1. NATIONAL COUNCIL FOR WORKFORCE EDUCATION ANNUAL CONFERENCE OCTOBER 16, 2013  Milwaukee, WI Randall Wilson, Ph.D, Senior Project Manager WORKFORCE EDUCATION: MEETING THE CHALLENGE OF THE AFFORDABLE CARE ACT

2. 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

3. AFFORDABLE CARE ACT: A MOVING TRAIN

4. 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

5. 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

6. 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

7. 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

8. LABOR DEMAND

9. Source: US Bureau of Labor Statistics

10. MAJORITY OF JOB GROWTH OUTSIDE OF HOSPITALS SOURCE: US BLS

11. MASS. HEALTH REFORM: A PRELUDE?

12. 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)

13. 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

14. 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

15. 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

16. 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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