arizona health workforce demand in a rapidly … · arizona health workforce demand in a rapidly...
TRANSCRIPT
ARIZONAHEALTHWORKFORCEDEMANDINARAPIDLYCHANGINGMARKET:
PERSPECTIVESOFSTATELEADERS
June22,2016Preparedby:LiselBlashJoanneSpetz,PhDUniversityofCalifornia,SanFrancisco3333CaliforniaStreet,Suite265SanFrancisco,CA94118ThisstudyissupportedbyVitalystHealthFoundationofArizonaandtheCityofPhoenix.AnyviewspresentedinthisreportdonotnecessarilyreflecttheopinionsorpositionsofVitalystHealthFoundationortheCityofPhoenix.
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EXECUTIVESUMMARY
TheimplementationoftheAffordableCareActinArizonarapidlybroughtaboutnoticeableincreasesintheshareofArizonanswithhealthinsurance.This,inconjunctionwithcontinueddemographicchanges,hasledtogrowthinthedemandforhealthcareservices,causingpolicymakers,healthcaredeliveryorganizations,andeducatorstobeconcernedabouttheadequacyofthecurrentandfuturehealthworkforceofthestate.Avarietyofchangeshavebeenmadetohealthcaredelivery,bothattheorganizationallevelandatthestatewidepolicyleveltoaddressthesedevelopments.ThisreportpresentsfindingsfrominterviewswithhealthcareleadersacrossArizonaaboutthetrendstheyareobservingandtheirexpectationsforfuturehealthworkforceneeds.
Methods
Weconductedinterviewswith16healthcareleaderstolearntheirplansandprojectionsabouthowhealthcaredeliveryischangingandimpactingworkerneeds.
SummaryofFindings
1. TheformationofAccountableCareOrganizationsandestablishmentofvalue-basedpurchasingareacceleratinganddrivingafocusonpopulationhealth,integratinginformationsystems,andquality-basedpayments.However,mergersandshiftingcoveragealsocausedisruptionforpatientsandhealthcareworkersalike.
2. Thereisaheightenedfocusonpreventionandwellness,andonbringingcareoutofthehospitalandintocommunitysettings.Thisincludestheplacementofphysicalfacilities,suchasclinicsandstandaloneemergencycenters;thedeploymentofworkerstohomelocations,especiallyinlong-termcareandcommunityhealthoutreach;theuseoftechnologytoenhanceremotemonitoringandcommunicationacrossdistances;andgreaterpatientengagementinself-managementofchronicdiseases.
3. Anemphasisonpatient-centeredcare(“consumerism”)andpatientexperience,aswellastheneedforpatientself-management,isleadingtoincreasedeffortsatpatientengagement.Thisrequiresthathealthcareworkersimprovetheircustomerserviceandcriticalthinkingskills,aswellasculturalcompetencytraining.Patientnavigatorsandcarecoordinatorsmaybeneededinincreasingnumbers.
4. Theintegrationofbehavioralhealthandprimarycareisacceleratingbuttheinformationsystems,reimbursementmethods,andlicensingthatwouldfacilitatethischangearecurrentlyinadequate.Providersandnursesneedcross-traininginbehavioralhealthandprimarycareinordertoworkinintegratedmodels.
5. Healthinformationtechnologies,especiallyelectronichealthrecords,arecommonintheworkplace.Remotetechnologiessuchastelehealthandremotemonitoringsystemsshowgreatpotentialforexpandingaccesstocare,especiallyinruralareas,buttheyarenotyetwidespreadduetolackofreimbursement.Staff,providersandpatientsallneedfurthereducationintheuseofnewtechnologies,andincumbentstaffneedtraininginbetterdocumentationanddrawdownofdatatouseinformationsystemstotheirfullestcapacityinpopulationmanagement.
6. Newmodelsofcarearebeingpiloted,suchascommunityparamedicine,team-basedcare,primarycareandbehavioralhealthintegration.Newrolesarealsoemerging,includingthe
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increaseduseofcommunityhealthworkers,dentalhealthaidetherapists,andpotentiallyclinicalscribes.
7. Changesneedtobemadetohealthcareeducationtomeetthechangingneedsofthefield.a. Graduates,particularlyproviders,needtounderstandhealthcarereimbursement,
healthsystemorganization,populationhealth,andthebasictenetsofpatient-centeredcare.
b. Growingdependenceoninformationtechnologymayrequiremoregraduateswithskillsindataanalytics,computersystemmanagement,andsetupandmaintenanceofhardwaresystemsandsecurity.
c. Adiminishedsupplyofclinicalplacementsnecessaryforstudentandnewgraduatetraininghasinspirededucationorganizationstousetechnologytocoordinateplacementsandprovideclinicalsimulationexperiencesforarangeofprofessions.
d. Theexpandedemphasisonprimarycarehasincreaseddemandforandexpectationsofmedicalassistants,butintervieweesindicatedthatexistingprogramsformedicalassistantsdonotprovidesufficienttrainingforemploymentinnewrolesandmodelsofcare.
e. Newrolesmaynecessitatenewdegreeprograms,includingthosewithaninterprofessionalfocustomeetchangesinthefield.
8. Regulatorychangescanfacilitatebetteruseofthehealthcareworkforce.Theseinclude:a. Statewidecertificationofcommunityhealthworkersb. Credentialingofmedicalinterpretersc. Expandedscopeofpracticefordentalhygienists,nursepractitionersd. Streamlinedrulepackagesforprimarycareandbehavioralhealthtoenhance
integratione. Streamlinedlicensureprocessestodecreasecycletimeforhiringout-of-statephysiciansf. Increasingandenhancingthestateloanrepaymentprogram
Conclusions
Ashealthsystemtransformationcontinues,acombinationofregulatory,education,andtrainingchangeswillbenecessarytofacilitatenewmodelsofcareandaddresschangingdemographics.Thereareshortagesormaldistributioninsomeoccupations,particularlybehavioralhealthproviders,nurses,andsomemedicalproviders,especiallyinruralareas.Newoccupationsaredevelopingthatwillrequirenewcredentialsandtrainingprograms,whileexistingoccupationsarechangingasalliedhealthworkerstakeonincreasedresponsibilitythatwillrequiremoreadvancedtraining.Mostoccupationsnowrequireskillsincaremanagement,patientengagement,newtechnology,andteam-basedcare.Employersandeducatorswillneedtobothexpandtheireducationprogramsintheseareasandreassessthecurricularcontentoftheirprogramstoensureanadequatelysizedandskilledworkforceinthefuture.
