In the context of health care reform, and as the American public wrestles with complex chronic health conditions, new models of care are placing greater emphasis on prevention, community-based care, and coordination of care for those who are ill. These new care models require new sets of skills for people who work in healthcare settings, with nonclinical staff working alongside clinical staff on multi-disciplinary teams to ensure that patients receive comprehensive care.
To examine the workforce implications of these new models, the Primary Care Development Corporation (PCDC) and 1199SEIU Healthcare Workers East (1199SEIU) researched New York State’s Health Home program. A recent report, Who’s Going to Care? Analysis and Recommendations for Building New York’s Care Coordination and Care Management Workforce, describes important lessons they learned about education and skills requirements, salaries, training and other workforce issues.
A Health Home manages care for Medicaid enrollees with complex medical, behavioral, and long-term care needs. Improved care coordination and service integration improves health outcomes while controlling health care costs. The lessons learned by these care coordination initiatives will be increasingly important as DSRIP (Delivery System Reform Incentive Payment Program) proceeds into its second year. DSRIP redirects Medicaid funding to coalitions of service providers who are charged with coordinating primary care, prevention, and population health and reducing hospital use for Medicaid enrollees.
Key findings of the Health Home survey included:
- The care coordination and care management workforce needs a diverse and broad set of skills and competencies.
- The staff who provide care coordination and care management need ongoing training and supervision.
- Recruitment and retention challenges are prevalent, driven by insufficient salaries, high caseload and lack of appropriate skills and competencies.
- Job titles for those providing care coordination and care management are still evolving.
Given these findings, 1199SEIU and PCDC put forward several policy recommendations to build an effective workforce to meet care coordination and care management needs. These include:
- Collect data about the care coordination and care management workforce.
- Require all payers to support care coordination and care management staff.
- Ensure sufficient wages and benefits.
- Provide ongoing support for this workforce’s development.
As our care delivery system evolves, we must create new industry standards, certification, education and training, and career ladders to ensure that healthcare workers get the development and support they need.