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Joel Allison
CEO, Baylor
Scott & White
Health
Dr. Nancy Dickey
Professor, Texas
A&M University;
President
Emeritus,
Texas A&M
Health Science
Center
Edward Salsberg
Professor,
George
Washington
University School
of Public Health
and Health
Services
THE CHANGING HEALTHCARE
WORKFORCE
#MHBreakfast
#MHBreakfast
Agenda:
7:30-7:50 a.m. Registration & Networking
7:50-8:00 a.m. Opening & Speaker Introductions
8:00-9:00 a.m. Roundtable Presentation
9:00-9:30 a.m. Q&A & Closing
Panelists: Joel Allison
CEO, Baylor Scott & White Health
Joel Allison is Chief Executive Officer of Baylor Health Care System and Baylor Scott & White Health. Allison joined
Baylor Health Care System in 1993 and served as Baylor’s senior executive vice president and chief operating officer
before being promoted to president and CEO in 2000. Nationally, he serves on the Healthcare Leadership Council and
is a member of the United Surgical Partners, International board. In 2005 Allison was awarded Modern Healthcare’s
“CEO IT Achievement Award” and was awarded the Dallas Historical Society’s “Award for Excellence in
Community Service.”
Dr. Nancy Dickey
Professor, Texas A&M University, President Emeritus
Texas A&M Health Science Center
Dr. Nancy W. Dickey serves as a professor in the Department of Family and Community Medicine and the Department
of Medical Humanities in the College of Medicine, and as a professor in the Department of Health Policy and
Management in the School of Public Health, Texas A&M Health Science Center. She also is the President Emeritus of
the Health Science Center. Dr. Dickey assumed the role of president of the Texas A&M Health Science Center and vice
chancellor for health affairs for The Texas A&M University System in 2002, and served in that role until 2012. Prior to
her current appointment, she served as interim dean of the TAMHSC-College of Medicine. Dr. Dickey is a past president
of the American Medical Association, and the was the first woman to be elected to that role. She was elected to the
prestigious Institute of Medicine in 2007 and to the Texas Women’s Hall of Fame in 2010.
Edward Salsberg
Professor, George Washington University School of Public Health and Health Services
Edward Salsberg has been a national leader in health workforce research, policy and data for over 25 years. He is
currently on the faculty at George Washington University. Until recently, Mr. Salsberg was the founding director of
the National Center for Health Workforce Analysis in the U.S. Department of Health and Human Services. Mr.
Salsberg previously established and directed the Center for Workforce Studies at the Association of American Medical
Colleges and the Center for Health Workforce Studies at the University at Albany, State University of New York. All
three health workforce centers have been leaders in providing information on the supply, demand, distribution and
use of the healthcare workforce, and they have pioneered approaches to collecting health workforce data.
Moderator: Maureen McKinney
Editorial Programs Manager, Modern Healthcare
Maureen McKinney is the editorial programs manager for Modern Healthcare, overseeing webinars, conferences and
other healthcare leadership events. She also reports on timely issues affecting healthcare leaders, including clinical
and financial best practices. McKinney joined Modern Healthcare in 2010 as the magazine’s quality and patient safety
reporter. She has covered the healthcare industry for more than a decade.
A Modern Healthcare Briefing
Dallas, TX
May 6, 2014
Major Developments and
Trends Impacting the Health Workforce
• Demand for health care rising as the US population is growing and
aging and coverage expands
• Unsustainable cost increases
• Uncertainty about adequacy of health workforce supply
• Concern with inefficiencies and potential overuse
• Increasing interest in identifying ways to improve efficiency and
health outcomes
• Delivery system reforms and innovations and growing size of health
care organizations
States Are Central to Health Workforce Supply,
Distribution and Use
• State-supported education and training
• Scholarships and loan repayment
• State labor department- tracking employment and workforce
needs (LMI Directors)
• State Primary Care Offices
• Medicaid policies
• State employee health insurance
• Provision of state and local public health services
• Licensure and regulation of practitioners
• Regulation of service delivery
Delivery System Transformation and the
Workforce
• Pressure to do more with less
• The transformation is being driven by public policies as
well as the provider and payer community and patients
• The growing supply of PAs, NPs and other health care
practitioners will enable and stimulate the transformation
• Incentives to make better use of the workers we have;
• Teams and collaborative practice and education
• New categories/variations on support personnel
• Reassess scope of practice and scope of work
• Increased use of technology
• Comprehensive Primary
Care (CPC) Initiative
• Multi-Payer Advanced
Primary Care Practice
(MAPCP) Demonstration
• Federally Qualified Health
Center (FQHC) Advanced
Primary Care Practice
Demonstration
• Independence at Home
• Health Care Innovation
Awards
• State Innovation Models
• Graduate Nurse Education
Demonstration
Federal Initiatives Support Systems
Redesign
Source: CMMI
Federal Initiatives and the Workforce
• CMMI Health Care Innovation Awards
Care coordinators and better management of patients;
Use of inter-professional teams;
Use of patient navigators;
Use of community health workers;
Use of patient care technicians, advanced aides, assistants;
Improved care transitions and in home services.
