Thoughts on addressing healthcare workers’ challenges and staffing shortages, how to pursue health IT workforce development programs, and the new strategic direction at the Center for Medicare & Medicaid Innovation (CMMI) were keynote topics at the recent Collaborative Care Tech Summit.

LeadingAge and the LTPAC Health IT Collaborative hosted the 2022 Summit online June 7-8, 2022. You may still see the program and purchase on-demand access to content. Highlights of the three keynotes are presented below.

Fixing the Workforce Issues Faced by Healthcare and Services Eco-System

Steven Landers, M.D., MPH, President and CEO, VNA Health Group

Landers began by recognizing the human toll that healthcare workers have faced due to COVID-19. Deaths, concern for families and patients and colleagues, confusion and controversy around COVID-19 mitigation policies, and no time to cope are among the many challenges. “I don’t think it can be understated how much added burden, stress, challenge has been placed on our workers,” he said.

Plus, the healthcare system needs to prepare for the rise in the number of people aged 85+, many of whom need help with daily living and managing chronic conditions.

Additional challenges on the horizon include the caregiver support ratio, which is predicted to fall by half by 2050 and leave families unable to support the burden. Severe shortages of Registered Nurses and geriatricians, psychiatrists, neurologists and physicians are predicted. Now one-quarter of skilled nursing facilities are understaffed with aides and assistants, and major home care companies are turning away 50-70% of clients.

Taken together, these issues create serious challenges for compassionate aging.

Solutions

Landers shared four solutions to build workforce capacity.

• Expand education and enrollment in nursing programs. Nursing schools turned away approximately 90,000 applications in 2021, primarily because the schools are not competitive in attracting faculty, and local hospitals do not have enough clinical capacity to accept more students. New, mobile and hybrid approaches to simulation and virtual reality could help.
• Learners also need to be involved in elder care. The industry could look broadly at education venues like home and community care and residential care systems, and enable students to focus on long-term care and aging. Legislation may be able to support these goals.
• Introduce regulation to expand educational capacity. Innovation and demonstration grants could help. Increasing opportunities for faculty, like loans and compensation, could get more advanced-degree nurses into faculty roles. Encouraging entrepreneurship in the education space could also pay dividends. Investor-backed education concepts are the biggest trainers of nurses now. In nursing education, looking at exam pass rates and graduation rates could create more capacity in the system, though regulation would be needed to prevent fraud and abuse.
• Enact immigration reforms that create opportunities for nursing. Immigration is related to economic growth and diversity in our communities. While the issue is complex, there is room for opportunity where nurses or aging services experts want to come to the United States. 
• Encourage innovation. Virtualization of care can provide important solutions—for example, creating virtual companions in home health, enabling hard-to-find wound care experts to provide bedside video consults to generalist nurses in patients’ homes, and testing voice-to-text documentation pilots to save clinicians time. In addition, the regulatory framework needs more flexibility around reimbursement for telehealth within home health services.

 For more on the application of telehealth in different care settings, attend the LeadingAge Learning Hub webinar “Telehealth in Practice: Driving Efficiencies & Improving Outcomes,” to be held Thursday, July 21, 2022, from 2 p.m. to 3:30 p.m. ET.  Lastly, you can also view this session on-demand by visiting the Summit event page.

Empowering Clinicians with Health IT: ONC’s Education Programs 

Dr. Thomas Keane, MD, Senior Advisor, U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology (ONC) Moderator: Brenda Akinnagbe, ONC Staff Lead

In 2010, only 15% of providers used electronic health records (EHRs). The HITECH Act provided funds and tech support for rapid digitalization of healthcare, which led to incentives of $30 billion through the Centers for Medicare & Medicaid Services (CMS) and $1 billion in grants through ONC. By 2020, 95% of hospitals and physicians were using EHRs.

Public health IT workforce development programs continue to help healthcare workers and others stay current in the changing healthcare environment and deliver care more effectively. Because the pandemic shifted from provider-based IT to public health IT, ONC has recently given grants to medical centers and historically Black colleges and universities to help develop a minority workforce to provide services in minority communities. One strong resource is the Workforce Development Programs on HealthIT.gov.

Planning Pointers

Keane offered pointers to those deciding how to structure a program, partner, and ask for assistance.

