Building a Health Care Workforce to Achieve Health Equity

BUILDING A HEALTH CARE WORKFORCE TO ACHIEVE HEALTH EQUITY

REPORT OF THE UIC HEALTH CARE WORKFORCE DEVELOPMENT TASK FORCE

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.

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.

Task Force Members

Task Force Representative / Title/Department
Saul Weiner (Co-Chair) / Vice Provost for Planning and Programs*
Surrey Walton (Co-Chair) / Associate Professor, Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy
Jonathan Art / Associate Dean, Graduate College
Beth Calhoun / Professor, Division of Health Policy and Administration, School of Public Health
William Chamberlin / Interim Executive Director, Institute for Patient Safety Excellence, College of Medicine
Caswell Evans / Associate Dean for Prevention and Public Health Sciences, College of Dentistry
Kathy Christiansen (through 5/14) / Executive Director, Care Innovation, College of Nursing
Jorge Girotti / Associate Dean and Director, Admissions, Special Curricular Programs, College of Medicine
Cynthia Herrera Lindstrom / CIO & Executive Director, Academic Computer & Communication Center
John Hickner / Professor of Clinical Family Medicine, College of Medicine
Nicole Kazee / Senior Director, Health Policy and Programs
Mary Keehn / Associate Dean, College of Applied Health Sciences
Robert Kaestner / Professor, Institute of Government and Public Affairs
Katherine "Kappy" Laing / Executive Director, University Office of Governmental Relations, University of Illinois
Martin MacDowell / Associate Director & Research Associate Professor, National Center for Rural Health Professions/ Dept. Family and Community Medicine, College of Medicine-Rockford
Christopher Mitchell / Associate Dean, Jane Addams College of Social Work
Marieke Schoen / Associate Dean, College of Pharmacy
Terry Mason / Chief Operating Officer, Cook County Department of Health
Cleo Pappas / Associate Professor & Assistant Information Services Librarian, University Library
Lisa Pitler / Assistant Vice Chancellor, Office of the Vice Chancellor for Research
Jamila Rashid / Executive Director, Urban Health Program
Bernard Turnock / Clinical Professor, Division of Community Health Sciences, School of Public Health
Nancy Valentine (5-14- ) / Associate Dean for Practice, Policy and Partnerships, College of Nursing

*Laura Stempel in the Office of VPPP provided extensive support with researching and preparing report.

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

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1. 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.).

1. 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 five-year 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 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.