WORKFORCE EDUCATION: MEETING THE CHALLENGE OF THE AFFORDABLE CARE ACT

1. WORKFORCE EDUCATION: MEETING THE CHALLENGE OF THE AFFORDABLE CARE ACT NATIONAL COUNCIL FOR WORKFORCE EDUCATION ANNUAL CONFERENCE OCTOBER 16, 2013 Milwaukee, WIRandall Wilson, Ph.D, Senior Project Manager

2. 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

3. AFFORDABLE CARE ACT: A MOVING TRAIN

4. 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

5. AFFORDABLE CARE ACT 101: THE RESPONSE • Expand access to care • Health care exchanges • Expanding Medicaid to 138% of poverty line • Prevent 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

6. 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

7. 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

8. LABOR DEMAND

9. LABOR DEMAND Source: US Bureau of Labor Statistics

10. MAJORITY OF JOB GROWTH OUTSIDE OF HOSPITALS SOURCE: US BLS

11. MASS. HEALTH REFORM: A PRELUDE?

12. 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)

13. 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

14. 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

15. 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

16. 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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