GSETA 2011 Conference Presentation

1. 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

2. 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

3. What!are!your concerns!about!the!health!care!workforce?

4. 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.

5. 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!

6. An!Aging!Workforce
In!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.

7. New!Jersey’s!Health!Care!Workforce!is!highly!educated,!
and!slightly!surpasses!the!overall!NJ!population!in!degree!attainment:

8. 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
#1
Inpatient and Part B spending per decedent during last 2 years of life
Source: Dartmouth Atlas of Healthcare. 2006.

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

10. 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!workforce
Bureau!of!Labor!Statistics:!www.bls.gov/news.release/ecec.nr0.htm
World!Health!Organization:!“World!Health!Statistics!2009”.
Wall!Street!Journal:!"Consumers!Cut!Health!Spending,!As!Economic!Downturn!Takes!Toll”.

11. 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!Environment
Deinstitutionalization
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”.

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

13. 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

14. 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!training
Need!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

15. 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?

16. 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?

17. 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.

18. 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!occupations
Identify!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!and
team!would!look!like!and! workforce!data
how!it!would!work

19. DATA!MATRIX
for!Selected!Health!Occupations
Supply!+ Education =Demand
Current!Projections,!
Current!Number!in! weighted!by!Trends:
Number!in!school!now
Occupation
Changes!to!Delivery!and!
Staffing!Models
Minus!Exits!(retirement,! More!Community!Care
left!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!Pressures
Note:!Current!Salaries
Medicare/Medicaid

20. 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

21. 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!

22. 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

23. 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

24. 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”.

25. Discussion