Beyond the numbers (although Ill present some numbers too) Joanne - - PowerPoint PPT Presentation

Health workforce in a post-ACA world: Beyond the numbers

(although I’ll present some numbers too)

Joanne Spetz, PhD, FAAN Associate Director of Research, Healthforce Center at UCSF Professor, Philip R. Lee Institute for Health Policy Studies

June, 2017

The ACA didn’t just expand insurance

• Payment reforms to increase value

‒ CMS value-based purchasing ‒ CMS bundled payments and ACOs ‒ Private high-deductible health plans ‒ Price transparency

“Hospitals will exist in a world where they are rewarded more for the quality of care than for the volume of patients they treat.”

Value-based care: Here to stay?

The ACA ramped up value-based purchasing

• Value-based purchasing (VBP) for all hospitals
• Reporting is now mandatory
• Percentage of Medicare reimbursement tied directly to quality
• Incentive payments to meet or exceed performance

benchmarks

• Merit-Based Incentive Payments for physicians
• This program was codified in the Medicare Access and CHIP

Reauthorization Act (MACRA) of 2015

• Bipartisan legislation
• Unlikely to be reversed

Center for Medicare and Medicaid Innovation programs

• Bundled Payments for Care Improvement (BPCI)
• January 2016 – Mandatory bundled payments for hip & knee

replacements in selected cities

• Coming soon – Mandatory bundled payments in 98 markets for

bypass surgery, heart attacks, and surgeries for hip and femur fractures

• Tied to MACRA, so likely to continue
• Accountable Care Organizations
• Group of providers who voluntarily coordinate care
• The ACO takes financial & medical responsibility

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Consumer-driven & high-deductible health plans: Non-ACA “innovations”

• High deductible health insurance plan: deductible $1300-$6550
• CDHP adds tax-advantaged (and funded) spending or savings

account

• Money in the spending/savings accounts usually can roll over

to the next year

• Giving consumers incentives to shop for price

‒ Consumers are responsible for all costs up to the deductible

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Will value-based care survive?

• President Trump: Mixed messages
• Secretary Price: Slowing it down
• Has said he might keep CMMI
• Private insurers: The horse has left the barn
• My projection:
• Value-based care will grow, but more slowly

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Health system responses: HSI/UCSF study of Calif. health leaders

Insured Demand Complexity Focus on metrics Focus on population health

Key Drivers Responses Change Needed

Demand for quality Demand for time/discussion Knowledge sharing Patient Expectations Technology Innovation Information sharing Engagement w/patient Occupational health Affordable Care Act (ACA) ─ Places of care ─ Increased outpatient presence ─ Social media ─ New positions New Models of Care – Pilots Patient Engagement New Vehicles of Access ─ Partnerships ─ Team-based ─ Alignment of finances ─ ACOs/ACO like arrangements ─ Motivational Interviewing ─ Care coordination ─ New Positions ─ New use of technology Retooling the Workforce Leadership ─ Education ─ Regulation ─ New graduates ─ Existing workforce ─ Drive changes ─ Implement

All of these are somewhat interconnected and impact the workforce

Credit to Shelley Oberlin (HSI), Susan Chapman (UCSF), & Renae Waneka (UCSF)

Themes from HSI/UCSF study

There is heightened focus on the metrics (quality, costs, patient satisfaction) Metrics Patient Expectations New Vehicles of Access Leadership Retooling the Workforce Technology Models of Care Patient expectations are leading to an increased need for patient engagement The benefits of technology do not come without costs The ACA and health care reform have spurred new vehicles of access The status quo is no longer a viable option; many are piloting new models

• f care

It’s not just about growth, but re-tooling the education system and current workforce Leadership is needed to respond to the changes and ensure balanced implementation of solutions

Credit to Shelley Oberlin (HSI), Susan Chapman (UCSF), & Renae Waneka (UCSF)

What roles are appearing?

• Care management and coordination
• Transitional care models, guided care, etc.
• Coaching, patient education, motivational interviewing, referrals to

specialists, home visits

• Informatics
• Electronic health records as a tool for quality management
• Telehealth and telemonitoring
• Geriatric and long-term care:
• Home- and community-based services
• Population health
• Assess panels and populations of patients
• Develop, initiate, and evaluate programs

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How much impact will these changes have? Quantitative scenarios based on ARCOLA

• More effective preventive care, lowers growth in hospital services

by 10 percentage points

• Slower growth in hospital demand holding all staffing constant
• Slower growth in hospital demand but increasing RN staffing by 10% due

to acuity increases

• Effective use of telephone, video, and email consultations

reduces physician office and outpatient center visits by 5 percentage points

• Care management by RNs increases RN staffing in physician
• ffices, outpatient centers, home health, hospitals
• Increase RN staffing by 10% in all settings
• Increase RN staffing by 10% in hospitals, 20% in other settings

Quantitative scenarios continued…

• Increase in employment of social workers and counselors, to

better integrate behavioral health with primary care

• Increase social worker and counselor employment by 10% in offices of

physicians, offices of other health practitioners, outpatient care centers, home health care, other health care services, hospitals, nursing care facilities, and residential care

• Increase social worker and counselor employment by 20%
• Increase in employment of medical assistants and LVNs, for

patient navigation, health coaching, etc.

• Increase medical assistant and LVN employment by 10% in offices of

physicians, offices of other health practitioners, outpatient care centers, home health care, other health care services, hospitals, nursing care facilities, and residential care.

• Increase medical assistant and LVN employment by 20%

855,107 903,219

2011 2021

New Jobs Forecasted for CA (2011 - 2021)

Baseline California scenario from HSI/UCSF study

• The ACA will drive the need for 48,112 new health care and select

support care jobs in California by 2021

• About 6% increase in jobs over ten years as a direct result of ACA

48,112 Source: American Community Survey, HSI Analysis

Only a fraction of jobs needed Does not factor in:

• Aging of the population
• Long-term Care
• Changes to care delivery

Less use of hospitals

Greater use of telehealth

Greater use of RNs, behavioral health, or MA/LVNs in integrated care

Skills needed for the evolving health system, with or without the ACA

• Are workers prepared to work effectively in teams?

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Skills needed for the evolving health system, with or without the ACA

• Do providers automatically approach care in a patient-centered way?

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Skills needed for the evolving health system, with or without the ACA

• Are health workers prepared to span the boundaries of hospitals,

home health, long-term care, and households?

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Skills needed for the evolving health system, with or without the ACA

• Is the workforce prepared to deliver culturally competent care?

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Skills needed for the evolving health system, with or without the ACA

• Do health care providers have knowledge of patient education,

public health, and population health?

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Skills needed for the evolving health system, with or without the ACA

• Do all health workers have leadership skills to implement change?

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“As a leader, you are not directly responsible for the results, you are responsible for the people who create the results.” – Simon Sinek

Questions?

Thoughts? Ideas? Perspectives?

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