The Impact of ACA on thePublic Health Workforce

June 24, 2011APHA Mid-year meeting

Chicago, Illinois

Cynthia D. Lamberth, MPH, CPH

Associate Dean, Workforce Development

University of Kentucky College of Public HealthCenter for Public Health Systems & Services Research

Increase in Demand for PH Services?

• ACA may increase demand for PH services– Emphasis on prevention and thus activities related to

prevention (not just preventive care) • School Based Health Centers

• Community Transformation Grants

• MCH Visit programs

• Epidemiology/Lab Capacity Grants

• Healthy Living/Aging Well

• Incentives for Prevention of Chronic Disease

• May lead to increased need for PH workers in certain areas

Decrease in Demand for PH Services?

• Increased insurance coverage in previously uninsured

– Drive users of PH clinical servicers to private providers

• Decrease in reimbursement to PH depts.

• Decrease demand for clinical services in LHDs

• May result in decreased demand for PH workers in certain areas

The Net Result?

• Net loss or gain of PH workers?

• Shift in workforce away from clinical services

• Opportunities to collaborate with community health centers FQHC’s

• The final outcome is uncertain and it may vary from state to state

Enumeration

The public health workforce is composed of individuals whose major work focus is delivery of one or more of the essential services of public health, whether or not those individuals are on the payroll of an official, voluntary, or not-for-profit public health agency.

Public Health Functions Project, 1997

The size and composition of this workforce should be identified, and should be tracked over time in order to develop appropriate plans for workforce development, recruitment and retention.

The Public Health Work ForceEnumeration 2000

HRSA

Enumeration of PH workforce

• Need to know how many workers to know if we need more or less of them to respond to impact of ACA

• Need to know composition to know if we need more or less in certain areas to satisfy changes from ACA

UK Center of Excellencein Workforce Research & Policy Gather information about relevant databases; post on NLM

website

Technical assistance to PH workforce researchers

Explore TRAIN and other LMS data elements as research resource

Map literature to 8 research themes

Study BLS data inputs for characterizing the PH workforce

Sponsor scientific session at annual CPHSSR Keeneland Conference

Support National Advisory Committee

What we’re finding

• Much discipline-specific research; not much re: public health workforce as a whole

• Organizations often reluctant to share data; but researchers very willing to discuss work

• Data usually not comparable. Data Harmonization efforts addressing this issue

• HHS agencies, other federal agencies (e.g., BLS) eager to collaborate

• The call for a common taxonomy is still needed today

Enumeration Activity to Date

• UK and UM developed case definition to guide work

• UK and UM determined there is no one existing system that can be easily adapted for enumeration; same problems Gebbie, et al encountered

• Agreed upon “family of systems” approach to guide thinking

CHARACTERIZING the PUBLIC

HEALTH WORKFORCE

ASTHO

NACCHO

TRAIN

BUREAU of LABOR

STATISTICS

ASPH FACULTY

NIHB

CSTEOPM

US Public Health Service

CDC/ HRSA

APHL

NEHA

ATPM

ASTPHND

NSSRN

ASTDD

A FAMILY OF SYSTEMS

Enumeration Activity to Date

• Agreed upon “family of systems” approach to guide thinking

– Envisioned system will make use of multiple, currently available streams of data to characterize the workforce

• We have the specs ready for a trial of this sentinel type approach, however the funding for the COE is no longer in place.

• Working with Data Harmonization Workgroup to understand various surveys and comparable data

Research to Examine Impact of ACA

• PHSSR funding to examine impact of ACA

• PBRN RFP

• RWJF PHSSR Solicitation

Impact of ACA on Academia

• How does it impact the production of PH workers?

– Different competencies necessary?

– Different training (e.g. focus on H.I.T. may necessitate technical proficiency)

– Need more or less workers?

– Change in settings: Governmental, private, community health workers, local public health

UKCPH Response to ACA

• Increase in enrollment and emphasis on serving most vulnerable populations through practical experiences

• Change in curriculum to include ACA scenarios in classroom training

• Increased interest in certificate and degree programs in gerontology

• Overall increase in Schools of Public Health and accredited programs

For more information contact:Cynthia D. Lamberth, MPH, CPH

cynthia.lamberth@uky.edu

121 Washington Avenue, Suite 212Lexington, KY 40517

859-257-5678 www.publichealthsystems.org