2013 NYATEP Fall Conference Monday, November 18 th , 2013 Saratoga Springs, New York

1. The Health Workforce and Health Reform: What are the Issues? 2013 NYATEP Fall Conference Monday, November 18th, 2013 Saratoga Springs, New York Robert Martiniano, Project Director Center for Health Workforce StudiesSchool of Public Health, SUNY at Albany (518) 402-2050 rmartiniano@albany.edu http://chws.albany.edu

2. The Center for Health Workforce Studies Based at the School of Public Health at SUNY Albany Not-for-profit academic research center Our mission is to provide timely, accurate data and conduct policy-relevant research about the health workforce Our goal is to inform public policy makers, the health and education sectors, and the public

3. What Do We Look Like Now

4. What Do We Look Like Now Source: NYS Department of Labor, ES-202

5. Where Are We Going? Average Annual Growth of Selected Occupational Settings in the Health Care Sector in the U.S., 2000 – 2010 and Projected 2010 - 2020

6. Where Are We Going? The projected fastest growing health occupations include: Personal care aides (71%); Home health aides (69%); Veterinary technologists and technicians (52%); Physical therapy assistants (46%); Diagnostic medical sonographers (44%); Occupational therapy assistants (43%); Physical therapy aides (43%); Medical secretaries (41%); Marriage and family therapists (41%); and Physical therapists (39%).

7. Health Reform • Federal reform: ACA • Expand access to basic health care services • Contain costs • Improve health care quality • State reform: Medicaid redesign • Focus on expanded access, improved quality, • lower costs, and better outcomes • Private Insurers • Focus on quality, costs, and outcomes

8. What Changes With Health Reform? Shift in focus for the health care delivery system to primary and preventive care Emphasis on effective management of chronic diseases Payment reform, moving away from fee-for-service and toward managed care arrangements Incentives for keeping people healthy and penalties for poor outcomes, e.g., inappropriate hospital readmissions or no copays for well visits Risk Sharing

9. Health Reform Supports Innovative Models of Service Delivery • Accountable Care Organizations, Patient-Centered Medical Homes, Health Homes, and Behavioral Health Homes use multidisciplinary teams to deliver primary care (and other) services • Teams can include: physicians, NPs, PAs, RNs, social workers, LPNs, medical assistants, and community health workers • The most effective and efficient teams demonstrate a substantial amount of scope overlap – i.e., shared responsibilities

10. So What’s the Problem? • Primary care workforce shortages • Health workforce education and training not fully focused on team-based models of care • Health professionals often not allowed to practice to the full scope of their professional competence • Scope overlap needed for team-based care is challenging to achieve • Not a good definition of what care coordination is or who delivers it

11. Steady Decline in the In-state Retention of New PC Physicians in NY Source: Center for Health Workforce Studies

12. Primary Care Practitioners in New York: Can We Expand Capacity? Source: Center for Health Workforce Studies

13. Are We Training the Health Workforce for Team-Based Practice? Health professions education and training typically occurs in disciplinary siloes Focusing on specialized clinical roles can interfere with delegation and collaboration on teams Doctors, nurses, and others get little guidance on how to interact effectively with each other in support of team care Limited exposure to newer models of care that demonstrate use of group-based decision making

14. Health Professions Regulation:Barriers to Effective and Efficient Health Care • Mismatches between professional competence and state-specific legal scopes of practice • Lack of uniformity in legal scopes of practice across states for some health professions • Limited ability to support scope of practice overlap across health professions • The process for changing state-specific scope of practice is slow and adversarial

15. Are We Training the Health Workforce for Emerging Functions? Both clinical and non-clinical staff. Skills need Care coordination Case management Outreach Patient education Health coaching Understanding of systems outside of health care

16. Strategies to Support Multidisciplinary Education and Training Break down training silos by building collaboration between training programs. Focus on skills for successful team functioning: Effective communication Role overlap Conflict resolution Delegation Supervision/leadership Collaboration Multidisciplinary education and training is still in its infancy in many places

17. Strategies to Support Health Workforce Development Grow your own primary care workforce. Create health careers pipelines that target underserved communities. Develop and maintain statewide initiatives that focus on training that is responsive to community needs. RP2 HWRI Develop and maintain incentive programs to attract and retain health professionals DANYS PSCS