1. Metro North Regional Employment Board – Quarterly Meeting Cambridge, MA June 19, 2013 The Workforce Implications of the Affordable Care Act: Research in Progress

2. The Workforce Implications of the Affordable Care Act Overview Research Questions and Methods ACA Breakdown Labor and Skills Demand Opportunities Challenges and Next Steps Discussion

3. EMPLOYER LEADERSHIP OF RESEARCH

4. OVERVIEW High degree of uncertainty – “building the car while driving it” Frontline workers essential to Triple Aim Demand will increase in both patient and technology-centered positions Higher skill expectations: top of the job description, specific skills Opportunities for new or expanded roles and advancement Challenges, unknowns and cross-cutting trends

5. AFFORDABLE CARE ACT: A MOVING TRAIN

6. Extending care to more patients Achieving the triple aim: better care, lower cost, improved health o Coordination of care (ACOs, Patient-Centered Medical Homes) o Reducing readmissions, focus on “frequent flyers” o Patient follow-up and self-management o Population health and community-based care Implementing electronic health records AFFORDABLE CARE ACT: BREAKDOWN

7. How will the Affordable Care Act affect frontline health care workers? What are the forecasts of labor demand in the next 10 years? How are individual providers preparing for workforce needs? What skills will be required of the workforce? What are the opportunities for frontline worker advancement? What are the best current models of workforce development? What are the potential challenges? RESEARCH QUESTIONS

8. RESEARCH METHODS Scan of literature from health care and workforce Analysis of labor market data Interviews with key informants Interviews and roundtable discussions with providers

9. LABOR DEMAND Health Care Subsector Growth 2010 – 2020 Source: US Bureau of Labor Statistics

10. LABOR DEMAND

11. Source: US Bureau of Labor Statistics

12. LABOR DEMAND: MA HEALTH REFORM

13. SKILLS IN DEMAND General: team skills, communication, technology, problem-solving, knowledge of the care transition Direct Care (CNAs, PCAs): observational skills, customer service Medical Assistants: administrative as well as clinical skills; supervisory skills in some cases Patient navigators: assertiveness, cultural competencies Health Information/Med Records Techs: medical terminology, data analytics, detail orientation, cross-disciplinary understanding

14. OPPORTUNITIES FOR FRONTLINE WORKERS Expanded responsibilities and skill upgrades o Cross-training for medical assistant and admin (Youngstown, NYC) o Calling “timeouts” for error reduction (PCAs in Boston) o DCWs assuming routine tasks of RNs (documentation, med pulls) – Northern VA Assuming new roles o Patient navigator (discharge, follow-up) o Health coaches o Care coordinators

15. CHALLENGES No template or standards for new roles – “you can’t download the job description” Payment model lagging behind delivery reforms Scope of practice restrictions Providers’ reluctance – ACA uncertainties, cost concerns Potential job reductions with merged positions, shift to primary, use of technology More responsibility without compensation Potential cutbacks in talent development

16. NEXT STEPS / DISCUSSION

17. RANDALL WILSON, SENIOR PROJECT MANAGER JOBS FOR THE FUTURE rwilson@jff.org rwilson@jff.org TEL 617.728.4446 FAX 617.728.4857 info@jff.org 88 Broad Street, 8 th Floor, Boston, MA 02110 122 C Street, NW, Suite 650, Washington, DC 20001 WWW.JFF.ORG