• CMMI State Innovation Models (SIMS)
• Medical home initiatives
• ACOs/Bundled payment
• Texas 1115 Health Care Transformation Waiver
Growing Evidence of Systems TransformationHealth Affairs Workforce Issue, Nov. 2013
• Primary Care: Proposed Solutions To the Primary Shortage Without
Training More Physicians by Bodenheimer and. Smith
• Nurse-Managed Health Centers And Patient-Centered Medical Homes
Could Mitigate Expected Primary Care Physician Shortage by Auerbach, et.al.
• Physician Assistants And Nurse Practitioners Perform Effective Roles on
Teams Caring For Medicare Patients With Diabetes by Everett, et. al.
• Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That
Can Be Achieved In Retail Clinics by Spetz, et.al.
• Primary Care Technicians: A Solution To The Primary Care Workforce
Gap by Kellermann,et. al.
• It Is time to Restructure Health Professions Scope-Of-Practice
Regulations To Remove Barriers To Care by Dower, et.al.
8
Team for Comprehensive Care
Physicians
Nurse practitioners
Physician assistants
Psychologists
Optometrists
Registered Nurses
Pharmacists
Case Managers
Nutritionists/Dieticians
Physical Therapists
Community Health Workers
…And more
Recent HRSA Report:
“Projecting the Supply and Demand for Primary Care
Practitioners through 2020”
• Demand for primary care services will increase due largely to
population growth and aging
• Demand for PC physicians will grow more rapidly than supply resulting
in a projected shortage of approximately 20,400 FTE physicians
• The supply of primary care NPs and PAs, is projected to grow rapidly
and could mitigate the projected shortage of physicians if NPs and
PAs continue to be effectively integrated into the delivery system
• Assuming full deployment of available NPs and PAs, the projected
shortage of PC Practitioners in 2020 (6,400 FTEs) is very close to the
estimated shortage in 2010 (7,500 FTEs).
• The national numbers can mask regional and local shortages.
7,261
6,979
6,611
6,5266,900
7,583
8,014
8,8659,698
11,135
12,273
14,310
16,031
5,500
7,500
9,500
11,500
13,500
15,500
17,500
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Source: American Association of Colleges of Nursing and National Organization of
Nurse Practitioner Faculties Annual Surveys1Counts include master’s and post-master’s NP and NP/CNS graduates, and
Baccalaureate-to-DNP graduates.
Gra
duate
s
Growth in Nurse Practitioner Graduates2001 - 2013
Physician Assistant Growth
Source: National Commission on Certification of Physician Assistants “Certified
Physician Assistant Population Trends ”; 2013 data from personal communication
with NCCPA January 2014
Newly Certified PAs, 2001 - 2013
New
ly L
icensed P
As
4235
4009
4337
4512
43934654
4989
5215
5243
5823
59796479
6,607
3000
3500
4000
4500
5000
5500
6000
6500
7000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Pharmacy School Graduation Trends2000 - 2015
Nu
mb
er
of
Gra
du
ate
s
* Graduation projection figure based on enrollment dataData represent first professional degrees including B.S. Pharmacy, B.Pharm., and Pharm.D.1 Source: AACP 2012 Enrollment Data
7,260
7,000
7,573
7,488
8,158
8,268
9,040 9,812
10,50010,988
11,487
11,931
12,71913,335
14,21314,930
4,000
6,000
8,000
10,000
12,000
14,000
16,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013* 2014* 2015*
Workforce Composition:
Growth of PAs/NPs Compared to Physicians
Source: Prepared by National Center for Health Workforce Analysis
Ratio of Types of Direct Patient Care Providers,
Supply and Production
82%
18%
In Practice in 2010
42%
58%
New Providers per Year
PAs/NPs
Physicians
What will the staffing of the Patient Centered Medical
Home look like*?
A. If no delegation: 1 physician for 983 patients =
315,000 PC physicians; Then significant shortage!
B. If significant delegation: 1 physician for 1,947 pts =
159,000 PC physicians; Then significant surplus!
