Innovative Workforce Models Highlight the Value of Pre-Baccalaureate Health Care Workers

As the nation seeks to improve access to primary care services, medical assistants (MAs) and other pre-baccalaureate occupations highlighted in a recent Brookings report will be a critical component of that growth and expansion. Medical assistants are some of the most common clinical support staff in ambulatory and outpatient healthcare settings but are also relatively low-paid and can face limited career development. Our research at the Center for the Health Professions at the University of California, San Francisco shows that medical assistants are a largely untapped resource to improve healthcare delivery.

The Affordable Care Act has increased the number of insured individuals seeking care. More patients grapple with chronic diseases like diabetes that require ongoing management. Linguistic and cultural barriers challenge the provision of adequate care as patients and providers struggle to understand one another—even when they ostensibly speak the same language. Research suggests that the average primary care physician does not have enough hours in a day to adequately attend to the needs of a patient population that is aging and facing increasingly complex health conditions. Many pioneering primary care practices are addressing these challenges with innovative staffing models that make better use of their frontline staff, delegating more tasks to qualified pre-baccalaureate health care workers.

With support from the Hitachi Foundation, we visited and profiled 15 such practices around the country that were employing medical assistants in new roles in team-based models that improved patient access, health outcomes and provider satisfaction, while cutting costs and/or increasing revenues. In these practices, MAs are being trained to move beyond rooming patients and taking their vital signs to working as health coaches, helping patients with chronic diseases manage their conditions; serving as dual-role interpreters, alternating between medical interpretation and medical assisting roles as needed; visiting patients in their homes to perform risk assessments; scribing during the medical exam to free the provider to focus on the patient; and much more. These MAs have become an integral part of the care team and make a considerable contribution to continuity of care.

Health care training programs, while growing in capacity, are not keeping up with the actual skills needed to work in these new roles—requiring that practice sites make a considerable investment in staff training. In order to reward and retain highly trained staff, many sites are offering career development as a part of their practice change model, providing career ladders with promotions both within and beyond the MA job category, wage increases, quality bonuses, educational reimbursement and other means of recognition for the value added by their MAs. Career development for frontline workers may provide a broader benefit, enabling local health care organizations to serve as “economic engines” for the communities they serve, providing not only culturally competent health care to patients, but economic opportunity and upward mobility to the health care workers who often originate from those same communities.