BUILDING A HEALTH CARE WORKFORCE TO ACHIEVE HEALTH EQUITY. Report of the UIC Health Care Workforce Development Task Force

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1 BUILDING A HEALTH CARE WORKFORCE TO ACHIEVE HEALTH EQUITY Report of the UIC Health Care Workforce Development Task Force

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3 TASK FORCE MEMBERS *Laura Stempel in the Office of VPPP provided extensive support with researching and preparing report. Building A Health Care Workforce to Achieve Health Equity 1

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5 EXECUTIVE SUMMARY The University of Illinois at Chicago (UIC) is a state, regional and national leader in the training of health care professionals. Over eighty degree and certificate programs across seven health science colleges provide undergraduate, graduate and professional training for the health care workforce (Table A10, appendix). The UIC Health Care Workforce Development Task Force (referred to as task force ; see page 1 of appendix for membership) was charged to study emerging workforce needs and propose recommendations to inform decisions about the numbers and kinds of health care professionals UIC trains in the decade ahead as demographic factors and changes in health care delivery systems influence both demand for and supply of health care. This project follows from UIC s mission to train professionals in a wide range of public service disciplines, serving Illinois as the principal educator of health science professionals and as a major health care provider to underserved communities. Workforce planning begins with an acknowledgement of both the idiosyncrasies and uncertainties related to the financing and organization of health care and to anticipated demographic shifts. First, oversupply of and unmet demand for services often coexist. There may be high unmet demand for specific services in a community because those services are poorly reimbursed or large numbers of individuals are uninsured. For instance, there are underserved communities with a great need for basic dental care, but few professionals to meet those needs because of a lack of reimbursement. Training more dentists will not resolve the disparity. Second, a changing regulatory environment can affect demand when different job titles share overlapping skills. Demand for primary care physicians, for instance, diminishes when less costly nurse practitioners are authorized to provide primary care and bill for their services independently, based on state regulations regarding scope of practice and level of supervision, and the policies of individual health plans regarding credentialing and reimbursement for their services. Third, shifting models of health care delivery in which integrated health systems assume all financial risk while maintaining or improving quality increases demand for individuals who facilitate care coordination and outreach. Such systems should have strong incentives to keep their patients healthy and out of the hospital. Achieving these goals may call for new types of service providers such as community health workers as well as a more collaborative team based approach to care delivery. Finally, there are demographic and epidemiologic shifts, such as growth in the elderly population and in numbers of people with complex chronic disease, which, while more predictable at a national level, exhibit a great deal of local variation. In addition to acknowledging the vagaries of the health care marketplace, workforce planning must also acknowledge the competing priorities and constraints for academic programs seeking to respond to workforce demand. In deciding which programs to expand, contract, revise, eliminate, replace, and link to other programs, colleges must consider whether they can recruit good students at a tuition rate that covers costs, as well as competition (are other programs emerging in the region?), resources (do we have clinical training sites, faculty, lab space?), and new opportunities (federal or state grants, international interests, etc.). Some of these variables are proxies for market demand while others, such as resources, are not. With these caveats noted, workforce development based on the best available evidence remains a valuable and essential part of planning, and is surely a responsibility for a campus that trains such a diverse and significant number of health care professionals. To that end, the task force reviewed a wide range of policy reports, commissioned its own study of job and wage growth for health care occupations, compiled college and campus level data (including survey data), and identified both state and federal funding opportunities for workforce development. Although the principal focus of the task force was on addressing emerging workforce needs in terms of the numbers and kinds of degree and certificate programs, it also became evident that the changing health care environment will require an evolving set of competencies across all disciplines and that this should be a part of the task force report as well. Building A Health Care Workforce to Achieve Health Equity 3

