OREGON HEALTH POLICY BOARD HEALTHCARE WORKFORCE COMMITTEE HealthCare Industry Trends: Emerging Workforce Categories 11/1/2014 1 Table of Contents I. Executive Summary………………………………………………………………………………..3 II. Oregon Trends………………………………………………………………….………...……………4 III. Background……………………………………………………………………………...…..…………...6 IV. Educational Capacity…………………………………………………….………………………..7 V. Industry Trends……………………………………………………..……….……………..……....10 A. Care by Non-Clinician Providers…………………………………………………………………….....10 B. Earlier Intervention………………………………………………………………………...…….......……13 C. Coordinated Care………………………………………………………………...........................….........14 VI. Recommendations………………………………………………………………….…….............20 VII. Conclusion…………………………………………………………...………………………………….22 Appendices: A. 2013-2014 Approved CTE Programs – Health-related Programs by High School B. List of OHA Office of Equity and Inclusion Approved Traditional Health Worker Training Programs C. List of OHA Addictions and Mental Health Services Approved Peer Support Specialists Training Programs D. Inventory of Health Care Industry-related Degrees at the Associate Level or Higher E. Oregon Employment Department Health Occupations Projections 2012-2022 2 I. Executive Summary Oregon’s health care workforce is influenced by many factors including Oregon’s changing demographics, implementation of the Patient Protection and Affordable Care Act and national trends in provider education and accreditation. Oregon is becoming older and chronic diseases more prevalent. The ACA has brought insurance coverage to many Oregonians as well as greater integration of health technology such as electronic health records. Providers as a group are also becoming older and the looming retirement of many providers in the boomer generation is affecting the workforce. These changes, among others, made Oregon’s health care workforce recession-proof. According to the Oregon Employment Department, the health care industry continued to grow throughout the recession. It is a time of dynamic change and adjustment for the healthcare workforce. Many traditional roles are being retooled to add competencies in, for example, care coordination, team-based care and health information technology. Some roles new to clinical practice are being added to the provider mix such as “coach”, “health navigator” and “scribe”. Many of these roles are just now being tested in the clinical setting and are undergoing refinement as providers and patients adjust to the new demands of a reforming health system. This makes the task of defining industry trends and workforce categories challenging. Oregon’s educational system is responding to the new requirements of the healthcare workforce as well as to the need for additional professionals. For example, in 2012, the latest year for which data is available, Oregon graduated 256 medical assistants from Associates degree programs compared to 175 in 2010. This increase over the last two years holds true for many health professions, but not all. In 2012, Oregon graduated 352 social workers compared to 322 in 2010, however, only graduated 409 doctors (naturopathic, allopathic, osteopathic and physician assistants) compared to 443 in 2010. Anecdotally, it appears that many existing programs are incorporating new competencies into their traditional training, although this is difficult to quantify. More quantifiable are efforts being made by government and community organizations to standardize training and certification requirements for many categories of workers including community health workers and peer support specialists, who fall under the definition of traditional health workers. The Committee has developed a list of recommendations and suggestions for the Health Policy Board and partners in education and industry to consider. The Committee believes these recommendations and suggestions will help to improve Oregon’s ability to develop 3 the healthcare workforce Oregon needs to meet the triple aim of better health and better care at lower cost. Recommendations to the Oregon Health Policy Board from the Committee include: Investigating models for tracking and connecting supply and demand for healthcare professionals, and, Continued advocacy for payment reform. Suggestions for education and industry partners include: Supporting healthcare workforce faculty development, Supporting the establishment of a Healthcare Industry Council, and, Encouraging the Healthcare Industry Council, when operational, with developing job descriptions, duties and hiring criteria to assist both industry and education in preparing the healthcare workforce. II. Oregon Trends Oregon’s health care industry will continue to grow due to the ageing of the population as well as to the drive to expand health insurance coverage to those who previously could not afford it. As of June 2014, the Oregon Health Plan was insuring almost one million people – up from 614,000 in December 2013.i This, along with an increase in those seeking private insurance has led to a dramatic decrease in Oregon’s uninsured population to five percent.ii Additionally, more focus on patient engagement and empowerment, health promotion, disease prevention, population health, team-based care among providers, and coordinated care across health care organizations is changing how care is delivered, resulting in workforce fluctuation, but also in great opportunity. One in twelve Oregon jobs is in the health care industry. These jobs include occupations in professional, management and technical services as well as traditional clinical services. Health care industry occupations are among the fastest growing in the state.iii These are just a few of the influences on Oregon’s health care landscape. The passage of HB 2009 in 2009 put Oregon on the forefront of health reform and the state has been on a fast track to achieve the triple aim of better health and better care at lower cost. Oregon’s health care workforce is responding to these influences. More than 500 clinics have been recognized as Patient-Centered Primary Care Homes, bringing coordinated care to thousands. Community organizations and colleges have taken on the challenge of training community health workers and are over halfway to the goal of training 300 CHWs 4 by the end of 2015.iv Many of Oregon’s health systems are implementing pilot programs to learn how to best reconfigure their workforce to respond to the changing healthcare environment. The health care workforce is a large part of Oregon’s economy and is growing due to increased demand for care. At the same time, change in how care is delivered is causing a major shift in health care and health care delivery. Developing accurate predictions of demand is difficult as change in the field is rapid, new occupations and competencies are being developed and the data sources available for predicting demand are limited. Another major change to care delivery is the advent of telehealth. Marketing firm BCC Research predicts that the market for remote monitoring and telemedicine applications will double from $11.6 billion in 2011 to about $27.3 billion in 2016.v Advances in technology make telehealth an exciting option for those people with reduced access to care due to location or income. For example, in Oregon, Yamhill CCO is developing a pilot project utilizing advanced mobile and cloud-based medical technologies to provide dermatology services to members. Yamhill CCO members could have images of dermatologic issues taken, uploaded to a secure server, then sent to a participating dermatology practice or research institution for diagnosis and advice. This would provide service to a rural area with only one dermatologist in regular practice. A large, statewide Federally Qualified Health Center in Connecticut used advanced imaging technology and a partnership with the Yale School of Ophthalmology to screen low-income residents for Diabetic Retinopathy. Members would come to a primary care visit at the FQHC site, with no on-site ophthalmologist, and would have a high-resolution picture taken of their retina which was then sent to Yale for screening. This was in place of a standard referral to a specialist for diabetic patients (requiring another appointment, transportation and added cost) that may or may not have been necessary. Results included: More screenings among low-income and minority populations More appropriate referrals to specialists Perceived (but not yet analyzed) cost savings for the FQHC and for the patientsvi On April 26th, 2014, the Federation of State Medical Boards passed a model policy on telemedicine that is available for states to use when establishing a telemedicine platform. The policy provides guidance on the definition of telemedicine, licensure, security of patient information, prescribing and appropriate disclosures before treatment. vii 5 III. Background To better understand the emerging workforce needs of Oregon’s health care industry, the Oregon Health Policy Board requested the Health Care Workforce Committee deliver: An analysis of health care industry trends in emerging employment categories and new workforce roles, accompanied by an audit of Oregon’s training capacity for those jobs and roles. In response to this request, the Healthcare Workforce Committee will present an analysis of industry trends in the healthcare workforce through the lens of three major shifts in care: 1) To care by non-clinician providers 2) To earlier intervention 3) To coordinated care Each major shift has brought with it