1. 119 Pere Marquette Lansing, MI 48912 (517) 485-4477 (517) 485-4488 Fax ppa@publicpolicy.com The Affordable Care Act is here. Now how do we take care of all of these people? Michigan's Health Care Workforce in the 21st Century Laurence S. Rosen, Ph.D. Michigan Legislative Briefing May 7, 2013

2. Where are we and how did we get here? Demographics Economics Changes in health care delivery Health information technology (HIT) Affordable Care Act of 2010 2

3. Demographics We’re Getting Older Not Much Migration TO Michigan Source: Census Bureau, State Population Estimates, 2010-2012. 3

4. Economy: Changing Workforce Source: U.S. Department of Labor, Bureau of Labor Statistics, Employment Data Tables; calculations by PPA. 4

5. Changes in Health Care Delivery Surgical centers Urgent care centers Retail health services Accountable Care Organizations Hospital consolidation Walgreens 5

6. Changes in Health Care Delivery More ambulatory care More hospital care Sicker patients Shorter stays Robotic surgery Telemedicine Electronic medical/ health records 6

7. Health Information Technology Electronic health records Meaningful use Interoperability Regional health information organizations Health insurance marketplaces Telemedicine Practice management Care management Source: 2012 CHIME CIO Survey; PwC Health Research Institute Human Capital Survey, 2012. 7

8. Impact of ACA on Patients Up to 725,000 new patients through the Exchange Up to 782,000 new adult Medicaid patients with Medicaid expansion 220,000 new adult Medicaid patients even without Medicaid expansion Approximately 2 million additional office visits per year 8

9. Exchange-Eligible Population in Michigan Will Exceed 725,000 9

10. Potential Adult (18 to 64) Medicaid Expansion in Michigan, 2014 Source: U.S. Census Bureau, 2009-2011 American Community Survey, Table B27018, Public Health Insurance. 10

11. ACA Impact on the Health Care Workforce Demand is occurring at ALL wage levels Physicians RNs Mid-level professionals Therapists Technicians HIT Nurses aids, home health aids, home care aids 11

12. New Workers Needed by Provider Site, Michigan, 2010- 2020 (Before ACA) Source: EMSI, 2011. 12

13. MD and DO Supply and Demand in Michigan to 2020 Projected shortages Psychiatry Urology Pathology Surgery Radiology OBGYN Family practice, general practice Source: Michigan State Medical Society and Public Policy Associates, Inc., 2005. 13

14. Nursing Supply & Demand Aging nursing workforce Burnout and early retirement Insufficient nursing faculty Expanded need for clinical rotations Applicants exceed nursing school seats Source: Coalition of Michigan Organizations of Nursing, 2005. 14

15. New Workers Needed by Occupation in Michigan, 2010 – 2020 (pre ACA) Source: Public Policy Associates, Inc., unpublished data, 2011. 15

16. Hospital Demand Survey Greatest Expected Growth RNs Lab technicians Physical therapists Pharmacy technicians Hardest to Fill Physical therapists RNs* Pharmacists Certified Registered Nurse Anesthetists (CRNAs) * Newly graduated nurses; ADNs 16 Source: Public Policy Associates, Inc., unpublished data, 2011.

17. Long-Term Care Demand Survey Greatest Turnover Certified nurses aids (CNA) Licensed practical nurses (LPN) RNs Food services & housekeeping staff Hardest to Fill RNs LPNs Directors of nursing Long-term care administrators Source: Public Policy Associates, Inc., unpublished data, 2011. 17

18. Demand: Support Occupations, by Region, 2010-2020 1st2nd3rd4th5th Southeast Michigan Home health aide Nurses Aide Medical assist. Dental assist. P.T. Assistant South Central Michigan Home health aide Nurses Aide Medical assist. Dental assist. P.T. Assistant Southwest Michigan Home health aide Nurses Aide Medical assist. Dental assist. Med. Transcript. West Michigan Home health aide Nurses Aide Medical assist. Dental assist. P.T. Assistant Genesee-Lapeer- Shiawassee Home health aide Nurses Aide Medical assist. Dental assist. P.T. Assistant East Central Michigan Home health aide Nurses Aide Medical assist. Dental assist. P.T. Assistant Northern Lower MichiganNurses Aide Home health aide Medical assist. Dental assist. Med. Transcript. Upper Peninsula Home health aide Nurses Aide Medical assist. Dental assist. P.T. Assistant Source: EMSI, 2011. 18

