Board of Regents

Board of Regents - Joint Education Committee and Finance Commitee Minutes - December 2008

MINUTES
JOINT MEETING OF THE EDUCATION AND
THE BUSINESS, FINANCE, & AUDIT COMMITTEES, BOARD OF REGENTS
University of Wisconsin-La Crosse
Cartwright Center – Valhalla B

                                                                December 4, 2008             

Regent Davis convened the joint meeting of the Education and Business, Finance, and Audit Committees at 1:13 p.m.  Regents Davis, Bradley, Burmaster, Connolly-Keesler, Crain, Cuene, Falbo, Loftus, Smith, Spector, Thomas and Womack were present.  Regent Bradley joined the meeting in progress.

  1. Wisconsin Partnership Program:  2009-2014 Five-Year Plan

 

Regent Davis welcomed those present to the presentation of the second five-year plan for the UW School of Medicine and Public Health’s Wisconsin Partnership Program (WPP).  She reminded her colleagues that the Board of Regents had approved the first plan in 2003, and had received annual reports since that time, most recently in August.  She then introduced Dr. Robert Golden, Dean of the UW School of Medicine and Public Health (SMPH).

Dean Golden began by noting that the Wisconsin Partnership Program’s new five-year plan, covering 2009-2014, was developed through a year-long process involving discussion and debate between the Oversight and Advisory Committee (OAC) and the Medical Education and Research Committee (MERC), the Program’s two governance committees, as well as gathering information from stakeholders and the general public throughout the state of Wisconsin.  He described the Program’s governance structure and the operational structures of the OAC and MERC.  He outlined the responsibility held by the UW Foundation to invest and account for the funds approved by OAC and MERC for disbursement, and the role of WUHF, the Wisconsin United for Health Foundation, the public review body created by the Insurance Commissioner’s Order.

Dean Golden reviewed the Board of Regents’ responsibilities for the Wisconsin Partnership Program, including its approval of the Program’s five-year plans, review of annual reports, review of audits, and appointments to OAC.  He pointed to the Program’s mission and vision, which seek to have a dramatic impact on the health of Wisconsin by reducing health disparities through research, education, and community partnerships.  He described the SMPH as on the cusp of a radical transformation in developing a new kind of clinical workforce that would merge the scope of traditional medicine with the scope of public health.  This transformation, he said, is at the heart of the vision for an integrated school of medicine and public health, adding that individual medical care remains important but true improvement of health outcomes requires a broader public health perspective and framework.

The new five-year plan, Dean Golden continued, would work towards a more balanced portfolio of investments which span a continuum of  community-academic partnerships, education, and research, guided by the overarching strategies of transformation, balance, and collaboration.  He noted that over 100 community-academic partnerships had been funded since the beginning of the WPP and that this number would grow with the implementation of the new plan.  He shared with Regents some of the program highlights from 2004-08, which included innovative research and education programs focused on heath improvement, training for the public health workforce, and implementation of new public health programs and policies

Dean Golden then described the considerations that went into developing the 2009-2014 Plan, including the strategic planning to continue the transformation of the medical school into an integrated school of medicine and public health; the important input of program stakeholders and the public; program evaluation in order to measure progress; and the statewide health assessment completed in the report, Making Wisconsin the Healthiest State.  He pointed to his colleague Professor Emeritus Dr. David Kindig, who had played a lead role in the development of the Health of Wisconsin Report Card.  That report assessed the state with a B- in overall health but a D in health disparities.  The new five-year plan, said Dean Golden, sought to address and reduce these disparities. 

In reporting on the activities of the Oversight and Advisory Committee, Dean Golden discussed the continuing and new initiatives that would receive OAC funding, emphasizing the community-academic partnerships that the program sought to strengthen.  OAC would also continue to support public health education and training through programs like the Healthy Wisconsin Leadership Institute and the Wisconsin Population Health Fellowship Program.  One of the program’s new initiatives focused on reducing health disparities in birth outcomes, providing significant funding to address the issues surrounding Wisconsin’s dismal African American infant mortality rates.

