Vital Directions for Health & Health Care An Initiative of the National Academy of Medicine (2017) / Chapter Skim
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15. Workforce for 21st-Century Health and Health Care
15. Workforce for 21st-Century Health and Health Care
Pages 301-316
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From page 301... ...
Today, our health care system is in the midst of a transition from the traditional fee-for-service approach toward value-based models of care delivery. This reformation of care delivery and management is intended to make care more patient-centric and person-centric while reining in health care costs by keeping people healthy, reducing unnecessary treatment and duplication of services, emphasizing smooth continuity of care within and among sites, and improving the alignment between clinical need and delivery site.
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To deliver integrated care within these clinical clusters, the US health system will need to recruit, educate, and sustain a diverse health and health care workforce that is comfortable working collaboratively in interdisciplinary teams, is technically skilled, and is adept at harnessing the capabilities of modern health information technology. In identifying the vital directions for the future of America's health and health care workforce, we examine the vital health and health care needs of broad segments of the American populace with particular attention to characteristics of health status and corresponding health care use: • People who are generally healthy and experience only intermittent and minor episodes of illness or injury, including those who need maternity and perinatal services for healthy newborns.
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That will enable us to construct a health workforce capable of developing new and effective ways to promote both individual and population health, discourage harmful behaviors, and deliver cost-effective preventive services (IOM, 2003)
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Locations for accessing services may include the Internet, pharmacy or big-box, retail-based clinics, and urgent-care centers in addition to traditional primary care, hospital outpatient clinics, and health departments. Although members of the healthy population are not heavy users of care, ready access to their medical home should be ensured through telehealth, remotely supervised members of the primary care team, or, if required, office visits.
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The Population That Has Acute Illness or Injury: A Workforce to Care for People Who Experience Major Episodes of Illness or Injury Despite effective health-promotion and injury-prevention programs, a substantial minority of Americans will continue to experience unexpected serious health events (such as a very premature birth, cancer, or a serious injury due to a fall or car crash)
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Third, regionalization of care, in which health care institutions within a defined geographic area are centrally organized and managed, may reduce the number of interventional specialists that are needed. If regional health systems and state-based trauma-care and emergency-care networks start to funnel their most challenging cases to a smaller number of high-performing centers, the result may be the high procedural volumes needed to produce more consistent high-quality outcomes than currently occur in many densely served and highly competitive markets (IOM, 2010)
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The Population That Has Chronic Disease and Multiple Comorbidities: A Workforce to Serve People Who Have Chronic Medical or Behavioral Conditions This group includes people who have medical conditions that are not curable but can be treated for and managed so that they can lead productive lives with reasonable hope of normal life expectancy. It includes those who live in a chronic state of difficult life circumstances caused by low income, poor education, unstable housing, food deprivation, obesity, mobility restrictions, and substance abuse.
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From page 308... ...
That is the only practical way to prepare doctors, nurses, and other health professionals to work effectively in teams to deliver the care that patients who have chronic diseases need. Second, those experiences must be less hospital based and instead based more in the community to align with the needs of patients (IOM, 1989, 2014)
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For that reason, the health care workforce of the future must be more diverse and culturally competent than the current one. Complex patients require the talents and expertise of many who are interconnected to work as one team of problem solvers who not only manage patients' medical conditions but also address behavioral health and poor social conditions.
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From page 310... ...
On the basis of our assessment of the health and health care needs of four critical patient populations -- those in good health, those who are facing acute illness and injury, those who have chronic diseases and multiple comorbidities, and those at the end of life -- we offer the following vital directions for the future health care workforce: 1. Assess and ensure the sufficiency of the front-line health care workforce.
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From page 311... ...
To serve patients effectively and to achieve optimal health outcomes, the workforce must have the collective education, skills, and capacity to help patients to live with their chronic conditions. Diverse, interdisciplinary workforce teams that include community health workers, primary care technicians, and other occupational groups are needed for the effective health management of patients who have complex chronic diseases.
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SUMMARY RECOMMENDATIONS FOR VITAL DIRECTIONS 1. Assess and ensure the sufficiency of the frontline health care workforce.
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. Health policy brief: Preventive services without cost sharing.
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From page 314... ...
2013. Prevalence of multiple chronic conditions among US adults: Estimates from the National Health Interview Survey, 2010.
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Robert Phillips, MD, MSPH, is Vice President, Research and Policy, American Board of Family Medicine. David Sklar, MD, is Distinguished Professor Emeritus, Department of Emergency Medicine, University of New Mexico.
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