Meeting the Demand for Health: Final Report of the California Future Health Workforce Commission

Source: California Future Health Workforce Commission, February 2019

From the summary:

California’s health system is facing a crisis, with rising costs and millions of Californians struggling to access the care they need. This growing challenge has many causes and will require bold action by the new governor, legislators, and a broad spectrum of stakeholders in the public and private sectors. At the core of this challenge is the simple fact that California does not have enough of the right types of health workers in the right places to meet the needs of its growing, aging, and increasingly diverse population.The California Future Health Workforce Commission has spent nearly two years focused on meeting this challenge, issuing a new report with recommendations for closing California’s growing workforce gaps by 2030…..

…..The Commission’s final report includes a set of 27 detailed recommendations within three key strategies that will be necessary for: (1) increasing opportunities for all Californians to advance in the health professions, (2) aligning and expanding education and training, and (3) strengthening the capacity, retention, and effectiveness of health workers. Throughout its deliberations, the Commission has focused on the need to increase the diversity of the state’s health workforce, enable the workforce to better address health disparities, and incorporate new and emerging technologies.

While advancing all 27 recommendations over the next decade will be important, the Commission has high-lighted 10 priority actions that its members have agreed would be among the most urgent and most impactful first step toward building the health workforce that California needs.

To make these proposals a reality, the Commission also recommended establishing statewide infrastructure, starting in 2019, to implement the recommendations in partnership with stakeholders, to monitor progress, and to make adjustments as needs and resources change. This statewide effort will need to be paired with strong regional partnerships to advance local workforce and education solutions.

The Commission’s 10 priorities for immediate action and implementation are:
1. Expand and scale pipeline programs to recruit and prepare students from underrepresented and low-income backgrounds for health careers….
2. Recruit and support college students, including community college students, from underrepresented regions and backgrounds to pursue health careers….
3. Support scholarships for qualified students who pursue priority health professions and serve in underserved communities….
4. Sustain and expand the Programs in Medical Education (PRIME) program across UC campuses….
5. Expand the number of primary care physician and psychiatry residency positions….
6. Recruit and train students from rural areas and other underresourced communities to practice in community health centers in their home regions….
7. Maximize the role of nurse practitioners as part of the care team to help fill gaps in primary care….
8. Establish and scale a universal home care worker family of jobs with career ladders and associated training….
9. Develop a psychiatric nurse practitioner program that recruits from and trains providers to serve in underserved rural and urban communities….
10. Scale the engagement of community health workers, promotores, and peer providers through certification, training, and reimbursement….

Together, the Commission’s prioritized recommendations will:
● Grow, support, and sustain California’s health work-force pipeline by reaching over 60,000 students and cultivating careers in the health professions.
● Increase the number of health workers by over47,000.
● Improve diversity in the health professions, producing approximately 30,000 workers from under-represented communities.
● Increase the supply of health professionals who come from and train in rural and other underserved communities.
● Train over 14,500 providers (physicians, nurse practitioners, and physician assistants), including over 3,000 underrepresented minority providers.
● Eliminate the shortage of primary care providers and nearly eliminate the shortage of psychiatrists.
● Train more frontline health workers who provide care where people live…..

California’s Behavioral Health Services Workforce Is Inadequate for Older Adults

Source: Janet C. Frank, Kathryn G. Kietzman, and Alina Palimaru, UCLA Center for Health Policy Research, Health Policy Brief, January 2019

The Workforce Education and Training component of California’s Mental Health Services Act, which passed in 2004, has infused funding into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California. The brief offers recommendations to the following specific audiences for improving workforce preparation and distribution: state policymakers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers…..

Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions

Source: Carolyn C. Foster, Rishi K. Agrawal, and Matthew M. Davis, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
With the medical and surgical advances of recent decades, a growing proportion of children rely on home-based care for daily health monitoring and care tasks. However, a dearth of available home health care providers with pediatric training to serve children and youth with medical complexity markedly limits the current capacity of home health care to meet the needs of patients and their families. In this article we analyze the workforce gaps, payment models, and policy challenges unique to home health care for children and youth with medical complexity, including legal challenges brought by families because of home nursing shortages. We propose a portfolio of solutions to address the current failures, including payment reform, improved coordination of services and pediatric home health training through partnerships with child-focused health systems, telehealth-enabled opportunities to bridge current workforce gaps, and the better alignment of pediatric care with the needs of adult-focused long-term services and supports.

Historical Mismatch Between Home-Based Care Policies And Laws Governing Home Care Workers

Source: Lisa I. Iezzoni, Naomi Gallopyn, and Kezia Scales, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
Americans generally want to remain in their homes even if they develop chronic health problems or disabilities that qualify them for nursing home care. While family members or friends provide the preponderance of home-based support, millions of Americans use paid personal assistance services (PAS). Inexorable demographic trends are increasing the numbers of people who need paid home-based PAS, with this need rapidly outstripping the capacity of the paid PAS workforce. While many factors contribute to this widening discrepancy, its roots reach back more than eighty years to asynchrony among various policies affecting home-based supports for people with functional impairments and policies affecting home-based PAS workers. Finding solutions to the growing gap between demand for the services and the PAS workforce requires policies that cut across societal sectors and align incentives for consumers, workers, and other key stakeholders.

