The Affordable Care Act and the Evolution of Healthcare Staffing

Originally published here

There is little doubt that the Affordable Care Act (ACA) has transformed the healthcare industry. Over the past six years, the way people receive healthcare and the manner in which medical facilities provide that care has evolved significantly.

This changing healthcare landscape has made headlines and has been hotly debated by many Americans across the nation. However, regardless of one’s opinion on the ACA, legislation has gone into effect and will continue to evolve in the coming years, so it’s important that everyone understands the implications of this law and what this means for patients, healthcare professionals, and healthcare providers.

Countless articles have been written on those topics, but this whitepaper aims to specifically discuss the impact that the Affordable Care Act will have on healthcare employers. Questions such as, “how can I adapt my staff to changes being felt across our medical facility as a result of the ACA?”  and “what are some best practices for attracting and retaining top talent?” will be answered, while topics about the current healthcare environment and emerging trends and shortages will be discussed from a staffing perspective.


By 2030, the over-65 population is expected to reach 72.1 million people—a whopping 19% of the entire American population, according to the U.S. Administration on Aging. That’s a lot of patients with possible chronic, long-term diseases or health problems to cover. In addition, changes made by the Affordable Care Act to provide insurance to 32 million previously uninsured individuals will have taken effect, overwhelming healthcare staff with rapidly-growing needs as a result.

This exponential growth of patients will create new strains on the healthcare system. Not only will there be a higher ratio of patients to providers, there will be a greater influx of unhealthy patients. Many individuals who have not had access to health insurance are now living with chronic health conditions that require regular care and, as a result of recent changes, insurance providers are no longer able to deny them coverage. 12% of newly-insured patients are expected to be entering healthcare facilities with pre-existing, long-term problems.

This means there will be a high demand for extensive care and treatments that may be taxing on existing resources at the same time resources are already taxed by the overwhelming jump in patient population size. In order to keep up with these needs, hospitals and medical practices will need to make major changes, such as investing in new equipment and technology, improving turnover rate and workflow efficiency, and adding qualified staff.

Additionally, the healthcare field will have to be prepared for the face of the patient population to change. Insurance coverage is now coming from employers, individual exchange, and Medicaid/Medicare, with the majority of patients (45%) falling under the individual exchange category. Only 69% of newly-insured patients speak English, compared to 88% of those currently insured, and many are unfamiliar with their insurance policies and the services they cover. Healthcare providers will therefore have to invest in hiring professionals with bilingual language skills, and may need to spend more time with patients on the administrative side, going over costs, payment plans and other details about their coverage and treatment.


Of course, change can be unsettling. Before making any large-scale changes to your facility or programs to adapt to ACA mandates and the evolving healthcare landscape, be sure to first inform current staff and ensure everyone is comfortable with the changes. Then, continue to communicate with them regarding changes they can expect to see moving forward. One great way to do so is to find a balance between the industry-wide changes taking place—such as the added importance of patient satisfaction ratings— and your practice’s personal culture, which will assist staff in seeing how your organization fits into the larger picture.

This would also be a great time to adapt your staff members’ roles to your new needs. Rather than stagnating their growth as their environment evolves around them, evaluate your current employees’ responsibilities and focus areas and consider making changes to help them fit better into the new environment. Shifting the roles of your current employees, and letting them utilize their skills in new ways in order to improve patient care and adapt to the changes being made through the Affordable Care Act, is a great way to increase your efficiency in a time when workflow is at a bit of a risk.

For example, clinical staff RNs can be trained and repurposed as Care Managers and Coordinators and, as a result, they will be given the responsibility of working with patients before, during, and after visits. This expands the RN’s responsibility to the patient’s entire unique care plan, rather than just during their stay, to prevent further health problems and rehospitalization—two major initiatives of the ACA.

Changes like these will also allow you to put an emphasis on outpatient healthcare, which in turn will only improve your organization’s reputation and overall care of patients. Implementing a program in which Care Managers and Care Coordinators assist in all stages of the care process can help keep patients healthier, lower rehospitalization costs, and avoid subsequent fees. Especially when dealing with higher-risk patients who may have had existing issues before seeking treatment, professionals like Care Managers and Coordinators can perform a risk assessment prior to a patient’s visit and determine certain factors that can pose them as a high risk for rehospitalization in the future. From there, Coordinators and Managers can work together to make sure the patient’s needs are met and properly monitored.

Healthcare leaders should ensure they are flexible and open to feedback and questions during this time of change. The impact of planned strategies needs to be examined ahead of time to allow a clear picture of what to expect, what to explain to any staff members who may have questions or concerns, and what to inform new hires of as staffing efforts are refocused.


