1. Tomorrow’s Workforce: Surfing for solutions Tomorrow’s Workforce: Surfing for Solutions

2. Prediction  By 2030 youngest baby boomers – those born in the early 1960’s will mostly have retired and the U.S. will face the fallout of a permanently smaller labor force, barring a major change in immigration policy or some other surge in population. Gad Levanon “From Not Enough Jobs to Not Enough Workers” Conference Board September 2, 2014

3. Understanding what we need  How many health professionals do we need?  What kind of health professionals do we need?  Where do we need them to work?  What will they be doing?

4. Factors impacting the workforce  Expanded access  Aging population  Health care consumerism  Technological advancements  Cost-reduction imperatives  Call for improved health outcomes  New or adapted models to finance and deliver care  Changing regulatory landscape  Impact of work redesign  License portability

5. Drivers of workforce capacity  Education and training  Supply and demand  Roles and responsibilities  Practice models

6. Education and training  Improve health professions education capacity  Expand existing programs  Implement new programs  Adapt curriculum to align with new models of care  Implement innovative education and training solutions  Limitations  Competition for finite number of clinical training sites  Lack of residency training slots for new medical school graduates  Lack of comprehensive workforce data for projecting need  Inability to accelerate change in academic programming 6

7. Supply and demand  Michigan’s aging healthcare workforce Average age of nursing – 48 Average age of nursing faculty – 58 Physician retirements 0-10 years – 47%  Michigan’s aging population 1 in 4 Michiganders will be 60+ by 2030 Fastest growing segment of population are those 85 years or older More than 182,000 Michiganders between 85-95 and 1,700 centenarians (2010)  Michigan’s newly insured  Healthy Michigan Plan – 373,171 new Medicaid beneficiaries  Health Insurance Marketplace – 272,539 new enrollees 7

8. Current Supply Source: Michigan Department of Licensing and Regulatory Affairs, June 2014 active license counts report.

9. Supply and demand projections  Michigan’s health care workforce needs are projected to grow 18% - or 108,000 jobs – by 2018. 1  Need is at all levels from direct care workers, to registered nurses, to professionals with advanced degrees like physicians, APRNs, and Physician Assistants.  Michigan will need 6,000 additional physicians and 5,000 nurses by 2020. 2  Geographic maldistribution of health care providers will continue to limit access in rural and underserved urban communities. Michigan has 507 communities designated Health Professional Shortage areas. 1. Michigan Workforce Development Agency, 2013 2. Michigan Health Council 9

10. Roles and responsibilities  Having a sufficient number and the right mix of providers to ensure access to quality services delivered efficiently  Adopting a culture of collaboration centered around the patient  Maximizing the use of knowledge, skills and abilities  Changing the professional continuum of care paradigm 10

11. Right care, right provider…. Patient 11

12. Leveraging clinician supply  Physician supply can be leveraged through greater use of other clinician types  Clinicians can be leveraged through greater use of other licensed non-clinicians and non-licensed personnel.  Studies have found that up to 24% of a primary care team physician’s time could be saved by delegating to other team members. (Bodenheimer and Smith, “Primary Care: Proposed Solutions To The Physician Shortage Without Training More Physicians,” Health Affairs, 32, no.11 (2013):1881-1886)

13. Defining practice Medical Assistant CHW Tech RN APRN, PA Primary Care Physician Specialty Physician Ani Turner, Deputy Director Center for Sustainable Health Spending Altarum Institute July 25, 2014

14. New or expanded roles  Physician Assistants  Advanced Practice Registered Nurses  Pharmacists  Doctors of Nursing Practice  Community Health Workers  Grand-aides  Primary Care Technicians  Community Paramedics

15. Practice models  Interprofessional collaborative practice  Importance of providing a work environment that supports interprofessional collaborative practice.  Importance of the role of preceptors 15

16. Practice models  Primary care reinvention  Technology-based care  Clinical innovation  Managing the flow of information  Telemedicine  Remote training and supervision

17. Workforce challenges  Improving access to comprehensive workforce data  Identifying types and numbers of health professionals needed  Aligning education with practice and practice with education  Expanding capacity of the existing workforce 17

18. Workforce challenges  Educating and engaging providers in interprofessional collaborative practice  Retaining an aging workforce  Strengthening regional partnerships of healthcare employers, educators, workforce boards, and other stakeholders to meet the specific healthcare employment needs of local and regional markets  Aligning reimbursement policies with new practice models

19. Contact Information 19 Melanie Brim President & CEO Michigan Health Council Email: melanie.brim@mhc.orgmelanie.brim@mhc.org Phone: 517.347-3332