19. Supply: Community Colleges in Michigan Top 10 Health Care Degrees/Certificates Awarded by Michigan Community Colleges, 2010-2011 Registered Nurse 2,581 Licensed Practical Nurse 1,334 Nursing Assistant/Patient Care Assistant 1,149 Medical/Clinical Assistant 409 Emergency Medical Technician 401 Medical Insurance Specialist/ Medical Biller 254 Phlebotomy Technician/Phlebotomist 226 Surgical Technician 185 General Allied Health 183 Medical Administrative Assistant 180 Source: Michigan Community College NETwork, Workforce Development Agency, State of Michigan, 2012. 19

20. Nursing Supply and Demand Supply Factors Aging nursing workforce Burnout and early retirement Faculty shortages Shortage of clinical sites in all areas Applicants exceed nursing school seats Demand Factors Insured population growth Expanded Medicaid population Growing need for nurses in primary-care and ambulatory-care settings 20

21. Future Nursing Shortages Source: Coalition of Michigan Organizations of Nursing, 2005. Source: EMSI, 2011; Public Policy Associates, Inc., unpublished data, 2011. 21

22. Major Obstacle: Shortage of Nursing Faculty by Education Provided Source: National League for Nursing, 2012; Annual Survey of Schools of Nursing, 2011. 22

23. HIT Impacts on the Health Care Workforce Creates entirely new health care occupations Practice workflow and information management redesign Clinician/practitioner consultants Implementation support specialists Implementation managers Technical/software support staff and trainers Expands health care workforce 23

24. HIT Impacts on the Health Care Workforce (continued) Expands staff knowledge and skills Requires new education and training resources Facilitates evidence-based practice 24

25. HIT Training in Michigan Demand: 50,000 nationwide 2,000-3,000 in Michigan EHR/EMR in hospitals and physician offices Supply: HITECH Act and ACA fund training Train up to 2,700 techs annually Delta College Lansing Community College Macomb Community College Wayne County Community College 25

26. Diversity in Michigan’s Health Care Workforce White, Non- Hispanic African American All Others Michigan76.60%14.00%9.40% Dental hygienists94.00%1.00%5.00% Dentists90.00%3.00%7.00% LPNs82.80%12.20%5.00% RNs87.00%5.80%7.20% Pharmacists86.00%3.00%11.00% Physician assistants92.00%2.00%6.00% Physicians71.90%4.20%23.90% Source: Census of Population, 2010. Source: MDCH, Bureau of Health Professions, 2010. 26

27. Health Care Degrees Awarded to Michigan Minorities, 2009-2010 Source: U.S. Department of Education, IPEDS database, 2011. 27

28. Diversity in RN Education Source: American Association of Colleges of Nursing, http://www.aacn.nche.edu/leading-initiatives/research-data/Enrollment- by-State.pdf. 28

29. Conclusions Demand will grow at all levels Professionals: MDs, DOs, RNs, NPs, PAs Mid-level: Physical/occupational therapists; laboratory, imaging, and pharmacy techs Entry level: Nursing assistants, home health aids, home help aids ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Health Info. Tech.: All levels—from billers and coders to programmers and business analysts 29

30. Issues We Need to Address Nursing faculty shortages Home health and home care workers Low wages High turnover Inconsistent training Health care workforce diversity HIT growth Growing opportunities for mid-level health care workers 30

31. 119 Pere Marquette, Suite 1C Lansing, MI 48912-1270 (517) 485-4477 Fax (517) 485-4488 www.publicpolicy.com 31