Health Workforce Subcommittee Governors Council for Workforce an - PowerPoint PPT Presentation

Health Workforce Subcommittee Governor’s Council for Workforce an and Ec Economi onomic c Development elopment 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 Scientif ific ic Evidence ce: findings from published research Or Organiz izatio ational nal Evidence ce: data, facts, and figures gathered from organizations and experts Experi riential ential Evidence ce: the professional experience and judgment of partners and other states Stakeho eholder lder Evidence ence: 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 ence of Inef effecti ectivenes eness s  Mixed ed Evidence ence ▲ Insuf suffi ficie cient nt Evidence ence ▲▲ Exper pert Opini nion on ▲▲▲ Some me Evidence ence ▲▲▲▲ Scientif entifically cally Suppo pported ed ▲▲▲▲▲

Evidence Rating Scale Ratin ing Eviden ence ce Criteria ia: Amount nt & Type Eviden ence ce Criteria ia: Qualit ity 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 Ratin ing Eviden ence ce Criteria ia: Amount nt & Type Eviden ence ce Criteria ia: Qualit ity 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 Directi ction on and Exten ent t of Impa mpact ct ↑ ↑ ↑ ↑ 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 /Bene nefit it Is there a defined Positive cost/benefit? Retu eturn rn on Negative Is there N/A or Unknown Investm estmen ent demonstrated ROI? Long-term Is there evidence Susta tainab inability ility Short-term for sustainability? N/A or Unknown Examples: Are one or more Impact act geographic; subpopulations Distri tribut bution ion ethnicity or race; impacted more? sub-populations

Evaluation Example – Tort Reform Qualit lity of Cost st/Be /Benef efit it Sustainabil tainabilit ity Impa mpact: t: Impa mpact t IMPACT CT AREA Evid iden ence ROI ↑ or ↓ Distr trib ibutio ion: 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