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TABLEOFCONTENTS
EXECUTIVESUMMARY.................................................................................................................................2Methods..........................................................................................................................................2SummaryofFindings........................................................................................................................2Conclusions......................................................................................................................................3VisualSummary...............................................................................................................................4
BACKGROUND:HEALTHWORKERDEMANDINARIZONA............................................................................6
FINDINGS......................................................................................................................................................9Driversofchange.............................................................................................................................9Newmodelsofcare........................................................................................................................10Impactofchangesinthehealthcaresystemonthehealthcareworkforce....................................12Changesneededtoensureanadequatehealthcareworkforce......................................................14Interviewees’topthreepriorities...................................................................................................18
CONCLUSIONS............................................................................................................................................19
ACKNOWLEDGEMENTS..............................................................................................................................20
APPENDIX...................................................................................................................................................21
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BACKGROUND:HEALTHWORKERDEMANDINARIZONA
Arizona,alongwiththerestofthenation,experiencedadeepeconomicrecessionstartinginDecember2007andasloweconomicrecoverysincemid-2009.Whilethestate’seconomyhasbeenrecovering,therehavebeensignificantchangesinhealthcarefinancinganddelivery.ThestaterestoredandexpandedMedicaidcoverage,andtheimplementationoftheAffordableCareAct(ACA)of2010expandedprivatehealthinsuranceaccesstothousandsinthestate.TheACAcontainsprovisionsthatarespurringanincreasedemphasisontheintegrationofcare,providinghigh-valuecare,andconsideringpopulationhealthbroadly.Inaddition,Arizonafacesanagingpopulation,withincreasingratesofchronicconditionsanddisabilities.1
Thesefactorsaredrivingdemandforhealthcareworkersacrossthestate.Overthepastdecade,employmentgrewinallthehealthoccupationsinArizona,from75,490in2004to135,070in2013.2Shortagesofmanyhealthworkershavebeenreportedinrecentyears,includingforphysicians,andsurveyresearchhasrevealedthatphysiciansarethemostdifficulthealthprofessionaltorecruit,followedbynursepractitionersandphysicianassistants.3LicensednurseshortagesalsoareasignificantconcernforArizona,withprojectionsthatArizonawillneed87,200registerednurses(RNs)by2025,butsupplywillbeonly59,100RNs,producingashortfallof32percent.BureauofHealthWorkforce(BHW)alsoforecastsashortfallof9,590licensedpracticalnurses(LPNs),whichisabout50percentofanticipateddemand.4
Otherhealthcareoccupationsalsoarefacingsubstantialgrowthindemand.About47,000newjobsareexpectedinthealliedhealthprofessionsbetween2013and2020,withthegreatestgrowthprojectedforpersonalcareaides,medicalrecordsandhealthinformationtechnicians,emergencymedicaltechniciansandparamedics,medicalandhealthservicesmanagers,medicalassistants,andpharmacytechnicians.TheAffordableCareAct’sprovisionsalsoareexpectedtospurgrowthinemergingoccupations,suchasexpandedfunctiondentalassistants,communitydentalhealthcoordinators,healthandtransitioncoaches,communityhealthworkers,andintegratedcarecasemanagers.5
ThechallengeofmeetinganticipateddemandforhealthcareworkersismademorecomplexbythesignificantgeographicvariationfoundinArizona.ThestatehasoneofthelargestmetropolitanareasintheUnitedStatesandsomeofthemostruralareasinthecountry.6Thenumbersofphysicians,
1Borns,Kristin,andVanPelt,Kim.HealthWorkforce,HealthyEconomy.ArizonaHealthFuturesPolicyPrimer,December2014.2DatafromtheArizonaDepartmentofAdministration,reportedinIrvine,Jane,andWilliamG.Johnson,AlliedHealthNeedsAssessment.Phoenix,AZ:MaricopaCommunityColleges.May14,2015.3Tabor,Joe,NickJennings,LindsayKohler,BillDegnan,HowardEng,DougCampos-Outcalt,andDanDerksen.ArizonaCenterforRuralHealth2015SupplyandDemandStudyofArizonaHealthPractitionersandProfessionals.Tucson,AZ:UniversityofArizona.February2016.4BureauofHealthWorkforce,HealthResourcesandServicesAdministration,U.S.DepartmentofHealthandHumanServices.TheFutureoftheNursingWorkforce:NationalandState-LevelProjections,2012-2025.Rockville,MD:U.S.DepartmentofHealthandHumanServices.December2014.5Irvine,Jane,andWilliamG.Johnson,AlliedHealthNeedsAssessment.Phoenix,AZ:MaricopaCommunityColleges.May14,2015.6Borns,Kristin,andVanPelt,Kim.HealthWorkforce,HealthyEconomy.ArizonaHealthFuturesPolicyPrimer,December2014.
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physicianassistants,nursepractitioners,RNs,andpharmacistsper100,000populationaresubstantiallyhigherinurbansettingsofArizonathanruralsettings.7
TounderstandtheimpactofArizona’sagingpopulation,growinginsurancecoverage,andchangingdeliverysystemoncurrentandfutureneedsforhealthcareworkers,theVitalystHealthFoundationandtheCityofPhoenixcommissionedtheUniversityofCalifornia,SanFrancisco(UCSF),toconductastudyofcurrentandfuturehealthworkforceneedsinthestate.Thefirstphraseofthisstudyinvolvedsurveysofhospitals,communityhealthcenters,long-termcarefacilities,andhomehealthagenciesinArizona.Thesecondphaseofthissurvey,whichisthefocusofthisreport,involvedconductinginterviewswith16stateleadersregardingtheworkforcepressuresfacedbytheirorganization,theirperceptionsofemploymentandeducationneeds,andtheirexpectationsforthefuture.
7Tabor,Joe,NickJennings,LindsayKohler,BillDegnan,HowardEng,DougCampos-Outcalt,andDanDerksen.ArizonaCenterforRuralHealth2015SupplyandDemandStudyofArizonaHealthPractitionersandProfessionals.Tucson,AZ:UniversityofArizona.February2016.
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METHODS
ASteeringCommitteewasconvenedtoguidethisresearch.Wedevelopedalistofcategoriesofhealthcareworkforceleadersandexperts,suchasclinicleaders,healthsystemleaders,educators,andstategovernmentofficials,anddevelopedalistofpotentialintervieweeswithineachcategory.TheSteeringCommitteeandresearchteamcollaboratedtoprioritizeinvitationsanddevelopinterviewquestions.
AfterobtainingapprovalfromtheUCSFCommitteeonHumanResearch(UCSF’sInstitutionalReviewBoard),emailinvitationsweresentto20individualsbetweenMarch22andApril28,2016.Weconductedsemi-structuredinterviewswith16peopletolearntheirperceptionsofchangesinthestate’shealthcaredeliverysystem,howthesechangeswillaffectworkforceemploymentandtraining,andtheirorganization’splanstoadapttotherapidly-changingenvironment.Allinterviewswereattheexecutivelevel,werevoluntary,andfollowedtheguidelinesoutlinedbytheCommitteeonHumanResearch.
Sixoftheintervieweeswererepresentativesofstatewideassociationsrepresentingbehavioralhealth,long-termcarefacilities,hospitals,humanresourcesdirectors,NativeAmericantribes,andnurses.Interviewswereconductedwithleadersfromtwocommunityhealthcenters,twohomehealthagencies,onelong-termcarefacility,andonelargehealthcaresystem.ThreeinterviewswereconductedwithrepresentativesofArizona’shighereducationinstitutions,andoneinterviewwasconductedwitharepresentativeofstategovernment.