Dean Golden then reported on the work of the Medical Education and Research Committee or MERC.  There again, he noted, the program has a thoughtful strategy for moving forward in the next 5 years, including more research and education focused on community engagement beyond the boundaries of the SMPH.  Formal accreditation of the new Master of Public Health program was expected in 2009.  Through MERC support, the SMPH was continuing the redesign of medical education.  Having already redesigned the first two years as a part of the first five-year plan, the next plan would focus on the third and fourth years.  Among other improvements, students would receive a better balance of disease prevention and more hands-on experiences in public health.  MERC research initiatives included the New Investigator Program for junior faculty, the Institute for Clinical and Transformational Research, and the SHOW (Survey of the Health of Wisconsin) Project.  The new MERC framework would also expand community-based research focused on public health, health services, and health policy development.  He described the significant role OAC has played in expanding the community engagement focus of MERC for faculty and students.

Dean Golden concluded his remarks by observing that the economy has had a deleterious effect on the WPP endowment, which has decreased by 20% since last year.  The program was proceeding cautiously in implementing its new initiatives to ensure the fiscal integrity of the program going forward.

Dean Golden then introduced Doug Mormann, La Crosse County Public Health Officer, and Vice Chair of the OAC.  Mr. Mormann thanked the Regents for their support and for allowing him to serve on OAC.  As a member of the OAC, he participated extensively in the planning process for the new five-year plan, reviewing all the information that came in about the work of the two committees and the projects they funded.  He described the important and valuable process by which the new plan was arrived at, including the meetings with stakeholders.  The Wisconsin Partnership Program, he concluded, had affected his community in various ways, as Chancellor Gow’s morning presentation had shown in his referencing of one of the WPP-funded programs.

In opening the floor for discussion, Regent Davis acknowledged Regent Emeritus Axtell’s liaison role to OAC.  Regent Loftus then directed a number of questions to Dr. Kindig regarding the accountability and measurements of progress used by Wisconsin health researchers in determining whether health disparities were being reduced.  He asked whether the indicators used would be comprehensible to the Regents, other policy-makers, and the public.  Dr. Kindig responded that the two reports alluded to earlier by Dean Golden—the Making Wisconsin the Healthiest State and the Health of Wisconsin Report Card—were outcomes-based.  The overall health for the state, which received a grade of B- in the Report Card, was commonly understood and measured nationally.  The Report Card grade of D, given to the state’s goal to reduce health disparities, was determined by tracking a large number of health measures over time.  Some of these measures, like race, ethnicity, geographical location and gender, were more clearly understood; others, like smoking, violent behavior, and educational attainment, were more complex and hence difficult to explain.  Regent Loftus mentioned a report he had read that morning that the infant mortality rate for African Americans in Milwaukee had gone down.  Dr. Kindig observed that while the decrease is good, the number should be zero, and that even a small gap between the majority and other populations—whether based on race or income—was unacceptable.

In response to a question from Regent Loftus, Dean Golden noted that the mental health focus of the Wisconsin Partnership Program would be getting increased attention, as indicated by the work being done to reduce excess alcohol consumption.  Returning to the topic of accountability, he reported that Dr. Kindig and his colleague had just received a large grant from the Robert Wood Johnson Foundation, which felt that the report card approach was so important that other states should replicate it.  Dean Golden noted that the Wisconsin Partnership Program had done everything it could to be transparent, the Report Card being one indicator, in addition to annual reports to WUHF and the Board of Regents, extensive web postings of program and funding information, and both virtual and face-to-face town meetings.  He further explained the ways in which the Wisconsin Partnership Program engaged community partners and held them accountable through data, thus building the evidence that could lead to good policy by decision-makers.  Mr. Mormann added that the public health community was very appreciative of the work of the Wisconsin Partnership Program.

