The Affordable Care Act - National Council for Workforce Education

Report
WORKFORCE EDUCATION: MEETING THE CHALLENGE OF
THE AFFORDABLE CARE ACT
NATIONAL COUNCIL FOR WORKFORCE EDUCATION ANNUAL CONFERENCE
OCTOBER 16, 2013  Milwaukee, WI
Randall Wilson, Ph.D,
Senior Project Manager
OVERVIEW
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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 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
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 20102020
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
Less than high
Personal Care Aides 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
# Jobs 2010
Job Growth 20102020
Change
334,400
32%
198,300
Medical Secretaries HS
Diploma/equivalen
t
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
Occupation
Entry Education
Pharmacy
Technicians
HS Diploma/
equivalent
Source: US Bureau of Labor Statistics
MAJORITY OF JOB GROWTH OUTSIDE OF HOSPITALS
Health Care Jobs by Subsector: 2010-2020
6000
5000
4000
3000
2010
2020
2000
1000
0
Home health care
services
Outpatient,
laboratory, and
other ambulatory
care services
SOURCE: US BLS
Office of health
practitioners
Hospitals
Nursing and
residential care
facilities
MASS. HEALTH REFORM: A PRELUDE?
Employment Growth by Occupation 2005-2009
MA
18.4%
Rest of US
18.2%
11.4%
9.5%
8.0%
7.6%
5.9%
2.8%
Administrative positions
Health care professionals
Patient care support
All other non-administrative
positions
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
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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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