

The example I frequently will use is you take a young nurse, someone who’s gone and gotten her RN, maybe a BSN, comes out and works, and now she’s been in and out of the workforce with a couple of kids for a while. Now she’s thirty-eight and her back hurts. What happens then if she doesn’t feel like she can be a bedside nurse?  What do we do to help her have a career and take advantage of her expertise beyond that? So, we need to think longer term than just those first twenty-two years.

Van

Before we get off the topic of the high school students, it’s becoming harder and harder to get that first job, and that first job is so critical in terms of determining the lifetime worth of employment. I was wondering, Bill, if you could share any stories from graduates who are coming out with certificates already under their belt, and how does that affect their confidence and ability to be employed by the labor market?

Dr. Hazel

What we know, I think, is that work-based learning is critical in terms of deciding whether people like a career or not. It’s hard to read about it and know it. Outside of healthcare, I’ve just heard a gentleman this morning who was a teacher talk about student teaching, and it doesn’t take long when you’re a student teacher to realize ‘I can do this or I’m not going to do this.’ Actually having an experience that makes someone say hey, this isn’t for me is perfectly fine because they haven’t spent their life training to be that before they decide they’re not interested. So it’s good.

Work-based learning also creates relationships, sets expectations, it helps the potential employer know you, and what we see is those opportunities to see and experience can really excite a lot of kids who may not just want to spend their time in the classroom.

Van

So, with all these best practices that you’ve alluded to, including work-based learning, why did you take steps to create Claude Moore Opportunities beyond the foundation itself?

Dr. Hazel

So, the foundation itself is a private 501(c) (3) that’s really grounded in real estate and as a private foundation we’re accepting no outside funding and also really reluctant to form partnerships and so forth because of the nature of the foundation. So we decided to create a public charity which enables fundraising, it enables partnerships in different ways.  The truth is this is a bigger problem than any one organization can solve alone and so we need the ability to do those things.

Van

Well, I was very impressed by all the different partners that you had gathered in the room when I was visiting and doing a keynote at one of your events, from the community colleges to the employers and K-12 and beyond.

Dr. Hazel

Yeah, we appreciated your visit. We’ve expanded that. Obviously, we started in K-12 and community college, and some of our four-years are there. In the last year or more, we have been working more deliberately with our workforce boards in Virginia and our economic development folks. The model that we have chosen for implementation of this concept is basically a regional sector-based workforce initiative, so we’re really promoting bringing these partners together. I think you’d love this. You’re a collective impact fan, I know that for sure. So bringing these groups together to work towards common goals becomes really important. It’s essential.

Van

I was wondering if you can zoom out a little bit. I’d love to hear your analysis of the healthcare workforce situation in Virginia and where you see opportunities to improve from the status quo.

Dr. Hazel

Virginia is not unique. I think that we see the same workforce shortages that are seen across the country in virtually every aspect. I think we have focused a little bit more on behavioral health as a way to get started in some of your nurse aid and medical assisting types of positions and the reason for that is those become really more urgent to the public. Nurses, because of the volume and the number, if you look at every survey that asks what do you need the most of, they say nurses. I mean, that’s pretty much it. But it’s the absence of a technician, maybe an ultrasound tech that can really mess up a hospital function if that person isn’t available. So, we’ve tried to look into the system a little more deeply.

I’ve settled a little bit on behavioral health because in Virginia — again, I think like the country — we’ve seen a lot of attention devoted to mental health issues, behavioral health, opioid recovery. A new program is set up and they’re gonna fund all this, but who’s there to do the work? None of these programs work without staff and because it’s in the public interest to solve that, coming up with solutions to public problems becomes important as we think largely about the issue.

And frankly, healthcare, probably more than any other industry except perhaps education and law enforcement, requires public-private engagement because if you think about health care career,  what one can do, who can do it in what setting, how you get paid, how you document, maybe who your employer is…it’s all really determined in regulation of some sort. There’s no other field quite like that except, as I say, perhaps teaching or law enforcement.

Van

So Bill, when you were Secretary of Virginia’s Health and Human Resources Agency for eight years, and you were thinking through the opioid crisis along the line of the behavioral health needs, how did you think through Virginia’s approach to tackling that problem, especially from the workforce side?

Dr. Hazel

I’ve told people that my life after office has been an atonement tour for all the things I didn’t fix when I was secretary. And you don’t fix it all, there’s just so much. But as we looked at it, during my tenure there, which was 2010 to 2018, this opioid crisis really erupted around 2013, 2014. It was there before, but it became really enormous, a little bit later.

