Healthcare Workforce Development: Where Are We Now

Health!Care!Workforce!Development:!!Where!are!we!now? 2011!GSETA!Conference Atlantic!City,!NJ September!14,!2011 Ashley!Conway,!SETC!Sr.!Policy!Analyst ashley.conway@dol.state.nj.us Sheryl!Hutchison,!SETC!Policy!Analyst sheryl.hutchison@dol.state.nj.us Janet!Moran,!Camden!WIB!Chairperson janetpmoran@gmail.com

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!delivered o 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:

New!Jersey!is!#1!in!health!care!spending!per!person,!for!the!last!2!years!of!life.! From!Dr.!Jeff!Brenner!– Camden!Coalition!Data!presentation Dartmouth!Atlas #1Inpatient and Part B spending per decedent during last 2 years of life Source: Dartmouth Atlas of Healthcare. 2006.

NJ!could!be!called!the!Acute!Care!State!

Current! Unemployed "ment Medical! Consumer! homes expectations! &!preferences Nurse! Faculty! Shortages Some!US!Health!Care!System!facts: Focus!on! primary! care Emerging! health! • US!spends!more!money!per!person!than! problems any!other!nation!in!the!world Aging! Workforce Economic! • Medical!debt!contributes!to!46.2%!of! Health! Care! Crisis all!personal!bankruptcies Reform • Life!expectancy!is!ranked!42nd – below! most!developed!nations Existing!System! Problems Population! Demographics • Higher!infant!mortality!rate!than!most!of!the world’s!developed!countries Accountable! Care!Act! Transforming!the!health!care!workforceBureau!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!Trends Moving!from!acute! With!mass! Baby"boomers! 450,000!newly! New!knowledge! All!of!these! care!to! retirements,! retire!and!more! insured!Health! and!training! changes!are! community"based! expertise!leaving! people!need!more! Care!consumers!in! needed!in!a!rapidly! happening!during!a! care the!workforce care NJ!by!2014!– or! changing! time!of!record! Medical!and!Technological! Health!Care!Reform Advances Economic!EnvironmentDeinstitutionalization Aging!Workforce Aging!population not environment!e.g.! level! Health!Information! unemployment! Technology and!a!stagnant! economy Uncertainly!that!threatens! A!dangerous! Organizational!Crisis high"priority!goals opportunity. Robert!Ulmer,!“Effective!Crisis!Communication:!!Moving!from!Crisis!to!Opportunity”.

Health!Care!Workforce!Council Employers Education WorkforceGoals:!• Recommend!policy!to!address!health!care!workforce!issues• Formulate!strategies!to!address!problems!or!implement!change

Overarching!needs:!!Geriatrics!and!Mental!Health Tier!I!Priority!Occupations Primary!Care! Physician! Nurses Physicians Assistants Terminal! Advanced! Degree Practice! Nurses Nurses Frontline/Direct! Radiography Care!Personnel Registered! Registered! Technicians! Nurses!– Nurses!– Baccalaureate! Associate! Degree Degree! (4!year) (2!year) Certified! Nursing! Home! Registered! Licensed! Assistants! Health Nurses!– Practical! (and!other! Aides Diploma! Nurses job!titles) Program (1!year) (3!year) Nurse Tier!2!Priority!Occupations Aides,! Patient!Care! Orderlies,! Technicians! Physical,! Attendants Social!Occupational,! Community! Pharmacists Dentists Workers! Speech!&! Health! (add!Pharm! (add!Dental! (LCSW!&! Respiratory! Workers Techs?) Hygienists?) MSW) Therapists

The!NJ!Health!Care!Workforce!Council!identified!health!care!workforce!issues. Need!for!shared,!coordinated!Primary!care!physician!shortages!! state!health!care!data. Training!and!education!to!fit!and!needs:• Reimbursement current!and!future!jobs!• Retention!in!NJ! Alignment!of!• Quality!of!life!issues Transition!from! training!&! Train!and!educate!from!• Able!to!specialize acute!care!to! education!with! generic!to!specific!!through! community" workplace! work"based!trainingNeed!for!greater!use!of!APNs: based!care needs• Reimbursement• Physician!collaborating!agreements• Nursing!faculty!shortages Coordination!of! patient" Implementation!of!!a!meaningful,! centered!care! Need!for!greater!collaborative! replicable,!statewide!!Health!Care! provided!by! learning!!&!training!and!education! model!– a!template!for!a!NJ! effective!teams that!links!fields/disciplines!and!! Accountable!Care!Team! transcends!the!isolation!of!silos. 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.

Action!Items: Change!and! Legislation Data Innovation Gather!employer!input! and!ideas!to!understand!Clarify!health!care!roles what!future!demand Identify!short,!mid,!and! may!be long"term!health!system! needs!for!making! recommendations Map!jobs!and!required! job!skills!and!identify! Gather!supply and!how!the!two!are!aligned! education!capacity data! – or!not to!identify!critical! shortages!for!high! demand!occupationsIdentify!workable!models Select!one!council! recommendation!to! become!model! legislation Explore!establishing!a!Explore!what!a!NJ!model! central!repository!for! for!an!accountable!care! state!health!care!andteam!would!look!like!and! workforce!data how!it!would!work

DATA!MATRIX for!Selected!Health!OccupationsSupply!+ Education =Demand Current!Projections,! Current!Number!in! weighted!by!Trends: Number!in!school!now Occupation Changes!to!Delivery!and! Staffing!ModelsMinus!Exits!(retirement,! More!Community!Careleft!field,!moved!out!of! Minus!Number!NOT! state) Retained in!New!Jersey Population!Demographics Epidemiologic!/Chronic! Disease!Rates Note:!Number! Unemployed Aging!and!Long"Term!Care Note:!Program!Capacity! and!Number!Waitlisted Charity!Care!PressuresNote:!Current!Salaries Medicare/Medicaid

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

To!perform!the!collection,!analysis!of!multiple!data!sources,!and!comprehensive!reporting!on!health!workforce!supply!and!demand!trends*.!! State!and! Federal! Agencies NJ!Center! for!Health! NGOs/CBOs Employers Workforce! Planning Education! Institutions *New!Jersey!Council!of!Teaching!Hospitals:!!“New!Jersey!Physician!Workforce!Task!Force!Report”.

Discussion

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Healthcare Workforce Development: Where Are We Now

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Healthcare Workforce Development: Where Are We Now — Presentation Transcript