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Healthcare Workforce Development: Where Are We Now
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
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