Randall Wilson, PhD Jobs For The Future National Fund for Workforce Solutions Annual Meeting Chicago, IL April 9, 20

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

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 definitionsfor 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) CareerSTAT: A Guide to Making the Case for Investing in the Frontline Hospital Workforce By Randall Wilson and Robert Holm (link) Visit the CareerSTATwebsite:http://nfwsolutions.org/initiatives/careerstat

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