It is clear that there are a number of factors at play that have contributed to emerging trends and shortages when it comes to healthcare staff. According to Kelly Mattice, Vice President of The Execu|Search Group’s Health Services division, three developments employers should pay particular attention to include: the growth of Managed Long Term Care and Community Health, and the shortage of critical healthcare professionals such as physicians and nursing professionals.

Managed Long Term Care:

As the population continues to age and the number of newly insured patients with chronic or preexisting conditions rises, many states including New York and New Jersey have begun to transition from Medicaid Long-Term Services and Support to Managed Long-Term Care Models (MLTC). Though these managed care models vary from state to state, according to the New York Department of Health, Managed Long-Term Care is, “a system that streamlines the delivery of long-term services to people who are chronically ill or disabled and who wish to stay in their homes and communities.” Some examples of services provided by MLTC include homecare, adult day care, nursing home care, and physical, speech, and occupational therapy outside of the home.

“Whether your state is in the process of transitioning to a Managed Care model and the deadline to adapt is fast-approaching, or you are seeing a general rise in demand for managed long-term care services, it might be a good idea for your facility to start adjusting their care models to prepare,” advises Kelly. “A key part of your implementation plan should be to have the right staff on hand.”

This is another instance in which bringing on Registered Nurses in a care management capacity can be beneficial to an organization looking to adapt to the changing healthcare landscape. As Kelly explains, “All of an individual’s care will be coordinated under a Care Manager and this will most likely keep expenses under the plan’s cap—the preset amount that must cover all the care a plan member requires. At The Execu|Search Group, we are seeing that many facilities we work with have begun realizing that care managers and coordinators are the key to keeping patients healthy and spending at a minimum, so they have started to recruit more heavily in these areas.”

Therefore, the type of healthcare professional ideal for this opportunity would be one who wants to focus on chronic care and/or care management. Nurses currently working in Home Care, Long-Term Care, and Case Management would all be assets to Managed Long-Term Care plans. As this type of health care model is new and many patients receiving this care are newly insured, it’s also important to hire staff with strong communication skills who can articulately explain all the services your organization offers and how they can benefit each patient. Furthermore, hiring bilingual professionals is becoming increasingly valuable, as newly-insured patients are less likely to speak English as their primary language.

Community Health

The Community Health Center Fund was established by The Affordable Care Act to provide $11 billion in funds over a 5 year period for the operation, expansion, and construction of these health centers across the county. According to the U.S. Department of Health and Human Services, money allocated from this fund will: support ongoing health center operations; create new health center sites in underserved areas; expand preventative and primary healthcare services, including oral health, behavioral health, pharmacy, and/or enable services at existing health centers; and support major construction and renovation projects at these centers across the country. The primary difference between community health and a traditional practice is that rather than focusing on patients with shared characteristics, community health focuses on bringing healthcare into a geographic area.

To be considered a federally qualified health center (FQHC) and receive grants under Section 330 of the Public Health Service Act (PHS), according to the U.S. Department of Health and Human Services, medical facilities must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have an ongoing quality assurance program, and have a governing board of directors. It is also important to note that FQHC Look-Alikes or organizations that meet PHS Section 330 eligibility requirements, but don’t receive grant funding, are eligible to receive special Medicare and Medicaid reimbursement.

Therefore, regardless of whether or not they receive governmental funding, there are plenty of incentives and opportunities for organizations to either become or develop Community Health Centers. “Community Health is expected to play a large role in the implementation of the Affordable Care Act,” says Kelly. “Now that some of our clients are able to provide these home and community-based services through Medicaid and federal grants, they are experiencing an increase in patients demanding access to this type of care. As a result, they have started to build their staff in home care as well as in urgent care centers to meet these demands.”

Since the goal of Community Health is to provide a continuum of preventative and primary care to underserved populations on a sliding fee scale basis, medical facilities looking to get involved in this type of health system will want to hire medical professionals who can work within a team-based environment. To provide this care, organizations will want to consider hiring: nurses, nurse practitioners, physicians, physician assistants, dental providers, behavioral health specialists, and social workers.

Critical Staff Shortages

As the demand for health services rises, the demand for professionals who can provide that care is rising significantly, and at this point, there is no end in sight to the surge in demand. Therefore, now, before the shortage worsens, is the time for health facilities to start creating a plan to manage the shortage. Consider these figures about physicians: According to the American Association of Medical Colleges, over the next 10 years the supply of physicians will only grow by 7%, resulting in a shortage of 90,000 primary care physicians, surgeons and medical specialists by 2020. During this time, it has also been predicted that approximately one-third of currently practicing doctors will be retiring, which creates an even greater need for professionals to fill in the gaps.