Interviewquestionsweresemi-structuredandfocusedonhowtheintervieweethoughtchangesinhealthcaredelivery,technology,education,skills,reimbursement,regulation,impactofnewlyinsured,andjobturnoverwouldimpactthefuturehealthcareworkforceinArizona.AppendixAliststheinterviewquestionsthatservedasaguideforeachinterview.Questionsweremodifieddependinguponexpertiseoftheinterviewee.
InterviewnoteswereanalyzedtoidentifykeythemesdescribingchangesinhealthcaredeliveryinArizona,andhowthesechangesareimpactinghealthworkforceneeds.Challengesfacedbyintervieweeswereexamined,aswererecommendedsolutions.
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FINDINGS
Driversofchange
IntervieweesidentifiedmultiplefactorsthataredrivingchangesinhealthcaredeliveryinArizona.ThereboundingeconomyandtheimplementationoftheAffordableCareAct(ACA)withtheMedicaidrestoration/expansionin2013broughtaboutadramaticincreaseininsurancecoverageandasurgeindemandforhealthcareservicesinArizona.However,thestateisfacingshortagesofmedical,dental,andmentalhealthproviders,whichhavebeenexacerbatedbycutsduringtherecessionof2007-2009,particularlyinruralareas.
ThemandatesoftheAffordableCareAct(ACA)areleadingtoanemphasisonpopulation-basedandprevention-orientedcare.Relatedchangesinreimbursementmodelsthatrewardqualityratherthanvolume-basedincentivesarepushinghealthcareorganizationstoproducemeasurablequalityimprovements—andtomakemoreeffectiveuseoftechnologytotrackandcompilethesemeasures.However,newpaymentmodelsarestillinearlystagesandnotwidespread.
Healthinformationtechnology(HIT)implementationrequirementsestablishedbytheFederalgovernment,aswellasfinancialincentivesformeaningfuluseofHIT,aredrivingthedevelopmentofnewcomputerandphonesystems,especiallyinfederally-qualifiedhealthcenters(FQHCs).Thewidespreaduseofelectronichealthrecords(EHRs)bothfacilitatesandhinderscareaccordingtointerviewees.Itcanenhancetheabilityoforganizationstotrackoutcomes,sharedata,anddelegatetasks,butitalsoconfoundsinterpersonalinteractionsbetweenpatientsandclinicians.Moreadvancedtechnologiesliketelehealthandhomemonitoringholdpromisetoimproveaccessandqualityofpatient-providerinteractions,butreimbursementandtrainingchallengeshavethusfarprecludedtheirwidespreadadoption.Whiletechnologyiscitedasapotentialfacilitatorinpatientcare,thebenefitsareyettobefullyrealizedformostorganizations.
Inaddition,theACAincludedreauthorizationofandupdatestotheIndianHealthCareImprovementAct,whichallowedIndianHealthServices(IHS)toparticipateinthehealthcarereform,helpedmodernizesystems,andledtoanincreaseinthirdpartyrevenuestoIHShospitalsandclinics.ThesefactorsareincreasingthedemandforcareservicesamongtheNativeAmericanpopulation,andprovidingmoreresourcestoIHSfacilities.
FactorsdrivingchangeatthestatelevelincludethetransferofBehavioralHealthservicesoutoftheDepartmentofHealthServicesandintotheAHCCCS(ArizonaHealthCareCostContainmentSystem),Arizona’sMedicaidmanagedcaresystem.There-institutionofKidsCare(CHIP)inArizona,whichwillstartonSeptember1,2016afterasix-yearfreeze,alsohelpedincreaseaccessto,anddemandfor,care.
Demographicfactorsarealsoplayingapartindrivingchange,includinganagingpatientpopulation,withanincreaseinchronicdiseaseandcōmorbidities,aswellasanaginghealthcareworkforce.Theneedtoaddressbehavioralhealthissuessuchassubstanceabuse,dementiaandAlzheimer’sdiseaseinconjunctionwithprimarycareisalsochanginghowcareisdeliveredandorganized.Thelargenumberofveteransinthestatehasincreasedtheneedforappropriatebehavioralhealthservices,andmaybeafactorbehindtherelativeyouthofthelong-termcarepopulation.Finally,anincreaseinthenumberof
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single,childlessadultsinthelong-termcarepopulationwillrequirechangesinworkforcecompositionandcompensationasthesectorrelieslessonadultchildrentoprovidecare.
Despitetheincreasesinhealthinsurancecoverage,ArizonahasmanyundocumentedresidentswhoarenotcoveredbytheACAorMedicaidexpansion.Inaddition,manyproviders,especiallydentalproviders,willnotacceptMedicaidbeneficiaries,providingfurtherchallengestoaccessingcare.
Newmodelsofcare
Manyhealthcareorganizations,particularlyinthePhoenixarea,areformingaccountablecareorganizations(ACOs).Banner,Dignity,andHonorHealthwerementionedasimportantplayersmakingtheshiftfromfee-for-servicereimbursementtovalue-basedreimbursement,witharelatedfocusonpopulationhealth.HospitalsystemshavepurchasedprimarycarepracticesinanefforttomeetACOrequirementsandalsoacquiredsmallerhospitals.SomeFQHCsarealsomovingtopartnerwithACOsandhospitals.Thishasoccurredatthesametimeasthebuyoutofinsurancecompaniesbyothercompanies,resultinginshiftinginsuranceforpatients.
Someorganizationsarestartingtoimplementteam-basedcareandpatient-centeredmedicalhomes.Thisrequiresthatprimarycarestaffinparticularworkininterdisciplinaryteamsoftenmadeupofphysiciansandotherproviders,includingnurses,medicalassistants,nursingassistants,behavioralhealthproviders,andothers.
Largehealthcareorganizationshaveestablishedmoreurgentcareclinicsandfree-standingemergencydepartmentsinabidtokeepindividualsoutofthehospitalemergencyrooms.Free-standingemergencyroomsareafairlynewdevelopmentandareopenaroundtheclock,althoughpatientswouldneedtobetransferredtoahospitalforsurgeryandovernightstays.
Manyhealthcareorganizationsareworkingtowardsgreaterintegrationofmentalandphysicalhealthcare.AlargeshareofFQHCshavedonesoforsometime,utilizingstafflikesocialworkerstohelpwithdepressionscreeningandaidingpatientsinself-managementofchronicconditions.ThestatehasaCDCgranttodevelopintegratedsystemsofcareanddevelopself-managementtoolsforcommunityclinics.Atthestatelevel,RegionalBehavioralHealthAuthorities(RHBAs)havebeencontractedtodevelop“healthhomes”thatintegratebehavioralandphysicalhealthforthosewithseriousmentalillnesses(SMIs).Undertheseplans,adultMedicaidbeneficiarieswithSMIscanreceivecoordinated,integratedphysicalandbehavioralhealthcareservicesunderoneplanandinoneplace.BehavioralhealthorganizationsservingthosewithSMIsaretakingonprimarycareprovisionandapplyingtobecomeFQHCs.However,licensure,Medicaidreimbursementissuesandotherdifferencesbetweentheinformationandbillingsystemsestablishedforbehavioralandphysicalhealthchallengethisintegrationatmanyorganizations,andreportedsalarydifferentialsbetweenphysicalandbehavioralhealthstaffgeneratefurthercomplications.