6 RECOMMENDATIONS Incorporate emerging workforce needs into strategic planning at the college level Each college should identify and set targets for existing and new programs, informed by market trends and anticipated demands. These targets should be revisited annually with updates to the provost and VCHA. Colleges are encouraged, in particular, to use data and analysis provided in Tables 4-7 of this report, which should also be updated annually as a planning resource. Colleges should also be current about other health professions programs in the region. Data resources, such as the HRSA National Center for Health Workforce Analysis, and the Degree Program Inventory of the Illinois Board of Higher Education (IBHE) are listed with URLs in Section A16 of the appendix. Pursue funds allocated for health care workforce development Explore and where feasible pursue state, federal funds and foundation funds, including those available through the Affordable Care Act and the proposed Medicaid 1115 Waiver. In particular, the Colleges of Nursing, Dentistry, and Medicine, the School of Public Health, and the University of Illinois Hospital and Health Sciences System (UI Health) should develop a plan for pursuing these initiatives. The Office of the Vice President/Vice Chancellor for Health Affairs (OVPHA/OVCHA) could play a coordinating and tracking role to assure that campus units are aware of and informed about how to capitalize on funding opportunities. Develop a cross-college interprofessional curriculum addressing essential core competencies Further development of a collaborative curriculum, which would draw on strengths from each college, could become a signature program across the UIC health science colleges. The curriculum would build knowledge and skills through didactic and experiential learning activities that focus on patient centered care, quality, safety and efficacy in health systems delivery, collaborative care, and health equity. The curriculum would also include interprofessional training opportunities at community based clinical sites. This program could be developed through an Interprofessional Council that works with each health science college and that is supported through an administrative partnership between the OVPHA/OVCHA and Office of the Provost. Build a pipeline Coordinate and track campus-wide programs that support underrepresented minorities at the secondary and post-secondary levels through STEM education into the health professions and beyond, documenting the impact of investment in disadvantaged students on developing a diverse workforce. Additionally, identify and pursue partnerships with two-year colleges and other community education programs to achieve the following: Advance the pipeline in health professions education, particularly for underrepresented groups. Develop curriculum for emerging mid-level occupations such as health care navigators, care coordinators and community health workers. Develop joint programs that require both associate level and baccalaureate or master s level training (e.g., physician assistants). Develop programs around non-clinical emerging workforce needs Include colleges from throughout the campus, particularly the College of Education, the School of Continuing Education, and the School of Public Health (Division of Health Policy and Administration), and the College of Business Administration in the development of online and blended professional degree and certificate programs to train health care managers, actuaries, and health systems and safety analysts. Prioritize placement in medically underserved areas and underrepresented disciplines Set targets in each health science college for placing graduates in medically underserved areas and in primary care or subspecialty fields that are underrepresented (for instance, pediatrics) and identify state and federal funds for scholarships and other incentives to meet those targets. Develop tracking systems to monitor performance. 4 Report of the UIC Health Care Workforce Development Task Force

7 PROVOST S CHARGE TO THE HEALTH CARE WORKFORCE DEVELOPMENT TASK FORCE November 26, 2013 Dear Colleagues: Thank you for agreeing to serve on the Health Care Workforce Development task force, which will hold its first meeting on December 10. I appreciate your willingness to help the campus to begin thinking about how we can align future health care needs with the education and training we offer. As the leading supplier of the state s health care professionals, the University of Illinois at Chicago as a whole, and particularly the seven Health Science Colleges, have a fundamental investment in the future of Illinois health care workforce. Changing needs, the impact of the Affordable Care Act, and predictions of increasing practitioner shortages make it crucial that we understand what we can and should do to ensure that UIC continues to produce the high quality health care workforce Illinois requires. How will upcoming changes affect Chicago and the State? This task force is charged with analyzing UIC s capacity to train successful health care professionals in numbers that will meet the State s future needs. The Affordable Care Act mandates financial support to increase primary care providers and allied health workers through grants, scholarships, and loan repayment programs but how do we make the case to federal and state funders? What academic programs or community partnerships will have to be expanded or contracted? Do we need new kinds of training? Should we consider new certificate or degree programs? To provide strategic guidance to the campus in planning to address workforce needs and to align the campus with funding priorities to finance those needs, I ask this task force to develop answers to the following questions: What sort of workforce will be needed to serve the citizens of Illinois, Chicago, and our catchment in five years? In ten years? Which of these workforce needs do we view as an opportunity and responsibility for UIC to fulfill? What will UIC need to do over the next ten years in order to meet these responsibilities and goals? The answers to these and other questions will play an important part in UIC s planning for the next several years. I look forward to hearing the task force s ideas about the how to meet these new challenges as well as the opportunities the changing health care scene will offer. Sincerely, Lon S. Kaufman Vice Chancellor for Academic Affairs and Provost Building A Health Care Workforce to Achieve Health Equity 5

