Executive Summary
Healthy citizens, families, and workers with access to quality health care are all essential components of Wisconsin’s economic infrastructure. Wisconsin health care providers have enthusiastically embraced their responsibility to lead Wisconsin’s continuous improvement effort in delivering quality health care and pride themselves on being active, innovative, effective members of Wisconsin’s economic community.
Being active, innovative and effective in today’s health care world is absolutely necessary, but it’s not easy, and most providers will tell you that they are grappling with three specific issues affecting their ability to help people build the healthy Wisconsin everyone wants, employers need and that the economy must have. The three issues are interrelated. Each represents both a threat to public health and an opportunity to address the issue in a manner that could not only improve public health, but also strengthen Wisconsin’s economic wellbeing.
Issue 1: Workforce Shortages
The most immediate and visible issue is the shortage of health care professionals and providers. In 2016 the Association of American Medical Colleges released a report indicating that, “Under every combination of scenarios modeled, the United States will face a shortage of physicians over the next decade … The projections show a shortage ranging between 61,700 and 94,700, with a significant shortage showing among many surgical specialties.” A 2011 Wisconsin Hospital Association study reported that Wisconsin needed 900 new doctors a year to meet existing demand and concluded that even if one assumed the current recruitment and retention patterns could be sustained, only 800 of those needed would be found and the state would be short at least 100 doctors each year.
The nurse shortage is equally acute and the deficit numbers are much larger. In 2013, for example, the Bureau of Labor Statistics estimated that the 2012 nurse population would have to grow nearly 20 percent to meet demand in 2022. That projection would require the training and hiring of more than 1 million new nurses, 525,000 to replace nurses retiring from the profession and 526,800 to meet growing demand. The projected national shortages are confirmed in a series of reports issued by the Wisconsin Center for Nursing that indicate that Wisconsin will be short more than 1,000 new nurses every year for the next 20 years.
To address these workforce shortages, the BE BOLD III Health Care Strategic Planning Group (HC-SPG) recommended that Wisconsin recognize Wisconsin’s physician and nurse shortages as urgent, timecertain, systemic challenges that represent a genuine threat to the state’s public and economic health that can best be addressed collaboratively on a statewide basis. To that end, the HC-SPG developed a set of operating assumptions (see p.33) and based on those operating assumptions recommends charging the Wisconsin Council on Medical Education and Workforce (WCMEW) with convening a multi-sector consortium – consisting of WCMEW, employers and community leaders – tasked with defining challenges and proposing outcome and cost effective systemic proposals on how best to address Wisconsin’s short- and long-term physician and nurse shortages.
The HC-SPG believes that the systemic proposals will involve systemic changes that will require funding
and, in keeping with the BE BOLD tradition, boldly recommends that Wisconsin think of this necessary
investment in public health and economic wellbeing as the surest road to revenue that can only be
generated if these jobs are filled. We are not talking about creating jobs. We are talking about filling jobs
and creating taxpayers.
Issue 2: Population Health
Scientific and technological advances are revolutionizing the diagnostic, treatment, and delivery elements of the health care system. Concerns about cost; the emergence of Big Data mining as a analytical tool; and politics are changing what gets measured, how it gets measured, who gets paid what for it, and who will pay what for it.
In this mind-boggling storm of change, three challenges have emerged around population health,
including:
Challenge No. 1: The decision to shift from a treatment volume-based reimbursement system to an outcomes-based reimbursement system for health care forces a recognition that environmental, economic and lifestyle choices are contributing factors that determine the health of the patient seeking care and the care options available to his/her health care provider. A growing awareness that these factors represent a sort of “societal preexisting condition” is driving a major re-assessment of the factors affecting public health and what exactly constitutes “health care.”
To address this challenge, the HC-SPG calls for the creation and empowerment of a collaborative systemic infrastructure focused holistically on improving population health. (see pp. 45-46).
Challenge No. 2: Demographic realignments (see Figure 1) and economic pressures are exacerbating the challenges health care providers face and affecting their ability to adjust to the need to address community-wide health issues.
To address this challenge, the HC-SPG recommends creating a collaborative of existing and new sources tasked with scaling up and systematizing existing best practices; developing new approaches and strategies; identifying systemic efficiencies; and developing and marketing commercial products and applications related to addressing the challenges and opportunities of the target populations (see p. 47-48)
Challenge No. 3: While recognizing that addressing the economic, social and behavioral phenomena that adversely affect community health is a critical step toward more comprehensive health care, it requires understanding that: a) doing so will have minimal, if any, impact on current patient outcomes for some time; b) that achieving economic, social and behavioral changes that positively affect community health outcomes will take time and money; and c) that the investments required to make progress on this front must either come from existing budgets, which may affect current patient outcomes, or from some new source of revenue.
To address this challenge, the HC-SPG recommends (see p. 49):
- initiating a comprehensive statewide public information and education campaign targeted at employees and employers dedicated to promoting adoption of proven best practice wellness and prevention care insurance plans. The costs of the campaign should be financed with state funds and tax-deductible private sector employer funds. The statewide education and information campaigns should be augmented with local and regional efforts.
- adopting a statewide transitional funding plan.
Issue 3: Research, Development and Investment Entrepreneurs know that opportunity lies at the intersection of need and vision and capacity. In recent years, it has become more and more apparent that health care, particularly that of the aging, is generating a major and growing need. Companies like Epic, Exact Sciences, Promega and dozens of others in
Wisconsin developed scientific and technological capacity to create their own opportunities and now employ thousands of Wisconsin residents and taxpayers.
The emerging demands of the population health marketplace referenced above will potentially create a larger and equally important demand for goods and services and cures and miracles and for some way to access them on and/or deliver them to our mobile devices. The need is clearly there. Wisconsin has the necessary research and development skills. The question is whether or not we have the vision and whether or not we can attract capital to implement the vision and seize opportunity.
To address these issues, the HC-SPG recommends developing a health care management ecosystem (e.g.,
similar to that emerging in Wisconsin around water management) tasked with, among other things:
- creating a centrally located innovation hub that can provide opportunities for entrepreneurs to network
and learn in the pre-start-up phase and supporting commercialization with public and private sector
engagement; - incentivizing collaboration between private and public organizations; and
- promoting specific investment opportunities and tax incentives that will increase investments in technology infrastructure and tools.
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