Masi, 2009), and consequently on RNs and nurse practitioners to practice in these settings (Craven and Ober, 2009). In addition, investment in the expansion of interoperable health information technology (HIT) platforms that are critical to the implementation of these system reforms will spur the growth of community-wide information exchange that has the potential to change the distribution, skill-mix, and scope of practice of nurses in profound ways.

So what does a reformed health care delivery system foretell for the future nursing workforce? Will the demand for services provided by RNs change, as the provisions in the legislation suggest, and if so is the nursing workforce positioned to effectively respond? What role will the nursing workforce play in a post-reform environment? This paper examines these questions. We assess the composition, skill set, and scope of practice needed from a future RN workforce to support the health care delivery and coverage reforms that will emerge from the reform legislation and related initiatives. We describe the future demand for RNs under these reforms, how that demand comports with the current and anticipated future supply of RNs, the challenges in meeting the workforce demands of a reformed health care delivery system, and recommendations for future RN workforce planning.

THE IMPACT OF HEALTH CARE DELIVERY REFORMS ON DEMAND FOR HEALTH CARE SERVICES OF NURSES

What will be the demand for the health care services of RNs under the proposed health care delivery reforms? An examination of the health reform legislation and other related policy initiatives reveals a number of programs and provisions that call for reorganization of health care services and the workforce responsible for delivering them. Their implementation could have a significant effect on the future roles of and requirements for RNs.

Advancing Care Management Models

“Care management” comprises a broad and evolving range of strategies to effectively intervene and improve the care for primarily chronically ill individuals—those whose care spans multiple providers and requires continuous, long-term management. Disease management (DM) programs—diagnosis-specific programs targeting chronic illnesses responsible for the largest share of health care spending—have been the dominant form of care management programs for the past 15 years. DM programs target patients with specific chronic illnesses (e.g., heart failure, chronic obstructive pulmonary disease, diabetes), offer providers tools to improve their clinical management, promote outreach and support strategies to improve patient adherence to treatment plans, and provide feedback systems to monitor patient outcomes (Krumholz et al., 2006). Out of DM programs came case management and care coordination strategies that target persons with multimorbidity chronic illnesses and complex care needs in addition



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