8 I. PREPARATORY WORK OF THE TASK FORCE The task force was convened to consider the impact of a number of anticipated changes in health care needs and delivery systems. Experts predict that an aging and increasingly diverse population and the implementation of the Affordable Care Act (ACA) 1 will have significant effects on the health care workforce, increasing demand for some specialties and occupations, decreasing others, and creating a need for new ones. In addition, the rising cost of tuition and the burden of large student loans, along with decreasing state support, are likely to affect students decisions about which, if any, health care professions to pursue. The goal of the task force was to consider how UIC might respond to these changes by educating a workforce that meets future needs. Task force members were selected because of their experience with the issues at hand, whether as researchers and administrators dealing directly with health care workforce issues or as representatives of UIC s seven health science colleges. Along with staff in the Office of the Vice Provost of Planning and Programs, a small group of task force members with specific expertise in health policy, economics, and data collection identified resources and data needs and proposed priorities and hypotheses for the larger group to consider. This group accomplished the following set of tasks: compiled datasets on numbers and types of health care programs and trainees across UIC; compiled and reviewed national and regional reports on the health care workforce and on emerging federal and state funding opportunities to support health care workforce development; commissioned a study to extract data from the National Bureau of Labor Statistics dataset for health care occupations for Illinois, the Midwest, and the U.S. including changes in numbers of people hired and wages; and elicited information on health workforce education priorities and plans by surveying all seven of UIC s health science colleges. The resulting data is reported below and resources gathered to support the task force s work are listed in Section A16 of the appendix. The survey of health science colleges asked the following two questions: Are you aware of any strategic planning initiatives to adjust the numbers of trainees or to establish, revise, or eliminate programs based on assessments of emerging workforce needs? If so, can you please describe them? Responses: None of the colleges indicated that they plan their educational programs around workforce data, although some colleges are responsive to major trends (particularly in social work and some programs in the applied health sciences). Can you describe the factors that do in fact determine the numbers and kinds of health professions training programs your college supports? Responses: Colleges indicated that program planning in health professions education consists of determining program types, program size, curriculum, location, and partnerships. College decisions about which programs to expand, contract, revise, eliminate, replace, and link to other programs is driven by demand (can we recruit good students?), tuition rates (can we cover our costs?), competition (are other programs emerging in the region?), resources (do we have clinical training sites, faculty, and lab space?), and new opportunities (federal or state grants, international interest, etc.). II. WORKFORCE DEMOGRAPHICS: WHAT DO THE NUMBERS SHOW? The task force commissioned a report on recent trends in health occupations based on data compiled by the Office of Employment Statistics in the National Bureau of Labor Statistics (BLS). Employment and wage data on health care related occupations for the fiveyear period from 2008 to 2012 were collated by state, region and nationally in order to track changes that indicated which occupations could be considered in demand. Occupations were identified as having increased in demand if there was an increase in both employment 1 A Glossary appears in section A17 of the appendix. 6 Report of the UIC Health Care Workforce Development Task Force

