The Affordable Care Act marked a national healthcare reform effort, and within that context, New York State, led by Governor Cuomo’s Medicaid Redesign Team, is undergoing a substantial shift in publicly funded physical and behavioral healthcare. The authors have been deeply involved in the rollout of these changes dating back to the Adult Chronic Illness Demonstration Project (a precursor to Health Homes), the Adult Health Home Rollout, NYS Mental Health Clinic Re-design, and now, the transition to Managed Care. A consistent thread within each of these initiatives is the evolving skillset needed among the workforce. Hospitals, FQHC’s, Community-Based agencies, government, and payers are each struggling to identify the specific workforce skills needed for individual staff and organizations to succeed in this ever-evolving environment. This article draws from the authors’ experience developing the NYS behavioral health workforce to propose a number of core skills in which all staff need increased knowledge.
A key area that defines successful organizations across multiple different systems and provider types, is the ability of staff to communicate across roles. In our experience, organizations that have successfully adapted to recent changes are those where the administrative, program and clinical, finance, and HIT staff have regular and ongoing dialogue. When each of these systems operate in separate silos or do not collaborate, it does not bode well for the respective departments, or most importantly, the provider’s clients. Perhaps in the behavioral health system of a decade ago it was possible to know “your job only,” but in the new world, each staff member needs to know how all of the different pieces fit together and understand their role within the overall organization and healthcare delivery system.
Familiarity with the following identified topics is necessary in order for each staff member to be successful:
- Finance: In successful organizations, all staff have a basic understanding of where they fit in the overall funding structure of the agency. This includes a staff member’s role in generating revenue and supporting overall fiscal health of the organization. For example, front line clinicians need to understand how productivity and documentation affect their program’s bottom line. The program director not only needs to have a budget, but also understand the details of that budget and be involved in its development and, when necessary, modification. In the same vein, agency finance staff need to understand the program implications of budget decisions and the contractual and regulatory requirements that might impact meeting the goals and expectations for productivity, overall budget, quality of care, or documentation.
- Integrated Health and Best Practices: Clients with mental health and substance use challenges have complex needs, both behavioral health and often, also co-morbid medical conditions, all of which are deeply affected by the social determinants of health. Understanding the interplay between all of these different needs is critically important to helping a consumer move towards recovery. A basic understanding of common terms, an ability to communicate effectively with each of the different service systems, and an ability to help clients navigate those systems is a critical and necessary skill.
- Outcomes and Key Performance Indicators: As the New York State health care system moves toward value-based payments, a significant factor in an organization’s success will be its capacity to demonstrate the impact of its services. The understanding of the shift from Fee-for-Service to Value-Based Payment will be important at all levels of the organization. Each individual provider will have to understand the impact of their interventions, and be able to monitor and adapt the interventions based upon data and evidence-based practice. In addition, organizations will need to understand how their delivery of service fits into the broader context of a person’s care, demonstrating their impact across programs and systems and extending beyond their individual agency. For example, a staff member who is tasked with supporting a client’s connection with primary care will need to understand the critical impact their role has on reducing ER utilization.
- The Consumer Experience: Consumer experience is a key component in evaluating an organization. As we move to managed care and value-based payments, agencies will have to distinguish themselves based upon the quality of their outcomes as well as the experience of the individuals they serve. Successful staff and agencies will create an engaging and welcoming environment, requiring collaboration across what have traditionally been silos. This applies to direct care staff as well as staff who manage the front desk, maintenance, and beyond. Customer service will also need to consider and reflect the principles of a trauma-informed workplace.
- The Role of Technology in Treatment and Reporting: Technology is a crucial component in healthcare. It organizes the work we do and how we measure it through the use of electronic health records. As we move into an APP environment, technology is also quickly becoming a treatment extender and for some, the direct link with care. Interoperability is a critical component of integration as it facilitates communication among providers. In addition, the ability to generate actionable, clear and simple reports will be one of many requirements for staff and agencies who are successful in the new world. There is often a tendency to keep technology purchases to the IT staff. In a changing system, agencies must be thoughtful as they consider the implementation of any new systems to ensure that they cut across departments and systems, and ensure that both operational and IT staff communicate about these crucial technologies to ensure that they perform the bridge role they are capable of—staff must not only be well-trained in the systems, but will also play a key role in informing the technology acquisition process.
- Social Determinants of Health: Social determinants of health, the conditions in which people are born, grow, live, work and age, are a crucial component of recovery. More than ever, staff will need to understand the role they play and how to interact with other social service providers both inside and outside of the behavioral health field. Understanding social needs and engaging consumers in establishing pathways in meeting those needs is best accomplished through collaborative work with other social service providers, health homes, and community supports.
While there is no reasonable expectation that any one individual within an organization would be an expert in all or even most of the proposed content areas, each staff member will need to possess a working knowledge in regard to how these different aspects of the whole impact their specific job and day-to-day responsibilities. Traditionally, only senior executive staff was expected to have significant content knowledge outside of their discipline. As the behavioral health field trends toward integration and value-based, however, all staff will require this knowledge. Payers, providers, and regulatory bodies alike will need to work together in order to address this workforce development challenge.
Andrew F. Cleek, PsyD is the is the Executive Officer at the McSilver Institute for Poverty Policy and Research, NYU School of Social Work and a Research Assistant Professor at the NYU School of Medicine. Boris Vilgorin, MPA is the Healthcare Strategy Officer at the McSilver Institute for Poverty Policy and Research, NYU School of Social Work Questions can be directed to Andrew Cleek at Andrew.cleek@nyu.edu.
