The following article is the product of a collaborative effort between Kairos Policy Group and Workmorphis to present forward-thinking workforce policy alternatives to Congress. KPG and Workmorphis are united by their shared goal of enhancing critical workforces through pragmatic policy approaches.

This article first appeared on the Kairos Policy Group website.

Key Takeaways

• Congress should redevelop federal statutes to increase medical workforce alternatives in the healthcare sector.

• Workforce Alternatives include:

• Allow “paraprofessionals” to take the burden from higher trained workforces.
• Reimagine the concept of paraprofessional for the digital age.
• Allow artificial intelligence & other digital technologies to replicate human workforce service delivery because it can improve access, care quality AND price.
• Why pay for what would otherwise be free?

Introduction 

Service delivery in all U.S. economic sectors comes with a cost. The current economic and political climates make solving workforce shortages and other problems hard for lawmakers in Congress. They also make it hard for local communities during tough economic times. 

It is the authors’ intent to provide lawmakers with thoughts on legislating service delivery in healthcare with economic austerity in mind. These ideas can also serve as resources for lawmakers seeking to address longstanding workforce-related issue areas like mental health without the costs traditionally associated with policymaking. 

Principle 1: Congress Should Redevelop Federal Statutes to Increase Workforce Alternatives in Health Care 

The U.S. economy operates as a set of individual markets, each containing specialized workforces that adhere to the market’s rules and regulations. In healthcare, medically licensed workers typically spend years training to develop their sufficient skills before being allowed to deliver services. Once licensed, they recoup the costs and time of training through higher salaries than other economic sectors on average. The problem for lawmakers: training and employing new licensed medical workforces are costly and time-intensive compared to other workforces like teachers. 

These high costs impede lawmaker efforts to address medical workforce shortages and other policy problems manifesting in the market. So do federal statutes that financially favor medically licensed workforces and prevent alternatives. For instance, the federal government spends roughly $380 billion dollars a year on the mental and behavioral health needs of Americans. Numerous federal statutes that govern this spending specify medically licensed workforces as the only ones authorized to receive payments. This effectively prohibits alternative workforce reforms, including those listed in this article, from doing business with federal healthcare programs like Medicare. Requiring medically licensed workforces under statute also unnecessarily increases the costs of some healthcare services, and exacerbate workforce shortages, which can impede access to care. Lawmakers can help address this issue by updating federal healthcare payment statutes to allow workforce alternatives where the quality of those alternatives is high.

Principle 2: Allow “Paraprofessionals” to Relieve Burden from Higher Trained Workforces

Paraprofessionals are skilled aides who provide support to–and act under–the direction of professionals in markets, including education and real estate. These workforces are often vocationally trained and specialize in performing some professional services as well as administrative services as an extension of the professional. There are many benefits to a paraprofessional workforce in health care. 

Paraprofessionals can be valuable workforce alternatives to licensed medical professionals because they expand the capabilities of existing professionals. These alternatives can also help alleviate the burden on highly trained and licensed workforces like doctors so they can dedicate more time to treating sicker patients. Further, paraprofessionals are less expensive to employ, suggesting built-in savings over what is otherwise available today. Increased use of paraprofessionals could therefore solve for medical workforce shortages much quicker and cheaper than expanding hospital graduate medical education programs. A flexible, multi-disciplinary workforce can help lawmakers address a variety of health sector issues. Vocational or hands-on training can help specialize and eventually professionalize service delivery. All good reasons for lawmakers to ensure paraprofessionals can receive reimbursement under federal statute for the high-quality services they can deliver.

Principle 3: Reimagine the Concept of the Paraprofessional with Digital Technologies & Artificial Intelligence (A.I.)

The concept of paraprofessionals was first introduced after the end of the Second World War to address teacher shortages. One clear limitation of paraprofessionals is the range and intensity of services they can provide because they lack the training that comes with with a medical license. Another is that human workforces are limited in the number of services they can provide before requiring rest. The technology of the 20th Century was not able to overcome these limitations, but the era of Artificial Intelligence can.

Consider the capabilities of paraprofessionals enabled by A.I. Clinical Decision Support (CDS), for instance, is a digital product that offers physicians medical advice. Pairing physician advice with paraprofessionals could increase the quality and number of professional services they can provide. A tool that pairs the capabilities of medically licensed workforces with the manpower of A.I.-enabled paraprofessionals could open many new possibilities in healthcare once thought impossible. For instance, some forms of artificial intelligence are already working with patients to create unique mental health and chronic care plans based on their behavior and personal preferences. Something not otherwise possible before now.

The authors anticipate that digital technology innovation will continue to replicate professional services in the coming years, which in turn should increase the value of reimagined paraprofessionals.

Principle 4: Allow Digital Technologies & A.I. to Replicate Human Workforce Service Delivery

There has been much public discussion on the possible dangers of relying upon A.I. as a workforce alternative. While the authors recognize that machine learning A.I. technologies operating without internal controls can pose a threat to human health, regulated A.I. have been used safely in healthcare for years. Lawmakers can find ways to ensure federal statutes support A.I. use in the market, offering benefits for patients, doctors, clinical research, taxpayers, and health insurance companies alike.

