COLLABORATING TO CREATE SOLUTIONS:
FRONTLINE WORKERS AND THE PATIENT
PROTECTION AND AFFORDABLE CARE ACT
Randall Wilson, PhD Jobs For The Future
National Fund for Workforce Solutions Annual Meeting
Chicago, IL April 9, 2014
PRESENTATION OVERVIEW
• Purpose and Goals
• Jobs and Skills in Demand from the ACA
• Opportunities, Challenges and Recommended Next Steps
INTRODUCTION
• Frontline health care workers act as a crucial link between the
patient’s experience and the delivery and management of care
• To date, frontline workforce needs haven’t received equal attention to
other aspects of ACA implementation
• Goal: understand how ACA will impact labor demand and skill
requirements, in order to drive health care employer investments
ACA HEALTH CARE IMPACTS
• Transforming 1/6 of the U.S. economy; biggest change in our
system of social support in half a century
• Transforming health care delivery
-Focus on wellness and prevention
-Care is coordinated across the continuum and across
disciplines
-Care is patient-centered
• Transforming health care financing
-Paying for performance: incentives to lower readmissions,
improve patient satisfaction, achieve better health outcomes
LABOR DEMAND AND THE ACA
Several Emerging Patterns
• Job growth is moving from acute care to outpatient settings, home health
and long-term care facilities
• Strong occupation demand in support & tech: home health aides, CNAs,
pharm techs, EMTs, medical assistants, health information techs
• Working harder and smarter: performing at the top of your license/job
description; problem-solving, using technology, rethinking the job from
treating sickness to promoting wellness
• New roles and responsibilities to meet ACA cost and patient care goals.
EMPLOYMENT GROWTH BY SUBSECTOR
Health Care Jobs by Subsector: 2010-2020
5563.6
5209.6
6000
4685.3
3129
4000
1952.4
3000
2000
3951
3818.2
5000
1086.6
1077.1
1471.2
1000
0
Home health
care services
Outpatient,
laboratory, and
other
ambulatory
care services
Office of health
practitioners
2010
2020
Hospitals
Nursing and
residential care
facilities
OCCUPATIONS IN DEMAND: LARGEST GROWTH
Occupation
Entry Education
# Jobs 2010
Job Growth 20102020
Change
Home Health Aides
Less than high
school
1017.70
69%
706.2
Personal Care
Aides
Less than high
school
861.0
70%
607.0
Nursing Aides
Post-secondary
certificate
1,505.3
20%
302.0
Medical Secretaries HS
Diploma/Equivalent
508.7
41%
210.2
Medical Assistants
527.6
31%
162.8
HS Diploma/
equivalent
OCCUPATIONS IN DEMAND: FASTEST GROWTH
Employment Growth Rate 2010-2020
Medical Assistants
Dental Hygienists
Medical Secretaries
30.9
37.7
41.3
Physical Therapist Aides
43.1
Occupational Therapy Assistants
43.3
Diagnostic Medical Sonographers
43.5
Physical Therapist Assistants
Home Health Aides
Personal Care Aides
45.7
69.4
70.5
TRADITIONAL JOBS, EXPANDED ROLES
• CNAs, Patient Care Assistants:
– Customer service, observation (for safety), patient transitions
– Assume routine tasks of RNs (documentation, med pulls)
• Medical Assistants:
–
–
–
–
Cross-training to assume administrative and patient care roles; EMRs
Coaching patients in disease management
Assist with chart reviews and updates
Follow-up with patients outside of visit (meds, Dr. appointment, selfcare)
• Health IT and Information Management
– ICD-10 codes; cross training in clinical and IT; data analytics
NEW ROLES, EMERGING OCCUPATIONS?
Emerging Roles:
•
•
•
•
Case managers
Community health workers
Patient navigators
Care coordinators
Critical skills: knowledge of community resources; interpersonal and
team skills; assertiveness; understanding the care transition
MODELS FOR WORKFORCE DEVELOPMENT
• Employer-led
– Union Health Center (NY)
– Sutter Health (CA); Norton Healthcare (KY)
• State Transformation Grants
– NY: Health Care Retraining Initiative
– MA: Health Care Workforce Transformation Fund
• Federal Initiatives
– Center for Medicaid and Medicare Innovation (HHS)
• Labor-Management Partnerships
– SEIU 1199 Training and Upgrading Funds
OPPORTUNITIES
• ACA (and its workforce) are a work in progress–room for innovation
in shaping new systems for education and skill development
• Openings for young, underemployed, high turnover workforce –
create options for mobility – improve retention
• Foster greater respect, understanding of frontline worker skills and
contribution to patient care
• Serving more diverse patient population effectively
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
• Need for 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
RECOMMENDATIONS: HEALTH CARE EMPLOYERS
• Conduct workforce planning and analysis across organizations
and disciplines; include clinical and non-clinical leadership, HR,
finance and operations
• Map current workforce skills within the organization and invest in
frontline workers’ skills and career development
• Share best practices and develop solutions to workforce
challenges with policymakers, educators, public and private funders,
and other health care employers
• Develop shared standards and definitions for emerging health
care occupations, in consultation with policymakers, industry and
professional associations, workers and unions
RECOMMENDATIONS: POLICYMAKERS & ADVOCATES
• Refocus data collection and projections to better understand
present and future needs for frontline health care labor and skills
– Fund and convene Health Care Workforce Commission
• Develop strategies for reforming Medicaid and Medicare
reimbursement for paraprofessional services and training
• Advocate for investment in upgrading of low-quality, but essential
frontline jobs, in particular home health aides, personal care aides,
and similar roles
• Evaluate the impact of new care models, occupations, and
workforce strategies on patients, workers, and business
RECOMMENDATIONS: WORKFORCE & PHILANTHROPY
• Pilot, document, and scale promising practices in communities
and in health care employers
• Build on existing federal, state and philanthropic investments,
i.e. HPOG, TAACCCT, CMMI, National Fund for Workforce
Solutions, Health Care Workforce Transformation Fund
• Build the capacity of smaller health care employers, especially
primary care clinics, to offer training and educational opportunities to
frontline staff
• Create career pathways with stackable credentials and/or
certificates, incorporating current and emerging frontline health care
functions
DISCUSSION BREAKOUT QUESTIONS
• What workforce impacts have you seen in your
organization?
• How are you responding to these impacts?
• How do you plan to respond in the future?
• What would you most like to learn from your peers about
responding to the ACA?
RESOURCES
CareerSTAT Resources:
Implementing the Patient Protection and Affordable Care Act: Impacts
on the Frontlines of Caregiving By Randall Wilson (link)
CareerSTAT: A Guide to Making the Case for Investing in the Frontline
Hospital Workforce By Randall Wilson and Robert Holm (link)
Visit the CareerSTAT
website:http://nfwsolutions.org/initiatives/careerstat
Rrwir
JAN HUNTER, CAREERSTAT DIRECTOR jhunter@jff.org
RANDALL WILSON, PhD, SENIOR PROJECT MANAGER, rwilson@jff.org
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WWW.NFWSOLUTIONS.ORG
TEL 617.728.4446 FAX 617.728.4857 info@jff.org
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