Northwest Arkansas Healthcare

NORTHWEST ARKANSAS HEALTHCARE

Assessment u Economic Impact u Vision for the Future

Prepared for the Northwest Arkansas Council by Tripp Umbach Northwest Arkansas’ economic future will be strengthened by targeted health-sector growth initiatives.

THE REGION IS CURRENTLY LOSING CONTENTS $950 MILLION A YEAR.

EXECUTIVE SUMMARY ...... 3 If specialty services are added ASSESSMENT ...... 15 to satisfy regional demand, we can add more than STUDY FINDINGS ...... 17 $2 billion a year to the RECOMMENDED APPROACH ...... 32 heathcare economy by 2040 AREAS OF PRIORITY ...... 34 and transform Northwest Arkansas ECONOMIC CONSIDERATIONS AND IMPACT ...... 40 into a thriving healthcare destination. APPENDICES ...... 45 CONSULTANT CONCLUSIONS ...... INSIDE BACK COVER

Northwest Arkansas Council N 1 Northwest Arkansas’ economic future will be strengthened by targeted health-sector growth initiatives.

THE REGION IS CURRENTLY LOSING CONTENTS $950 MILLION A YEAR.

Northwest Arkansas Council N 1 % 6,000 jobs Executive Summary are recommended to be added to the Northwest Arkansas $3.4 billion healthcare economy. will be added to the Northwest Northwest Arkansas NORTHWEST annual healthcare Arkansas 1,400 hospital beds economy by 2040 if every in Northwest Arkansas are ARKANSAS has much to celebrate: recommendation in this Healthcare serviced by acute care, critical report is accomplished. access, psychiatric, military, rehabilitation and women’s population growth, and workforce by the The region has development efforts are ongoing. healthcare providers. experienced fast job Thus, recognizing the need to Numbers enhance the economic vitality of 7% of Northwest Arkansas growth over 25 years, the region’s healthcare sector3, expanded workforce training The Northwest the Northwest Arkansas Council employees are working 5,840 programs, new recreational in the healthcare sector. Arkansas Council hired Tripp Umbach, a nationally and cultural venues, improved recognized consulting firm with Peer regions such as Madison, Estimated annual hospital serves as a convener for infrastructure, and revitalized expertise in community health Wis., and Des Moines, Iowa, stays occur outside downtowns. The Northwest Arkansas regional economic and needs and healthcare economic have higher portions of their Northwest Arkansas because Council creates overall regional economies focused on healthcare. Northwest Arkansas community initiatives. impact, to gain a comprehensive strategic plans to push forward (9% and 8.6%, respectively) residents seek treatment understanding of the relationship has room to grow for advanced cancer care critical economic and quality-of-life between healthcare and economic elsewhere. Those hospital initiatives. These plans incorporate success. Tripp Umbach serves the economy’s input from stakeholders across all stays have an average hundreds of communities at the An additional healthcare sector. sectors. The region has a strong intersection of health, education, estimated cost history of thinking about the of $37,000. and economic development. The 8.5 cardiologists highest priorities and pursuing Northwest Arkansas Council serves are needed to serve them collaboratively. Past successes as a convener for regional economic Northwest Arkansas’ $950 million have included the opening of the and community initiatives. current population. leaves Northwest Arkansas The healthcare sector Northwest Arkansas Regional Unlike traditional healthcare The region has 23 currently adds Airport, the establishment of the Benton/Washington assessments with the purpose of focusing exclusively each year as residents travel Regional Public Water Authority, and the consistent