healthcare workforce development: where are we now
DESCRIPTION
GSETA 2011 Conference PresentationTRANSCRIPT
Health!Care!Workforce!Development:!!Where!are!we!now?
2011!GSETA!ConferenceAtlantic!City,!NJSeptember!14,!2011
Ashley!Conway,[email protected]
Sheryl!Hutchison,[email protected]
Janet!Moran,[email protected]
Workshop!Agenda
• An!overview!of!the!current!state!of!the!health!care!workforce!in!New!Jersey
• What!does!the!future!hold!for!the!health!care!workforce?
• NJ!Health!Care!Workforce!Council
• Overcoming!barriers!to!work"based!training!programs!for!in"demand!health!care!occupations
What!are!your concerns!about!the!health!care!workforce?
Health!Care!is!unique:• Everyone!is!a!health!care!customer.
• Government!is!a!big!player!in!the!health!care!industry:!! Medicare/Medicaid!regulations!determine:
o What!type!of!services!are!delivered!o Where!and!How!services!are!deliveredo Reimbursement!rates!for!services
! 28!Health"Related!Licensing!boards!under!Division!of!Consumer!Affairs!(Law!&!Public!Safety,!Attorney!General),!each!with!its!own!rules!for!licensure,!depending!on!the!legislation!that!created!the!board.
• Insurance!Payers!also!play!a!large!role!in!determination!of!types!of!services!provided.
Health!Care!is!a!growing!industry!in!New!Jersey.The!industry!shows!steady!employment!growth,!and!is!recession"proof.Mainly!service!sector,!not!goods"producing.Could!argue!that!the!growth/cost!of!health!care!is!a!drain!on!our!economy,!not!a!driver.
Source:!NJ!Department!of!Labor!and!Workforce!Development,!Division!of!Labor!Market!&!Demographic!Research!
An!Aging!WorkforceIn!2009,!half (48.8%)!of!NJ!health!care!workers!were!45!or!older.And!of!those,!16.7%!were!already!at!retirement!age!(55!and!older).A!bad!economy!has!delayed!some!anticipated!retirements.
New!Jersey’s!Health!Care!Workforce!is!highly!educated,!and!slightly!surpasses!the!overall!NJ!population!in!degree!attainment:
From!Dr.!Jeff!Brenner!– Camden!Coalition!Data!presentationDartmouth!Atlas
Source: Dartmouth Atlas of Healthcare. 2006.Inpatient and Part B spending per decedent during last 2 years of life
#1
New!Jersey!is!#1!in!health!care!spending!per!person,!for!the!last!2!years!of!life.!
NJ!could!be!called!the!Acute!Care!State!
Nurse!Faculty!
Shortages
Medical!homes
Emerging!health!
problems
Transforming!the!health!care!workforce
Accountable!Care!Act!
Population!Demographics
Existing!System!Problems
Economic!Crisis
Aging!Workforce
Current!Unemployed
"ment
Health!Care!
Reform
Consumer!expectations!&!preferences
Focus!on!primary!care
Some!US!Health!Care!System!facts:
• US!spends!more!money!per!person!than!any!other!nation!in!the!world
• Medical!debt!contributes!to!46.2%!of!all!personal!bankruptcies
• Life!expectancy!is!ranked!42nd – below!most!developed!nations
• Higher!infant!mortality!rate!than!most!of!theworld’s!developed!countries
Bureau!of!Labor!Statistics:!www.bls.gov/news.release/ecec.nr0.htmWorld!Health!Organization:!“World!Health!Statistics!2009”.Wall!Street!Journal:!"Consumers!Cut!Health!Spending,!As!Economic!Downturn!Takes!Toll”.
Health!Care!Industry!TrendsDe
institu
tionalization
Moving!from!acute!care!to!community"based!care
Aging!Workforce
With!mass!retirements,!expertise!leaving!the!workforce
Aging!po
pulatio
n
Baby"boomers!retire!and!more!people!need!more!care
Health!Care!Re
form
450,000!newly!insured!Health!Care!consumers!in!NJ!by!2014!– or!not
Med
ical!and
!Techn
ological!
