Major Workforce Overhaul Needed for Home Health Care Coordination

As health care transformation gets underway, requiring greater care coordination between hospitals and home- and community-based settings, a number of significant challenges threaten to undermine the coordination and care management provided by health care staff, particularly among the home health labor force, a recent report finds.

To overcome obstacles associated with job training, recruitment and retention problems, policymakers must make a “major workforce investment” to ensure that successful care coordination and care management can occur, according to the report “Who’s Going to Care? Analysis and Recommendations for Building New York’s Care Coordination and Care Management Workforce,” released this month by 1199SEIU United Healthcare Workers East and the Primary Care Development Corporation (PCDC).

The report examines the State of New York’s Health Home program, which manage care of Medicaid enrollees with complex and often costly chronic conditions that drive a high volume of inpatient episodes.

By analyzing the Health Homes model, researchers believe this initiative can provide insight on the steps needed to create and support a skilled care coordination and care management workforce for the health care system as a whole.

“New York’s experiment in shifting care for elderly residents from nursing homes to a largely underpaid home care workforce offers painful and expensive lessons as the larger and more complex healthcare system embarks on a similar shift,” states the report’s researchers.

To better understand provider challenges and expectations for the care coordination and care management workforce, 1199SEIU Healthcare Workers East and the Primary Care Development Corporation (PCDC) surveyed New York State Health Home providers about workforce roles and jobs, including education and skills requirements, salary range and training needs.

The survey was sent to 213 Health Homes primarily in the New York City/downstate area. Community-based organizations comprised 65% of survey respondents, while community health centers represented 27% and hospitals accounted for 8%.

Key findings from the survey indicated that recruitment and retention challenges are prevalent and are driven by several factors, including insufficient salaries, high caseload and lack of appropriate skills and competencies.

A significant majority of organizations reported recruitment challenges (88%) and retention challenges (78%), while more than half reported insufficient salaries as a barrier to recruitment and retention.

On average, salaries reported by the organization that were surveyed—the majority of which were community-based—are 27% to 50% lower than the salaries for those with similar titles operating in the hospital workforce.

Responses also revealed that ongoing training and supervision are needed for staff that provide care coordination and care management, as less than 60% of organizations responding said they provide training in patient-centered care and chronic care management.

Furthermore, less than half of organizations said they offer training in health coaching, working in a team, housing placement, stress management or running and reading reports—all skills that organizations considered crucial to care coordination and care management roles.

1199SEIU, whose mission is to achieve quality care and good jobs for all, is the largest health care union in New York, representing over 300,000 members throughout the state. Its members are “deeply committed” to transforming the health care system to better serve communities, said George Gresham, president of 1199SEIU.

“Key to achieving this goal is ensuring that high-quality care coordination services are available to everyone who needs them, which will require thousands of new care managers and other workers,” Gresham said in a written statement. “Policymakers must ensure that the structure is in place to train, recruit and retain this new workforce.”

Based on an analysis of survey results and additional research, 1199SEIU and PCDC developed several recommendations for policymakers and health care organizations.

These include collecting data about the care coordination and care management workforce; requiring all payers to support coordination and care management; ensuring recruitment and retention through sufficient wages and benefits for staff; as well as provide ongoing support for the development of the care coordination and care management workforce.

The workforce lessons learned through Health Homes, and other programs involving high levels of care management, researchers say, will be particularly relevant as New York launches its five-year Delivery System Reform Incentive Payment Program (DSRIP), which has a goal of reducing avoidable hospitalizations by 25% by building community-based health care capacity.

Through DSRIP, over $400 million will be available for workforce development, including training and retaining the health care labor force.

This presents a “remarkable opportunity” for New York State to minimize disruption for the existing healthcare workforce as it transitions to new settings and to provide meaningful careers for low wage, underemployed or unemployed individuals in low income communities, all while improving the quality of care for the highest need patients, according to the report’s researchers.

“This report demonstrates that providers need adequate funding to invest in our care coordination workforce, including compensation, supervision and training, in order for these services to play a transformative role in New York State’s health care system,” said Charles King, president and CEO of Housing Works, which participates in the Health Home initiatives.

Written by Jason Oliva