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Health Workforce Subcommittee Governo nors s C Counc ouncil f for W Workfor orce and Econom onomic D Develop opment nt June 22, 2017 Health Workforce Subcommittee Governors Council on Workforce and Economic Development


  1. 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

  2. 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

  3. 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”

  4. 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

  5. Research to Recommendations Identify Topic Area Research Key Findings Implications / Environment Recommendations

  6. 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.

  7. 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 ▲▲▲▲▲

  8. 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

  9. 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

  10. 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) •

  11. 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

  12. 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

  13. 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

  14. 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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