NATIONAL COUNCIL FOR WORKFORCE EDUCATION ANNUAL CONFERENCE OCTOBER 16, 2013 Milwaukee, WI

Randall Wilson, Ph.D, Senior Project Manager

WORKFORCE EDUCATION: MEETING THE CHALLENGE OF THE AFFORDABLE CARE ACT

OVERVIEW

• Session purpose and goals

• Affordable Care Act 101

• Occupational demand and the ACA

• Skills in demand and the ACA

• Opportunities and challenges for the frontline workforce

• Opportunities and challenges for workforce education

AFFORDABLE CARE ACT: A MOVING TRAIN

AFFORDABLE CARE ACT 101: THE PROBLEM

• 57 million Americans lacked insurance coverage, more at risk

• US spends more per capita on health care than all other industrialized nations, but has worse results on many measures

– Life expectancy, mortality; obesity

• At least 30% of health care expenditures are wasted

• Five percent of the patient population accounts for 50% of spending

– Aged; multiple chronic conditions; mental health/substance abuse

• Twenty percent of Medicare patients are readmitted to the hospital within 30 days

AFFORDABLE CARE ACT 101: THE RESPONSE

• Expand access to careHealth care exchangesExpanding Medicaid to 138% of poverty linePrevent denial of coverage for pre-existing conditions Individual and employer mandates

• Improve the delivery of care (“triple aim”)Lower costs Increased quality of care Improved health of populations

AFFORDABLE CARE ACT 101: SYSTEMIC CHANGES

• From treating sickness to promoting wellness and prevention

• From paying by “volume” of services to paying for value, or performance outcomes

• From emphasizing acute care to primary or outpatient care

• From treating care in isolated “episodes” to coordination across the continuum of care and across disciplines

• From treating chronic disease in isolated individuals to managing care among populations

• From paper-based management of patient records and transactions to electronic health records

• From doctor (and system)-centered care to patient-centered care, with decision-making shared by caregivers, patients, and their families

AFFORDABLE CARE ACT: THE MECHANISMS

• Payment reforms: paying for performance

– Lower readmission rates

– Higher patient satisfaction

– Better health outcomes (heart failure, pneumonia, infections)

• Improving coordination of care across providers & episodes

– Accountable Care Organizations

– Patient Centered Medical Homes

• Promoting prevention

• Patient self-management

• Community-based car e

– Grants to community health centers

LABOR DEMAND

Occupation Entry Education # Jobs 2010 Job Growth 2010-2020

Change

Registered Nurses Associates degree 2,737,400 26% 711,900

Nursing Aides Post-secondary certificate 

1,505,300 20% 302,000

Home Health and Personal Care Aides

Less than high school

1,071,000 69% 706,300

Personal Care Aides Less than high school

861,000 70% 607,000

Licensed Practical Nurses

Post-secondary certificate 

752,300 22% 168,500

Medical Assistants HS Diploma/ equivalent 

527,600 31% 162.900

EMTs and Paramedics

Post-secondary certificate 

226,500 33% 75,400

LABOR DEMAND

Occupation Entry Education # Jobs 2010 Job Growth 2010-2020

Change

Pharmacy Technicians

HS Diploma/ equivalent

334,400 32% 198,300

Medical Secretaries HS Diploma/equivalent

508,700 41% 210,200

Radiologic Technicians

Associate's Degree 219,900 28% 61,000

Medical Records & Health Information Technicians

Post-secondary certificate

179,500 21% 37,700

Source: US Bureau of Labor Statistics

MAJORITY OF JOB GROWTH OUTSIDE OF HOSPITALS

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Health Care Jobs by Subsector: 2010-2020

20102020

SOURCE: US BLS

MASS. HEALTH REFORM: A PRELUDE?

Administrative positions Health care professionals Patient care support All other non-administrative positions

18.4%

2.8%

18.2%

7.6%8.0%

5.9%

11.4%

9.5%

Employment Growth by Occupation 2005-2009

MA Rest of US

SKILLS IN DEMAND

• General: team skills, communication, technology, problem-solving, knowledge of the care transition, cultural competencies

– “Working at the top of your license” (or job description)

• Direct Care (CNAs, PCAs): observational skills, customer service

• Medical Assistants: administrative as well as clinical skills; supervisory skills in some cases

• Health Information/Med Records Techs: medical terminology, data analytics, detail orientation, cross-disciplinary understanding

– Need to know “health” as well as “IT”

– New coding scheme (ICD-10)

TRADITIONAL JOBS, EXPANDED ROLES

• CNAs, Patient Care Assistants:

– calling “timeouts” to prevent errors, monitor safety

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

• Medical Assistants:

– cross-training to assume administrative and patient care roles;

– coaching patients in disease management

– assist with chart reviews and updates

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

• Patient service representatives:

– follow-through at discharge on MD appointments, medication

– cross-training in registration, referrals, scheduling, billing

NEW ROLES, EMERGING OCCUPATIONS?

Emerging Roles:

• Case managers: RNs, social workers, non-licensed staff

• Community health workers

• Patient navigators

• Care managers

• Health coaches

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

FRONTLINE WORKER CHALLENGES

• Inadequate compensation and benefits

• Inadequate training and supervision

• Lack of well-defined roles and career pathways

• Need for basic skills and college readiness

• New responsibilities without change in title or compensation

• Cost concerns could lead to cutbacks in staff development

• Potential job reductions with merged positions, shift to primary, use of technology

CHALLENGES FOR WORKFORCE EDUCATORS & EMPLOYERS

• 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

• 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

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