But even with a national surplus, local shortages are likely !
The Importance of the Team in Assuring
Access to Primary Care Services
* “Estimating a Reasonable Patient Panel Size for Primary Care Physicians
with Team Based Delegation”, Altschuler, Margolis, Bodenheimer and Grumbach; Annals of Family Medicine, Sept/Oct 2012
• Geographic and specialty mal-distribution is a serious
problem
• For many professions and many physician specialties,
the national supply may look adequate but there are
serious access problems for many people due to the
distribution of the supply
• Different strategies needed to address mal-distribution
compared to general shortages
• Targeted investments are needed
The Problem of Mal-distribution
• Demand is rising but it is usually for services not a
particular profession; there are multiple ways of
assuring access to care.
• Health systems transformation will drive changes in the
health workforce, including the mix and configuration of
the workforce, responsibilities and roles, and supply
and distribution.
• The increasing supply of non-physician clinicians and
other caregivers will facilitate delivery system change.
• While there are many unknowns related to the future
delivery system, we do know that more practitioners will
work in teams.
Closing Comments
Edward [email protected]
Joel Allison
CEO, Baylor
Scott & White
Health
Dr. Nancy Dickey
Professor, Texas
A&M University;
President
Emeritus,
Texas A&M
Health Science
Center
Edward Salsberg
Professor,
George
Washington
University School
of Public Health
and Health
Services
THE CHANGING HEALTHCARE
WORKFORCE
#MHBreakfast
Modern Healthcare Leadership BreakfastMay 6, 2014
Dallas, TX
Nancy W Dickey, MDPresident Emeritus, Texas A&M Health Science
Center
The Future of the Healthcare Workforce
Factors impacting workforce:
1. “Baby Boomers” born between 1946 and 1964 will turn 65, when health care utilization historically doubles.
2. Nation’s growing population3. Growing burden of chronic diseases4. Continued scientific progress and tech innovation5. New health care payment models6. Younger professionals desire a different lifestyle – life/work
balance7. In the US, the supply of physicians and nurses is projected to
decrease (retirement, leaving the field)a. We are producing more annuallyb. The supply measure is numbers of professionals per
population) over the next 15 yearsc. Productivity/hours worked per professional have decreased
6 0
%4 0
%
5 0
%
5 0
%
5 0
%
5 0
%
5 5
%
4 5
%
6 7
%
3 3
%
Canada France Singapore
Thailand Britain U.S.
Primary Care
Specialists
Primary Care/Specialty Mix
Current US System
Most
Highly
Specialized
Specialist
Generalist
Non-Physician Provider
Community Health
Worker
Patient Driven System Driven Professional Driven
Preferred System ?
Most
Highly
Specialized
Specialist
Generalist
Non-Physician Provider
Community Health
Worker
System Supported Professional Supported
What’s Next?
1. Several things exacerbating shortages in the next decades2. Takes a long time to expand the workforce
as it is currently composed3. Solution may be to change the “needs” by
changing the make up of the workforce4. More work as teams
Teams…Increased Efficiency, Everyone Working to Their Full Potential
• Need to identify appropriate ways to utilize a broader group of care givers –– Many requiring shorter/different
training periods
• Potential for changes of scopes of practice
• Imperative that traditional practitioners become more collaborative, communicative
AAHC’s recommendation
• Solution is more complex than simply increasing the numbers of providers
• Issues of:– which specialties– geographic distribution– training to enhance work as
interdisciplinary teams• Past due in preparing for future health
workforce
•
Without Planning…
• Currently we turn spigot off & on
• ACA included the establishment of a National Health Care Workforce Commission
• ACA also provided for state health care workforce development grants to address shortages in each state
Going Forward…
PlanningChanges in training
Incentives to encourage efficiency & quality
Joel Allison
CEO, Baylor
Scott & White
Health
Dr. Nancy Dickey
Professor, Texas
A&M University;
President
Emeritus,
Texas A&M
Health Science
Center
Edward Salsberg
Professor,
George
Washington
University School
of Public Health
and Health
Services
THE CHANGING HEALTHCARE
WORKFORCE
#MHBreakfast
Modern Healthcare
The Changing Healthcare Workforce
Tuesday, May 6, 2014
Joel T. Allison, FACHEChief Executive Officer
32
Baylor Scott & White Health
Combined Assetsand Clinical Footprint/Access
33
• $8.6 billion in assets, based on most recent audited financial statements
• $6.3 billion in total operating revenues
• Includes:
– 43 hospitals
– 500+ patient care sites
– 6,000+ affiliated physicians
– 36,000 employees
– Scott & White Health Plan
• Provided more than $850 million in community benefit FY13
Population Health
• Managing population health is critical to the future of Baylor Scott & White Health.