cardiologists in 2018. on the access, quality, or capacity of healthcare to hospitals and physicians development and updating of regional highway services, this report also recommends actions intended $2.7 billion priorities at the Northwest Arkansas Regional Planning in other regions to provide to Northwest Arkansas’ to drive regional economic prosperity, advance quality Commission. Additionally, Northwest Arkansas has a of life, reduce costs, and increase productivity through the services they seek. economy annually. wealth of resources dedicated to serving medical needs, collaboration. A critical step in this assessment was 200 additional including hospitals, physicians, clinicians, community to create a Regional Healthcare Steering Committee, leaders, educators, and supporters. The 2018 opening There are 3,490 registered nurses Only 5% of the nation’s including an array of leaders from education, residency positions of Arkansas Children’s Hospital Northwest and the are recommended in Northwest Arkansas. medical schools offer healthcare, economic development, nonprofit $277 million being spent on expansions at Mercy organizations, and bioscience (See Appendix E). The to be pursued in Peer Evansville, Ind., has a smaller research as a key Northwest Arkansas are examples of the region’s Regional Steering Committee members provided population but has 4,450 RNs. 1 Northwest Arkansas. curriculum component. willingness to expand and meet identified needs. guidance and support for this assessment. The Northwest Arkansas Council’s strategy for Tripp Umbach facilitated work sessions, one-on- the region includes a goal of establishing Northwest Healthcare accounts for about In 2018, there were 2 one interviews, and site visits over a 10-month period. Arkansas as a regional healthcare destination. Regional To supplement interviews and face-to-face engagement, 22,450 healthcare providers and academic institutions continue the firm examined quantitative data to define the , 58 years $3.2 trillion healthcare-related to expand service offerings in a bid to keep pace with region’s strengths and challenges. of the nation’s gross jobs in Northwest Average age of Northwest 1 Mercy Northwest Arkansas and Arkansas Children’s Early in the assessment, Tripp Umbach identified Hospital Northwest expansions drew the most attention, that the region’s strengths include an established or 17.8%, domestic product Arkansas. Arkansas’ specialty care but Washington Regional Medical Center in Fayetteville and physicians. As physicians are Northwest Medical Center in both Springdale and Bentonville primary care base with relatively high-quality, low-cost are investing in healthcare improvements as well. Northwest recruited, many will replace healthcare compared to other regions across the United Medical spent $3.7 million on a behavioral health unit addition States. These strengths align well with the “Triple Aim” 300 medical students will graduate within “aging out” retirees rather that finished in 2018. Washington Regional’s growth included 70-miles of Springdale, Ark., by 2022. major 2016 and 2017 expansions as well as more than $40 than add to the number of million expansion that should finish up in 2019. 3 Nationally, the healthcare sector is defined as the Medical programs in Fort Smith, Ark., Joplin, Mo., and Tahlequah, Okla. 2 physicians serving the For this report, Northwest Arkansas is defined as Benton, economic sector concerned with provision, distribution, and will reach full enrollment by that year. Madison, and Washington counties in Arkansas. consumption of healthcare services and related products. growing population. 2 N Northwest Arkansas Council Northwest Arkansas Council N 3