What we did was we brought lots of people together. I’m a big fan of bringing folks into a room, agreeing on what the problem is, and then thinking about different ways we can contribute to solving it. We thought through an approach and at that point for me, the workforce relationship was really more about reducing stigma and finding peer recovery specialists. We were one of the first states, if not the first, to actually have paid peer recovery specialists. We helped define some regulations for that, had Medicaid set up so that it could pay for it.

We were really learning from that, but the goal was also that people needed to go back to work. If you come through this whole process of recovery and are in recovery and you can’t get a job, then you’ve got time on your hands, you don’t have a particularly good future…and guess what happens? So you’re really beginning to solve what was important.

Van

So you achieved something that many states struggle with, and especially in healthcare, which is the mechanics of reimbursement. The healthcare providers need to get reimbursed for the services, and that way they can permanently, or at least in a sustained way, hire the staff who are trained to do those skill sets, like peer recovery support. You were able to enact the reimbursement mechanism, which is not a small task, right? Otherwise these roles would be on grants and then organizations are skittish to bring them on because they can’t sustain them beyond the grant. I wonder if you could give a little bit of detail on how you were able to achieve that.

Dr. Hazel

Well, I can, but I can’t take credit for it. We had a very strong team that was doing this work. You know, I joke sometimes that the cabinet secretaries really don’t do anything. I mean, actually, that’s not true. We try to take the credit for things when the governor doesn’t and if it works, the governor always takes the credit, so that doesn’t work. And we do try to absorb the blame sometimes for our staff when things go wrong. But that said, my role was to help bring people together. What happens in government is we have these silos — and we actually would refer to them as our cylinders of excellence — and to get say peer recovery specialists to work, we had to think about the department of behavioral health, had to think about health professions, which does the regulation, we had to think about Medicaid which had the payment program, and you have to bring these people into the same room to agree on what’s going to happen. That doesn’t happen naturally, because it’s no one’s job typically to do those things.

But my agency heads were able to do that and they came together nicely and it works. So really it’s the good people around you working as a team and it reinforces, again, that you can’t solve these problems in isolation, you have to work together.

Van

That’s a good philosophy. You mentioned that you’re doing atonement for the things you didn’t fix as secretary…I would love for you to highlight some programs at Claude Moore Opportunities that you’re particularly excited about right now.

Dr. Hazel

Well, I can tell you that we do several things to engage young people and get them interested in health careers. One thing we funded through Virginia Cooperative Extension 4-H program is a mobile life sciences van that will go around to rural areas to schools that don’t really have the resources and be able to discuss digestive health and respiratory health and mental health and really a little bit about environmental health and tie it to career opportunities. And they will come with a lesson plan that can be offered to the children in advance and then they can come visit the van or things can be taken inside. So something unique that we’re doing and we’re trying out.

You know, one thing we’re doing is we’re really looking at data. Not that data is fun for everybody, but I was a geek back before it was fashionable when we were still called nerds. But we fund a center for health workforce at George Mason University to try to help us get a common picture of the data in Virginia on workforce needs and also to think about what will success look like and how will we measure it becomes really important.

We’re also working with the Health Workforce Development Authority on a pipeline program reaching kids in high school. Another thing that we have done is helped to set up regional collaboratives, regional sector initiatives. Right now, Virginia divides for economic development into nine regions called growth and opportunity regions and “Go Virginia” regions and we now have activities in various stages of employer-engaged or employer-led partnerships in every region of Virginia which we’re excited about.

The other thing we’ve done recently is we’ve begun to look at issues of medics and corpsmen coming out of the military. A common problem is that military credentials don’t match civilian credentials and you end up with people who need to have some sort of bridge program to get them from where they are to where they would like to be. However,  they don’t know how to get there, and we don’t know how to get them there and they still need a job in the meantime, so how do they earn and learn? So, we’re working a little on trying to solve that problem going forward.

Behavioral health is another big thing. We’ve involved Virginia’s established youth mental health corps that will be operational this fall, so we’re encouraging engagement in that. So, we’ve got our hands full right now.

Van

That’s an impressive portfolio of work and initiatives going on. Thank you for your leadership there in Virginia,

Dr. Hazel

Thank you.

Van

What’s your prediction about whether your efforts and other workforce development initiatives in Virginia will meet the growing needs of the Virginia health care workforce?

Dr. Hazel

We will see. They’re still early, as you know, and we are working through a variety of different options. I think some of our initiatives will work out and really bear fruit, while others probably won’t. Recognizing which is which and moving on will be an important part of that.

It’s hard to say, but what I can tell you, Van, is what we’ve been doing is not working. We  have to try different approaches and this is one that we are really pleased about. As we are talking, we have seventy-five people in a room down the hall here from all over the state convening to share best practices of regional cooperation, youth ambassador programs, data collection…all these things that by sharing with one another will speed this process along.