In response to a question from Regent Spector, Dean Golden answered that the Wisconsin Partnership Program sponsored jointly with the Medical College of Wisconsin’s Partnership Program the Leadership Institute for the public health workforce.  Several other collaborations with the Medical College of Wisconsin (MCW) were underway, including a Wisconsin Genomics Project with the Marshfield Clinic.  In response to another question from Regent Spector, Dean Golden reported that WUHF monitors the MCW and the WPP programs, evaluating for gaps in programming among other things.  WUHF was scheduled to sunset but the WPP advocated for its continued involvement because of its critical roles in coordinating public input and evaluation, and in offering advice.  Eileen Smith, Director of the Wisconsin Partnership Fund, informed the Committee that the Insurance Commissioner made appointments to WUHF, and that each of the medical schools had two representatives on WUHF.

Regent Spector cited a report that he and Regents Crain and Walsh, the Regent appointees to the Hospital Authority, had heard the day before.  Quoting from the report, he referred to the dysfunctional approach to disease by academic medicine, which across the nation was more reactive than proactive.  He asked whether the WPP could provide funding to make academic medicine more proactive.  Dean Golden responded that his question provided an articulate argument for what UW-Madison was seeking to achieve through its transformed school of medicine and public health.  Traditional health care entities, he continued by way of example, would not work to clean up polluted water or air, but they would treat the victims of such problems.  The reconfigured SMPH, with its renewed mission, was working to train its students to have a broader health perspective and approach to problem-solving by understanding the many determinants of health which go beyond the provision of health care.

In response to a question from Regent Crain, Dean Golden described the progress made thus far in implementing the School’s expanded mission.  The School has done an effective job of transforming the first two years of medical education for SMPH students, and the transformation of the third and fourth years contained in the WPP’s second five-year plan was beginning.  SMPH students would be out in the communities rather than in classrooms for their third and fourth years.  This meant that the School’s community partners had to be more engaged in this new kind of training.  This process was generally more complex and expensive, and there were several bureaucratic hurdles to cross.  Dean Golden referred to the accreditation process as one such hurdle, noting that the agency that accredits schools of public health would not give accreditation if the dean was also the dean for the school of medicine.  He also cited the difficulty in providing training to SMPH students in underserved communities, given the scarcity of resources in those communities.  In the next few years, the SMPH would be working hard to address these obstacles.

In response to a question from Regent Davis on the connection of the strategic planning process to the transformation of the SMPH, Dean Golden offered the school’s website as a great resource for providing a fuller description of the School’s new vision for a synthetic model more attuned to the health needs of Wisconsin, the advantages of community engagement, and the need to look after underserved groups who were most vulnerable.  He asked the Regents to continue holding the SMPH accountable to this expanded mission and vision. 

Regent Davis then called for the motion.

I.1.A.:  It was moved by Regent Crain, seconded by Regent Spector, that, upon
 recommendation of the President of the University of Wisconsin System and the
Chancellor of the University of Wisconsin-Madison, the Board of Regents
approves the 2009 - 2014 Five-Year Plan of the Wisconsin Partnership Program,
which was collaboratively developed by the Oversight and Advisory Committee
and the Medical Education and Research Committee of the UW School of
Medicine and Public Health, in accordance with the Order of the Insurance
Commissioner and the Grant Agreement between the UW System Board of
Regents, the UW Foundation, and the Wisconsin United for Health Foundation,
Inc.

The resolution PASSED unanimously.

Regent Davis expressed the Committee’s appreciation to Dean Golden, Mr. Mormann, Dr. Kindig and the other representatives from the School of Medicine and Public Health for their work on the Wisconsin Partnership Program.  She thanked Dean Golden for his leadership and observed that she had a newfound understanding of the revolutionary transformation in medicine and public health being undertaken by the SMPH.

Resolution I.1.A. was referred to the consent agenda of the full Board of Regents at its Friday, December 5, 2008, meeting.

 

The joint meeting adjourned at 2:10 p.m.