Healthcare Reform & the
New York Landscape
NYC Healthcare Landscape
There are an estimated 850,000 healthcare workers in New York City and the sector represents about 18% of the local economy.
Healthcare employment has grown steadily in New York City since 2000, and that growth—at least before the COVID-19 pandemic—was faster than employment growth in all other sectors and decoupled from economic downturns. In the midst of ongoing change, NYACH works to ensure that the workforce development ecosystem is brought along and in lockstep with new industry needs.
NYACH is committed to creating efficient pathways for advancement that help hard-working New Yorkers get into good-paying jobs at scale, and to ensuring that all healthcare jobs—regardless of wage or required training—are nevertheless good jobs that are structured in ways that do not reinforce pre-existing systemic inequities. All healthcare occupations are essential to our healthcare delivery system and we need to ensure that all workers can find fulfillment and earn a living wage.
Healthcare Reform
A tidal wave of changes has washed over healthcare in the past twenty years, accelerating through the 2010 Affordable Care Act and more recently with the COVID-19 pandemic.
Policymakers and industry leaders alike have lined up behind the triple aim as a rallying cry for healthcare reform: simultaneously improving patient experience and population-based quality care while reducing costs. Similarly, we have seen the system take up a widespread transition from a fee-for-service (FFS) financial model to value-based payments (VBP) model, hoping to incentivize a better system.
As these healthcare policy and business changes have rapidly introduced new financial models, job titles, and ways of working, we have been stuck with a stubborn workforce challenge that NYACH calls “the barbell problem.”
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In brief, a FFS financial model pays for each healthcare service individually, incentivizing healthcare professionals and organizations to provide as many services as possible, which may not be in the best interest of the medical and/or social health of the patient or the financial health of the sector. In contrast, a VBP model pays for the “value” of health services. For Example, under VBP, a network could receive payment if it is able to reduce the rate of uncontrolled diabetes in a population. In theory, VBP allows healthcare providers to prioritize good health outcomes and still get paid. In practice, many organizations use a combination of FFS and VBP models, as implementing effective VBP models is incredibly challenging, and it is not suited to all types of care and circumstances.
The Barbell Problem
Healthcare staffing models that have been in place for decades involve a high volume of low-paying jobs and many high-paying ones, but relatively few jobs in the middle-income range.
Contributing to this uneven distribution, staffing structures are bound to educational attainment, with the majority of low-wage jobs requiring only low levels of education, such as a high school diploma, while most high-paying titles require a high or very high level via bachelor’s or graduate degrees.
Thus there are relatively few jobs that require six months to two years of training—jobs that in other sectors might afford someone without prior education a pathway to earning a living wage or to accelerated degree programs that give credit for prior work experience.
The Barbell Problem
An Imbalanced Workforce
The healthcare sector employs more than 750,000 workers in New York City, an outsize economic force. But this essential workforce relies on staffing models that have been in place for decades that have resulted in an imbalanced workforce of extremes, which NYACH calls the “barbell problem”.