Building the On-ramps to Education and Health Careers - Van Ton-Quinlivan, CEO of Futuro Health
The gap is staggering. Just in California alone, 500,000 allied health workers are needed by 2024. Realizing it was time for new approaches to developing this workforce, a unique partnership formed this year with Kaiser Permanente and SEIU United Healthcare Workers to fund and facilitate the educational journey required. Leading the effort is veteran educator Van Ton-Quinlivan, who has her eye on all of the associated issues of student debt, diversity and inclusion, shifting skillsets due to COVID, and other factors. Check out this fascinating discussion with Shiv Gaglani on the innovative thinking and partnerships that are driving workforce development.
SHIV GAGLANI: Hi. I'm Shiv Gaglani. Today, on Raise the Line, I'm happy to be joined by Van Ton-Quinlivan, who's currently the CEO of Futuro Health, a nonprofit established to address the nation's allied health workforce shortage, starting in California. Van is a nationally recognized leader in workforce development who has been quoted in the New York Times, the Chronicle of Higher Education, and many other publications.
Her career spans the public, private, and nonprofit sectors. In 2013, she was named a White House Champion of Change under the Obama administration in recognition of her notable career. She also previously served as Executive Vice Chancellor of the California Community Colleges, which are the nation's largest system of higher education. Van, thanks so much for being with us today.
VAN TON-QUINLIVAN: I'm delighted to join you, Shiv.
SHIV GAGLANI: I'd like to give a quick shout out to Victor Hu at Lumos Capital, who first introduced us. When he first sent me the information about Futuro, I was like, “Victor, please. I have to meet Van,” so I'm really glad that, fast-forward a couple of weeks, we're on this call together.
VAN TON-QUINLIVAN: Likewise.
SHIV GAGLANI: There's been a lot of stressful events over the past few months, obviously COVID, the protests, the political situation. We’d like to start off with our first value, start with the heart, and just ask our guests, “How are you doing? How are things over on your side?”
VAN TON-QUINLIVAN: Well, I feel very fortunate to have had Futuro Health be launched in January of this year as a nonprofit, addressing the shortage in allied health workers for the nation starting here in California. I feel we're right at the moment of time of need, so feel very much that it's a gift that we have the commitment of Kaiser Permanente and SEIU United Healthcare Workers to do this work at a time when the country needs this workforce so very much.
SHIV GAGLANI: Totally. Do you mind going a bit into how Futuro was formed, and then how you came to lead the organization?
VAN TON-QUINLIVAN: Absolutely. My career has spanned the private sector, the public sector, and now the nonprofit sector. I once did workforce development for a company of 20,000 men and women in the energy sector, where we were able to take the company from having no opinion in workforce development into a nationally recognized industry best practice. That was an industry that was facing an aging workforce and could not source qualified, diverse talent in a reliable way. Then I was appointed by the governor of California back then, Governor Brown, to serve as Executive Vice Chancellor of the California Community Colleges.
As you know, the allied health workforce is trained through mostly credentials and degrees that are less than a bachelor, but more than a high school degree, such as an associate’s degree, an industry-valued credential or certificate. The Community Colleges, in general, are sort of the production engine for most of these roles in most communities across America and that’s absolutely true right here in California. That work led me to have this opportunity here, where I can focus specifically on the healthcare industry.
What's so concerning is that when you look at the projections, just even for California, which is one state alone, there's a gap of 500,000 allied health workers that are needed through 2024 so when you start having numbers that big, you know that it's actually a structural issue that no one organization can solve on their own. It requires a different approach rather than one hospital sort of doing incremental work on workforce development or frankly, even the government or any community-based organization.
Maybe you have the question of why do I do this work? Back in 1975, my family escaped from the Vietnam War and came here as refugees, and I knew that every time someone opened the door for me in education whether it was into college or graduate school or even executive education, each time that door was open, I saw greater opportunities than I had before, so I feel very thankful that that was my life's journey. My work is really to open the door for many others who may need that help.
SHIV GAGLANI: I'm 100% aligned. I've seen the impact education can have on even my own life as an immigrant from Namibia with South Asian roots. What are some of the goals of Futuro? When we first spoke, I was just really impressed with how ambitious you all are and how many people you're already working to reach, so would you mind explaining for our audience some of the specific objectives and goals that you all have set?