Oralhealthcontinuestobeanareainwhichashortageofprovidersandlackofaccesstoservicesplaguelow-incomecommunitiesandthoselivinginruralareas.Arizona’sMedicaidagency–theArizonaHealthCareCostContainmentSystem(AHCCCS)–doesnotgenerallycoverthecostofadultdentalcareexceptforpatientsoftheArizonaLongTermCareSystem(ALTCS)orincasesofemergency,although
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children’sdentalservicesarecovered.ManydentistsreportedlywillnotworkwithAHCCCSduetolowMedicaidreimbursementrates.Thishasprovokedhealthcareorganizationstolookatcross-trainingotherphysicalcareproviderstodobasicoralhealthscreenings,andtoexperimentwithalternativestaffingsuchasdentalhealthaidetherapistsonreservationsorextendedscopefordentalhygienists,aswellasteledentistrytoincreaseaccessinremoteareas.
Overall,intervieweescitedashifttowardsa“CultureofHealth”withagreaterfocusonhealththanhealthcare,andanefforttobringhealthcareservicesintothecommunityandthehome.Thistrendincludeshome-basedcareforaginginplace,agreateremphasisonself-managementforpatientswithchronicdiseases,morehealthpromotionandwellnessactivities,andanincreasedrolefortelehealthtoallowpatientstomonitorconditionsandsharehealthinformationwithcliniciansfromhome.
Theroleoftechnology
Technologyinnovationsarebeingexploredbyhealthcareorganizationsaspotentialsolutionstosomeofthechallengesassociatedwiththestate’sdistributionofhealthcareworkersandprovidershortages.Anumberofthoseintervieweddiscussedthepotentialoftelehealth,particularlyinruralareaswherepatientsmaybeisolatedandhomehealthvisitsrequirehoursofdrivingtime.Oneintervieweeobservedthatasinglenursecanmonitor40to50long-termcarepatientsusingtelehealthtechnology.However,thecostlytechnologyandlackofreimbursementarechallengestofullimplementation.Homehealthmonitoringalsoholdspromise,especiallyinruralareasandforthosewithlong-termcareneeds.Thistechnologycouldpotentiallyenhancepatientengagementinmonitoringtheirownhealthconditionsandreportingbacktoproviderswithoutleavingtheirhomes.ThechallengeisinvalidatingthehomehealthtechnologyandintegratingitwiththeEHR,aswellastrainingstaffandpatientstouseitproperly.
Oneparticularchallengetobetterleveragingtechnologyfornewmodelsofcarehastodowithsharinghealthinformationacrossphysicalandbehavioralhealthsystemsasorganizationsmovetointegratethesetwoaspectsofhealth.Tacklingfederalrequirementsaroundbillingandservicedelivery,anddevelopingandmanagingITsystemsthatcanhandlethisintegration,willrequiremoresophisticationfromstaff.
Finally,technologycanhelpimproveaccountability,particularlyforstaffthatmeetwithpatientsintheirownhomesorinthefield,byensuringthatstaffencounterswithpatientsarerecordedwiththetimeofarrival,servicesprovided,anddurationofvisit.
Ruralregions
Shortagesofhealthcareworkerswerereportedtobemorecommoninruralareas,andskilledstaffandprovidersarehardertorecruitandretainintheseareas.Recruitingphysiciansisparticularlydifficult,especiallysurgeons,andorganizationsfindthattheyalsosometimesneedtofindemploymentforspousesinordertorecruit.Loanrepaymentprogramswerecitedasonetoolforrecruitment,althoughthereisreportedlynotenoughmoneyinthestate-supportedprogram.Behavioralhealthpractitionershaverecentlybeenincludedaseligibleforloanrepaymentprogramspartiallydueshortagesoftheseprovidersinruralareas.
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Intervieweesdiscusseddeployingnewtypesofhealthcareworkerssuchascommunityhealthworkers,dentalhealthaidetherapists,mobileteams,andcommunityparamedicinetoreachthoseinremotecommunities,includingNativeAmericanreservations.Apilotcommunityparamedicineprogramhasbeguntrainingparamedicsthroughoutthestatetoprovidepreventivecareinthecommunity,especiallyforthosemostatriskofusingthe911system.AHCCCSwillbeginreimbursing“treatandrefer”activitiesinOctober2016.
Manyofthoseinterviewedindicatedthattheyactivelysupportprogramstointerestlocalhighschoolstudentsinhealthoccupations.However,somealsonotedthatitcanbedifficulttohirelocallyandmaintainprivacywhencommunitiesaretoosmalltoprovideadegreeofanonymity.Someorganizationsusecontingentlaborandtravelingnurseswhenpermanentstaffisdifficulttorecruitandretain.
Impactofchangesinthehealthcaresystemonthehealthcareworkforce
Increasesinhealthcaredemandarespurringneweffortsatrecruitmentandretention,aswellasmorecreativeusesofstaffingandtechnology.Theincreaseindemandhasrequiredthatprimarycareproviderorganizationsutilizestaffmoreefficiently.Thisincludesincreasingthenumberofnursepractitionersandphysicianassistants,andrequiringthatallstaffworkatthetopoftheireducationandscopeofpractice.Withashortageofprovidersinsomefields,andanincreasedfocusonprimarycare,manyhealthcareorganizationsarerelyingmoreonalliedhealthworkerssuchasmedicalassistants(MAs),andcommunityhealthworkers(CHWs).However,greaterrelianceonthesetypesofworkers,particularlyMAs,isnecessitatingadditionaltraininginsoftskillsandothercompetenciesthatallowthemtoworkatashighalevelaspermittedbyscopeofpracticeregulations.Greateremphasisonpopulationhealthandprimarycarehasincreasedthedemandformedicalassistants,particularlythosewithgoodpatientcommunicationskills,ashealthcareorganizationsopenmorecommunity-basedfacilities.
Growinginsurancecoverageforbehavioralhealthserviceshasledtogreaterdemandforbehavioralhealthworkers.However,manyintervieweesindicatedthatthereisashortageofbehavioralhealthproviders,particularlyinsafetynetclinicsandinruralareas.Behavioralhealthtraineeswhoareinterestedinruralpracticehavefacedchallengesduetotheneedtohaveadequatesupervisionduringtraining.RegulationsmanagedbytheBoardofBehavioralHealthExaminersweremodifiedtoallow90%ofclinicalsupervisiontobeprovidedelectronicallyviaSkypeorteleconferencesothatmarriageandfamilytherapists(MFTs)andotherproviderscanfinishtheirclinicalhoursinruralareas.
