The Workforce Implications of the Affordable Care Act:
Research in Progress
Metro North Regional Employment Board – Quarterly Meeting
Cambridge, MA
June 19, 2013
The Workforce Implications of the Affordable Care Act
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Overview
Research Questions and Methods
ACA Breakdown
Labor and Skills Demand
Opportunities
Challenges and Next Steps
Discussion
EMPLOYER LEADERSHIP OF RESEARCH
OVERVIEW
• High degree of uncertainty – “building the car while driving it”
• Frontline workers essential to Triple Aim
• Demand will increase in both patient and technology-centered
positions
• Higher skill expectations: top of the job description, specific skills
• Opportunities for new or expanded roles and advancement
• Challenges, unknowns and cross-cutting trends
AFFORDABLE CARE ACT: A MOVING TRAIN
•AFFORDABLE CARE ACT: BREAKDOWN
• Extending care to more patients
• Achieving the triple aim: better care, lower cost, improved health
o Coordination of care (ACOs, Patient-Centered Medical Homes)
o Reducing readmissions, focus on “frequent flyers”
o Patient follow-up and self-management
o Population health and community-based care
• Implementing electronic health records
RESEARCH QUESTIONS
How will the Affordable Care Act affect frontline health care workers?
• What are the forecasts of labor demand in the next 10 years?
• How are individual providers preparing for workforce needs?
• What skills will be required of the workforce?
• What are the opportunities for frontline worker advancement?
• What are the best current models of workforce development?
• What are the potential challenges?
RESEARCH METHODS
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Scan of literature from health care and workforce
Analysis of labor market data
Interviews with key informants
Interviews and roundtable discussions with providers
LABOR DEMAND
Health Care Subsector Growth 2010 – 2020
6000
5000
4000
3000
2010
2000
2020
1000
0
Offices of health
practitioners
Hospitals
Home health
care services
Outpatient,
Nursing and
laboratory, and residential care
other ambulatory
facilities
care services
Source: US Bureau of Labor Statistics
LABOR DEMAND
# Jobs 2010
Job Growth 20102020
Change
Less than high school
1,878,700
70%
1,313,200
Registered Nurses
Associates degree
2,737,400
26%
711,900
Nursing Aides
Post-secondary
certificate
1,505,300
20%
302,000
Licensed Practical
Nurses
Post-secondary
certificate
752,300
22%
168,500
Medical Assistants
HS Diploma/
equivalent
527,600
31%
162.900
226,500
33%
75,400
Patient-Centered
Positions
Entry Education
Home Health and
Personal Care Aides
EMTs and Paramedics Post-secondary
certificate
LABOR DEMAND
TechnologyCentered
Positions
Entry Education
# Jobs 2010
Job Growth 20102020
Change
Pharmacy
Technicians
HS Diploma/
equivalent
334,400
32%
198,300
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
LABOR DEMAND: MA HEALTH REFORM
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
• Direct Care (CNAs, PCAs): observational skills, customer service
• Medical Assistants: administrative as well as clinical skills;
supervisory skills in some cases
• Patient navigators: assertiveness, cultural competencies
• Health Information/Med Records Techs: medical terminology, data
analytics, detail orientation, cross-disciplinary understanding
OPPORTUNITIES FOR FRONTLINE WORKERS
• Expanded responsibilities and skill upgrades
o Cross-training for medical assistant and admin (Youngstown,
NYC)
o Calling “timeouts” for error reduction (PCAs in Boston)
o DCWs assuming routine tasks of RNs (documentation, med pulls)
– Northern VA
• Assuming new roles
o Patient navigator (discharge, follow-up)
o Health coaches
o Care coordinators
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
• Potential job reductions with merged positions, shift to primary, use of
technology
• More responsibility without compensation
• Potential cutbacks in talent development
NEXT STEPS / DISCUSSION
RANDALL WILSON, SENIOR PROJECT MANAGER
JOBS FOR THE FUTURE
rwilson@jff.org
TEL 617.728.4446 FAX 617.728.4857 info@jff.org
88 Broad Street, 8th Floor, Boston, MA 02110
122 C Street, NW, Suite 650, Washington, DC 20001
WWW.JFF.ORG