VAN TON-QUINLIVAN: Absolutely. The mission of Futuro Health is to improve the wealth and health of communities by growing the largest network of allied health workers in the country, starting here in California. We have an immediate goal of credentialing, 10,000 more allied health workers in areas that are of greatest labor demand. If you look at the gap of 500,000, 75% of those roles are concentrated in just 10 occupations.
Our work is just going through those occupations and beginning to improve production. Now, we are not the education providers ourselves. What we do is build the ecosystem. We curate the partners that come together so that the student has what they need in order to move along in that journey. It starts with our partner SEIU United Healthcare Workers with their members who work already in hospitals. They're going out to scout and recruit candidates and there’s no one better than people working in healthcare to be able to have an eye for who would be a good fit for healthcare.
If the individuals have already taken anatomy, physiology, and medical terminology, for example, they can go straight into a medical assistant program that we've lined up and have vetted with six education providers. If they haven't done that, then their on-ramp would be a set of jumpstart courses that includes anatomy, physiology, and medical terminology. If they're struggling with English and confidence in English, then we start them with a partner named Voxy. They started a course called English Readiness for Allied Health.
That's an example of how we're building out all the on-ramps for just the medical assistant program, and we're underwriting 1,000 medical assistants in 2020 to go through and get this certification this year. We're also adding other occupations, several occupations in health IT as well as care coordinator. And of course, we are also impacted by the pandemic as everyone else. Our board recently came together to look at the question of how the pandemic is permanently affecting healthcare and the healthcare workforce versus it being a temporary adjustment.
We know that many organizations, healthcare employers, have their financials upside down because no one's able to do much elective care. However, that's a temporary adjustment. What is made permanent is the incorporation and adoption of telehealth at full scale. We're rolling out Advanced Telehealth Coordinator and a number of other programs that then begin to build skills in graduates as well as in people who are working in healthcare and need to then skill up for that new reality.
SHIV GAGLANI: You preempted my question, which was, workforce development has always been an important topic for decades, I mean, automation and globalization were the catalysts for a lot of this in the past. Now, this pandemic clearly has led to the greatest unemployment rates since the Great Depression. What are some of the lasting effects do you think COVID will have on the workforce and then also within healthcare?
VAN TON-QUINLIVAN: There's going to be a number of factors, but let's follow on the example of telehealth. Even the medical assistant, for example, the traditional medical assistant is someone who is interested in providing care, and those are the skillsets, but if you look at the medical system in the new world that is over telehealth, not only do they have to provide care, but now they have to deal with troubleshooting the patient's devices and equipment to make sure that the patient is ready for the appointments with the doctor.
All of a sudden, you're doing some IT support. Furthermore, you're dealing with situations in the home, so it’s a little bit closer to the skillset, for example, the Geek Squad that has to mobilize in order to get to somebody's house. The skill sets, all of a sudden, have gotten much more complicated than just somebody who's got very empathetic caring and wishes to deliver that human touch. As we look around the corner, we're having all of our education providers beginning to think about pivoting their skill sets in their curriculum, but we're also doing additional work on the soft skills, even for the medical assistant.
It's not only your normal technical curriculum, but we're doubling down on the soft skills, the interpersonal skills that are needed to operate on the care team, but also the soft skills necessary to operate in a telehealth environment. So you need to pivot. All of your assumptions on what is valuable today need to be revisited for the skill sets that used to be around the corner but that are actually right in front of us now.
SHIV GAGLANI: That's a really, great, and very specific example. The Geek Squad analogy is very interesting too because we all can relate to the fact that setting up certain technology can be tough, and as people have to stay in their homes to be able to measure their own vital signs, if they don't know how to operate a blood pressure cuff, they'll need help with that, so that's really interesting.
As far as the 1,000 medical assistants, you're planning to train this year, do you have any sense of the profile? Are these people who maybe lost their jobs at say JCPenney who are trying to reskill, or are they people who maybe already work in the health system, like a medical billing person who wants to upscale or laterally transfer within healthcare?