Advances
New!knowledge!and!training!needed!in!a!rapidly!changing!environment!e.g.!Health!Information!Technology
Econ
omic!Enviro
nmen
t
All!of!these!changes!are!happening!during!a!time!of!record!level!unemployment!and!a!stagnant!economy
Uncertainly!that!threatens!high"priority!goals Organizational!Crisis A!dangerous!
opportunity.
Robert!Ulmer,!“Effective!Crisis!Communication:!!Moving!from!Crisis!to!Opportunity”.
Workforce
Employers Education
Health!Care!Workforce!Council
Goals:!• Recommend!policy!to!address!health!care!workforce!issues• Formulate!strategies!to!address!problems!or!implement!change
Frontline/Direct!Care!PersonnelRadiography
Technicians!
NursesPrimary!Care!Physicians Physician!
Assistants
Terminal!DegreeNurses
Advanced!Practice!Nurses
Registered!Nurses!–
Baccalaureate!Degree(4!year)
Licensed!Practical!Nurses(1!year)
Certified!Nursing!Assistants!(and!other!job!titles)
Home!HealthAides
NurseAides,!
Orderlies,!Attendants
Patient!Care!Technicians!
Tier!I!Priority!Occupations
Physical,!Occupational,!Speech!&!Respiratory!Therapists
Social!Workers!(LCSW!&!MSW)
Community!Health!Workers
Dentists(add!Dental!Hygienists?)
Tier!2!Priority!Occupations
Registered!Nurses!–Diploma!Program(3!year)
Overarching!needs:!!Geriatrics!and!Mental!Health
Pharmacists(add!Pharm!Techs?)
Registered!Nurses!–Associate!Degree!(2!year)
Coordination!of!patient"
centered!care!provided!by!
effective!teams
Transition!from!acute!care!to!community"based!care
Alignment!of!training!&!
education!with!workplace!needs
Primary!care!physician!shortages!!and!needs:• Reimbursement• Retention!in!NJ!• Quality!of!life!issues• Able!to!specialize
Need!for!greater!use!of!APNs:• Reimbursement• Physician!collaborating!agreements• Nursing!faculty!shortages
Training!and!education!to!fit!current!and!future!jobs!
Train!and!educate!from!generic!to!specific!!through!work"based!training
The!NJ!Health!Care!Workforce!Council!identified!health!care!workforce!issues.
Need!for!greater!collaborative!learning!!&!training!and!education!that!links!fields/disciplines!and!!transcends!the!isolation!of!silos.
Need!for!shared,!coordinated!state!health!care!data.
Implementation!of!!a!meaningful,!replicable,!statewide!!Health!Care!model!– a!template!for!a!NJ!Accountable!Care!Team!Organization
Training!&!Education!to!fit!current!and!future!jobs
• What!are!those!jobs?!!Docs?!!Nurses?• For!Workforce!Investment!Boards!/!One!Stop!Career!Centers– Nursing!Assistants
• Given!the!transition!to!Accountable!Care!Organizations!– we’re!not!quite!sure!what!the!jobs!will!look!like–Will!assistive!personnel!(very!broad!definition)!administer!non"controlled!meds?
Generic!to!specific!by!work"based!training!
• Where!should!the!training!occur?• If!the!Accountable!Care!Organization!is!not!in!place,!should!training!occur!at!the!One!Stop!Career!Center?
• If!the!jobs!are!better!defined,!can!the!training!occur!in!the!community,!out"patient!or!in"patient!setting?
Collaborative!training!that!transcends!silos
• Once!jobs!are!defined,!can!the!One!Stop!Career!Centers!work!with!the!colleges!and!health!organizations!to!provide!qualified!candidates!to!be!trained!and facilitate!training?
• One!organization’s!barrier!to!providing!training!– a!real"life!lesson.
