Health Reform and the Health Workforce
This guide brings together all the Resources, Organizations, Funding, Events, and News we've discovered related to Health Reform.
Here are some top picks to get you started:
Frequently Requested Information
- Looking for Health Reform resources by state?
- Browse some of the most common topics related to Health Reform:
Overview
I’ve heard there are aspects of health reform that focus on strengthening the health workforce.
What are they, and how will they help?
Provisions in the Affordable Care Act seek to:
-
Assess the nation’s health workforce needs
and develop strategies to meet them by supporting research on the health workforce and creating
a national body to offer policy recommendations. See: "How does the Affordable Care
Act support state and national health workforce research, policy and planning?"
for more information.
-
Enhance the supply, distribution, and diversity of health care providers,
particularly those in
primary care, to meet the needs of the newly insured. Specific provisions target the
physician,
nursing,
dental,
public health, and
direct care workforce.
-
Prepare students to provide quality care. Provisions support training in community settings,
distance learning, interprofessional education, geriatrics training, and cultural competency.
- Encourage the current health workforce to practice more effectively and efficiently
by funding demonstration projects of new models of care such as the patient-centered
medical home and accountable care organizations, particularly through the
Center for Medicare and Medicaid Innovation.
Some of the workforce provisions in the ACA have not been funded. For more information, see "What is the difference between provisions of the ACA that were funded and those that were only authorized?"
For a more detailed analysis of the ACA, the Congressional Research Service addresses the health workforce
provisions on pages 6-29 of
Public Health, Workforce, Quality, and Related Provisions in the Patient Protection and Affordable Care Act (PPACA) and focuses on the physician supply impact of the ACA in Physician Supply and the Affordable Care Act.
The
health workforce provisions of the law and the
amendments are also available.
How does the Affordable Care Act support state and national health workforce research,
policy and planning?
The Affordable Care Act (ACA) authorized a number or programs and initiatives to support health
workforce planning, although some await funding before they can be fully implemented.
- Created the National Health Care Workforce Commission
to provide direction on national workforce policy. The committee members were announced
in September 2010, but the commission has not yet been funded to meet. The Commission is responsible
for reviewing health workforce issues and submitting annual recommendations to Congress and the Administration
- Established the
National Center for Health Workforce Analysis
to examine the nation’s health workforce. Responsibilities assigned to the Center under the ACA include:
- Describing and analyzing the health workforce
- Creating a Uniform Health Workforce Minimum Dataset for the health workforce
- Developing a national online registry of Title VII grants, which focus on improving
the supply, distribution, and minority representation of health professionals
- Developing performance measures for workforce programs
Performance measures for workforce programs are included in HRSA's annual performance index; pages 25-6 addresses the ACA.
For more about the Center’s work, please see their Areas of Focus and the February 2011 Health Workforce News
interview with Center director Edward Salsberg,
Plans for HRSA’s New National Center for Health Workforce Analysis.
- Authorized funding for state health workforce planning and implementation. Twenty-four state
workforce planning grants and one implementation grant were
awarded in 2010. A list of state planning grantee reports is available; two states were unable to meet the grant requirements and were deobligated. In 2011,
the anticipated funding for twenty-five implementation grants was not available.
For more about the one state to receive an implementation grant, please see the July 2011
Health Workforce News interview with the program director Kathy Wibberly,
Implementing State-Level ACA Workforce Initiatives.
What are some of the impacts that expanded access to health care under health reform might
have on the workforce?
Expanded insurance coverage is expected to increase demand for health care, which may:
For more information, see "What research or data is available so far on the impact of health reform on the health workforce?"
What types of practice innovations will be part of health reform and
how might they impact the workforce?
The Affordable Care Act supports
Patient-Centered Medical Homes and Accountable Care Organizations.
- The
medical home model is based on the idea that patients should have access to a health care provider
who will coordinate their care. The model carries a number of workforce implications:
-
By supporting primary care providers as central to a patient’s care, the model emphasizes
their importance in the health care system as well as potentially increasing demand for primary
care providers and interest in the field.
- The emphasis placed on
care coordination
encourages team-based care, interprofessional training, and increased physician responsibility.
- By making access to care a priority, the PCMH model encourages providers to offer additional
communication options like e-mail and texting, after hours care, same-day appointments, and
special services like medical interpreters.
-
Accountable Care Organizations are groups of providers who manage the full continuum
of care for particular patients and are held accountable for the cost and quality of their care.
The model recognizes the PCMH as a foundation of a health practice and builds on it, resulting in
additional impacts on the health workforce:
-
New responsibilities for physicians, as they are expected to lead efforts to reduce costs
and improve the quality of care
- Increased hospital employment of physicians, as ACOs seek to create a network of providers
to manage the full continuum of a patient’s care. Hospital employment may offer better
work-life balance for physicians, fewer administrative responsibilities, and shelter from the impact of
decreased Medicare payments, although it may come at the price of decreased autonomy, income, and status.
One concern
is that hospital employment may keep physicians from leading ACOs, and that as a result,
the goals of ACOs may not be accomplished.
-
New reimbursement methods like bundled payments and pay for performance
to encourage providers to coordinate care, meet quality measures, and adopt
other practice elements of the PCMH and ACOs.
- Access to more robust health information technology systems which may require additional
training for providers as they learn how to use and incorporate them into their practices.
For more information, see
Better to Best: Value-Driving Elements of the Patient Centered
Medical Home and Accountable Care Organizations, Patient-Centered Primary Care Collaborative,
The Commonwealth Fund, The Dartmouth Institute for Health Policy and Clinical Practice, 3/2011
and
Report to Congress: National Strategy for Quality Improvement in Health Care, Department of
Health and Human Services, 3/2011.
What research or data is available so far on the impact of health reform on the workforce?
One of the major areas of research has focused on the impact of
anticipated increases in demand for health care providers
as a result of offering insurance coverage to 30 million additional Americans by 2014.
For information on future areas to research, see
Preparing the Workforce for a Reformed Health Care System: Toward a Research Agenda,
Rutgers Center for State Health Policy, John J. Heldrich Center for Workforce Development, 1/2011
How can I find out when specific aspects of the Affordable Care Act will be implemented?
Kaiser Family Foundation offers an
Implementation Timeline that explains when various
provisions will be implemented, identifies how many have been implemented so far,
and allows you to narrow to just those provisions related to the health workforce.
What is the difference between provisions of the ACA that were funded and
those that were only authorized?
Discretionary workforce programs were only authorized for funding and still require action
by congressional appropriators before the government can spend money on them.
Implications for the health workforce include:
- Congress may fund a program at less than the amount the program is authorized to receive
-
Many health workforce provisions, though authorized, may not be implemented if funding is not
appropriated by Congress
- Programs with appropriated funding
are more likely to be implemented as they do not require additional action by Congress to receive money
It sounds like states have some latitude in how they implement certain aspects of the Affordable Care Act.
How can I find out what is being done in my state?
- For state legislation related to health reform, see the National Conference of State
Legislatures’ resource,
State Legislative Tracking Database. Select your state and the topic “Workforce and Providers”
for health workforce related legislation.
- To find out which task forces, special committees, commissions, and boards are
examining the ACA requirements in your state and their reports, see
NCSL’s list.
- State Refor(u)m,
created by the National Academy for State Health Policy and Robert
Wood Johnson Foundation, provides real-time discussions related to health reform and
enables states to share documents on various aspects of health reform,
including the workforce.
- The U.S. Department of Health & Human Services provides
information on funding awarded to each state
to support various programs such as primary care training.
For more information, see
Health Reform Implementation, National Conference of State Legislatures.
Page last updated May 16, 2013 |
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