Health Workforce Subcommittee Governo nor’s ’s C Counc ouncil f for W Workfor orce and Econom onomic D Develop opment nt June 22, 2017
Health Workforce Subcommittee Governor’s Council on Workforce and Economic Development June 22, 2017 1:30 p.m.-3:30 p.m. OSDH 1000 NE 10 th Street, Room 1102 Oklahoma City, OK 73117 Presenter Time Section Shelly Dunham, Co-Chair Welcome and Introductions David Keith, Co-Chair Research to Recommendations Jennifer Kellbach Graduate Medical Education John Zubialde, MD Recruitment and Retention Jana Castleberry Critical Occupations Shelly Dunham Health Workforce Plan Priorities Shelly Dunham, Co-Chair Discussion David Keith, Co-Chair Innovation Waiver/Quality Measures Buffy Heater Shelly Dunham, Co-Chair Wrap Up and Next Steps David Keith, Co-Chair 2
Meeting Objectives • Advance understanding of evaluation process to ensure data-informed and evidence-based recommendations • Determine support for graduate medical education, recruitment and retention recommendations • Understand and approve “Critical Healthcare Occupations” list • Identify priorities in “Health Workforce Action Plan”
Health Workforce Subcommittee Governor’s Council on Workforce and Economic Development June 22, 2017 1:30 p.m.-3:30 p.m. OSDH 1000 NE 10 th Street, Room 1102 Oklahoma City, OK 73117 Presenter Time Section Shelly Dunham, Co-Chair Welcome and Introductions David Keith, Co-Chair Research to Recommendations Jennifer Kellbach Graduate Medical Education John Zubialde, MD Recruitment and Retention Critical Occupations Jana Castleberry Health Workforce Plan Priorities David Keith, Co-Chair Discussion Innovation Waiver/Quality Buffy Heater Measures Shelly Dunham, Co-Chair Wrap Up and Next Steps David Keith, Co-Chair 4
Research to Recommendations Identify Topic Area Research Key Findings Implications / Environment Recommendations
Sources of Evidence Sci cient entific c Evi Evidenc ence: findings from published research Organization onal l Evidence: data, facts, and figures gathered from organizations and experts Exper Ex eriential Evi Evidenc ence: the professional experience and judgment of partners and other states Stakeholder E Evidence: The values and concerns of people who may be affected by the decision (implications) Source: Center for Evidence Based Management. (2014). Evidence-Based Management: The Basic Principles. Retrieved from: https://www.cebma.org/wp-content/uploads/Evidence-Based-Practice-The-Basic-Principles-vs-Dec-2015.pdf.
Quality of Evidence Evidence o of Ineffectiveness s Mixed E Evidence ▲ Insu sufficient E Evidence ▲▲ Exper ert O Opini nion n ▲▲▲ Some E Evidence ▲▲▲▲ Scientifically S Suppor pported ▲▲▲▲▲
Evidence Rating Scale Rating Evid idence C Crit iteria: Am Amount & & Type Evid idence C Crit iteria: Q Qual ality Scientifically 1 or more systematic review(s), or at least: Studies have: • Supported 3 experimental studies, or Strong designs • • ▲▲▲▲▲ 3 quasi-experimental studies with matched concurrent Statistically significant positive • • comparisons findings 1 or more systematic review(s), or at least: Studies have statistically significant • 2 experimental studies, or positive findings • Some 2 quasi-experimental studies with matched concurrent • Evidence comparisons, or Compared to 'Scientifically ▲▲▲▲ 3 studies with unmatched comparisons or pre-post Supported', studies have: • measures Less rigorous designs • Limited effect(s) • Generally no more than 1 experimental or quasi- Expert recommendation • • experimental study with a matched concurrent supported by theory, but study Expert Opinion comparison, or limited ▲▲▲ 2 or fewer studies with unmatched comparisons or pre- Study quality varies, but is often • • post measures low Study findings vary, but are often • inconclusive Source: University of Wisconsin Population Health Institute. What Works for Health: Policies and Programs to Improve Wisconsin’s Health. http://whatworksforhealth.wisc.edu/rating-scales.php