Severalintervieweesnotedthatthelabormarketfornursesiscomplicated.Manyindicatedthattherewasashortageofnurses,andexpressedconcernthat,withanaverageageof55,manyRNsmightneedtotransitionoutofacutecareandintootherrolesinhospitals,suchascarecoordination.However,duetothelackof“newgrad”trainingprogramsthatallowyoungernursestoobtainthetrainingandexperienceneededtofillacutecarepositions,hospitalsarefacingashortage.
Long-termcare(LTC)isagrowingfieldduetotheaginglocalpopulation,thelargenumberofpeoplemovingtoArizonatoretire,and“snowbirds”wholiveinthestateonlypartoftheyear.ThiscreatesaperiodicsurgeinneedforLTCworkers,whichmakesitdifficulttostaffagenciesandorganizationsthatprovidelong-termcareservices.IntervieweesreportedanongoingshortageofLPNs,thepredominant
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workerinthisfield,aswellasCertifiedNursingAssistants(CNAs).ThelackofacareerladderforentrylevelstaffsuchasCNAsmakesitdifficulttoretainanddevelopthisgroupofworkers.Intervieweesalsoreportedshortagesofoccupational,physicalandspeechtherapistsinlong-termcare.Theseshortagessometimesresultin“poaching”betweenorganizationsandinflatedsalaries.
Somelong-termcareorganizations,whichhavereliedonLPNsandCNAs,haveneededtohiremoreRNsduetorisingcomplexityofpatientconditions.However,manyRNsreportedlyhaveahardtimeadjustingtolong-termcareemploymentbecausemuchoftheworkisone-to-onewithpatientsintheirhomes.Thereisalsoagrowingneedforstafftoassistpatientswithdailyfunctionssuchasshopping,cleaning,cooking,andaccessingmedicalappointments.Oneorganizationnotedthatthesefunctionsareoftendeliveredseparately,andthattheyaremovingtowardintegratingtheseservicesintooneposition–theAttendantCareWorker—whoisoftenretirement-ageandfrequentlyafamilymember.
Theintroductionofnewtechnologyliketelehealthorremotemonitoringcouldmakehealthcareorganizationsmoreefficient,whichcanincreasethecapacitytoseepatients,butalsomightentailreductionsintheworkforce.Oneintervieweenotedthatthecurrentdemandexceedscapacity,andthusitismorelikelythattechnologywillbeusedtoincreasecapacityandaccesstocare.However,manyintervieweesindicatedthathealthcareorganizationslacktheworkforcewithspecificskillstomakefulluseofnewtechnologytools.Whilemanyofthoseinterviewedsawpositivebenefitstonewtechnology,afewintervieweesnotedthatsomenursesandprovidersareunhappywithEHRdocumentationrequirementsthatoftendistractthemfromtheirpatientfocus.Thisisparticularlytrueforolderhealthcareworkers.Clinicalscribeswerenotedasonepossiblesolutionforassistingprovidersduringpatientencounters.Severalintervieweesnotedthattechnologycouldnotreplacetheneedforface-to-faceinteractionsandcriticalthinkingskillsforthepractitionersusingthenewtechnology.
Finally,themandatethatemployerswith50ormoreemployeesprovidehealthinsurancemighthaveanadverseimpactontheworkforce.HealthcareorganizationsandagenciesmightchoosetodownsizetokeeptheirFTEsbelow50inordertoavoidtherequirement,ortheymightchoosetouseindependentcontractorstoavoidthisprovision.
Turnoverandretention
Intervieweesnotedbothburnoutandhighdemandforcertainclassesofworkersasbeingimportantfactorsinturnoverandretention.Theycitedturnoverratesfrom14to75%dependingonoccupationandhealthcaresector,withmostreportingsomewherearound25%.Whileburnouthasalwaysbeenafactorinhealthcare,theunusuallyhighdemandbroughtaboutbyArizona’sparticipationinhealthcarereformanditsMedicaidexpansionhaveincreaseddemandandwagesforcertaintypesofhealthcareworkers.Thisvariesagreatdealbyoccupation.Therecontinuestobeanursingshortage,andnursesappeartofrequentlychangejobsforhigherwagesandbetterworkingconditions,asareoccupational,physical,andspeechtherapists.Employersalsonotedthatnursesarebeing“poached”bycompetitororganizations.Someintervieweescitehighemployeeengagementasbeingkeytotheirsuccessfulretentionefforts.
Fourintervieweesinstatewideorganizationsindicatedthattherewasaproblemwithturnoverattheleadershiplevel.Asonenoted,“Theoverallchangesinhealthcareareaffectingleaders.Tryingtocome
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upwithastrategicdirectionisarealcrap-shootrightnow.”However,threeintervieweesinproviderorganizationsindicatedthatmostoftheirturnoverwasforfrontlinestaff,notleadership.
Changesneededtoensureanadequatehealthcareworkforce
ThoseinterviewedwereaskedaboutthechangestheythinkareneededtoensurethatthehealthcareworkforceofArizonacanmeetcurrentandfuturehealthcareneeds.Avarietyofrecommendationsweremaderegardingtheskillsrequiredforhealthworkersinthefuture,educationalchangesthatwouldensureadequateskillsandnumbersofworkers,andregulatorychanges.
Newskillsneededfornewandexistinghealthcareworkers
Changesinhealthcare–includingthedesiretointegratephysical,dental,andmentalhealthservices–arenecessitatingnewskillsandknowledgeamongexistingstaff.
• Trainingforbehavioralhealthandprimarycareintegration.Medicalproviderswerecitedasneedingmoreeducationinneuroscienceandneuropsychiatrytobetterunderstandpatientconditions,andmoretraininginusingCTscansandMRIstomonitorbrainconditions.
• Trainingfordentalhealthandprimarycareintegration.Medicalcliniciansmightneedsometraininginassessingthehealthofteethandgumsinordertoreferpatientsfordentalcareortoprovidesomesimplesuggestionsonoralhealthcare.
• Interprofessionaltrainingisincreasinglynecessaryforthoseworkinginteam-basedcareaspatient-centeredmedicalhomesbecamemoreprevalent.
• BasiccomputerskillsareachallengeforolderprovidersandRNs,butalsochallengingforfrontlineworkerswithlimitededucationalpreparation,includingsomementalhealthandsubstanceabusepeerproviders.Thecontinuedadvanceofelectronichealthrecordsystemsrequiresthatstaffhavegoodcomputerskillsinordertodocumentpatientvisitsforbillingandcompliancepurposes.
• Understandingfederalrequirementsforbillingandcodingisagrowingareaofconcernasnewtypesofalliedhealthstaffbecameeligibleforreimbursement.
