Health Workforce Trends, Challenges and Opportunities: A Federal Perspective

1. Health Workforce Trends, Challenges and Opportunities: A Federal Perspective Edward Salsberg, MPA Director, National Center for Health Workforce Analysis Department of Health and Human Services Health Resources and Services Administration Bureau of Health Professions 47th Semi-Annual Substance Abuse Research Consortium Meeting September 11th, 2013

2. Overview of Presentation • Workforce Challenges & Goals • National Center for Health Workforce Analysis • Health Workforce Trends & Developments • Substance Abuse Workforce • Closing Comments

3. HRSA • HRSA provides national leadership, program resources and services needed to improve access to culturally competent, quality health care • Improving access to health care services for people who are uninsured, isolated or medically vulnerable • Training health professions to improve the supply, capacity and distribution of the health workforce • Funds over 80 grant programs; FY2013 budget: $11.7 billion

4. Potential shortages; specific areas of concern: Primary Care, Chronic/Long Term Care, Behavioral Health, Oral health Mal-distribution of existing workforce Increasing need for workforce diversity Using health workers to the maximum of their education and skills Assessing the impact of a changing health care system on the need for individual health occupations Developing comprehensive data to inform health workforce decisions Workforce Challenges

5. Goals for the Future Workforce • High quality care at a reasonable cost • Assuring access to care • Increasing diversity to improve health equity • Making effective use of the workforce we have • Health workers practicing consistent with their education, training and competencies

6. To support more informed public and private sector decision making related to the health workforce through expanded and improved health workforce data, projections and information. To promote the supply and distribution of well-prepared health workers to ensure access to high quality, efficient care for the nation. National Center for Health Workforce Analysis

7. NCHWA : Core Activities • Expanded and improved health workforce data collectionand analysis • Improved projections of supply and demand/need • Disseminationof findings, data and information especially to key stakeholders • Collaboration with states on data collection and analysis and identifying needs

8. Data Collection and Analysis • Build on existing sources of data including from federal agencies, states and professional associations • ACS, NAMCS, IPEDS, NPI, BLS, AMA-MF, NCCPA • Develop and promote national minimum data sets • National Sample Survey of NPs • Improved Primary Care Service Areas

9. Extensive data collected across the health workforce but comparisons across states and professions difficult or not possible due to variations in approach to data collection MDS seeks to develop comparable data across health professions, locations and time Building on existing efforts is the most cost-effective approach to collecting the needed data State licensure boards are usually in the best position to support this endeavor Health Professions Minimum Data Set (MDS)

10. MDS Professions Behavioral Health Occupations Physicians Nurses (including advanced practice) Physician assistants Pharmacists Dentists Dental hygienists Physical therapists Occupational therapists • Psychiatrists • Psychologists • Social workers • Licensed professional counselors • Substance abuse counselors 10

11. The Area Health Resources Files • The Area Health Resources Files (AHRF) is a county-level health resource information database • The AHRF system and database change in response to user needs • AHRF products: downloadable files and web-based tools • The AHRF compiles data from over 50 different sources • AHRF has over 6,000 variables, including data for over 20 health professions • Downloaded as compressed zipped files • Downloadable for free: ASCII and Access versions

12. Area Health Resources Files: 2013 • New 2013 release • Renamed the Area Health Resources Files (AHRF). • New data: Several environmental indicators (air quality, ozone, toxic waste sites), National Health Service Corps sites and providers. • Improved Web-based Tools: Health Resources County Comparison Tool & Mapping Tool. • State and national level data coming soon. • http://arf.hrsa.gov/

13. Compendium of Federal Data Sources for Health Workforce Analysis http://bhpr.hrsa.gov/healthworkforce/compendiumfederaldatasources.pdf The U.S. Nursing Workforce: Trends in Supply and Education http://bhpr.hrsa.gov/healthworkforce Other Data from the NCHWA

14. Strengthen the Capacity of States • Collaboration with federally supported programs with states: PCOs, AHECs, SORH, LMIs, WIBs • Support for minimum data sets through state licensure boards • Development of state data under AHRF and comparison tools • Health Workforce Research Center – State TA

15. Other NCHWA Work • Cooperative agreement with the National Governor’s Association (NGA) • Health Workforce Research Centers (forthcoming) • Primary Care Service Area Improvements • HHS representative on the Standard Occupational Classification (SOC) Policy Committee

