“Who’s Going to Care?” Reveals Significant Challenges to Care Coordination and Care Management Workforce

Categories: Capacity Building, Press Release

July 22, 2015 (New York, NY) — “Who’s Going to Care? Analysis and Recommendations for Building New York’s Care Coordination and Care Management Workforce,” a new report by 1199SEIU United Healthcare Workers East (1199SEIU) and the Primary Care Development Corporation (PCDC), finds significant challenges that threaten to undermine the care coordination and care management workforce as healthcare transformation gets underway.

George Gresham, President of 1199SEIU United Healthcare Workers East, said, “The members of our union are deeply committed to transforming the healthcare system to better serve our communities. 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. Policymakers must ensure that the structure is in place to train, recruit and retain this new workforce.”

Healthcare providers are beginning to adopt team-based approaches to healthcare, where care coordination is provided for all patients and care management is provided for high-need, high-cost patients, primarily in community settings. Care coordination and care management are widely recognized as essential to lowering costs and improving patient outcomes and engagement. But the field is still evolving, and the workforce needed to undertake these challenging jobs lags far behind, according to the study.

Ronda Kotelchuck, CEO of the Primary Care Development Corporation said: “The success of New York State’s healthcare transformation initiatives is heavily reliant on a workforce with the skills and competencies necessary to undertake the myriad complex tasks of coordinating patient care.” “There must be sufficient compensation, training and career ladders to build and sustain a skilled workforce for these positions of considerable responsibility. Failing to do so puts the entire healthcare transformation enterprise at risk.”

Results from a survey of 49 mostly downstate New York Health Homes (which manage care of Medicaid enrollees with costly and complex chronic conditions) about their care management and care coordination workforce reveal the need for sufficient compensation, training and career ladders to ensure the effectiveness of care coordination.

The study revealed that:

Recruitment and retention challenges are prevalent, driven by insufficient salary, high caseload and lack of appropriate skills and competencies.
A significant majority of organizations responding reported recruitment challenges (88%) and retention challenges (78%). More than half reported insufficient salary as a barrier to recruitment and retention, while large caseloads and insufficient skills and qualifications were also major factors. Salaries reported by organizations surveyed, the majority of which are community-based, are on average 27% – 50% lower than those for the similar titles in the hospital workforce.

Job titles for those providing care coordination and care management are still evolving.
While 72% used the title “care manager” for the job of managing and coordinating patient care, there was no consensus about job titles for supervisory staff or those providing patient outreach and engagement.

A diverse and broad set of skills and competencies are needed by the care coordination and care management workforce.
There is a strong consensus about what skills staff need to be effective in care coordination and care management roles. Basic knowledge of clinical conditions, advanced organizational and interpersonal skills and familiarity with tasks required in nursing and social work are required in these roles.

Ongoing training and supervision are needed for staff that provide care coordination and care management.
Less than 60% of organizations responding provided training in patient-centered care and chronic care management, while less than half offered training in health coaching, working in a team, housing placement, stress management or running and reading reports – all skills that many organizations considered crucial to care coordination and care management roles.

Charles King, President and CEO of Housing Works, said: “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.”

The Health Home workforce experience is particularly relevant as New York State embarks on the five-year Delivery System Reform Incentive Payment Program (DSRIP), which has a goal of reducing avoidable hospitalizations by 25% in large part by building community-based healthcare capacity. Over $400 million will be available for workforce development under DSRIP.

Based on analysis of the survey results, and additional research and experience in the field, 1199SEIU and PCDC make the following recommendations to policymakers and healthcare organizations seeking to build a strong and effective care management and care coordination workforce:

  1. Collect data about the care coordination and care management workforce
  2. Require all payers to support care coordination and care management 
  3. Ensure recruitment and retention through sufficient wages and benefits for care coordination and care management staff
    • Set a wage floor for care and care management workers;
    • Ensure sufficient provider payment to meet compensation standards; and
    • Ensure health plans are incentivized to invest in the community-based sector and that community-based providers are incentivized to invest in their frontline staff
  4. Provide ongoing support for the development of the care coordination and care management workforce
    • Develop industry standards and certification programs;
    • Fund education and training initiatives that leverage economies of scale;
    • Establish care coordination and care management career ladders; and
    • Provide clinical supervision and support for unlicensed care coordination and care management staff.

1199SEIU Healthcare Workers East (1199SEIU)

1199SEIU United Healthcare Workers East is the largest union in New York and the largest healthcare union in the nation, representing over 300,000 members throughout New York State. The union’s mission is to achieve quality care and good jobs for all.