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Event Recap | 8.23.2023 | Government's Role in Supporting a Thriving Healthcare Ecosystem

On Wednesday, August 23, 2023 HC3 hosted the latest installment of the Future of Work Series - Government’s Role in Supporting a Thriving Healthcare Ecosystem presented in collaboration with HC3 partner Capitol Edge. In this discussion, advocates and policymakers shared updates on Illinois’ legislative response, as well as opportunities for local government to play an active role in the advancement of the future of the health care workforce.


Moderators:

Debbie Broadfield, Senior Vice President and Lobbyist, Capitol Edge Consulting

Kristin Rubbelke, Vice President of Government Relations, Capitol Edge Consulting


Featured Speakers:

Lakesia Collins, Illinois State Senator, District 5

Ashley Colwell, Vice President of Clinical Services and Workforce Development, IPHCA (Illinois Primary Health Care Association)

Bob Morgan, Illinois State Representative, District 58

Lauren Wright, Executive Director, Illinois Partners For Human Services


News Coverage

POLICYMAKERS DISCUSS EFFORTS TO STABILIZE HEALTHCARE WORKFORCE | Health News Illinois | 8.24.2023 | Article here


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Event Recap

Panelist Introductions

Senator Lakesia Colwell (LC): Prior to being a state senator, I served on many different workgroups as a state representative, including Dobbs, and have experience working in nursing homes for ten years. Some of our work in the General Assembly has been tackling short-staffing issues. Overall, since 2009, I have been part of an effort to get more staff into nursing homes, as well as protection for reproductive rights.


Representative Bob Morgan (BM): I serve as chair of the health care licensing committee in the house and on the insurance committee. I have a background in health care, specifically health law and policy.


Ashley Colwell (AC): IPHCA (Illinois Primary Health Care Association) is a trade association for FQHCs (Federally Qualified Health Centers). We represent nearly 60 health care organizations across the state of Illinois. Community health centers operate primarily in underserved areas, so they tend to be impacted by workforce shortages. FQHCs haven’t recovered from shortages that took place during COVID. Shortages have existed for a long time, but they look different now. For many years, it was highly skilled staff such as dentists or nurses, but now it’s dental/medical assistance, such as front desk staff or coding specialists. Thanks to the General Assembly, a new rate increase will start in 2024. Rate increases are a way to help compete for talent. Another opportunity was the passage of the Equity in Health Care and Representation Act, which aims to bring health care workers from underrepresented backgrounds into medically underserved areas. The Act awards roles such as medical and dental assistants, offering scholarships, which is rarely seen in these professions.


Lauren Wright (LW): We are a coalition of 850 health and human service organizations representing every legislative district in the state. Our coalition provides services across the board, from childhood to care for older adults. Our work is to erase the line between health and human services, recognizing that so many people who need health care access also need social services to address SDOH. We conduct research to highlight workforce-related issues and present policy and legislative solutions. We also lead a coalition of coalitions, partnering with more narrow associations in their focus and amplifying their efforts.


Discussion

Q: Please share some updates around the most recent legislative session and different policy initiatives in which you were a part or have a vested interest.


LC: We put more money into safety net hospitals than we ever have before. That is where the need is great right now. Attracting and retaining workers will help with access and providing quality care. We need to focus on ensuring that people want to come to work and are attracted to the industry again.


BM: If you talk to a nurse, you’ll have the same conversation as with a teacher or police officer. These front-line industry workers are having the same workforce issues, which are mainly due to compensation. You’ll hear the same things and the same kinds of challenges. It’s important to recognize.


LW: This fact sheet shows workforce-focused legislation supported or passed by health and human services associations in the last session. We have a human service professionals loan repayment program for which we will seek appropriations in the next legislative session. It is focused on front-line workers and covering as much of the sector as possible.


Q: Are there examples of successful policy interventions that have effectively addressed shortages in the health care workforce?


