The healthcare workforce has experienced unprecedented attrition in the wake of the COVID-19 public health emergency (PHE), and the shortage of essential workers is expected to continue to rise over the next decade. From 2020-2021, the total supply of Registered Nurses (RNs) decreased by more than 100,000, the largest decrease over the past four decades.1 Additionally, the US is facing a projected shortage of up to 124,000 physicians within the next 12 years, according to a report released by the Association of American Medical Colleges (AAMC).2 A 2021 Washington Post-Kaiser Family Foundation Survey found that 30% of health care workers are considering leaving their profession altogether, and nearly 60% reported impacts to their mental health stemming from their work during the COVID-19 pandemic.3 Further, the US is predicted to face a shortfall of almost 200,000 social workers by 2030.4
The implications of staffing shortages have tangible impacts on patient care. Staffing ratios become untenable for nurses, which impacts patient care and healthcare outcomes. Given the current landscape and the shortages forecasted over the next decade, care coordination efforts will continue to be paramount to delivering high quality, patient-centered care.
Impact to the Care Coordination Structure
Staffing shortages directly affect individuals dually eligible for Medicare and Medicaid, as they must navigate both programs to address complex needs across a variety of specialties and levels of care, thus necessitating an integrated healthcare workforce, leveraging all parts of the care team. Teamwork is particularly essential in times of staff shortages; any disruption in the multi-disciplinary care team’s delicate balance could introduce opportunities for degradation in the care an individual receives. Using a team approach for care coordination by engaging staff in different disciplines helps familiarize all care team members with the process, making redistribution of work among the team easier in the event of turnover.
Developing an integrated care environment for health plans serving dually eligible individuals includes competencies such as understanding the community, gaining a deeper understanding of the members, involving caregivers, and enhancing understanding of systems and available resources.5 Adopting one or more of the approaches outlined below may ease the pressure of personnel gaps felt throughout the care team.
Health Plan Best Practices for Navigating Staffing Shortages
- Understanding the Community
Successful integrated care can be informed by understanding how a community’s social and cultural factors affect health and considering the specific needs and concerns of vulnerable populations. As a way to better understand factors impacting their members, several health plans engage in community activities. Examples of various health plan efforts to connect with the local community include:
- Convening community meetings including families, caregivers, members, and multi-disciplinary health care teams to discuss community challenges and identify existing assets and resources.
- Recruiting care team staff from the local community to attract candidates directly connected to and with an understanding of the members they support, then encouraging those staff to share their perspectives and experiences with non-local care team staff.
- Working with the local health department to contract with community health workers who share lived experiences with members and provide services and outreach directly in the neighborhood.
Efforts, such as those listed above, may help drive a clearer picture of how community structure and needs impact care teams. Through community engagement, establishing meaningful relationships, and tapping into a local workforce, health plans can leverage this knowledge in times of staffing shortages to meet the unique needs of their members, while providing care team staff with information to execute their roles efficiently and effectively.
- Gaining a Deeper Understanding of Members
Understanding individual members helps the care team develop a shared sense of goals and priorities. Many health plans utilize motivational interviewing techniques to encourage members to share their needs and preferences.6 Training staff to ask open-ended questions, to actively listen and reflect, and to carefully explore the ‘why’ of member concerns builds staff competencies and increases understanding of members.
Some health plans provide this staff education through clinical rounds with interdisciplinary teams, while others leverage specifically trained clinically integrated nurses or nurse practitioners to support members and to educate staff. Developing consistent long-term relationships with members through frequent conversation and skilled questioning builds a holistic understanding of individuals’ health and wellbeing, capabilities, self-management abilities, needs, preferences, and the environment in which they find themselves. When care teams are stretched, understanding individual members’ specific needs and concerns can allow the team to determine which services and support are highest priority.
- Involving Caregivers
An active approach to caregiver wellness – which includes understanding risk factors, recognizing signs of caregiver distress, assessing caregiver needs, and referring caregivers to support services – may enhance the care coordination team by strengthening the connection with and support of members’ caregivers. Several health plans recommend initiating connection with caregivers early in the care coordination process by initially asking members to identify those individuals who they prefer to have involved in their care, gaining permission to contact them, and integrating them within the care team.
Health plans use an array of caregiver assessments and caregiver education approaches to better support members’ caregivers and to mitigate risk of burnout. Education for caregivers includes enhanced understanding of available benefits and services, information about care management and care coordination, and resources for caregiver support groups, advocates, and services. Educating staff on caregiver supports, including condition-specific supports and culturally appropriate resources, enhances outreach and coordination efforts. A caregiver’s role as part of a member’s care coordination team can be demanding and stressful, even in times when the care team is fully staffed. Therefore, it is important these individuals receive the support necessary to help them fulfill their role, especially when there are vacancies left by other care team members.