9 and wages over the five-year period; those with declines in both employment and wages were considered to have decreased in demand. The complete report, including the methodology used and tables showing additional employment and wage data, is included in the appendix to this report. The purpose of this exercise was threefold. First, we needed to determine which among our approximately 80 degree and certificate programs in the health sciences are training students for occupations that are increasing (or decreasing) in demand as reflected in wage and job growth. Second, it was important to identify occupations that are growing in demand for which UIC is not currently providing training because these represent potential opportunities. Finally, it was useful to identify in demand occupations that do not specify particular professional degree requirements, such as health services managers, for which graduates of existing UIC programs would be well suited. The following tables present the occupations in demand nationally (Table 1), in the Midwest (Table 2), and in Illinois (Table 3) between 2008 and Each of the occupations listed has shown growth in both wages and job numbers. For instance, there has been a 20% increase in the number of nursing instructors and other health science teachers at the post-secondary level, coupled with 5% wage growth adjusted for inflation. In prognosticating about the future of the workforce, it is important to keep in mind that these labor statistics reflect past hiring and salary trends and therefore cannot predict what will happen in the future with any certainty. Health care systems and the services provided by specific occupations are in flux and it is difficult to know what impact particular changes will have. For instance, we can predict that the health care workforce will change because of the implementation of the Affordable Care Act (ACA). However, we cannot anticipate the extent to which that will lead to increased demand for pharmacists, nurses and physician assistants to take up responsibilities provided by physicians who work in primary care. Past data is also not inclusive of new occupations that may emerge, such as those related to coordination of care. Building A Health Care Workforce to Achieve Health Equity 7

10 TABLE 1. IN DEMAND JOBS IN THE U.S., Report of the UIC Health Care Workforce Development Task Force

11 TABLE 2. IN DEMAND JOBS IN THE MIDWEST, TABLE 3. IN DEMAND JOBS IN ILLINOIS, Building A Health Care Workforce to Achieve Health Equity 9

12 Pairing the data from the Occupation Codes (OCC) of the BLS in Tables 1-3 with educational programs at UIC poses several challenges. First, they do not necessarily match. On the one hand, the OCC may list multiple occupations that require the same degree, some of which are in demand and some of which are not. (That would certainly be true for the MD degree.) Conversely, there are a number of occupational codes that are sufficiently broad that they apply to graduates coming out of different degree programs on campus. We have attempted to address these challenges in Tables 4 and 5. Table 4 pairs UIC s degree and certificate programs with occupational codes from BLS data, indicating increasing demand at the state, regional and national level. Note that under some of the degrees listed, related occupational titles are indicated in italics that are taken directly from the BLS OCC codes. For instance, Social and Community Service Managers, which are in demand at both the state and regional level, is listed under Health Care Administration, and associated with both the MHA and the MPH because it seems like a relevant fit. However, it could also have been placed with our MSW degree program. For that degree, note that we paired nine different occupational titles, including Mental Health Counselors and Health Educators. 10 Report of the UIC Health Care Workforce Development Task Force

13 TABLE 4. EXISTING UIC HEALTH SCIENCE DEGREES AND CHANGING DEMAND, Building A Health Care Workforce to Achieve Health Equity 11

14 12 Report of the UIC Health Care Workforce Development Task Force

15 Table 5 takes a different approach. Here we began with broad occupational titles that are included in the BLS dataset, such as Medical Scientists or Health Care Diagnosing and Treating Practitioners, placed them as bold headings, and then listed for each one all of the UIC degree programs that apply. For instance, under Medical Scientists, Except Epidemiologists we list almost two dozen educational programs, including Anatomy and Cell Biology, Biochemistry and Molecular Biology/Biochemistry and Molecular Genetics, etc., most of which have both pre-terminal (e.g., MS) and terminal (e.g., PhD) degrees. Again, we indicate the demand for these broad occupational titles at the state, regional and national levels. Because this data is less specific, i.e. programs are clustered under broad occupational titles it may also be less accurate. Anatomy and Cell Biology, for instance, is classified as increasing in demand regionally only because it falls within a broad occupational title for which this is the case. Building A Health Care Workforce to Achieve Health Equity 13

16 TABLE 5. BROAD OCCUPATIONAL CATEGORIES WITH INCREASING DEMAND FOR WHICH MULTIPLE ACADEMIC DEGREES MAY PROVIDE QUALIFICATIONS 14 Report of the UIC Health Care Workforce Development Task Force