BM: We just passed the Healthcare Worker Reinforcement Act, which makes permanent some of the executive orders that were put in place during the pandemic. For example, it allows flexibility for administering services at different sites of care, such as vaccines or tests at pharmacies. Another example is licensing flexibility and removing months-long wait times for renewals so that people can immediately return to work. This Act continues some of the best practices that have been made, but there’s much more to do.

Policy decisions impact our communities, recruitment, training, and distribution of health care professionals. What are some of the recent legislative activities that support this idea?



LC: Policy plays a significant role because it comes from a place of people’s lived experiences. As a working mom, I knew during the pandemic that childcare would be a big deal, and it did shed a lot of light on this issue, so now we talk about expanding the past policy to include other types of guardians, such as foster parents. I also work with my constituents to hear what matters most to them. Policy has a significant impact, whether it's on your education, housing, or property tax. It affects everything.


BM: A common thread is that you can’t recruit a professional if you can’t pay them a living wage. You’re competing with big box companies that are paying more than a nurse would make. They won't take the job if you’re not paying them what they’re worth. There is a question of how do we recruit people to the areas that have always been left behind.


LW: Rates are directly connected to workforce. We can’t look at systemic underinvestment in health and human services without looking at 20 years when rates were stagnant in our state. This is inherently connected to our societal undervalue of care work. And the reason for that is because women, particularly women of color, primarily hold these professional roles. Our research has shown how much of this is a racial and gender equity issue. We must have conversations about our societal undervaluing of this kind of work and how that connects to policy change because those things are interconnected.


LC: Yes, it’s all connected and related to policy, but you can’t pass policy around morale. In many of these fields, many workers are not just burnt out; the morale in these institutions has a significant role in staff not wanting to return to work. There is a struggle between being able to pay rent and showing up to work where they are treated “less than others.” Workers on the frontline need to be treated with respect.


Q: How do reimbursement rates contribute to the financial stability of providers that rely on Medicaid patients?


LC: The smaller chains were very concerned about being able to still stand with those rates. There is still a lot of work that needs to be done; there has to be a way that the state can ensure we keep the smaller institutions afloat.


Q: We have talked about obtaining licenses and that it’s time-consuming and causes delays. What are some of the current opportunities to address these challenges?


LW: Licensing and credentialing issues arise in every health and human service sector segment. There are unique solutions for various challenges that are faced depending on what service you provide. Things we hear include needing help to ensure that folks with lived experience can serve and be promoted. Also, regarding language access, sometimes an individual is hired for their skills in a specific language, but the licensing and credentialing need to be aligned; otherwise, they can’t practice. There has been legislation to address this, but this is an example of one of the barriers we hear about.


BM: A significant issue with licensing challenges is the unnecessary wait times. This disproportionately impacts professionals of color in urban areas, especially women of color. This is harmful because of a trickle effect. It affects their ability to care for their families, pay their mortgage, and pay for medications. Our committee is working on this with the Illinois Department of Financial Professional Regulations.


Regarding compacts, Illinois doesn’t have a health care compact, meaning that we don’t have reciprocity across states. So, in the border areas, we are losing workers who can’t work in the state of Illinois because they live across the border. With the Dobbs decision to repeal Roe v. Wade, there has been a significant change in how health care licensing has been politicized. If someone is treating a patient from Mississippi or Missouri, their license may be threatened because they’re helping someone with reproductive health care. In states like Illinois, where there might have been a good compact, we have to be concerned about the other side of the ledger: ensuring our health care professionals are expected to provide reproductive health care and not discriminate.


Q: What role do education and training policies play in ensuring a competent and well-prepared health care workforce? Are there any areas where this can be improved?


AC: Many health centers are actively involved in training health professionals. Many do this formally through residency programs or partnerships with academic institutions. Some have been lucky to leverage federal funds through the Teaching Health Centers Graduate Medical Education program. However, many of them need more funding, so we still have many health centers that want to be involved in this formally. Some are starting “grow your programs” to develop a workforce of community health workers and medical assistants.


