Strengthening The Workforce For People With Serious Illness: Top Priorities From A National Summit

Absolutely critical to our health and freedom….

The United States will experience significant growth of the population older than age 65 in the coming decades, which will contribute to an increase in the number of people living with chronic and serious illnesses in the community. Field experts, policy makers, and health care leaders have identified the lack of an adequately prepared workforce as a critical barrier to delivering high-quality, community-based care for this population.

With support from the Gordon and Betty Moore Foundation, the Healthforce Center at UCSF brought together 40 national leaders from practice, payment, labor, advocacy, and research in May 2018 to make recommendations to accelerate progress toward an adequate workforce in the next three to five years. After three days of intensive discussion and prioritization, summit attendees made 16 recommendations within seven areas: expanding the pipeline, incorporating family caregivers into health care teams, supporting the home care workforce, leveraging technology to advance patient-centered team care, advocating for payment models that support community-based team-focused serious illness care, instilling cultural competency and humility skills across all health professions, and tracking the workforce. The list of recommendations is summarized at the end of this article.

16 Recommendations

Expand The Pipeline

1. Education programs should increase clinical experiences in the care of people with a serious illness during pre-licensure and certification education programs, and health care systems should actively offer such experiences.

2. Congress should ensure funding of relevant programs such as the Geriatrics Workforce Enhancement program.

3. Health care leaders should advocate for payment models that incentivize working in geriatrics, gerontology, palliative care, and team-based care.

Incorporate Family Caregivers Into Health Care Teams

4. Foundations and government funders should commission reviews of the literature on approaches that best support family members in the care of those with a serious illness and prepare clinicians to work with family members as part of the care team.

5. Stakeholder organizations should disseminate the results of such reviews through development, fielding, and evaluation of education curricula for clinicians and family members.

Support The Home Care Workforce

6. Dual Medicare-Medicaid programs should provide incentives and create programs to improve home care worker pay and working conditions.

7. Leading models for home care aide training should be adopted by all state Medicaid programs and regulatory agencies.

8. Researchers should conduct rigorous studies of the impact of higher pay, lower turnover, and better training for home care aides on client outcomes and total health care costs.

Leverage Technology To Advance Patient-Centered Team Care

9. Insurance companies should pressure purchasers of EHRs to demand modules that elicit and record patient goals of care, identify the full care team, and share this information across providers and settings.

10. Health information technology developers should create systems to link EHR data on social determinants of health to social workers and community programs.

11. A learning collaborative similar to the agriculture Cooperative Extension Model should be established to support technology advancement in health care delivery.

Advocate For Payment Models That Support Community-Based Team-Focused Serious Illness Care

12. Medicare Advantage plans should actively offer new services that meet enrollees’ social needs, support clinicians as they develop strategies to link patients to such services, and evaluate how these services impact quality and value of care.

13. CMS should expand the Independence at Home program, as well as other evidence-based programs that better meet the needs of those with a serious illness living at home and incentivize team-based care in geriatrics and gerontology.

Instill Cultural Competency And Humility Skills Across All Health Professions

14. Foundations and government funders should create a national workgroup to define minimum cultural humility and communications competencies and curricula for all health care providers.

15. Licensing and certification boards, and education credentialing boards, should mandate inclusion of the recommended cultural humility and communications competencies in all pre-licensure and certification programs and for continuing education.

Track The Workforce

16. A job analysis should be conducted of emerging care coordination and navigation occupations to improve their definition and ensure inclusion in the Standard Occupational Classification.

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