This field of medicine is not the only profession experiencing a shortage. By 2020, Bureau of Labor Statistics’ Employment Projections show that there will be a need for approximately half a million nurses. Additionally, as the American Nursing Association continues to lobby for legislation that will require hospitals and medical facilities to adopt safe staffing practices for nurses, this demand for nurses may grow further as hospitals are needing to increase the ratio of nurses to patients.

To manage these shortages, there are a number of steps that medical facilities can take. For example, to mitigate the effects the physician shortage can have on an organization and their patients, hiring talented nurse practitioners and physician assistants can prove to be a viable solution. Since both high-level medical practitioners can perform standard medical procedures and write prescriptions, they have the ability to free up doctors’ schedules for the less routine cases that cross their desks. Another solution that struggling healthcare facilities have adopted in the face of healthcare reform is to hire locum tenens physicians to avoid short staffing. Though locum tenens physicians take on shorter-term assignments, many of these doctors are highly skilled and specialized, and over time will be able to reach more patients throughout the country who need their specific talents and acute care.

To manage the nursing shortage, it’s important for medical facilities to be open to hiring recent nursing graduates and nurses with less experience. Though this may be easier said than done because organizations must ensure they have the proper training plans in place in order for these newer nurses to be successful, to prepare for the increase in patients and the retirement of the baby boomer generation, it’s vital to have a succession strategy. According to the BLS, nursing is one of the fastest growing fields, so as more Americans pursue nursing as a career, it’s clear that newer nurses can be considered a large portion of the future providers of healthcare. As a result, in order to ensure medical facilities can adequately provide their patients with high-quality care when the patient load increases and experienced nurses retire, they should consider hiring less experienced nurses. When doing this, it’s also important to keep in mind that just because a nurse has fewer years of experience, doesn’t mean they are less qualified. There are a number of factors that could have affected the quality of the experience they gained at their last employer, which include the size of the organization and the number of staff on hand.


As a result of these dramatic shifts in the healthcare environment, healthcare professionals like nurses, physicians, and clinical staff know they are going to be in high demand for the foreseeable future. This means they know they can be more selective about what offers they take and what offers they pass on—which, in turn, will result in an even more competitive market for employers to source and retain top talent.

What does this mean for employers? “In this candidate-driven market, employers are going to have to change the way they approach desirable applicants,” says Kelly. Some such ways to do so include making more competitive offers, making offers more quickly to avoid losing out on a qualified candidate to a competitor, and promoting your organization’s culture to show candidates why they should want to work for you. “Many of our clients are making adjustments in their culture and the ways they attract new employees, from offering work-from-home opportunities and providing wellness incentives to showing that their organization is pushing to be on the forefront of patient-centered care.”

Another great way to promote your company culture is to stay relevant on social media sites like Facebook and LinkedIn. Taking simple steps like posting relevant content and updating on company news can go a long way when forging an accurate presence of your organization’s mission, values, and culture, and studies are showing that company culture is becoming increasingly important to candidates’ decisions. In fact, surveys have shown  that social media is becoming much more integral to healthcare candidates’ job search processes, with  42% of clinicians reporting that they used social media for job searching and networking last year—a statistic that doubled from the previous year.

Though it may seem counter-intuitive, it can also help to hire from within and work to train and retain current staff. Ways to do so include providing educational opportunities, discussing advancement opportunities, taking note of and acknowledging accomplishments, and being flexible with scheduling and vacation time. When hiring and promoting from within the company, not only will you ensure current staff get the grooming, experience, and education they need to succeed in your organization, you will strengthen employee retention and promote a positive reputation in the industry. Candidates are often wary of companies with the “revolving door” reputation, so ensuring that your facility is known for employee growth and retention is a key in attracting top talent. Furthermore, it’s important to begin retention efforts early so your organization is prepared to shift from hiring to retention once you do find the right candidates.

Finally, don’t get discouraged. Though finding and retaining the perfect additions to your team can be difficult as the healthcare landscape evolves, facilities can ultimately take steps to beat the competitive market. Through the above methods—adapting and retaining current staff, staying abreast of emerging trends, and understanding what’s most important to today’s candidates—you should be able to easily transition into new care models and hiring trends with the best staff on hand.


About The Execu|Search Group:

As the leading recruitment, temporary staffing, and retained search firm in the New York City Tri-State area and Greater Boston, The Execu|Search Group has been connecting quality candidates with quality companies since 1985. From the start, the company mission has always remained the same: to provide leading employers with the highest caliber talent while maintaining a commitment to integrity, honesty and responsiveness.

Today, The Execu|Search Group serves the following practice areas: Accounting & Finance, Creative & Digital, Engineering, Financial Services, Health Services, Human Resources, Information Technology, Legal Services, Life Sciences, Nonprofit, and Office Support.