17 Note that neither Table 4 nor 5 captures pairing of degree programs with occupational titles that may be quite specific but to which numerous potential educational pathways are available to students at UIC. For instance, students might qualify to be Community Health Workers, Industrial-Organizational Psychologists, and Medical and Health Service Managers based on skills and qualifications acquired in a variety of undergraduate and graduate degree programs. These are indicated in blue in the next table (see below). The purpose of Table 6 is to highlight occupations for which UIC does not have degree or certificate programs but that are in demand at the national, regional or state levels. The table also indicates if degree programs exist on the Urbana campus or, for associate degree level programs, at the City Colleges of Chicago (CCC). For each, we note in the last two columns to the right whether UIC should consider either opening a program or, for associate level degrees, finding a two-year college partner. Finally, as just noted, we highlight in blue occupations for which many of our existing degree programs likely prepare students, but who may be unaware of emerging occupations in the health section for which they are qualified. Building A Health Care Workforce to Achieve Health Equity 15

18 TABLE 6. IN DEMAND OCCUPATIONS FOR WHICH UIC DOES NOT HAVE AN EDUCATIONAL PROGRAM 16 Report of the UIC Health Care Workforce Development Task Force

19 While Table 6 lists programs that UIC does not have but should consider establishing, it does not take into account programs that the campus already has in place that may be undersized given market demand for occupations associated with the skills acquired in those programs. Hence, Table 7 below lists existing programs that granted fewer than 20 degrees in AY 2013 but prepare students for in demand occupations. This data is derived by cross listing occupations listed in high demand in Tables 4-5 with associated programs of relatively small size listed in Tables A11 and A12 in the Appendix, which present enrollment and degree data for UIC s health sciences programs from 2009 to The programs in this table represent additional opportunities for UIC to capitalize on workforce demand by increasing enrollment and the number of degrees granted. TABLE 7. PROGRAMS TRAINING FOR IN DEMAND OCCUPATIONS BUT GRANTED FEWER THAN 20 DEGREES IN AY 2013 Building A Health Care Workforce to Achieve Health Equity 17

20 Not fully captured in any of the data from the BLS are the emerging unmet needs of health systems that are in a process of transformation in which they assume both greater financial risk for the care of large numbers of patients and concurrent accountability for maintaining or achieving measures of quality. Such needs, for instance, will likely include extensive care coordination provided by case managers (or some similar occupational title[s]) who serve as the glue linking patients and their families to complex care delivery services. Requisite skills may vary, depending on the complexity of patient illness and the range of services and providers in an integrated health system, but may include social work, nursing, information technology and health care administration expertise ranging from associate degree to graduate level skills development. In addition, the data in Tables 4-7 do not incorporate information on UIC s particular areas of strength for prioritizing program development. For instance, given its partnership with the College of Engineering, the College of Medicine is well positioned to develop a biomedical engineering track within the medical school curriculum to respond to regional demand for bioengineers (Table 5), many of whom need clinical expertise. And UIC is well position to provide professional development for the current workforce through additional degree or certificate programs, such as the highly successful RN to BSN program in the College of Nursing and a wide variety of IBHE certificate programs that build on current institutional strengths (see Table A10). Finally, another limitation of the BLS data, which is an indirect driver of other variables that impact enrollment and tuition rates (see box below), is that it is entirely a measure of market demand rather than community need. Unfortunately, many communities and the individuals who reside within them cannot afford services they need, or are ethnically/racially or geographically isolated. Serving these communities remains a signature dimension of UIC s mission. The university s commitment to serving the underserved requires admissions and other policies that ensure that low-income students and those from underrepresented and underserved communities have both the access and the financial means to pursue training in the occupations of their choice. It also requires that the health care professionals educated at UIC understand the needs of underserved communities and the impact of health disparities. 18 Report of the UIC Health Care Workforce Development Task Force