Evidence Rating Scale, continued Rating Evid idence C Crit iteria: Am Amount & & Type Evid idence C Crit iteria: Q Qual ality Generally no more than 1 experimental or quasi- Study quality varies, but is often • • Insufficient experimental study with a matched concurrent low Evidence comparison, or Study findings vary, but are often • ▲▲ 2 or fewer studies with unmatched comparisons or inconclusive • pre-post measures 1 or more systematic review(s), or at least: Studies have statistically • • 2 experimental studies, or significant findings • Mixed Evidence 2 quasi-experimental studies with matched concurrent Body of evidence inconclusive, or • • ▲ comparisons, or Body of evidence mixed leaning • 3 studies with unmatched comparisons or pre-post negative • measures 1 or more systematic review(s), or at least: Studies have: • Evidence of 3 experimental studies, or Strong designs • • Ineffectiveness 3 quasi-experimental studies with matched concurrent Significant negative or ineffective • • comparisons findings, or Strong evidence of harm • Source: University of Wisconsin Population Health Institute. What Works for Health: Policies and Programs to Improve Wisconsin’s Health. http://whatworksforhealth.wisc.edu/rating-scales.php
Impact Rating Direc Di ection a and d Extent of Impact ↑ ↑ ↑ ↑ or ↓↓↓↓ significant impact on many ↑ ↑ ↑ or ↓↓↓ significant impact for few or small impact on many ↑ ↑ or ↓↓ moderate impact on medium number ↑ or ↓ small impact on few ? uncertain None no impact Direction of the arrow indicates positive impact (increase or • improvement) or negative impact (decrease or makes worse) Number of arrows represents the level of impact (highest to none) •
Additional Evaluation Criteria Cost st/Be /Benefit it Is there a defined Positive cost/benefit? Return rn o on Negative Is there N/A or Unknown Investment demonstrated ROI? Long-term Is there evidence Sustain ainab abil ilit ity Short-term for sustainability? N/A or Unknown Examples: Are one or more Imp mpact geographic; subpopulations Distrib ibutio ion ethnicity or race; impacted more? sub-populations
Evaluation Example – Tort Reform Quali lity of f Cost/Benefit Sustai ainabi abili lity Impact ct: Impact ct IMPACT AR IMP AREA Evidence ROI RO ↑ or ↓ Distribu bution: Short-Term Long-Term Positive Direction and level of Rural, Regional, N/A or Unknown Negative impact Sub-Pop. N/A or Unknown ▲ Positive, but minimal N/A* ↓ N/A reductions found in litigation time can Mixed evidence on some studies; takeaway from direct reduction in Congressional Budget provision of health Wealth Generation health care spending Office calls for care services Employment as a result of tort national reforms in Growth reform efforts order to reduce Wages/Poverty overall healthcare spending by 0.5% ▲ no conclusive N/A* ↑ N/A evidence that reforms Some evidence to No conclusive increase or decrease suggest greater evidence to show tort “defensive medicine” access through Health Outcomes reform improves – even for higher risk marginal increases in Access to Care health outcomes specialty like OB practicing physicians ▲ Lower caps may lead N/A* ↑↑ Some reforms may to lower malpractice Modest impact in impact rural No conclusive insurance premiums *enacted increasing physician providers and some evidence to show tort which may lower legislation/regulation workforce specialty (emergency Team-Based Care will allow for long term reform increases or consumer health and OB/GYN) Scope and Roles sustainability, but decreases the insurance premiums Systems there is no direct physician workforce – but does not impact Transformation evidence for sustained workforce impact on any of the identified impact areas
Health Workforce Subcommittee Governor’s Council on Workforce and Economic Development June 22, 2017 1:30 p.m.-3:30 p.m. OSDH 1000 NE 10 th Street, Room 1102 Oklahoma City, OK 73117 Presenter Time Section Shelly Dunham, Co-Chair Welcome and Introductions David Keith, Co-Chair Research to Recommendations Jennifer Kellbach Graduate Medical Education John Zubialde, MD Recruitment and Retention Shelly Dunham Critical Occupations Jana Castleberry Health Workforce Plan Priorities David Keith, Co-Chair Discussion Innovation Waiver/Quality Buffy Heater Measures Shelly Dunham, Co-Chair Wrap Up and Next Steps David Keith, Co-Chair 13
BACKGROUND – GME ISSUE BRIEF The GME Committee has worked on a draft issue brief providing recommendations related to the supply of physicians in Oklahoma. OSDH staff supported research/writing; GME workgroup provided input on additions/changes which were incorporated since the April meeting. Working Title: “ Physician Supply Key to Oklahoma’s Health and Wealth” Purpose of the Brief: Provide evidence on Oklahoma’s challenges in physician training, recruitment and retention Highlight current state-specific training, recruitment and retention initiatives in Oklahoma. Recommend strategies for addressing physician supply challenges. Inform the overall subcommittee on the issue to help coordinate planning and future communications.
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