NWA-Healthcare-report-COVERS-r.indd 2 1/5/19 10:51 PM % 6,000 jobs Executive Summary are recommended to be added to the Northwest Arkansas $3.4 billion healthcare economy. will be added to the Northwest Northwest Arkansas NORTHWEST annual healthcare Arkansas 1,400 hospital beds economy by 2040 if every in Northwest Arkansas are ARKANSAS has much to celebrate: recommendation in this Healthcare serviced by acute care, critical report is accomplished. access, psychiatric, military, rehabilitation and women’s population growth, and workforce by the The region has development efforts are ongoing. healthcare providers. experienced fast job Thus, recognizing the need to Numbers enhance the economic vitality of 7% of Northwest Arkansas growth over 25 years, the region’s healthcare sector3, expanded workforce training The Northwest the Northwest Arkansas Council employees are working 5,840 programs, new recreational in the healthcare sector. Arkansas Council hired Tripp Umbach, a nationally and cultural venues, improved recognized consulting firm with Peer regions such as Madison, Estimated annual hospital serves as a convener for infrastructure, and revitalized expertise in community health Wis., and Des Moines, Iowa, stays occur outside downtowns. The Northwest Arkansas regional economic and needs and healthcare economic have higher portions of their Northwest Arkansas because Council creates overall regional economies focused on healthcare. Northwest Arkansas community initiatives. impact, to gain a comprehensive strategic plans to push forward (9% and 8.6%, respectively) residents seek treatment understanding of the relationship has room to grow for advanced cancer care critical economic and quality-of-life between healthcare and economic elsewhere. Those hospital initiatives. These plans incorporate success. Tripp Umbach serves the economy’s input from stakeholders across all stays have an average hundreds of communities at the An additional healthcare sector. sectors. The region has a strong intersection of health, education, estimated cost history of thinking about the of $37,000. and economic development. The 8.5 cardiologists highest priorities and pursuing Northwest Arkansas Council serves are needed to serve them collaboratively. Past successes as a convener for regional economic Northwest Arkansas’ $950 million have included the opening of the and community initiatives. current population. leaves Northwest Arkansas The healthcare sector Northwest Arkansas Regional Unlike traditional healthcare The region has 23 currently adds Airport, the establishment of the Benton/Washington assessments with the purpose of focusing exclusively each year as residents travel Regional Public Water Authority, and the consistent cardiologists in 2018. on the access, quality, or capacity of healthcare to hospitals and physicians development and updating of regional highway services, this report also recommends actions intended $2.7 billion priorities at the Northwest Arkansas Regional Planning in other regions to provide to Northwest Arkansas’ to drive regional economic prosperity, advance quality Commission. Additionally, Northwest Arkansas has a of life, reduce costs, and increase productivity through the services they seek. economy annually. wealth of resources dedicated to serving medical needs, collaboration. A critical step in this assessment was 200 additional including hospitals, physicians, clinicians, community to create a Regional Healthcare Steering Committee, leaders, educators, and supporters. The 2018 opening There are 3,490 registered nurses Only 5% of the nation’s including an array of leaders from education, residency positions of Arkansas Children’s Hospital Northwest and the are recommended in Northwest Arkansas. medical schools offer healthcare, economic development, nonprofit $277 million being spent on expansions at Mercy organizations, and bioscience (See Appendix E). The to be pursued in Peer Evansville, Ind., has a smaller research as a key Northwest Arkansas are examples of the region’s Regional Steering Committee members provided population but has 4,450 RNs. 1 Northwest Arkansas. curriculum component. willingness to expand and meet identified needs. guidance and support for this assessment. The Northwest Arkansas Council’s strategy for Tripp Umbach facilitated work sessions, one-on- the region includes a goal of establishing Northwest Healthcare accounts for about In 2018, there were 2 one interviews, and site visits over a 10-month period. Arkansas as a regional healthcare destination. Regional To supplement interviews and face-to-face engagement, 22,450 healthcare providers and academic institutions continue the firm examined quantitative data to define the , 58 years $3.2 trillion healthcare-related to expand service offerings in a bid to keep pace with region’s strengths and challenges. of the nation’s gross jobs in Northwest Average age of Northwest 1 Mercy Northwest Arkansas and Arkansas Children’s Early in the assessment, Tripp Umbach identified Hospital Northwest expansions drew the most attention, that the region’s strengths include an established or 17.8%, domestic product Arkansas. Arkansas’ specialty care but Washington Regional Medical Center in Fayetteville and physicians. As physicians are Northwest Medical Center in both Springdale and Bentonville primary care base with relatively high-quality, low-cost are investing in healthcare improvements as well. Northwest recruited, many will replace healthcare compared to other regions across the United Medical spent $3.7 million on a behavioral health unit addition States. These strengths align well with the “Triple Aim” 300 medical students will graduate within “aging out” retirees rather that finished in 2018. Washington Regional’s growth included 70-miles of Springdale, Ark., by 2022. major 2016 and 2017 expansions as well as more than $40 than add to the number of million expansion that should finish up in 2019. 3 Nationally, the healthcare sector is defined as the Medical programs in Fort Smith, Ark., Joplin, Mo., and Tahlequah, Okla. 2 physicians serving the For this report, Northwest Arkansas is defined as Benton, economic sector concerned with provision, distribution, and will reach full enrollment by that year. Madison, and Washington counties in Arkansas. consumption of healthcare services and related products. growing population. 2 N Northwest Arkansas Council Northwest Arkansas Council N 3