• Dataanalytics/healthinformatics/healthinformationtechnologists.Staffwithexpertiseinsettinguphealthinformationandphonesystems,trouble-shootingproblems,andtrainingotherstafftousethemwasmentionedasanareaofneed.Inadditiontomoreoperations-focusedstaff,individualswiththeskillstoextractandanalyzedatafromthesesystemsareneededtorealizethefullpotentialofthesenewsystems.
• Translationandculturalcompetencyskills.Thepaucityofproviderswithbiculturalandbilingualskillswhocancommunicatewiththepatientpopulationwascitedasanongoingproblem—bothforthoseservingSpanish-speakingpopulationsandontriballands.Someprovidersareutilizingmedicalassistantsastranslators.However,asoneintervieweeobserved,justbecauseastaffmemberisbilingualdoesnotguaranteegoodmedicaltranslationskills.Skillsassessmentandmedicaltranslatortrainingforexistingstaffisimportantbecausemanyprimarycareorganizationscannotaffordtoemploytranslatorsinaseparaterole.
• Traininginchronicdiseasemanagement,especiallyforfrontlinecareworkerswhomayobservesymptomstheycanconveytolicensedstaff,andtrainingininsurancenavigation,werenewskillsapplicabletofrontlinestaff.
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• Softskills/communicationskills.Patientengagementskills,customerservice,andcommunicationskillsarecriticalforincumbentstaffandfornewgraduatesenteringthehealthcarefield.OneorganizationhasdevelopedtrainingmodulesforprovidersinhowtocommunicatewithMAsandpatients,andanotherforMAstocommunicatewithpatientsandproviders.However,oneintervieweeobservedanimprovementinrecentyearsduetohealthcareorganizations’emphasisonpatientsatisfactionratings.Criticalthinkingskillsalsocameupasimportantbutoftenlacking,especiallyinfrontlinestaff.
• Understandingpatient-centeredcare.Inadditiontoimprovingskillsincommunicatingwithpatients,staffandprovidersneedtounderstandwhatpatient-centeredcareisandhowitisoperationalizedtoworkinthenewmodelsofcarelikethepatient-centeredmedicalhome.Takinginputfrompatientsisdifficultforsomeproviders.
• Carecoordinationskillswerecitedasveryimportantfornewmodelsofcareaimedatkeepingpatients,especiallylongtermcarepatients,healthyintheirhomes.Carecoordinatorscanassistpatientswithaccessingnecessarycareandservicesaswellastrackingtheircareovertimetomakesurethattheircareisfollowedthroughandintegrated.
• Usingincumbenthealthworkersmoreefficiently:Existingstaff,suchasmedicalassistantsandparamedics,canbecross-trainedtoprovidemorepreventivecarewhenprovidersareinshortsupply.
Skillsgapsinnewgraduatepreparation
Newgraduatesintohealthcareoccupationssometimeslackimportantskillsandknowledgeneededbyemployerorganizations.Specificareasofeducationwererecommendedbymanyofthoseinterviewed.
• Geriatricstraining:Forthoseworkinginlong-termcare,inparticular,trainingingeriatricsisvitaltoaddressingtheneedsofthestate’slargeseniorpopulation.However,itwasnotedthatfewnewgraduatesornewemployeescomepreparedwiththisknowledge.
• Healthcarefinancingandvalue-basedpurchasing.Oneintervieweenotedthatmedicalfacultyand,consequently,medicalstudentshavelittletraininginhealthcarefinancing.Existingstaffandadministratorsneedadditionaltraininginhowtoprepareforpaymentreforms.
• Clinicalskillsformedicalassistants:Asprimarycarebecomesmoredependentontherolesofstafflikemedicalassistants,trainingprogramsneedtopreparethesestudentsforexpandedrolesandresponsibilities.However,manycomeintoemploymentlackingbasicclinicalskillsandsometimesdonothavesufficientprimaryeducationtofunctionproperly.
• ClinicalexperiencefornewRNs:NewRNgraduatesmightnotreceiveenoughclinicaltimeintheirnursingprogramstobepreparedto“hitthegroundrunning”whentheygraduate;asaresult,theyfinditdifficulttofindemployment.
• Behavioralhealthtechnicians:Manyorganizationsusebehavioralhealthtechnicians(BHTs),whoareoftenindividualswithundergraduatedegreesinpsychiatryorsocialwork,toaddresslicensedprovidershortages.However,becauseBHTsdonothaveclinicaltrainingtoworkinthefield,theyrequireagreatdealofon-the-jobtrainingandsomepurportedlyenterthefieldwithunrealisticexpectationsandsubsequentlyencounterdifficultieswiththereportingrequirements.
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Changesneededinhealthcareeducation
Healthcareeducationwillneedtochangetoaddresstheseskillsgapsandnewskillsneeds.Inaddition,thenewoccupationsandjobtitlesnecessaryforthechanginghealthcareenvironmentarestillunderdevelopment.Intervieweesmaderecommendationsregardinghoweducationneedstochange,andhaschanged,toaddresstheseneeds.Someofthoseinterviewednotedpartnershipsbetweeneducatorandemployerorganizations.
• “Growyourown”strategiesareonesolutiontoshortages,particularlyinruralareas.Employersneedtopartnerwitheducatorstohireandtrainlocalpeople.Thiswillrequireafocusonprogramsthatinterestruralhighschoolstudentsinhealthcareersintheirowncommunities.Somecommunitycollegeprogramshaveonlineandhybridhealthcareerprogramsand/orcampusesnearruralcommunities.
• RNresidencyprograms.NewgraduateprogramssponsoredbyhealthcareorganizationscanprovideclinicaltrainingthatnewRNslackandcanhelpaddressthenursingshortageinhospitals,buttheseprogramsareinshortsupply.
• Newcategoriesofhealthcareworkertraining.Educationalprogramsareworkingwithhealthcareemployerorganizationstodeveloptrainingprogramsanddegreesfornewroles.Forexample,onecommunitycollegehasdevelopedaprograminhealthcaretechnologysystems,whichfocusesonhardware,asopposedtothesoftwareandcompliancefocusofhealthinformationmanagementprograms.ArizonaStateUniversityhasdevelopedaCollegeofHealthSolutionsthattakesaninterdisciplinaryapproachtohealthcareandincludesdegreeprogramsliketheScienceofHealthCareDelivery,whichincludestopicssuchaspopulationhealth,systemsengineering,andinformationscience.
• Concurrentenrollmentprograms/collaborativeprograms.Collaborativeprogramsbetweencommunitycollegesanduniversitiesprovideoneavenueforaddressingshortages,includingtheshortageofclinicallaboratoryscientists.IntervieweesnotedthecollaborativeprogrambetweenArizonaStateUniversityandPhoenixCollegewhichallowsstudentstosimultaneouslyearnanassociateandabaccalaureatedegreethroughahybridonline/in-personprogramwhilepursuingpartoftheirclinicalhoursinastate-of-theartsimulationlab.Associate’sdegree-to-bachelor’sdegreeprogramsinnursingaregrowinginresponsetoemployerinterestinhiringbaccalaureate-educatedRNs.
