1. Innovations in Front Line Health Workforce
Texas Medical Center, September 12, 2016
Susan A. Chapman, PhD, MPH, RN, FAAN
UCSF School of Nursing and Healthforce Center
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2. Why innovation in this workforce sector?
Triple aim
Shortages
Everyone practice at top of license
Training to practice time relatively short
Regulatory- delegation models
Wages are relatively low
Cost savings
Challenges in sustainable jobs, living wages, turnover
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3. What type of innovations?
Expanded roles
Expanded roles in new settings for workers
Addresses consumer preference for care setting
Greater use of technology
Changing payment models facilitate innovation
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4. What is the impact on health, quality, cost, workforce?
What do we know?
What is the evidence?
When do we have enough evidence to spread innovation?
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5. Affordable Care Act: California Personal and Home Care Aide State Training

6. Description of PHCAST Trainees
The typical personal care aide trainee:
Female
Early 40s
Latino or Asian
Single
Unemployed
High School graduate with some college
$0-$21,000 yearly income range
Seeking to advance career in health related field

7. Post Training Assessment of Preparedness
Most respondents “strongly agree” or “agree” that the course:
Increased their knowledge
Prepared them to work
Provided hands-on knowledge and skills
Will make it easier to get a job in personal or home care

8. Why I took this home care training…
To learn new skills/knowledge
To change/get new or get better job/career
Like caring for/working with elderly/people with disabilities
To work in medical/healthcare field (e.g., nurse, CNA)
To care for family and/or friends
Certification/credentials (e.g., for job; CPR)
Affordable/free training

9. CMMI Project: Care Team Integration of the Home-based Workforce Health Care Innovation Award of $11.8M
Train 6,000 IHSS Consumer-Provider Pairs over 3-Year Period
Consumer directed
Integrate provider into consumers’ care team
Better care
Reduce ER visits
Reduce LOS in nursing homes
Reduce hospitalization
Improve health
Achieve $25 million in savings
$10.2m Medicaid; $14.7m Medicare
Lower costs

10. Health Plan Summary Findings
Consistent trend within plan showing declining rates of utilization and reuse among members whose workers were trained.
Demonstrated cost savings post training for both ER visits and inpatient hospital stays
Differences are most notable by the second year after training

11. Hitachi Pioneer Employers Initiative
Inclusion Criteria for Case Study
Expanding the role of Medical Assistants (MAs) in innovative model resulting in:
Improved working conditions for MAs
Improved clinical functions for the organization
Documented evidence of successful outcomes for patients, MAs, or the organization
14 case studies completed
Replication and evaluation in process
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12. New Roles for MAs Relational:
Health Coach / CHW / Dual Role Interpreter / Patient Navigator
Ambassador to communities
HIT / Documentation
Panel Manager / Scribe / Super-user
Multi-task Rotation
Medical records/ greeter / schedule / referrals / phone bank
LLRT / Pharm Tech / Lab Tech / CPT / back office
Leadership
Supervisor, Lead, Trainer, Mentor
As part of larger practice transformation—largely team-based—a lot of training required
Role and model often related to incentive chosen.

13. Questions and Discussion
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