We've been doing a lot of upskilling to train front desk workers to become dental assistants or train dental hygienists as public health dental hygienists. We are also working with our service providers on providing medication-assisted recovery services and trying to build the peer recovery network and develop a robust workforce to provide substance use treatment. That's another area we are trying to engage in training with, and we hope to continue to expand behavioral health training as well.


Q: Can you explain the importance of the demographic composition of the health care workforce to receiving culturally competent care and some legislative initiatives that you know about or could think of that promote the diversity of the health care workforce?


LC: In the black community, some folks have experienced distrust and fear around seeing a doctor, so many are missing out on preventative services or other care. This comes from the history of black people and health care. It’s very important to ensure that there is access through representation in those health care settings where they can feel more comfortable and get their needs met promptly.


In my previous role as chair of the Black Caucus, we championed that through our pillars regarding the health care pillar, the infant mortality in the African American community, and ensuring women have access and feel comfortable.


I had a doula and a midwife [when I gave birth], but many mothers don't have that access to that. So, we need to support legislation to get more African-American doulas. We need to make sure that there is representation on all levels, but especially in communities of color.


When we're talking about access, I'm also talking about making it affordable. We have a lot of low-income families, especially in my district. I represent a diverse district with some affluent areas and others with incomes between $20,000 and $30,000 annually. Most of my constituents don't go to the hospital; they'll take whatever happens in the emergency room and don't even go to a follow-up because they fear getting stuck with more bills. I need to create pathways for them to feel comfortable and receive preventative services for their overall health. My top priority is working with other providers and community stakeholders and discussing the future of health care and what that looks like in the black community or communities of color.


LW: In our recent research around the health and human services workforce demographics, we see that 75 percent of the health and human service workforce identifies as female, and over 50 percent are people of color. So, as I mentioned earlier, this is a racial and gender equity issue, and there's been incredible work done to acknowledge that. The Black Caucus has been at the forefront of ensuring that health care integrates social determinants of health.

Q: What kinds of collaboration and conversations are happening that ensure that workforce policies are effective and relevant?

LW: The more we're siloed in our advocacy, the less we can do collectively for our communities and the health and human service sector. We try to break down those barriers with our work at the Health and Human Service Coalition. I appreciate so many of our legislators, including Senator Collins and Representative Morgan, who acknowledge that these issues shouldn't be siloed and are complex and can hold that space. The more often we can have those conversations with our legislators who understand not only their constituents and what they need but that it’s not always straightforward.

LC: Affordability as part of access has to remain a priority, but I also understand the workforce side and the side where you must keep the doors open. Want to stabilize the industries across the board, whether in education, trade, work, etc. We have to stabilize the industry because if we don't, we're looking at regressing 10 or 15 years.

Regarding funding, I prioritize health care because I know most of those jobs are held by women of color. I also understand that those facilities in these different communities, especially underserved ones, are their only lifeline. My sister, a liver transplant survivor, would not be here if she did not have access to a hospital in the community that could help her. So health care will always be a top priority, and part of that is ensuring we have a stable, well-funded workforce.


Q: Are there efforts to increase awareness of traditional roles in health care, such as allied health roles?


AC: We've been working on this with the Area Health Education Center, an HRSA-funded program. They are focused on creating a career manual to expose high school students to all the careers that exist.


Q: Is there a specific source of help to address the payer-provider collaboration? For nonprofit nursing homes to provide better value-based care, the type of collaboration is gaining traction.

BM: The payer-provider challenges are real. We've focused more on quality payments through collaboration. The reimbursement model is better if the payer and the provider work together for better quality outcomes for individuals in nursing homes. It's all interconnected, and having a payer source more closely tied to quality outcomes through collaboration has always proven to be better. Implementing that over the last 20 years has had mixed results, partly because they keep changing the framework and the reimbursement. There needs to be more consistency there.

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