A.I. is a truly disruptive technology. It not only supplements highly trained workforces like doctors and teachers, but also completely upends traditional pricing approaches to service delivery. Human workforces are paid based on a combination of factors but the one constant is time.  Some employees are paid hourly. Others are paid on a per-project or service basis. All ofthese payment amounts are based on the amount of time it takes to deliver a service.  A.I. is not limited in this way and so the payment arrangement is much more affordable. For instance, most companies that currently offer A.I. delivered services charge a set fee – usually monthly – regardless of how many services are used by the patient. Physicians, on the other hand, are paid for each service they perform. The economics speak for themselves. Where traditional economics are informed by the numbers of people delivering services, A.I. presents a unique opportunity for lawmakers because it does not.

As a compliment to existing workforces, A.I. is providing new healthcare services that human workforces cannot manage on their own. A.I. is also capable of replicating some medical service delivery (e.g., digital therapies) like a licensed medical worker. Given sufficient computing power, A.I. could deliver services to every American on the same day. Assuming sufficient controls are in place, these technologies could also give every American their own personal health assistant. Thus, A.I. opens up new possibilities for lawmakers looking to improve the health system and patients seeking access to quality care. 

Principle 5: Why Pay for What Would Otherwise Be Free?

General volunteerism has been a staple of American society for centuries. People helping their neighbors during times of trouble, regardless of denomination or political affiliation, was lauded by society as good community activities. Civic associations and neighborhood volunteers were willing to offer advice and aid when others needed help. Neighborhood gatherings fostered a sense of connection and support for everyday emotional and mental issues; everything and everyone as sources of support for their neighbors in need. Today, the problem for many is that opportunities to give support to strangers are all around, but opportunities to help neighbors are less available. 

Consider the possibility of volunteer workforces in local communities across America. People committing time to helping neighbors with chores, mentoring, or other services. The economic benefits of volunteer workforces, under the right conditions, can be comprehensive. By way of example, the Barefoot College  in India is a community-based grassroots organization which believes knowledge, skills, and wisdom found within a community should be used to aid the personal development and success of its people. 

[College] classes are held in the evening to allow children to work during the day, with teaching coming from the villagers themselves, for whom the [organization] provides the necessary training. This may not seem particularly relevant to the advanced education systems of developed countries, but the approach taken by Barefoot College is unusual and potentially has a valuable point to make. 

The College believes in tapping into the innate wisdom found within the people of impoverished rural communities; ‘literacy,’ they say, ‘is what one acquires in school, but ‘education’ is what one gains from family, traditions, culture, environment and personal experiences.’

Thus, in a radical departure from traditional schools, ‘everyone is considered an education resource, the teacher as well as the student and the literate as well as illiterate.’ It may not offer certificates and qualifications in the way we know them, and its lessons may not look like those we’d (recognize) in the UK, but this extraordinary (organization) strips education to the fundamentals and gives every individual the chance to develop themselves and improve their lives through practical education, of which literacy is only one aspect.

There are many lessons that can be drawn from other cultures. The key is the social fabric culture provides to local communities. Redeveloping the American social fabric such that neighbors are better able to help neighbors could obviate the need for some federally funded workforces and third-party businesses. 

The Barefoot College serves as an example of what is possible when people have a way to demonstrate altruism within a community. The economic benefits of local community volunteers who provide services to neighbors bring possibilities not otherwise possible because of financial constraints. 

Conclusion

The economics or politics of the moment can often impede lawmaker interests in legislating reform. In such instances, having alternative approaches to traditional issues can be the difference between success and failure. The authors hope this article aids lawmaker efforts to solve age-old issues like the mental health crisis.

Meet the Authors

Robert Horne is a partner and co-founder of Kairos Policy Group, an opportunity-making organization for executive leaders in business, philanthropy, investment, and political advocacy that want to increase and align their organization’s financial returns with a social ROI. Horne is a nationally published expert on payment reform and the future of care delivery in numerous peer-reviewed journals. He has extensive expertise in a range of health policy areas, including FDA regulatory policy, digital health technology, and payment and delivery transformation. He spent ten years working on Capitol Hill as professional staff on the House Energy and Commerce Committee under Chairman Fred Upton (R-MI) and as Senior Health Policy Adviser to Congressman Phil Gingrey (R-GA). Horne began his career in the Ohio House of Representatives, serving as the Chief Counsel to the Committee on Health. Horne is also the President of Forest Hill Consulting, where he works with provider organizations, pharmaceutical, and device companies, digital health vendors, consumer and patient organizations, and payers.

Jim Bialick is a partner and co-founder of Kairos Policy Group, whose mission is to “do well by doing good.” Bialick is a public policy expert and political tactician that brings 15 years of experience in legislative advocacy, community capacity building, and policy development to his role. He was involved in the passage of three federal laws, 31 state laws, and dozens of substantive regulatory changes, and he has testified before the U.S. House of Representatives twice. Bialick is also the Senior Program Officer for Policy and Advocacy for the Perigee Fund, a philanthropy focused on ending intergenerational trauma through the power of early relationships by resourcing BIPOC and women-led organizations focused on the needs of prenatal–age 3 families. 

Emily Fabiano(Contributor) is the founder of Workmorphis, a cross-sector workforce consultancy helping organizations build a more resilient workforce to thrive in a changing economy. Fabiano has deep experience in workforce transformation at the government level, working at the cross section of workforce strategy, economic development, and public policy. With a keen understanding of the unique challenges facing today’s and tomorrow’s workforce and the ability to communicate across sectors, Fabiano brings a new level of understanding and collaboration required to connect industry and education and prepare people for jobs.