Building a Value-Based Workforce in North Carolina

Abstract

Health care in the United States is likely to change more in the next 10 years than in any previous decade. However, changes in the workforce needed to support new care delivery and payment models will likely be slower and less dramatic. In this issue of the NCMJ, experts from education, practice, and policy reflect on the "state of the state" and what the future holds for multiple health professional groups. They write from a broad range of perspectives and disciplines, but all point toward the need for change-change in the way we educate, deploy, and recruit health professionals. The rapid pace of health system change in North Carolina means that the road map is being redrawn as we drive, but some general routes are evident. In this issue brief we suggest that, to make the workforce more effective, we need to broaden our definition of who is in the health workforce; focus on retooling and retraining the existing workforce; shift from training workers in acute settings to training them in community-based settings; and increase accountability in the system so that public funds spent on the health professions produce the workforce needed to meet the state's health care needs. North Carolina has arguably the best health workforce data system in the country; it has historically provided the data needed to inform policy change, but adequate and ongoing financial support for that system needs to be assured.

Is North Carolina's Workforce Prepared for Team-Based Care?

“…Health systems are moving away from hospital-centric care models and toward community based care models [14]. This change has led to the additional challenge of finding ways to educate both the new and current workforce for deployment in ambulatory and community settings.…”

The Accountable Care Workforce

“…Treatment of complicated social issues requires partnerships across multiple systems, yet an increase in multisector agencies will require a workforce that can move between these sectors with ease. These boundary spanning roles are essential in the coordination of care between the health care system and community partners as patient care shifts from visit-based, fee-for-service models to strategies that use community and population level approaches to focus on prevention [4]. A workforce with this kind of agility will not only assist patients in accessing and navigating clinical and community settings, but will also have the capacity to understand common goals, strengths, and barriers, and use that understanding to collectively meet the needs of individuals within their environments.…”

“…Although ACCs will develop a new and retooled workforce as they grow, several factors will affect the creation of a successful and sustainable model of partnerships [4]. This includes healthcare systems and communities working together to achieve a shared mission and culture of health, valuing an interprofessional workforce, and developing administrative and governance structures to promote the work of ACCs.…”

“…This multisector effort to improve health at the community level presents several workforce-related challenges. Collaboration in health care settings requires a flexible, boundary spanning workforce that not only accommodates diversity in the workers' discipline, education, and demographic characteristics, but is also committed to disease prevention strategies [4]. Furthermore, a fundamental step toward improving health through community collaboration is to address the social determinants of health (SDHs), which include social policies and environmental factors as well as the economic and community conditions that impact health outcomes [5].…”

Improving Continuing Education for Family Physicians: The Role of the American Board of Family Medicine

“…Although the last decade has seen great innovation in health professions education, [1][2][3] only a small percentage of physicians are enrolled in any given time in formal, structured medical education. 4 If care is going to improve, if innovation is going to spread, and if America wants changes in health care to occur more rapidly than the 30 years it takes to replace generations of health professionals, change must spread through a comprehensive and meaningful approach to lifelong learning. Therefore, as a specialty and as a profession, we must attend closely to the vitality and evolution of continuing medical education.…”