Van

It’s wonderful that you’re convening all the leaders so that they could get on the same page and row in the same direction. The intentionality is so important.

Dr. Hazel

You have to. I mentioned earlier that there is so much public involvement in healthcare and there’s so much public involvement in education that you have to speak more or less with one voice. You have to be on a common pathway. When you go to a legislature with multiple options, at least in Virginia, they’ll say, ‘that means you all don’t know what works, so go figure it out and come back when you do because you’re the experts, we’re not.’ And so it’s really important that we begin to work again collaboratively and collectively to address these issues.

Van

So I’m sure our listeners can discern that you are a leader who has shepherded change and change management from your current role, but also your prior roles as a public servant and leader. There’s so much change going on right now at the federal level. Any advice to those that are in roles to shepherd some of these change as they manifest at the state level?

Dr. Hazel

We are talking in February of 2025, and you’re referencing all the goings on in Washington related to federal funding and layoffs and so forth. And as hard as it is, everybody needs to take a deep breath and let some of this play out because, without making a political statement, we don’t know where this is going to end so we don’t know exactly what we’re going to be doing at the end. But one thing we do know is that it’s when things are changing, there’s opportunity and that’s probably true in almost every field.

The bad part is this is very unsettling and disturbing and upsetting and has risk. There is, though, the potential that there could be opportunities to make significant improvements as we go forward, but we have to be following closely. We can’t ignore it. And then we should develop contingency plans so that if and when opportunities for positive change occur, we can intervene.

Van

Good advice, good advice. We’ve talked mostly today about allied health roles and entry level roles in healthcare. You also sit with the board of the American Medical Association and I’m wondering if you can share your perspective on challenges that are facing the physician workforce?

Dr. Hazel

It is, I would say, understaffed and overwhelmed. Just this morning, I read an article about physician burnout and physician suicide.  I think that the changes that have been designed to make improvements in the system over the years — including electronic medical records, which I have supported — have really created an environment that is not what many people who came into the field really expected.

I think people go into medicine largely to deal with people. Even though things have changed, the selection of those who go to medical school and so forth are people who have fought independently and worked independently. I can remember when I was at Duke in medical school, you know what the problem with being on call every other night was? You missed half the patients. That type of work program came in and the world isn’t that way now.

I think we’re going to have to adjust the way things are working. I go to the behavioral health model, this one-on-one model where an individual is responsible for another individual or that individual and their family alone really creates situations where people get burned out and we need to think more about how team care works.

We need to find ways to master the technology that we have as opposed to having it master us. I think we really have to look at the payment schedules, which put a lot on the individual providing the service —  be it the physician or the licensed person — so we can make use of these teams, which then can support each other and add expertise. We have to fundamentally look at how we’re providing services going forward.

Lousy jobs will not attract and keep people and that has to be addressed as we think about it and that cannot be addressed with basically a fee-for-service payment system going forward.

Van

Well, good call to action for us all. To end today’s podcast, I wonder if you could share with us what makes you most optimistic about either the future of care or the future of learning?

Dr. Hazel

Necessity. Was it Winston Churchill who said about Americans that they’ll do the right thing after they’ve tried everything else? I think that was his quote, but I think that we’re going to have to. It’s just absolutely necessary that we do it, so we will do it. And I would like to put in one plug for philanthropy, which is the role that I play now.

We tend to think of government having answers for problems. I can tell you that in 2017, a graduate student working in our office was looking at programs that were serving youth age zero to twenty-one and identified, if memory serves me correctly, 152 line items in the budget that flowed through seventeen agencies and four secretariats.

You might ask, how does that work? Because these programs often start at the federal level and maybe at the state level and they come with particular eligibility requirements and particular confidentiality requirements. At the end of the day, we couldn’t talk about it, because we didn’t know what was happening to one person in the context of the family or the living unit that they lived in. We just couldn’t do that.

So imagine now that you’re working in a local community where you’re doing a program in education or healthcare and you’ve got all these funding streams that are independently designed from one another. Somebody has to come up with the funds to create the flexible money that allows you to take this pile of stones and make a structure that’s meaningful and that’s what philanthropy can do. It’s only when we can demonstrate that it works that then we can go back and say, hey, we need to change these funding streams.

Van

Well, Dr. Bill Hazel, it was so fantastic to reconnect with you today. Thank you for stepping out of your meeting and joining us in this podcast.

Dr. Hazel

The pleasure was mine, Van. Thank you. It’s great work you do out there and I look forward to coming out and seeing you someday.

Van

Likewise. I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you’ll join us again as we continue to explore how to create a future-focused workforce in America.