VAN TON-QUINLIVAN: It's open to the full range. When we look at the profile, it's more around the average age of 35 with a great range of diversity and life has just gotten in the way somehow -- death in the family, job loss, children -- so a lot of life circumstances have just disrupted and they are now revisiting getting their certification. As you know, concerns around student debt become much more pronounced. It was already a concern and is much more pronounced at this moment in time, so we're delighted to have the funds from Kaiser Permanente and SEIU to underwrite tuition in 2020 for all these candidates.
SHIV GAGLANI: That's wonderful. I was actually going to ask you about student debt. We are fans— Kaiser Permanente, along with NYU Medical School, both of which are partners of Osmosis - led the news in terms of making it free medical school tuition. The median debt of a medical school graduate is $200,000, according to the Association of American Medical Colleges. When I was in medical school, I think it was 180,000, so it's gone up 10, 20% in those years.
One interesting aspect of the COVID pandemic is that it seems to have made society treat healthcare professionals with more respect and care more about things like burnout and student debt. Do you think there will be actual long-term policy changes that address this issue of student debt, particularly for essential healthcare workers?
VAN TON-QUINLIVAN: Well, the pandemic has brought up, and it’s also echoed in the Black Lives Matter movement, the issue of equity and inequity. When we think about the healthcare workforce, especially when you're working with underserved communities, this issue becomes even more pronounced, and one root cause is whether there is the workforce that has the cultural competence and a desire to work in these respective communities.
What we found in my prior life was that it was easier to grow within the communities, especially where there's a lot more mobility, rather than import. People imported from other states or other regions didn't tend to stick as long as people who grew up in that community, so I think we have to look at all the solutions and think about how to make more transparent where the needs are because it's a confusing array of careers out there. Unlike doctors and nurses, which we know are in short supply, you don't often have a discussion around the dinner table about, “I want to grow up, or I want you to grow up to be a medical sonographer or a licensed vocational nurse, or licensed practical nurse, or a respiratory therapist."
I would not imagine that many conversations of this level of detail go on, so we have good jobs where the financial investment, the ROI is quite manageable, but there's a lack of awareness that these jobs exist, especially in underserved communities. We not only have to serve the financing, but we actually have to serve the career awareness part of the equation, and then make it easy for a candidate to move through a pipeline and not get distracted by all of these options that are out there that have not been vetted. I think part of our collective work is career awareness and then how to move people through good programming.
SHIV GAGLANI: Definitely. You are all about workforce development. Let’s say someone becomes a medical assistant through Futuro. How do you then give them more opportunities to go from the entry-level job into medical billing or medical sonographer and just work their way up?
VAN TON-QUINLIVAN: Let me break that maybe into two parts. First is that we need to get people in the door. If you don't yet have a bachelor's degree or a master's degree, it is a very long path, a very financially difficult path to get to that level. Many jobs are at that level. What we're beginning to see now is a whole set of modularizations of those bachelors into what are the stackable credentials in between each stack that is valued by the employer.
Instead of trying to take a giant bite of education, which not everybody has the time and the ability to access at this moment in time, how do they take smaller bites to get in the door? Then the next policy that we'd love to see to be more pervasive is not actually tuition, reimbursement, but tuition disbursement. The Aspen Institute has been really a good proponent of this. There was once a CEO whom I heard of at a large manufacturing company, and he went around his company and said, “You know, we have this tuition reimbursement policy, why don't you take advantage of it?”
Basically, it came down to two things. The first was flexibility. For most workers -- with their commitment to work and children and life -- they just did not have the flexibility to physically get on a campus and deal with the normal sort of a schedule of a college campus, so they needed adult-friendly programming in other words. The other part was actually the cash flow of the cost of the tuition. So actually having to pay it up front and then get reimbursed by the company for most average Americans, that was actually quite a difficulty and quite a burden.
Once he actually changed his internal reimbursement policy from being after the fact to actually floating the cash up front, he actually went from a, maybe, 60 takers to over 700 takers within these employees. I think we need to just look at how we can get people in the door into good industries and then begin to stack up their credentials with assistance from the employers while they're there.
Now, the other part is the dilemma that employees are not with their employers very long anymore. In the good old days -- like my father-in-law used to work with Boeing for over 30 years -- during that time, not only did they provide him with health benefits and other benefits, but they trained him. They sent him to education along the way.
