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

Value-based care: Here to stay? “Hospitals will exist in a world where they are rewarded more for the quality of care than for the volume of patients they treat.”

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 5

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 6

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 7

Health system responses: HSI/UCSF study of Calif. health leaders Key Drivers Responses Change Needed Retooling the Workforce New Vehicles of Access Affordable Care Act (ACA) ─ Education ─ Places of care Insured ─ Regulation ─ Increased outpatient presence Demand ─ New graduates ─ Social media Complexity ─ Existing workforce ─ New positions Focus on metrics Focus on population health New Models of Care – Pilots Leadership Patient Expectations ─ Partnerships ─ Drive changes ─ Team-based ─ Implement Demand for quality ─ Alignment of finances Demand for time/discussion ─ ACOs/ACO like arrangements Knowledge sharing Patient Engagement Technology ─ Motivational Interviewing Innovation ─ Care coordination Information sharing ─ New Positions Engagement w/patient ─ New use of technology Occupational health 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 Metrics satisfaction) Patient expectations are leading to an increased need for patient Patient Expectations engagement Technology The benefits of technology do not come without costs The ACA and health care reform have spurred new vehicles of access New Vehicles of Access The status quo is no longer a viable option; many are piloting new models Models of Care of care It’s not just about growth, but re -tooling the education system and current Retooling the Workforce workforce Leadership is needed to respond to the changes and ensure balanced Leadership 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 10

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 offices, 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%

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 Only a fraction of jobs needed New Jobs Forecasted for CA (2011 - 2021) Does not factor in: - Aging of the population 903,219 - Long-term Care - Changes to care delivery 48,112 855,107 2011 2021 Source: American Community Survey, HSI Analysis

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? 17

Skills needed for the evolving health system, with or without the ACA  Do providers automatically approach care in a patient-centered way? 18

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? 19

Skills needed for the evolving health system, with or without the ACA  Is the workforce prepared to deliver culturally competent care? 20

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? 21

Skills needed for the evolving health system, with or without the ACA  Do all health workers have leadership skills to implement change? “As a leader, you are not directly responsible for the results, you are responsible for the people who create the results.” – Simon Sinek 22

Questions? Thoughts? Ideas? Perspectives? 23