• Consider the current environment. We are still living with COVID, which caused a lot of deaths of older adults in long-term post-acute care (LTPAC). Interoperability of information was not met, and the LTPAC community lives on thin margins, making it hard to adapt.
• Consider goals of private and public institutions and where LTPAC goals might coincide. For example, the current Administration has a strong focus on addressing health inequities. Goals appear on the White House website, U.S. Department of Health and Human Services (HHS) websites, and HHS Budget in Brief Legislative Proposals.
• Outline where you most need help. Is it with selection and purchase of EHRs? On-demand technical assistance, interoperability, or end-user training? 
• Choose partners. The behavioral health, LTPAC, or substance use disorder communities or the U.S. Department of Housing and Urban Development may be good partners, but we need to ensure that we remain focused on where we can make a difference, and not try to boil the ocean.

Educational Resources of Tomorrow

Several vehicles can help improve health IT education: Extending the IMPACT Act to provide incentives to improve interoperability, extending Health Care Control Networks to the LTPAC community, tapping Public Health IT Workforce Grants, reconstituting Regional Extension Centers, extending the meaningful use program to promote interoperability, and tapping Quality Improvement Organizations.

The following agencies are potential partners: CMS, the Health Resources & Services Administration (HRSA), ONC, and the Centers for Disease Control and Prevention.

Akinnagbe shared an opportunity to work with agencies that may not have grant funds available. The Assistant Secretary for Planning and Evaluation (ASPE) has a Patient-Centered Outcomes Research Institute (PCORI) with a PCOR Trust Fund that calls for proposals annually and encourages applicants to work across agencies.

CMMI’s Strategic Direction: New Models and the Role for Technology-Empowered Workforce 

Brad Diephuis, M.D., MBA, Senior Advisor, Center for Medicare & Medicaid Innovation (CMMI), Centers for Medicare & Medicaid Services (CMS)

CMMI was founded under the Affordable Care Act to test alternative payment models while, ideally, improving quality and reducing cost. CMMI’s new mission statement, under its strategic refresh, is “a health system that achieves equitable outcomes through high quality, affordable, person-centered care.”

CMMI’s Strategic Direction

• Embed health equity in every model. Doing so is a focus of the current Administration. Many of the payment models do not reflect a full diversity of Medicare and Medicaid beneficiaries—in race and ethnicity, socioeconomic status, and geography. For some models, data is not available to reflect who is served. CMMI is now designing alternative payment models that increase participation of providers who focus on underserved populations and consistently collect data needed to achieve health equity.
• Streamline model portfolio. Complex and overlapping policies among models confused providers. Now, CMMI is streamlining and rationalizing its model portfolio to create a comprehensive, cohesive strategy for alternative payment models that fit together and send consistent market signals.
• Support a care delivery transformation. Many providers would like to move to value-based care and more efficiencies, but significant infrastructure investments might be needed. A learning network convenes groups of providers to share best practices and actionable data, to help drive care transformation.
• Model design may not ensure broad transformation. Multi-payer alignment means that CMMI and Medicare are aligned with state Medicaid, commercial payers, etc. That way, individual providers can focus on care transformation across all beneficiaries, not across those in a particular payment model. In the LTPAC space, Medicaid alignment is crucial. CMMI is collaborating closely with state-based efforts on care redesign and care transformations.

CMMI’s 5 Strategic Pillars

• Drive accountable care.  By 2030, 100% of Medicare beneficiaries should be in an accountable care relationship. This ambitious goal is a dramatic shift that requires policy changes.
• Advance health equity. Embed health equity in every aspect of CMMI models and increase focus on underserved populations. Improve data capture and standardize common terminology for health equity.
• Support innovation and tech development. Ensure that data exchange or submissions of data to CMMI align with industry standards such as FHIR.
• Address affordability from a beneficiary’s perspective. Use CMMI model authority to drive savings to the Medicare Trust Fund and to address the affordability crisis for beneficiaries.
• Partnering to achieve system transformation. CMMI cannot move industry alone; align priorities with other payers and other states and other entities.

Two Featured CMMI Models

• Accountable Health Communities Model. To address social determinants of health, community service providers are bridge organizations. They are incentivized to coordinate with the medical establishment, conduct care screenings of Medicare beneficiaries, and demonstrate to CMMI a closed loop referral process.
• ACO REACH Model. This redesigned model allows organizations to take on responsibility for the total cost of care of their patients and advance health equity. Payment benchmarks are increased for those who serve more beneficiaries who are dually eligible for Medicare and Medicaid and who reside in underserved areas. Model participants must also develop self-authored plans to address health equity within their own patient population.  

 If you would like to view this session on-demand, please visit the Summit event page.