Well, even with a good employer who is doing that, the average tenure of someone with their employer has now shortened down to five years and is growing less. One of the conversations I had at a National Governors Association gathering is how we make the financing of education because it's some combination of public financing, it's your personal, but then it's also the company. So in the same way that you save for your 401K, your company contributes to it, but it moves with you.
There could be a continuous 529 where companies can contribute to it, but it goes with you and can help you finance education and continuous upskilling throughout your career, but it's uncoupled from your employer because we're not with our employer as long as it used to be. These are some of the provocative policies that we could think about.
SHIV GAGLANI: That is really fascinating. I hadn't heard of that ever before, but it makes a lot of sense. You've definitely heard of income share agreements and those kinds of innovative models of financing as well. I know we’re coming up on time, so I have just two last questions. The first is, say you were beginning to look into upskilling or reskilling yourself, or you're a student, what advice would you want to be told at this point when so much seems to be in flux?
VAN TON-QUINLIVAN: I had the opportunity to speak at a graduation of master's level tax and accountants and MBAs. Of course, they were very anxious about future work and where they would stand. One of the exercises that I recommended was not to look at the one or two-year timeframe, but beginning to look at the 10-year timeframe because when you're looking at the shorter timeframe, you get very anxious about it. But 10 years seems far enough away.
I suggested they go through some serious, provocative questions. If everything written and repetitious in your profession is going to become automated and can be done by machines, then what kind of work would value the human touch? If you spent some time thinking about it, you would be able to think, “Okay, well, let's move more in that direction and less in some other directions.” If that world is one where your colleagues can be humans, robots, or avatars, what skills would make you a good colleague? That's another one where you have to ask what are the collaboration skills and the sort of digital integration skills?
What if the technology platforms and the algorithms become the new middle managers to assign work and to match you with work? What does that mean about you having a digital profile of who you are? Because again, algorithms can only read data, so if you cannot represent yourself and your experience, your education, your credentials, your networks, your influence through data by updating a profile, then the algorithm cannot recognize you and match you to work.
I think if you start thinking through some of these provocations about the 10-year future, then you begin to think, “Okay, am I moving my skill set in a direction that is more consistent with the future or is my skill set is going to stagnate?” Those are some exercises that I think we can all go through just to reflect on how we stay ahead and how we keep current.
SHIV GAGLANI: That's fascinating. I think our answer to that question is over the next five, 10, 15 years as so much of medical knowledge becomes automated and replaced - and also democratized with patients getting their own kind of information -- we are interested in developing more caring people because I think it's going to be a much longer time before a machine can demonstrate care in the way that humans can.
VAN TON-QUINLIVAN: In the short term, Shiv... I understand, like for doctors, that at the moment in the room where they touch the doorknob to exit, that's when the patient often stops the doctor and says, "Oh, well, but I have this other issue," so even in the telehealth environment, how would you mimic that signal? Those are short-term adjustments in addition to what you're talking about in the long term.
SHIV GAGLANI: That's a good point. Yes, for sure. It's a whole new environment. My last question is, is there anything else that you'd want our audience to know about you, about Futuro, about society as a whole, and what you’ve seen in the healthcare systems or the future work?
VAN TON-QUINLIVAN: Well, I think all of us need to contribute to the thoughts and actions around how we make an inclusive recovery. Whether you're going to become a doctor and you have a lot of staff around you who may struggle with the debt because they got in the door, but they can't move up, to those of you who are running organizations, I think we can all, from our seat, really just think hard about how the recovery can be inclusive so that not only are we a healthier country with healthier communities, but that it's a more equitable delivery of healthcare in the long run.
SHIV GAGLANI: Those are some great parting words and something we can all strive for. Van, thank you so much for taking the time to be with us today, and more importantly, for the work that you all are doing at Futuro.
VAN TON-QUINLIVAN: Thank you, Shiv. This has been a real pleasure. Keep up the good work.
SHIV GAGLANI: With that, I'm Shiv Gaglani. Thank you for checking out today's show, and remember to do your part to flatten the curve and raise the line. We're all in this together.