1. Randall Wilson, PhD Jobs For The Future National Fund for Workforce Solutions Annual Meeting Chicago, IL April 9, 2014 COLLABORATING TO CREATE SOLUTIONS: FRONTLINE WORKERS AND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT

2. PRESENTATION OVERVIEW Purpose and Goals Jobs and Skills in Demand from the ACA Opportunities, Challenges and Recommended Next Steps

3. 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

4. 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

5. 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.

6. EMPLOYMENT GROWTH BY SUBSECTOR

7. OCCUPATIONS IN DEMAND: LARGEST GROWTH

8. OCCUPATIONS IN DEMAND: FASTEST GROWTH

9. 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, self- care) Health IT and Information Management –ICD-10 codes; cross training in clinical and IT; data analytics

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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?

18. RESOURCES CareerSTAT Resources: Implementing the Patient Protection and Affordable Care Act: Impacts on the Frontlines of Caregiving By Randall Wilson (link)link CareerSTAT: A Guide to Making the Case for Investing in the Frontline Hospital Workforce By Randall Wilson and Robert Holm (link)(link Visit the CareerSTAT website:http://nfwsolutions.org/initiatives/careerstathttp://nfwsolutions.org/initiatives/careerstat

19. Rrwir JAN HUNTER, CAREERSTAT DIRECTOR jhunter@jff.orgjhunter@jff.org RANDALL WILSON, PhD, SENIOR PROJECT MANAGER, rwilson@jff.orgrwilson@jff.org TEL 617.728.4446 FAX 617.728.4857 info@jff.org 88 Broad Street, 8 th Floor, Boston, MA 02110 122 C Street, NW, Suite 650, Washington, DC 20001 WWW.JFF.ORG TEL 617.728.4446 FAX 617.728.4857 88 Broad Street, 8 th Floor, Boston, MA 02110 WWW.NFWSOLUTIONS.ORG