Emerging healthcare careers and pathways

1. Emerging healthcare careers and pathways Where are you from? Why did you come to this session? I am from __________________________ I came to this session to learn about _______________________ (one word)

2. Who am I? Curtis Dann-Messier • Associate director for continuing education at the CUNY Central or Systems office. CUNY is the largest urban public university in the country. 24 campuses throughout New York City. • I oversee our adult learner initiative, including an initiative to help formerly homeless individuals move along an education and career pathway, and I lead healthcare workforce strategy, at the sub baccalaureate level for the University • Started at CUNY as part of our TAACCCT 1 grant • I partner a lot with City agencies, industry experts, employers, continuing education / workforce administrators, faculty, and staff.

3. The state of healthcare The United States spends the most money on healthcare in the world

4. In some categories, such as infant mortality and life expectancy, our outcomes are middling or bad, when compared with the rest of the developed world. We’re excellent at things like cancer treatment, and other high-end life-saving services.

5. There is a desire to improve the healthcare system • Healthcare reform is centered around the “triple aim” • Improve population health outcomes • Improve the patient experience • Lower costs

6. How is New York State approaching healthcare reform? • We are in the midst of an epochal moment of transformation via an $8,000,000,000 Medicaid redesign effort named DSRIP. • How is NYS approaching the triple aim of reform? • Improve population health outcomes a)Healthcare systems are attributed patients and measured for how healthy their patients are. There are 13 systems in NYC with attributions of 50K – 1M “lives” • Improve the patient experience b) Care coordination services are being integrated into healthcare delivery, which is very fragmented • Lower costs c) Providers are paid based NOT on fee for service, but via value-based payments, linked to population health outcomes.

7. How are health systems / providers responding to this transformation? • Moving away from hospital and emergency-room based care • Move towards ambulatory / primary care in the community • Move towards preventative care • Focus on the “super-utilizers”, 10%-20% of the population who cost the system 80% - 90% of the costs. • These individuals often have some combination of substance use issues, mental health diagnosis, multiple chronic conditions, housing instability, food insecurity, high rates of unemployment, and more. They are often from low-income communities and are more likely to be black and Hispanic. • How do you help these individuals lead healthy lives? What type of workforce do they need? What are the skills that healthcare employees need to have?

8. How do you identify the trends to build programs around? • Join committee and boards • Advisory boards • Partnerships • Faith and community-based organizations • High level boards and committees

9. What skills are in demand? • Social work skills • Motivational interviewing, trauma-informed care, referrals, follow-up, counseling, coaching, support, etc. • These are not the traditional skills of many of the traditional healthcare professionals, taught in medical school or nursing. • What are entry-level, social work-type jobs in healthcare? What are the middle skill, social work-type jobs in healthcare?

10. What jobs are emerging? • Peer workers, with a lived experience with substance use or mental health challenges • Health coaches with experience in ambulatory / primary care settings, often as medical assistants. • Care coordinators who can manage a patient’s full set of needs, both within and outside of traditional healthcare • Care managers who can create care plans for difficult patients • Community health workers who can work outside of healthcare facilities and in the community. (The hype hasn’t lived up to the hiring.) • Specialized billers and coders who can keep up with new types of payers.

11. What is holding the system back from hiring for some of these positions? • M O N E Y • Follow the money

12. The problem https://www.nytimes.com/2017/10/12/nyregion/bronx-heroin-fentanyl-opioid-overdoses.html

13. Our new program • City program trains peer advocates to combat opioid crisis • It wasn't until her fourth attempt at recovery, in 2001, that Barbara Bell was able to end 27 years of addiction to drugs and alcohol. Since then she has devoted her life to helping others end their struggle with addiction.Bell, 55, is one of the 39 graduates of the city Department of Small Business Services' new training program for certified peer recovery advocates. They help individuals with substance-use disorders create recovery plans and provide support during the process. Since the three-month program was announced in January, two cohorts have graduated. • Partners: NYC Health and Hospitals Corporation, Bridge Back to Life • Expanding to new schools http://www.crainsnewyork.com/article/20171024/PULSE/171029963/city-program-trains-peer-advocates-to-combat-opioid-crisis

14. Our recovery peer graduates!!!

15. Opportunity: Apprenticeship funds Partners: 1199SEIU Bronx Lebanon Hospital NYC Department of Small Business Services We also have a medical coding apprenticeship https://www.nytimes.com/2017/09/28/upshot/apprentices-need-expert-eye-so-does-trumps-plan-for-them.html

16. Text from the article • She picked up certificates as a certified nurse assistant and an emergency medical technician, but neither led to permanent work — perhaps because in those fields, as in most, employers value skills that can be learned only on the job. But how do you get a job without the skills? • Then Ms. Garcia got connected to a new program jointly sponsored by Bronx-Lebanon Hospital, the New York Alliance for Careers in Health Care, LaGuardia Community College and the nation’s largest health care workers union, 1199 S.E.I.U. Using apprenticeships, the program trains people to become community health workers. • Apprenticeships have been around for ages. Ben Franklin and Paul Revere were apprentices. Since the Industrial Revolution, apprenticeship in America has been concentrated in areas like plumbing, welding and ironwork: male-dominated, blue-collar trades. • But the real growth in today’s job market is in fields like health care and technology. The number of community health workers, who connect vulnerable people to the medical and social service systems, increased to 51,900 in 2016 from 38,000 in 2013. • To learn the trade, Ms. Garcia took classes at Bronx-Lebanon taught by LaGuardia Community College professors. They covered the ins and outs of the health care system — insurance, government programs, medical terminology — along with interview techniques and principles of case management.

17. Health coaches • Upgraded medical assistants • Over 100 trained • Working in community-based practices • Training paid for by the employer

18. Turning programs to pathways • All of our newest programs award some credit • Are built with faculty • Are positioned along an education and career pathway • Pay at least $40,000 a year • Have strong employer commitments upfront • Do not require a degree

19. The education and career pathway framework we share with employers and industry partners

20. Education pathway for medical assistants This is the framework we share with college faculty and staff to gather feedback.

22. This needs to be revised based on employer feedback, but haven’t gotten around to it, yet!

25. How do you find a home for these new programs? • Let’s go back to the pathways and discuss where these pathways and programs should live.

27. Education pathway for medical assistants

32. Other programs we want to build • Mental health peers • Care managers • We’re still figuring out care coordinators / care navigators • Case managers in mental and behavioral health • The occupations that are most interesting to me, are those that require less than a bachelor’s degree and pay at leat $40K • Where should those programs live?

33. What do you do if employers aren’t on the same wavelength • Is it you, or is it me? • If it’s me, I can change • If it’s you, sometimes you just have to walk away

34. Comments? Questions? • Curtis.Dann-Messier@cuny.edu