Randall Wilson, PhD Jobs For The FutureNational Fund for Workforce Solutions Annual MeetingChicago, IL April 9, 2014

COLLABORATING TO CREATE SOLUTIONS:FRONTLINE WORKERS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT

PRESENTATION OVERVIEW

• Purpose and Goals

• Jobs and Skills in Demand from the ACA

• Opportunities, Challenges and Recommended Next Steps

INTRODUCTION

• Frontline health care workers act as a crucial link between the patient’s experience and the delivery and management of care

• To date, frontline workforce needs haven’t received equal attention to other aspects of ACA implementation

• Goal: understand how ACA will impact labor demand and skill requirements, in order to drive health care employer investments

ACA HEALTH CARE IMPACTS

• Transforming 1/6 of the U.S. economy; biggest change in our system of social support in half a century

• Transforming health care delivery

-Focus on wellness and prevention

-Care is coordinated across the continuum and across disciplines

-Care is patient-centered

• Transforming health care financing

-Paying for performance: incentives to lower readmissions, improve patient satisfaction, achieve better health outcomes

LABOR DEMAND AND THE ACA

Several Emerging Patterns

• Job growth is moving from acute care to outpatient settings, home health and long-term care facilities

• Strong occupation demand in support & tech: home health aides, CNAs, pharm techs, EMTs, medical assistants, health information techs

• Working harder and smarter: performing at the top of your license/job description; problem-solving, using technology, rethinking the job from treating sickness to promoting wellness

• New roles and responsibilities to meet ACA cost and patient care goals.

EMPLOYMENT GROWTH BY SUBSECTOR

0

1000

2000

3000

4000

5000

6000

1086.6 1077.1

3818.24685.3

3129

1952.41471.2

5209.6 5563.6

3951

Health Care Jobs by Subsector: 2010-2020

2010 2020

OCCUPATIONS IN DEMAND: LARGEST GROWTH

Occupation Entry Education # Jobs 2010 Job Growth 2010-2020

Change

Home Health Aides Less than high school

1017.70 69% 706.2

Personal Care Aides

Less than high school

861.0 70% 607.0

Nursing Aides Post-secondary certificate 

1,505.3 20% 302.0

Medical Secretaries HS Diploma/Equivalent

508.7 41% 210.2

Medical Assistants HS Diploma/ equivalent 

527.6 31% 162.8

Personal Care Aides

Home Health Aides

Physical Therapist Assistants

Diagnostic Medical Sonographers

Occupational Therapy Assistants

Physical Therapist Aides

Medical Secretaries

Dental Hygienists

Medical Assistants

70.5

69.4

45.7

43.5

43.3

43.1

41.3

37.7

30.9

Employment Growth Rate 2010-2020

OCCUPATIONS IN DEMAND: FASTEST GROWTH

TRADITIONAL JOBS, EXPANDED ROLES

• CNAs, Patient Care Assistants: – Customer service, observation (for safety), patient transitions

– Assume routine tasks of RNs (documentation, med pulls)

• Medical Assistants: – Cross-training to assume administrative and patient care roles; EMRs

– Coaching patients in disease management

– Assist with chart reviews and updates

– Follow-up with patients outside of visit (meds, Dr. appointment, self-care)

• Health IT and Information Management– ICD-10 codes; cross training in clinical and IT; data analytics

NEW ROLES, EMERGING OCCUPATIONS?

Emerging Roles:

• Case managers

• Community health workers

• Patient navigators

• Care coordinators

Critical skills: knowledge of community resources; interpersonal and team skills; assertiveness; understanding the care transition

MODELS FOR WORKFORCE DEVELOPMENT

• Employer-led

– Union Health Center (NY)

– Sutter Health (CA); Norton Healthcare (KY)

• State Transformation Grants

– NY: Health Care Retraining Initiative

– MA: Health Care Workforce Transformation Fund

• Federal Initiatives

– Center for Medicaid and Medicare Innovation (HHS)

• Labor-Management Partnerships

– SEIU 1199 Training and Upgrading Funds

OPPORTUNITIES

• ACA (and its workforce) are a work in progress–room for innovation in shaping new systems for education and skill development

• Openings for young, underemployed, high turnover workforce – create options for mobility – improve retention

• Foster greater respect, understanding of frontline worker skills and contribution to patient care

• Serving more diverse patient population effectively

CHALLENGES

• No template or standards for new roles – “you can’t download the job description”

• Payment model lagging behind delivery reforms

• Scope of practice restrictions

• Providers’ reluctance – ACA uncertainties, cost concerns

• Need for closer engagement with health care employers on emerging skill needs and curricula

• Insufficient or unreliable workforce data

• Lack of workforce and training capacity in smaller health care employers

RECOMMENDATIONS: HEALTH CARE EMPLOYERS

• Conduct workforce planning and analysis across organizations and disciplines; include clinical and non-clinical leadership, HR, finance and operations

• Map current workforce skills within the organization and invest in frontline workers’ skills and career development

• Share best practices and develop solutions to workforce challenges with policymakers, educators, public and private funders, and other health care employers

• Develop shared standards and definitions for emerging health care occupations, in consultation with policymakers, industry and professional associations, workers and unions

RECOMMENDATIONS: POLICYMAKERS & ADVOCATES

• Refocus data collection and projections to better understand present and future needs for frontline health care labor and skills

– Fund and convene Health Care Workforce Commission

• Develop strategies for reforming Medicaid and Medicare reimbursement for paraprofessional services and training

• Advocate for investment in upgrading of low-quality, but essential frontline jobs, in particular home health aides, personal care aides, and similar roles

• Evaluate the impact of new care models, occupations, and workforce strategies on patients, workers, and business

RECOMMENDATIONS: WORKFORCE & PHILANTHROPY

• Pilot, document, and scale promising practices in communities and in health care employers

• Build on existing federal, state and philanthropic investments, i.e. HPOG, TAACCCT, CMMI, National Fund for Workforce Solutions, Health Care Workforce Transformation Fund

• Build the capacity of smaller health care employers, especially primary care clinics, to offer training and educational opportunities to frontline staff

• Create career pathways with stackable credentials and/or certificates, incorporating current and emerging frontline health care functions

DISCUSSION BREAKOUT QUESTIONS

• What workforce impacts have you seen in your organization?

• How are you responding to these impacts?

• How do you plan to respond in the future?

• What would you most like to learn from your peers about responding to the ACA?

RESOURCES

CareerSTAT Resources:

Implementing the Patient Protection and Affordable Care Act: Impacts on the Frontlines of Caregiving By Randall Wilson (link)

CareerSTAT: A Guide to Making the Case for Investing in the Frontline Hospital Workforce By Randall Wilson and Robert Holm (link)

Visit the CareerSTAT website:http://nfwsolutions.org/initiatives/careerstat

RrwirJAN HUNTER, CAREERSTAT DIRECTOR jhunter@jff.org

RANDALL WILSON, PhD, SENIOR PROJECT MANAGER, rwilson@jff.org

TEL 617.728.4446 FAX 617.728.4857 info@jff.org

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