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
• 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 care
– Grants to community health centers

LABOR DEMAND
Occupation Entry Education
Registered Nurses Associates degree
Nursing Aides Post-secondary certificate
Home Health and
Personal Care Aides
Less than high school
Personal Care Aides Less than high school
Licensed Practical
Nurses
Post-secondary certificate
Medical Assistants HS Diploma/ equivalent
EMTs and
Paramedics
Post-secondary certificate
# Jobs 2010 Job Growth 2010-
2020
2,737,400 26%
1,505,300 20%
1,071,000
861,000
752,300
527,600
226,500
69%
70%
22%
31%
33%
Change
711,900
302,000
7 0 6 , 3 0 0
607,000
168,500
162.900
75,400

LABOR DEMAND
Occupation Entry Education
Pharmacy
Technicians
HS Diploma/ equivalent
Medical Secretaries HS t
Diploma/equivalen
Radiologic
Technicians
Associate's Degree
Medical Records &
Health Information
Technicians
Post-secondary certificate
Source: US Bureau of Labor Statistics
# Jobs 2010 Job Growth 2010-
2020
334,400 32%
508,700 41%
219,900
179,500
28%
21%
Change
198,300
210,200
61,000
37,700

MAJORITY OF JOB GROWTH OUTSIDE OF HOSPITALS
Health Care Jobs by Subsector: 2010-2020
6000
5000
4000
3000
2000
1000
0
Home health care services
Outpatient, laboratory, and other ambulatory care services
Office of health practitioners
Hospitals Nursing and residential care facilities
SOURCE: US BLS
2010
2020

MASS. HEALTH REFORM: A PRELUDE?
Employment Growth by Occupation 2005-2009
MA Rest of US
18,4% 18,2%
11,4%
8,0%
7,6%
9,5%
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
• 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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