- Enhanced Understanding of Systems and Available Resources
To provide effective, integrated care requires knowledge of the major social determinants of health, local resources available, health policies, and system design. Care coordination can bring together local, regional, and national resources to support members’ needs. Health plans develop, maintain, and update repositories of resources and connect their members to those resources. Some plans assign these efforts regionally, with departments maintaining the repository of resources for their county. Other plans use community health workers to update the resource lists and keep them accurate. Many plans hire licensed clinical social workers to manage the resource repository, lead the work of building relationships with community organizations, and share resources with members. Other plans leverage their enrollee advisory committees to better understand local resources and members’ social needs. As community resources frequently change, maintaining an updated list is crucial, including accurate contact and website information.
Plans train staff regularly, directing them to the updated resource repository and how the information can be used to benefit members. Some plans discuss community resources in structured rounding, clinical rounds, and interdisciplinary care team meetings so that care coordinators can share current member needs and connect them to potential support services. Other plans focus on staff onboarding and orientation for initial awareness of community resources, followed by annual training to highlight new resources. Collating community resources with the goal of directing members to available services can help bridge the gap in times of strained staffing structures.
- Additional Strategies to Support Staff
Additional strategies to support workforce education and staff development on the skills and competencies necessary for care coordination include:
- Creating a working environment that values wellness and supports a climate of respect and work-life balance.
- Engaging faculty teaching staff who convey joy in their work and provide trainees with education around work-life balance, self-reflection, and self-improvement.
- Embedding structures to support collaboration and interprofessional learning among colleagues and professions across services, strengthening multisector relationships.
- Allowing more time for networking, interprofessional education, and opportunities for individual service presentations and diverse attendance.
- Focusing on soft skills, such as communication, teamwork, and relationship building.7
Additional best practices for creating an integrated care team and helping prevent burnout include:
- Assigning mentors to combat burnout and react to staffing shortages facing newly hired case managers. The mentors are experienced peers that work with the staff before and after their formal trainings and offer additional support depending on staff members’ progress.
- Hiring Community Health Workers (CHWs) can be an effective strategy to enhance relationships with community organizations and to communicate with hard-to-reach members, while supporting and educating the care team.
- Conducting consistent staff training on practical tools for care coordination, such as motivational interviewing or use of website platforms, can encourage and develop staff.
While staff turnover and shortages are inevitable and can be disruptive to the care dually eligible members receive, health plans can deploy various strategies to mitigate the effects of these dilemmas. Some of the suggested approaches outlined here include, but are not limited to, creating an integrated and coordinated care team, identifying meaningful ways to embed health plan staff into the community, better understanding the unique and individual needs of members, engaging and supporting caregivers, and navigating available community resources.
1Auerbach, D., Buerhaus, P., Donelan, K., & Staiger, D. (2022, April 13). A Worrisome Drop in the Number of Young Nurses. Health Affairs Forefront. Retrieved from https://www.healthaffairs.org/do/10.1377/forefront.20220412.311784.
2Robeznieks, A. (2022, April 13). Doctor shortages are here-and they’ll get worse if we don’t act fast. American Medical Association. Retrieved December 12, 2022, from https://www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act.
3American Hospital Association. (2021). Strengthening the Health Care Workforce. Retrieved from https://www.aha.org/fact-sheets/2021-05-26-fact-sheet-strengthening-health-care-workforce.
5Barraclough, F., Smith-Merry, J., Stein, V., & Pit, S. (2021). Workforce Development in Integrated Care: A Scoping Review. International Journal of Integrated Care, 21(4): 23, 1–14. Retrieved from https://doi.org/10.5334/ijic.6004.
6Resources for Integrated Care. (2019). Integrated Care in Action Podcast: Foundations of Motivational Interviewing. Retrieved from https://www.resourcesforintegratedcare.com/wp-content/uploads/2019/08/Integrated_Care_in_Action_Podcast_Foundations_of_Motivational_Interviewing_Transcript.pdf?csrt=15812247867770167037.
7Barraclough, F., Smith-Merry, J., Stein, V., & Pit, S. (2021). Workforce Development in Integrated Care: A Scoping Review. International Journal of Integrated Care, 21(4): 23, 1–14. Retrieved from https://doi.org/10.5334/ijic.6004.