• Clinicalsimulation.Thelackofclinicalplacementsavailabletohealtheducationprogramshasbeenexacerbatedbythemergersandexpansionstakingplacebetweenhealthcareorganizations,whichhaveprecludedacceptingstudentsforclinicalrotations.Oneresponseistodevelopmorerobustclinicalsimulationtrainingfacilitiesandprograms.
o Integratingclinicalplacementsystems.MaricopaCommunityCollegesandlocallargehealthcareorganizationsformedaconsortiumtomanageclinicalplacements.Theyinstitutedasetofpre-clinicalmodulesforstudentsandfacultyin45alliedhealthand8nursingprogramsintheregiontostandardizepreparationforclinicals.Theyalsoadoptedacloud-basedplatformthatallowsthemtocentralizeplacementoperationsandtrackhours,relievinghealthcareorganizationsoftheburdenofindividualtrackingandplacementoperations.
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• Programsforveterans.Arizonahasalargenumberofveterans,anddevelopingmethodsofrecruitingandtrainingveteransfornewcareerswascitedasimportantnotonlyforveterans’financialviability,buttofillshortages.
• Improvedmedicalassistanttraining.Thequalityofmedicalassistanttrainingneedstobeimprovedtoaddressemployerneeds.
• Strongerclinicaltrainingforbehavioralhealthcarestudents.Thereissomeconcernthatbehavioralhealthandsocialworkprogramsarenotadequatelypreparingstudentstoworkinpublichealth.Graduatesneedtohavestrongerclinicaltrainingandmorebackgroundintrauma-informedcareandspecializedtreatment.
• Betterpreparationinbothbehavioralandphysicalhealth.NPsneedbetterpreparationinbehavioralhealth,andpsychiatricNPsneedbettertraininginphysicalhealth,toaddresstheneedformorecross-trainedstaffintheintegrationofphysicalandbehavioralhealth.Caremanagersthatcommunicatebetweenthephysicalandbehavioralhealthsidewillbeindemand,particularlyforthosewithchronicdiseases.
• Morecommunity-basedplacements.Thereisadearthofplacestotrainhealthprofessionalsinthecommunity.InvestingintraininginfrastructurefocusedonFQHCsandotherambulatorysites,aswellasinruralhospitalsandcriticalaccesshospitals,wouldhelprecruitmenteffortsinunderservedcommunities.
Regulatorychanges
Anumberofregulatorychangescouldbemade,orhaverecentlybeenmade,thatcouldfacilitateneededchangesinthehealthcareworkforcetoaddressthechanginghealthcarelandscape.
• Behavioralanalysts.Arizonawasoneofthefirststatestolicensebehavioralanalysts.Behavioralanalystsworkwithpeoplewithdevelopmentaldisabilitiesandautism.Theircurrentlocationforlicensing(thePsychologyBoard)haslimitedtheirscopeofpracticeandsomeintervieweeswouldlikethelicensingtransferredtotheBoardofBehavioralHealthExaminerstospurachangeintheapproachtocareandbecausethismovemightmaketheirservicesreimbursable.
• Communityhealthworkers.AlthoughanumberofintervieweesnotedtheimportantroleofCHWsandTribalHealthRepresentatives,thereisnotyetanycertificationforCHWsinArizona.IfCHWswerecertified,theirworkwouldbereimbursable.
• Oralhealthcareworkers.Expandedscopefordentalhygienistswouldallowforgreateraccesstocarewherethereareshortagesofdentists.In2015,legislationwaspassedallowingfortheuseofthedentalhealthaidetherapistroleontriballands.
• Pharmacists.Scopeenhancement(advancedpracticepharmacydesignation),similartowhathasbeenestablishedinNorthCarolinaandCalifornia,wouldallowpharmaciststoworkasprovidersandprescribefamilyplanningservicesandmedicationtherapymanagement.
• Nursepractitioners.MedicaredoesnotpermitNPstoorderhomehealthservicesforpatients.WhileArizonahaslegislationtoallowNPstopracticetotheirfullscope,federallawhasnotyetcaughtup.
• Referralstohomehealth.Physiciansdonotwanttorefertohomehealthbecausetheprocessisonerous.ThisconcernsfederalregulationthatsomeArizonaintervieweesidentifiedasaproblem.
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• Integratingprimarycareandbehavioralhealth.Whiletherehasbeenalotofemphasisonprimarycareandbehavioralhealthintegration,regulationshavemaintainedtwoseparatesetsofregulationsregardinghowlicensurecanhappen.Therulepackagesneedtobestreamlinedintoonesotheprocessislessprohibitive.
• Standardizeoutcomesinpay-for-performance.Providerefficiencymightbeimprovedifinsurancecompaniescouldreduceandstandardizethenumberofpay-for-performancemetricsprovidersarerequiredtomeet.
• Increasetheadoptionofvalue-basedreimbursementstosupportnewmodelsofcare.• Integratedentalcareandexpandaccess.AHCCCSdoesnotcoverthecostofdentalcarefor
adults,withtheexceptionoflong-termcare.Thereneedstobeanincentivetointegrateoralhealthcareandprimarycarebecausedentalandphysicalhealtharecloselylinked.
• Credentialmedicalinterpreters.Culturalandlinguisticcompetencyisacriticalfactorinhelpingminoritycommunitiesseekcare.However,Arizonadoesnothaveacredentialingprocessforhealthcareinterpreters.Thismightbothimprovetranslationservicesandprovideapayincreaseforthoseprovidingthisservice.
• Expandingthestateloanrepaymentprogram.Until2015,thestateloanrepaymentprogramcoveredprimarycareandsomedentalcareproviders(primarycarephysicians,dentists,andadvancedpracticeproviderslikenursepractitioners,physicianassistants,andnursemidwives).Asof2015,itincludesmentalhealth,pharmacyandgeriatricproviders,andtheannualdollaramountforprovidershasbeenincreased.Thispoolofmoneycouldbeexpandedinthenextcompetitionviaafederalmatchifthestateorotherentitieswerewillingtocontributemore.
Interviewees’topthreepriorities
Intervieweeswereaskedtoranktheirtopthreeprioritiesforhealthworkforcedevelopment.Onethemethatcameuprepeatedly(sixmentions)wasbetteruseoftechnology,especiallybetterimplementationofelectronicmedicalrecordsandenhancedtrainingsothatstaffcouldinputanddrawfromtheserecordsmoreeffectively.
Fiveintervieweesnotedthatimprovedtrainingandeducationforincumbentstaffandnewgraduateswereoftopimportance.
Fournotedthatrecruitmentandretention,particularlyofdoctorsandnurses,wastheirtoppriority.
Fournotedthatbetterrecognition,training,andwagesfortheparaprofessionalworkforcewouldhelpimprovecareandworkforceretention.OnenotedthatcredentialingCHWswouldstandardizetrainingandimprovereimbursementforthisclassofworker.Forone,theincreaseinparaprofessionalswasmoreofaproblemthanabenefitduetothefactthatthesepositionswerenotreimbursableand/orrequiredextensivesupervisionforreimbursement—eitherwaynecessitatingmorelicensedproviderstaff.