21 THE ECONOMICS OF PROGRAM AND WORKFORCE DEVELOPMENT As seen from the survey of UIC health science colleges, workforce development is not often a direct factor in program planning. However, workforce demand likely impacts the variables that influence decision-making. Specifically, when colleges make adjustments in enrollment and tuition rates those changes generally reflect changes in the workforce marketplace. When there is unmet workforce demand, wages for those job titles rise and tuition rates follow (as prospective students are willing to pay more based on anticipated higher future income). Hence, when programs increase enrollment and raise tuition they do so because the market will bear those rates and there is a pool of qualified applicants i.e., they are responding to workforce development needs. Workforce demand, however, should not be confused with workforce need. For instance, a community may need primary care services services that can be provided by physicians, nurse practitioners or physician assistants. Which health care professionals may provide those services depends on state regulations regarding the scope of practice, level of supervision for each type of practitioner, and whether the non-physician provider can bill directly or under the physician s provider number. A particular occupation is only in demand when there is both a need for the services that practitioner is trained to provide, a regulatory environment for credentialing of the job title, and reimbursement for the services provided. However, market forces are not a substitute for social policy that assures that trainees from underrepresented minority communities or low income strata can enroll and graduate, or the special planning and investments (such as grants, incentives, and loan payback agreements) that may be required for graduates to work in underserved areas. Building A Health Care Workforce to Achieve Health Equity 19

22 III. MAJOR THEMES In addition to compiling and analyzing workforce data, the task force conducted an environmental scan of major trends that have implications for health care workforce planning that others have documented in reports prepared by government organizations, think tanks, and professional societies. Five themes emerged and are described below. Significant Demographic Shifts A recent report of the Coalition of Urban Serving Universities indicated that 20% of the US population resides in communities that are medically underserved. This problem is exacerbated by an aging population with growing health care needs. The Association of American Medical Colleges (AAMC) predicts 91,000 more physicians needed by The American Association of Colleges of Nursing anticipates 260,000 more registered nurses needed by 2025, and the Association of Schools of Public Health anticipates 250,000 additional public health workers required by Underrepresented minorities (particularly Hispanics and African Americans) comprise over one third of the population and continue to grow as a proportion of the total population yet only comprise 9% of physicians, 7% of dentists, 10% of pharmacists, and 6% of registered nurses. 2 Implications: Leading educational and trade organizations project substantial shortages based on available workforce data and demographic projections, and also note a need for increased diversity among health care providers. Note that the actual shortage projections may not take into account crossover in the services health professionals can provide. For instance, the primary care physician workforce shortage may be mitigated by the training of more nurse practitioners who can provide many of the same services. Regardless, the evidence is that we need to train a more diverse workforce and provide incentives to health care professionals to work in medically underserved communities. This will require developing a workforce pipeline that is representative of the populations they will serve, with a particular emphasis on supporting student success in the STEM fields at the secondary and post-secondary school levels. Health Systems Assume More Risk for Excess Costs University of Illinois Hospital and Health Sciences System (UI Health) is engaged in developing an Accountable Care Entity contractual agreement with Medicaid for a subset of patients in which the health system will receive a fixed sum of money monthly from each participant for coordination of care and will, in turn, assume increasing risk while maintaining certain benchmarks of quality. The challenge will be to increase efficiency, i.e., to provide the same or higher quality care at lower cost. Although not yet complete, the Office of the VPHA is conducting its own needs assessment of the local population, the University of Illinois Survey on Neighborhood Health (UNISON), which includes neighborhoods from Humboldt Park to Englewood. UNISON will draw on 1,400 interviews of residents selected from a stratified probability sample to identify unmet needs for new programs and services, with a particular focus on uncontrolled hypertension, diabetes, and asthma. The goal of UNISON is to identify health disparities and the resources needed to address them so that UI Health can mobilize a data driven response. This project should provide insight into the kinds of workers and skills that support community health. Implications: As health care systems such as UI Health are held accountable for controlling costs while maintaining quality, they will create new job descriptions (e.g., various types of community health workers and care coordinators) and redesign old ones (e.g., employing pharmacists as clinical providers for chronic care management) to increase efficiencies. This requires avoiding overuse and misuse of medical services. UI Health will need to develop improved 2 Developing a health workforce that meets community needs, Workforce distribution maps available through the HRSA National Center for Health Workforce Analysis (http://bhpr.hrsa.gov/healthworkforce/) indicate similar workforce needs in Illinois. 20 Report of the UIC Health Care Workforce Development Task Force

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