Recently, we released a series of reports that we produced with the Center for Labor Markets and Policy at Drexel University (CLMP) under contract with the Office of the State Auditor.  Chapter 224 of the Acts of 2012—“An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation” directed the Massachusetts Office of the State Auditor (OSA) to “conduct a comprehensive review of the impact of [Chapter 224] on the health care payment and delivery system in the Commonwealth and on health care consumers, the health care workforce, and general public.” Over the past few years, Commonwealth Corporation and CLMP interviewed more than a dozen stakeholders and conducted focus groups of health care employers and workers. We analyzed publicly available data to understand how the industrial and occupational structure of health care employment in the Commonwealth has changed.  Below are a few highlights from the various papers detailing the results of our work.

Shift from inpatient to outpatient settings

The health care industry is in the process of transforming care delivery systems and shifting focus from inpatient to outpatient settings. From 2012 to 2015, outpatient providers, including doctor’s offices and home health agencies, added 4.2 jobs for every 1 job created by inpatient providers, such as hospitals and nursing homes.

Growth in occupations with stagnant wages

Direct care workers such as home health aides and personal care aides are anticipated to be some of the fastest growing occupations through 2024.  Unfortunately, these jobs have had stagnant wage growth since 2004, while wages for workers in all other industries have grown 8 percent.

Direct care occupations with similar skill requirements pose challenges for employers

Home health aides, personal care aides and community health workers/social and human service assistants share very similar requirements in terms of abilities, knowledge, skills and behavioral traits.  They require minimal formal training or education.  This means these occupations are very substitutable for one another.  Small differences in wages, hours and work setting can pull workers from one occupation to another.  This is a real challenge for employers who depend on external systems of reimbursement (such as Medicaid and Medicare).

Total number of nurses increased, those with associate’s degree declined

While the total number of nurses has increased since 2010-2011, those with only an associate’s degree have declined, offering some evidence of up-skilling in certain settings, such as hospitals.  

For more information, you can find links to the detailed reports below:

  Selected Health Care Support and Direct Care Occupations in Massachusetts This special topics report summarizes publicly available data and information gathered through interviews and focus groups with employers, workers, labor leaders and state officials in order to understand the labor market context of three already large and fast growing health care support and direct care occupations: home health aides, personal care aides, and community health workers (CHWs)/social and human service assistants. Characteristics of Workers and Jobs in the Massachusetts Health Care Industry The paper examines changes that have occurred in the demographic traits and the employment patterns and earnings of the state’s health care workforce between 2011, the year before the passage of Chapter 224, and the most current year for which data are available, 2015. Developments in Certificate and Degree Completions in Health Care Fields of Study in Massachusetts, 2001-2012 and 2012-2015 This paper provides information on trends in postsecondary completions in health care-related fields of study in Massachusetts over the 2001 to 2012 period, representing the period before the passage of Chapter 224, and over three years following the enactment of Chapter 224, 2012 to 2015. Health Care Employment, Structure and Trends in Massachusetts Fundamental changes have occurred in the way that health care is delivered in Massachusetts in recent years and this is reflected in the changing nature of demand for labor among the various component industries that make up the health care and social assistance sector. This paper examines the nature of these changes along a variety of labor market related dimensions and makes some observations about the outlook for growth and future change in health care diagnostic and practitioner occupations and in health care support/direct care occupations. Mass Layoffs in the Health Care Industry in Massachusetts, 2004-2016 This paper examines mass layoff activity within the state’s health care and social services industry relative to other major industry sectors over the 2004 to 2016 period, just before and after the implementation of Chapter 224. Profiles of Fifteen High Growth Health Occupations in Massachusetts This research brief presents a profile of 15 occupations in the Massachusetts health care industry. These occupations were selected on the basis of their importance within the state’s health care industry, either because of strong growth in employment or because of the emerging importance of the role that workers in these occupations play in the changing health care service delivery environment in the state. Summary of the Health Care Workforce Transformation Trust Fund Grants As health care employers align with the goals of Chapter 224 and cost controls begin to alter the delivery of health care services in differing ways within the sector, providers are changing some of their business processes, occupational job descriptions, and staffing structures. In anticipation of these changing skill and knowledge demands, Chapter 224 established the Health Care Workforce Transformation Fund. The Fund, which is administered by Commonwealth Corporation, was designed to support training and education activities that help health care employers address workforce challenges related to their efforts to meet the cost containment and quality improvement objectives of Chapter 224.  In 2015 and 2016 Commonwealth Corporation awarded training grants to 59 organizations. The organizations spanned the state and included health care providers in every health care sector. This paper provides information about the training grant applications and the 59 grants.