• Not enough primary care physicians; only 20% of all physicians in US
• Need to focus on growing, recruiting and retaining PCPs
• Specialists may need to become medical homes for some patients.
34
Quality AllianceFocused on patient-centered clinical integration across all points of care
Entry Point Redesign:
Primary Care strength, PCP PCMH; physician-designed best care and quality improvement processes, access & capacity challenge.
Care Integration/Specialty Alignment:
Standardized order sets, clinical protocols, care redesign. Large scale physician partnering, EHR adoption, and connectivity via HIE challenges.
Population Health Infrastructure:
Predictive analytics, comparative effectiveness, care coordination and population health management.
Financing: New innovative payment models, product & benefit redesign, data repository and control.
Entry Point Redesign
CI/ Specialty Alignment
Population Health
Infrastructure
Financing
Intended consequences: QualityImprovement, patient satisfaction and
cost reduction – otherwise unachievable
Staffing the Population Health Model
36
PCMH of the Future
• Typical physician practice will include:
– Physician
– Nurse practitioner
– Three medical assistants
– Care coordinator
– Receptionist
• Will be taking care of 4,000 patients instead of 2,200
37
Outpatient Growth
• Moving from hospital-focused world to an outpatient clinic world
– More folks will be needed to keep you out of the hospital as opposed to in it.
– New jobs created in outpatient medical labs and diagnostic imaging centers; i.e., lab techs, sonographers, etc.
38
More Mid-levels
• Care coordinators (more elaborate care coordination needed)
– R.N. w/several years clinical experience• Good communication skills• Broad knowledge• Comfortable working in different environments, i.e., in
person, telephonic, etc.
39
• #9: Occupational therapist
• #10: Speech pathologist
• #11: Dietitians
• #14: Optometrist
• #15: Physical therapist
• #17: Medical lab technician
• #23: Medical records technician
• #24: Medical technologist
• #29: Podiatrist
• #31: Physiologist
• #33: Pharmacist
• #34: Chiropractor
• #39: Optician
40
Top Healthcare Jobs
CareerCast’s Annual Report of Top 40 Jobs in America includes the following thirteen healthcare jobs:
No health careers ranked among the 20 worst careers.
High-demand Healthcare JobsProjected growth, 2012-20
Total27% Healthcare social workers19% RNs11% All occupations
Ambulatory care jobs52% Social workers41% RNs
Acute-care hospitals15% RNs14% Social workers
Home health52% Social workers43% RNs
Source: US Bureau of Labor Statistics Occupational HandbookModern Healthcare Magazine, March 31, 2014
Transformation of Top Administrative Healthcare Positions
• Addition of executive roles that previously did not exist
– Chief medical information officer
– Chief population officer
– Chief population health officer
– Chief patient experience officer
42
Technology
• Surge in demand for technology experts to install, upgrade and maintain IT infrastructure
– Population-centric data– Need better ways to take care of the population
through technology – especially for younger patients
• Growing number of hospitals could not hire IT workers fast enough to meet demand in 2012, with 67% of surveyed hospitals reporting a shortage.*
43
*College of Healthcare Information Mgmt Executives
Big Data
• Analytics
– Rising demand for workers who can understand and manipulate data
– Companies paying richly for those with quantitative skills
44
Triple Aim
Big dataData analytics & predictive modelingSocial/community supportTransportation/housingPriority setting“The Mediterranean Diet”
Delivery redesignScope of practiceLowest cost site of careTelehealthDigital substitutionSelf-carePalliative care
TransparencyCQI/LeanShared decision-makingStandardizationClinical guidelines and Care paths
Triple AimInformationIncentivesIntegration
Integrity
Better Health
Better Health Care Lower Per Capita Costs
Nate Kaufman, Kaufman Strategic Advisors, LLC
The New Winners:
46
• Well-capitalized health systems with high functioning, data driven, digitally connected, physician-lead TEAMS delivering evidence-based, patient-centered health care
• Able to treat higher volumes of patients
• At lower predictable costs per episode
• Demonstrating consistent measurable high quality
Questions/Discussion
47
Joel Allison
CEO, Baylor
Scott & White
Health
Dr. Nancy Dickey
Professor, Texas
A&M University;
President
Emeritus,
Texas A&M
Health Science
Center
Edward Salsberg
Professor,
George
Washington
University School
of Public Health
and Health
Services
THE CHANGING HEALTHCARE
WORKFORCE
#MHBreakfast