Related:
Home Health Care Providers Struggle With State Laws And Medicare Rules As Demand Rises
Source: Susan Jaffe, Health Affairs, Vol. 38, No. 6, June 2019

Care For America’s Elderly And Disabled People Relies On Immigrant Labor

Source: Leah Zallman, Karen E. Finnegan, David U. Himmelstein, Sharon Touw, and Steffie Woolhandler, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
As the US wrestles with immigration policy and caring for an aging population, data on immigrants’ role as health care and long-term care workers can inform both debates. Previous studies have examined immigrants’ role as health care and direct care workers (nursing, home health, and personal care aides) but not that of immigrants hired by private households or nonmedical facilities such as senior housing to assist elderly and disabled people or unauthorized immigrants’ role in providing these services. Using nationally representative data, we found that in 2017 immigrants accounted for 18.2 percent of health care workers and 23.5 percent of formal and nonformal long-term care sector workers. More than one-quarter (27.5 percent) of direct care workers and 30.3 percent of nursing home housekeeping and maintenance workers were immigrants. Although legal noncitizen immigrants accounted for 5.2 percent of the US population, they made up 9.0 percent of direct care workers. Naturalized citizens, 6.8 percent of the US population, accounted for 13.9 percent of direct care workers. In light of the current and projected shortage of health care and direct care workers, our finding that immigrants fill a disproportionate share of such jobs suggests that policies curtailing immigration will likely compromise the availability of care for elderly and disabled Americans.

Home And Community-Based Workforce For Patients With Serious Illness Requires Support To Meet Growing Needs

Source: Joanne Spetz, Robyn I. Stone, Susan A. Chapman, and Natasha Bryant, Health Affairs, Vol. 38, No. 6, June 2019

From the abstract:
Home health and personal care aides are one of the largest groups of health care workers in the US, with nearly three million people providing direct care for people with serious illness living in the community. These home care workers face challenges in recruitment, training, retention, and regulation, and there is a lack of data and research to support evidence-based policy change. Personal care aides receive little formal training, and they experience low pay and a lack of respect for the skill required for their jobs. High turnover and occupational injury rates are widely reported. There is little research on the factors associated with higher-quality home care, the extent to which worker training affects client outcomes, and how regulations affect access to and quality of home care. Health care leaders should seek to fill these gaps in knowledge, support the establishment of training standards and programs, implement Medicaid reimbursement strategies that incentivize improvements in pay and working conditions, reform regulations that now prevent the full utilization of home care workers, and create sustainable career pathways in home care policies.

2019 State of the Workforce Report: Pay, Promotions and Retention

Source: Ahu Yildirmaz, Christopher Ryan, Jeff Nezaj, ADP Research Institute, June 2019

All employers face the fundamental challenge of structuring, rewarding and motivating their organization’s workforce for optimal productivity and overall business performance. Unfortunately, there is no magic formula for success that works in all situations. Each employer faces its own unique circumstances — mission, market demand, competitive differentiation, labor availability and cost structure, among other things — that drive continuous change. Existing literature suggests that an organization’s ability to adapt to these changes is fundamental to the organization’s survival.

…. As a comprehensive, up-to-date source of organizational data, the findings in the report provide a solid basis for firms to understand their own organizational dynamics and improve performance.

Key observations from this inaugural study illustrate some of the ways employers can use this data:
– On average, employers will promote 8.9 percent of their employees annually, and those employees will receive an average wage increase of 17.4 percent
– Firms are more likely to promote internal employees for management positions
– Promotions within a team are associated with higher turnover among other team members
– Employee turnover varies significantly with demographic factors
– Males and females show significant disparities across pay and organizational hierarchies

2018 Annual U.S. Public Finance Default Study And Rating Transitions

Source: S&P Global Ratings, May 31, 2019
(subscription required)

– After rising for three straight years, the number of U.S. public finance (USPF) defaults fell to one in 2018 from 20 in 2017.
– In 2018, S&P Global Ratings raised its ratings on 1,427 USPF bonds and lowered 684.
– Local government, state government, utilities, and transportation had more upgrades than downgrades in 2018.
– Housing, higher education, health care, and charter schools had more downgrades than upgrades in 2018: This was the third consecutive year of negative rating trends for health care and housing and the eighth for charter schools.
– USPF ratings performance has been consistent with historical default trends, even at different time horizons. From 1986-2018, the one-, three-, five-, and 10-year average Gini coefficients were 94%, 87%, 81%, and 74%, respectively, when excluding housing. Gini values including housing were not as strong but still stable, with a one-year coefficient of 87%.

U.S. States Take Advantage Of A Prolonged Economic Expansion

Source: S&P Global Ratings, May 16, 2019
(subscription required)

– Consistent with a prolonged national economic expansion, overall state credit quality remains high.
– Even oil- and gas-reliant states have shown recent gains.
– Most states forecast improvement in fiscal 2019 fund balances, and preliminary indications are that April income tax collections will be strong.
– Most states project to build or maintain reserves in fiscal 2020, despite cautious revenue projections.
– Some states propose raising top taxpayers’ income taxes; others will increase gas taxes; and marijuana, sugary drinks, and plastics bags might become the new “sin” tax targets.
– Other state budgets will include funding for education, workforce development, and infrastructure.

Illinois Pension Consolidation: A Path Forward Or A Road To Nowhere?

Source: S&P Global Ratings, May 14, 2019
(subscription required)

– Illinois is considering consolidating numerous single-employer public safety plans as a possible remedy to its pension woes;
– While consolidation will likely lower long-term costs through the pooling of resources, we view these as benefits as marginal, and the current proposals leave major pension funding issues largely unaddressed;
– A proposal to reduce statutorily mandated funding to 80% from 90% and allow an additional 10 years to reach this goal would exacerbate existing pension funding weakness among these types of public safety pension plans.