The Workforce Implications of the Affordable Care Act: Research in Progress

Metro North Regional Employment Board – Quarterly Meeting Cambridge, MA June 19, 2013

The Workforce Implications of the Affordable Care Act

• Overview • Research Questions and Methods • ACA Breakdown • Labor and Skills Demand • Opportunities • Challenges and Next Steps • Discussion

EMPLOYER LEADERSHIP OF RESEARCH

OVERVIEW

• High degree of uncertainty – “building the car while driving it” • Frontline workers essential to Triple Aim • Demand will increase in both patient and technology-centered positions • Higher skill expectations: top of the job description, specific skills • Opportunities for new or expanded roles and advancement • Challenges, unknowns and cross-cutting trends

AFFORDABLE CARE ACT: A MOVING TRAIN

•

AFFORDABLE CARE ACT: BREAKDOWN

• Extending care to more patients • Achieving the triple aim: better care, lower cost, improved health o Coordination of care (ACOs, Patient-Centered Medical Homes) o Reducing readmissions, focus on “frequent flyers” o Patient follow-up and self-management o Population health and community-based care • Implementing electronic health records

RESEARCH QUESTIONS

How will the Affordable Care Act affect frontline health care workers?

• What are the forecasts of labor demand in the next 10 years? • How are individual providers preparing for workforce needs?

• What skills will be required of the workforce?

• What are the opportunities for frontline worker advancement?

• What are the best current models of workforce development?

• What are the potential challenges?

RESEARCH METHODS

• Scan of literature from health care and workforce • Analysis of labor market data • Interviews with key informants • Interviews and roundtable discussions with providers

LABOR DEMAND

Health Care Subsector Growth 2010 – 2020 6000 5000 4000 3000 2000 1000 0 Offices of health practitioners Hospitals Home health care services Outpatient, laboratory, and other ambulatory care services Nursing and residential care facilities 2010 2020 Source: US Bureau of Labor Statistics

LABOR DEMAND Patient-Centered Positions

Home Health and Personal Care Aides Registered Nurses

Entry Education

Less than high school Associates degree Nursing Aides Licensed Practical Nurses Post-secondary certificate Post-secondary certificate Medical Assistants HS Diploma/ equivalent EMTs and Paramedics Post-secondary certificate

# Jobs 2010

1,878,700 2,737,400 1,505,300

Job Growth 2010 2020

70% 26% 20% 752,300 22% 527,600 226,500 31% 33%

Change

1,313,200 711,900 302,000 168,500 162.900

75,400

LABOR DEMAND Technology Centered Positions

Pharmacy Technicians

Entry Education

HS Diploma/ equivalent Associate's Degree Radiologic Technicians Medical Records & Health Information Technicians Post-secondary certificate

# Jobs 2010 Job Growth 2010 2020

334,400 32% 219,900 28% 179,500 21%

Change

198,300 61,000 37,700 Source: US Bureau of Labor Statistics

LABOR DEMAND: MA HEALTH REFORM 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 • Direct Care (CNAs, PCAs): observational skills, customer service • Medical Assistants: administrative as well as clinical skills; supervisory skills in some cases • Patient navigators: assertiveness, cultural competencies • Health Information/Med Records Techs: medical terminology, data analytics, detail orientation, cross-disciplinary understanding

OPPORTUNITIES FOR FRONTLINE WORKERS

• Expanded responsibilities and skill upgrades o Cross-training for medical assistant and admin (Youngstown, NYC) o Calling “timeouts” for error reduction (PCAs in Boston) o DCWs assuming routine tasks of RNs (documentation, med pulls) – Northern VA • Assuming new roles o Patient navigator (discharge, follow-up) o Health coaches o Care coordinators

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 • Potential job reductions with merged positions, shift to primary, use of technology • More responsibility without compensation • Potential cutbacks in talent development

NEXT STEPS / DISCUSSION

RANDALL WILSON, SENIOR PROJECT MANAGER JOBS FOR THE FUTURE

[email protected]

TEL 617.728.4446 FAX 617.728.4857 [email protected]

88 Broad Street, 8 th Floor, Boston, MA 02110 122 C Street, NW, Suite 650, Washington, DC 20001

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