16. Major Health Workforce Trends and Developments

17. National Health Care Labor Supply Health Employment per 100,0001950-2010 Employees per 100,000 Population Year Adapted from Kendix and Getzen and the Bureau of Labor Statistics by Richard Cooper

18. Trends Impacting the Health Workforce • Demand rising as the US population is growing and aging • Health care reform to add insurance coverage for millions and improve coverage for millions more • Unsustainable cost increases • Concerns about potential health workforce shortages • Concern with inefficiencies and potential overuse • Increasing interest in identifying ways to improve efficiency and health outcomes

19. Trends Impacting the Health Workforcecont • Delivery system reforms and growing size of health care organizations • Increasing use of inter-professional teams • Disruptive innovations (e.g. increased use of non-physician clinicians; retail clinics) • Technology • Increased attention on outcomes and metrics • Patient/consumer empowerment • Globalization and global responsibility

20. Federal Activities to Support Systems Redesign • Center for Medicare & Medicaid Innovation (CMMI) • CMMI Challenge grants • State Innovation Models • Medical home initiatives • Accountable Care Organizations /Bundled payment • Medicare 10% PC payment bump through 2015 • Medicaid PC increase to at least Medicare levels for 2013 and 2014 • Workforce development: THCs, APRNs, NPs, Teams

21. CMMI Health Care Innovation Awards • Most approved projects include plans to use workers in new ways • Care coordinators and better management of patients; • Use of: • inter-professional teams; • patient navigators; • community health workers; • advanced aides, assistants; • Improved care transitions and in-home services • Greater use of telemedicine and Health Information Technology (HIT) • 16 of the 107 grantees in 2012 focued on behavioral health

22. Team for Comprehensive Care • Physicians • Nurse practitioners • Physician assistants • Psychologists • Optometrists • Registered Nurses • Pharmacists • Case Managers • Nutritionists/Dieticians • Physical Therapists • Community Health Workers • Substance Abuse Disorder Providers • …And more

23. Workforce Composition: Growth of PAs/NPs Compared to Physicians Ratio of Types of Direct Patient Care Providers, Supply and Production Source: National Center for Health Workforce Analysis

24. National Center for Inter-professional Practice and Education Overview: • Five-year cooperative agreement • Main site: University of Minnesota Aims: • Provide unbiased, expert guidance • Enhance the coordination and capacity building of IPECP among health professions and particularly medically underserved areas • Raise the visibility of high quality, coordinated, team-based care that is well-informed by interprofessional education and best practice models

25. The Substance Abuse Workforce • Integrated care is the future; Flexible use of workers will be key. This includes integration of behavioral health and primary health providers. • Primary care settings have become the gateway to the behavioral health system, and primary care providers need support and resources to screen and treat individuals with behavioral and general healthcare needs. • Delivering mental health and addiction services in collaborative primary care settings supports a “no wrong door” approach to care.

26. SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) • Promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings. • Funded jointly by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA), and run by the National Council for Behavioral Health. • The Center provides training and technical assistance to 93 community behavioral health organizations as well as to community health centers and other primary care and behavioral health organizations.

27. Trends Impacting the Behavioral Health Workforce • The Affordable Care Act will provide one of the largest expansions of mental health and substance use disorder coverage in a generation, through its insurance expansion provisions. • 47.5 million Americans lack health insurance coverage, and 25% of uninsured adults have a mental health condition or substance abuse disorder or both.

28. Trends Impacting the Behavioral Health Workforce, cont • The Affordable Care Actbuilds on the Mental Health Parity and Addiction Equity Act of 2008, which requires group health plans and insurers that offer mental health & substance use disorder benefits to provide coverage that is comparable to coverage for general medicine and surgical care. • Implementation of the Affordable Care Actwill require an expanded and appropriately trained workforce.

29. Workforce Implications of Health Systems Change • Encourage strategies to make better use of existing workers • Teams and collaborative practice and education • New categories/variations on support/assistive personnel • Reassess scope of practice and scope of work • Increased use of technology including HIT • Require flexibility to define and redefine roles and responsibilities to promote quality and efficiency • Need for better data to guide decision making

30. Contact Information Edward Salsberg, MPA Director, National Center for Health Workforce Analysis 301-443-9355 esalsberg@hrsa.gov