Threeintervieweescommentedthatimprovingreimbursementandwageswouldhelpaddressissuesaroundrecruitmentandretention.
Twobelievethatthestateneedstodoabetterjobstreamlininglicensingrequirementssothatprovidersandotherclinicianscouldmoveintotheworkforcefaster.
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Otherprioritiesincludedexpandingthescopeofpracticeforadvancedpracticeregisterednurses;expandingthestate’sloanrepaymentprogramsothattheprogramcoulddrawdownmorefederalmoneyandincentivizeemploymentinshortageareas;expandingresidencyprogramsinshortageareasforthesamereason,andgenerallyaddressingrecruitmentandretentionissuesandshortages.
CONCLUSIONS
Ashealthsystemtransformationcontinues,acombinationofregulatory,education,andtrainingchangeswillbenecessarytofacilitatenewmodelsofcareandaddresschangingdemographics.Thereareshortagesormaldistributioninsomeoccupations,particularlybehavioralhealthproviders,nurses,andsomemedicalproviders,especiallyinruralareas.Newoccupationsaredevelopingthatwillrequirenewcredentialsandtrainingprograms,whileexistingoccupationsarechangingasalliedhealthworkerstakeonincreasedresponsibilitythatwillrequiremoreadvancedtraining.Mostoccupationsnowrequireskillsincaremanagement,patientengagement,newtechnology,andteam-basedcare.Employersandeducatorswillneedtobothexpandtheireducationprogramsintheseareasandreassessthecurricularcontentoftheirprogramstoensureanadequately-sizedandskilledworkforceinthefuture.
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ACKNOWLEDGEMENTS
ThecollaborationoftheAdvisoryCommitteeconvenedbyVitalystHealthFoundation,theCityofPhoenix,andtheGreaterPhoenixChamberofCommercewasimportanttothedevelopmentofthesurveyquestionnaireandconductingofthesurvey.
AdvisingCommitteeMembers:
• AudreyBohanan(AdelanteHealthCare)• JudyClinco(CatalinaInHomeServices/AZDirectCareAlliance)• EricDosch(Cigna)• RobertFranciosi(MaricopaCommunityCollegeDistrict)• DanHunting(MorrisonInstituteforPublicPolicy)• TaraMcCollum(CommunityHealthCenters)• KathleenCollinsPagels(ArizonaHealthcareAssociation)• ScottSalzetti(BannerHealth)• SteveSchroeder(MaricopaCommunityCollegeDistrict)• JudySeiler(ScottsdaleLincolnHealthNetwork)
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APPENDIX
InterviewGuide:Thesearethegeneralquestionsthatwillbeaskedofeachinterviewee.Someinterviewsmayfocusononlyasubsetofthesequestionsdependingupontheinterviewee’sexpertiseandposition.
1. Whatisyourtitleandyourrolewithinthisorganization?Howlonghaveyoubeenwiththisorganization?
2. Whatkindsofchangesinhealthcaredeliveryareyouseeingatyourworkplaceoraroundyou?a) Whatisdrivingthesechanges?(prompt:creatinganACO,lowerMedicare
reimbursements,Medicarepenaltiesforpoorquality,morecompetitioninthemarket,lowerprivateinsurancereimbursements,agingofthepopulation,changesinnetworksandaffiliations)
b) Dothesechangesincludenewmodelsofcaresuchasintegratingphysicalandmentalhealth,patient-centeredmedicalhome,retailclinics,etc.?
c) Howrapidlyarethesechangesoccurring?d) Dothinkthesechangeswillaccelerate,decelerate,orcontinueatthesamepaceoverthe
next3-5years?3. Fromwhatyouhaveseenandheard,howdoyouthinkchangesinhealthcaredeliverywill
impactthehealthcareworkforce?a) Inwhatwaysdoyourthinkthehealthcareworkforcemightneedtochange?
Prompt:Numbersofworkers,agesofworkers,typesofworkers,training,changeinwhattheydo?
4. Areyouplanningforhealthworkforcechangesinyourhealthcaresystem(educationprogramofferings)?
a) Pleasetellusaboutthosechangesinacoupleofexamples.5. Fromyourexperienceandwhatyou’veseenandheard,whatnewskillsdoyouthinkthecurrent
healthcareworkforcemightneedtocompeteinthesechangingdeliverymodels?(Preliminarywork–overallskills,softskills,interprofessionalskills)(Alsokeepcontentonclinicalorspecificskills)
a) Couldyougiveussomeexamplesofnewskillsneededandwhyyouthinkthoseskillswillbeimportant?
6. Fromwhatyou’veseenandheardaboutchangingmodelsofcare,doyouthinkchangesintheeducationofthehealthcareworkforcewillbeneeded?
a) Whatkindsofchanges?b) Couldyougiveussomeexamples?
7. Fromyourperspectivearethereregulatorychangesneededinthehealthcareworkforcesuchaschangesinscopeofpractice(thelegaldescriptionofpracticebyaprofession),Medicaidpaymentpolicies,etc.?
a) Whatkindofchangesmightbeneeded?b) Canyougiveussomeexamples?
8. Whatisyourperspectiveonhowfuturetechnologymightimpactthehealthcareworkforce?Probe:Change in composition, trainingneeded,overall numbersanddistributionacross thestate’sregions?
9. Fromyourexperience,howwellpreparedarenewgraduatesintheskillsneededinyourorganizationtocompetentlydelivercare?
a) Ifthisisaproblem,whatarethemostsignificantgapsinpreparation?(prompts:clinicalexperience,softskills?)
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Probe:Ifthisisregionalemployer,askaboutdifferencesinthesegapsacrossregionsofthestate.
b) Pleasediscussacoupleofexamples.c) Pleasediscussanymodelsyouknowthatsuccessfullyaddressthesegapsinskillsneeded
bynewgraduates.(Specifically,howwouldyousuggestthisbeaddressed?)d) Haveyouconsidereddevelopingyourowntrainingprogramorpartneringwithaprogram
thatcould?Whyorwhynot?10. Somesuggestthatturnoverishighinsomehealthcarejobs,especiallyentry-leveljobs.Whatis
yourperspectiveand/orexperienceofturnoverinhealthcarejobs?a) Whataboutturnoverofleaders?b) Howmightturnoverbeaddressed?c) Howdoyoukeepprovidersengagedandavoidburnout?d) Doyouhavearetentionplan?
11. Forruralareas:Whenyouhaveaseriousshortage,howareyouaddressingit?(prompts:travelers,loanrepayments,etc.)
a) Arethereinnovativemodelsyouareusingorconsideringtoaddressneeds?(prompts:mid-level,CHWs,etc)
12. Insummary,whatwouldbeyourtop3prioritiestoaddressinplanningforandpreparingourstate’sfuturehealthcareworkforce?
13. Isthereanythingelseyou’dliketoaddthatwehavenotasked?