Upskilling Heath Care Workers in a Value-Based Care Model

As value-based approaches to care have gained traction, health care staffing has become more efficient. In the last few years, a trend of medical upskilling means that nurse practitioners and physician assistants have taken on tasks that doctors once performed, allowing physicians to focus on the duties for which they alone are qualified. It’s a more efficient use of resources, and it’s more professionally satisfying for everyone involved. Now, medical assistants (MA) are taking on some of the tasks formerly performed by nurses. With physician shortages growing, all of this adds critical capacity to the health care team.

This “task shifting” moves routine tasks to lower-skilled professionals, according to the Harvard Business Review. In health care, this is often termed “working at the top of one’s license.” The challenge is to ensure that the person is qualified for the task being assigned. That’s where upskilling the workforce comes in.

Medical upskilling is not a completely new concept, but it may be more important now than ever before. This is the year health care organizations — incumbents and disruptors alike — will identify which employees need to be upskilled, consulting firm PricewaterhouseCoopers (PwC) predicts. This will occur “from the back office to the front lines and all the way up to the C-suite.”

As with almost every business today, technology is driving the need for new training. Artificial intelligence, robotics and other technologies will create value by improving telehealth and reducing “transactional tasks,” according to PwC. But it won’t happen without training. In fact, 45% of provider executives surveyed by PwC said the capabilities of their workers are a “significant barrier to organizational change.”

MAs on the Front Lines

Such concerns are one reason MAs are being trained to perform some of the tasks delivered by nurses, including new roles in health IT and patient engagement — especially coaching. Training programs abound, from community colleges to nonprofits focused on cultivating primary care teams.

Patients — your employees — are more likely to see this happen on the front lines.

Allowing MAs to take on tasks previously performed by registered nurses (RNs) obviously saves money, but it also means that patients aren’t rushed through health coaching. The physician or RN may not have the time to sit down with patients to provide adequate coaching and support — and if they did, it would be considerably costlier.

Addressing Social Determinants of Health

It’s here that community health workers can play a role as well.

Social determinants of health, from income and education to housing and access to food, play a significant role in health care costs and outcomes. The American College of Physicians estimates that these health disparities result in $309 billion in economic losses each year.

Community health workers (CHWs), a relatively new addition to the health care team, are helping provider organizations address these issues early. CHWs often don’t have a medical background, but they frequently do have roots in the community. They may go shopping with a patient to help them select healthier food, or connect patients with transportation or social services. A physician can’t spend as many hours talking about nutrition, transportation or unpaid electric bills.

The Centers for Disease Control and Prevention offers a wealth of resources to train CHWs. With the right medical upskilling, they can specialize in a specific area, such as maternal health or stroke prevention.

Better Skills, Better Connections, Greater Value

Home health aides provide value similar to community health workers. According to Health Affairs, if high-quality care can be delivered in the home, it keeps costs down, makes life easier for patients who may have trouble getting to a physician and keeps patients out of the hospital.

For example, Health Affairs reports that training 6,000 home care workers in California contributed to a 41% decline in the rate of repeat emergency department (ED) visits and a 43% decline in the rate of rehospitalization. The result: savings of up to $12,000 per patient.

Similarly, home health workers in New York City received 200 hours of training in chronic diseases, among other things. After the training, they were designated Care Connections Senior Aides. They then made home visits to support the on-the-job upskilling of hundreds of other home-care workers. The bottom line? An 8% reduction in the rate of ED visits, as well as improved job satisfaction among home care workers.

Don’t let the term “medical upskilling” mislead you. Yes, health workers are learning new skills, but health systems are also capitalizing on these workers’ existing competencies — and their relationships with patients and caregivers.

Medication Management on the Team

Finally, let’s look at pharmacists.

Pharmacists can take on an array of tasks often left to physicians or nurses, including diabetes, hypertension and depression management, as well as new medications and dosage change. They can also review “polypharmacy” issues, which arise when a patient’s numerous drugs prescribed by multiple clinicians may interact badly with each other. And pharmacists can help patients gradually come off opiates.

The model can work in a variety of ways, from onboarding a clinical pharmacist as part of the practice staff to collaborating with a community pharmacist to working more closely with pharmacists within a particular health system.

Clinical pharmacists may need medical upskilling and certification to provide what’s called comprehensive medication management (CMM). Some pharmacy schools offer CMM-based certification programs for pharmacists. CMM often targets the most complex — and most costly — cases. And again, the pharmacists can spend more time with patients; in this case, they’re better-suited to talk about medications. As with the other examples, CMM reduces physician workload. Moreover, it has resulted in demonstrated reductions in ED and hospital admissions.

As CMM shows, medical upskilling isn’t limited to lower-paid health workers. Finding the best individuals for a particular set of tasks is simply a more efficient way to work. It controls costs, supports better outcomes and improves both patient and professional satisfaction.

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