Change!and!Innovation
Identify!workable!models
Explore!what!a!NJ!model!for!an!accountable!care!team!would!look!like!and!
how!it!would!work
Clarify!health!care!roles
Map!jobs!and!required!job!skills!and!identify!
how!the!two!are!aligned!– or!not
Legislation
Identify!short,!mid,!and!long"term!health!system!
needs!for!making!recommendations
Select!one!council!recommendation!to!
become!model!legislation
Data
Gather!employer!input!and!ideas!to!understand!what!future!demand
may!be
Gather!supply and!education!capacity data!
to!identify!critical!shortages!for!high!
demand!occupations
Explore!establishing!a!central!repository!for!state!health!care!and
workforce!data
Action!Items:
Supply!+
Current!Number!in!Occupation
Minus!Exits!(retirement,!left!field,!moved!out!of!
state)
Note:!Number!Unemployed
Note:!Current!Salaries
Education
Number!in!school!now
Minus!Number!NOT!Retained in!New!Jersey
Note:!Program!Capacity!and!Number!Waitlisted
=DemandCurrent!Projections,!weighted!by!Trends:
Changes!to!Delivery!and!Staffing!Models
More!Community!Care
Population!Demographics
Epidemiologic!/Chronic!Disease!Rates
Aging!and!Long"Term!Care
Charity!Care!Pressures
Medicare/Medicaid
DATA!MATRIXfor!Selected!Health!Occupations
Data!Plans
• Baseline!Supply!Data!=!What!we!have!now– Current!number!employed:!Labor!Data– Number!Unemployed:!Labor!Data– Replacement!Rate:!Labor!model– Education!Pipeline:!!Labor!gets!Higher!Education!and!training!provider!data!
• Licensing!Data!– Trends!in!licensure!rates
• Mapping!New!Jersey!– Find!gaps!in!workforce/services
A!Few!Workforce!Data!Issues• Data!collected!by!many!groups,!at!different!times
– State!Agencies!" Labor,!Health,!Human!Services,!Education,!Higher!Education
– Division!of!Consumer!Affairs!(Licensing)– Medicaid/Medicare– Employer!Associations!" NJHA,!NJCTH,!Primary!Care!Association– Community!Based!Organizations– Unions!and!Employee!Organizations
• Licensing!data!does!not!necessarily!match!up!with!employment!data– Licenses:! 120,000!nurses!(RNs!and!LPNs)– Labor:! 91,700!nurses!employed!
• Demand!is!an!unknown – we!are!in!a!time!of!change!
Data!Dream
• Minimum!Data!Set!of!survey!questions!administered!to!all!health!care!professionals!when!they!renew!their!licenses.– Demographic!(age,!zip!code)– Practice!information!(type!of!services!provided,!accept!Medicaid,!etc.)
– Retention/Retirement!plans
NJ!Health!Care!Workforce!Data!Center• Data!is!more!useful!when!you!have!the!whole!picture
– Employment!and!Wages " Practice!Information– Licensing " Location!and!Types!of!Care– Demographics " Billing!Information– Education " Plans!for!the!Future
• Economy!of!Scale!– more!efficient!to!have!data!for!all!health!care!occupations!housed!together,!rather!than!separate!centers!by!occupation!(more!silos,!more!cost)
• Share!information!freely!amongst!stakeholders,!across!state!agencies
• Make!informed!policy!decisions!as!a!state,!improve!quality!of!care!and!benefit!our!economy.!!Use!to!apply!for!grants.
• Benefit!to!having!state"driven!center,!no!self"interest
NJ!Center!for!Health!Workforce!Planning
State!and!Federal!Agencies
Employers
Education!Institutions
NGOs/CBOs
To!perform!the!collection,!analysis!of!multiple!data!sources,!and!comprehensive!reporting!on!health!workforce!supply!and!demand!trends*.!!
*New!Jersey!Council!of!Teaching!Hospitals:!!“New!Jersey!Physician!Workforce!Task!Force!Report”.
Discussion