NWA-Healthcare-report-COVERS-r.indd 2 1/5/19 10:51 PM Northwest Arkansas’ Peer Regions

N Spokane

N Boise Madison N Des Moines N

Evansville N Northwest N Arkansas Durham-Chapel Hill %

Austin N NORTHWEST ARKANSASʼ PEER REGIONS The peer regions for Northwest Arkansas are defined as: Austin-Round Rock, Texas; Boise City-Nampa, Idaho; Des Moines-West Des Moines, Iowa; Durham-Chapel Hill, N.C.; Evansville, Ind.-Ky.; Madison, Wis.; and Spokane- Spokane Valley, Wash.

of national healthcare reform, namely quality, access, models that leverage the current primary care base and cost effectiveness.4 However, additional work is while enhancing and attracting the next generation required to increase the health status of the region of advanced specialists, clinicians, researchers, and through coordinated population health strategies,5 scientific leadership. The region also must leverage new which is important to maintaining and strengthening and innovative technologies to enhance quality, increase quality and cost effectiveness. It also sets the stage for access, and manage healthcare costs. growth in advanced specialty care. Healthcare and higher education institutions in a Enhancing a region’s healthcare sector requires region have tremendous impact on the built environment a multi-pronged approach that reaches beyond and on the health of those who live and work in Northwest training and retaining physicians. A key element of Arkansas. A coordinated initiative through an aligned the equation is not only the size of the workforce, vision will shape the healthcare sector growth of Northwest but also the availability of a quality, well-trained Arkansas in a way that supports healthy lifestyles, while physician workforce. Support is required from both enabling regional organizations to collaborate and the public and private sectors, as well as an increased innovate in ways that support the business of healthcare. willingness to collaborate and adopt innovative Northwest Arkansas can create more connected, cohesive communities that align and support monumental, 4 The Triple Aim focuses on improving the health of the population, improving the experience of care – the subjective sustainable, regional initiatives focused on both healthcare experience, as well as the objective experience of care, transformation and community health improvement. resulting in care that is safe, equitable, timely, efficient, Doing so will give an edge to Northwest Arkansas in person- and family-centered – and lower costs. 5 Population health is defined as “the health outcomes of competing as a healthcare destination in the heartland of a group of individuals, including the distribution of such America and eventually on a national level. u outcomes within the group.” It is an approach to health that

aims to improve the health of an entire human population. photo courtesy Department Arkansas of and Tourism Parks

4 N Northwest Arkansas Council Northwest Arkansas Council N 5 Northwest Arkansas’ Peer Regions

N Spokane

N Boise Madison N Des Moines N

Evansville N Northwest N Arkansas Durham-Chapel Hill %

aims to improve the health of an entire human population. photo courtesy Department Arkansas of and Tourism Parks

4 N Northwest Arkansas Council Northwest Arkansas Council N 5 Table 1: Current and Projected Economic Implications KEY FINDINGS Northwest Arkansas can make significant additions to its $2.7 billion healthcare sector by reducing how many residents seek healthcare services elsewhere. The right combination of community investments can result in AND RECOMMENDATIONS a $3.43 B economic gain by 2040. ECONOMIC LOSS WITHOUT ECONOMIC GAIN WITH This unique study, positioned region for advanced healthcare at the intersection of healthcare, services, largely due to underdeveloped IMPLEMENTATION IMPLEMENTATION education, and economic wellbeing, is sub-specialty service lines, including 2018 intended to guide the transformation advanced cardiology and oncology. -$950 M of Northwest Arkansas healthcare. The region also loses patients to other Current Out-migration for It can serve as the platform for Northwest Arkansas can medical regions in Arkansas and specialty care generating billions of healthcare create more connected, outstanding healthcare destinations such cohesive communities 2030 2030 dollars in the economy. The following as the Mayo Clinic in Rochester, Minn. -$1.2 B $1.2 B key findings form the foundation for that align and and the Houston Medical Center. Projected Out-migration No deficit in specialty a series of recommended actions support monumental, With few people from outside the for specialty care with services factoring to undertake during the next 10 sustainable, regional region making Northwest Arkansas population growth and no population growth years to ensure Northwest Arkansas initiatives focused their healthcare destination, the additional services has a vibrant healthcare economy on both healthcare economic and employment impact of 2040 2040 that grows to become a healthcare transformation and the healthcare sector places Northwest -$1.43 B $2.0 B destination by 2040. community health Arkansas far behind its peers. Feedback Projected Out-migration Surplus in specialty improvement. for specialty care with care services factoring Independent analysis completed obtained from stakeholders during the population growth and no population growth by Tripp Umbach confirmed that assessment presented the reality that additional services $3.43 B the Northwest Arkansas healthcare employers evaluating the region as a Potential sector is underperforming in potential expansion site are examining difference in economic impact compared to the Northwest Arkansas healthcare economic impact peer markets.6 For example, the sector and recognizing its challenges. by 2040 healthcare sector in Spokane, Wash., Less investment from outside the a region with the same population region related to Northwest Arkansas’ as Northwest Arkansas, generates $4.5 billion annually. underperforming healthcare sector have long-term effects Key Finding economically impactful deficits to the regional economy The current economic impact of the healthcare on a region’s overall economic health. Northwest Arkansas are advanced cardiology and oncology. Additionally, sector in Northwest Arkansas is only $2.7 billion. This must either catch up or lose ground to competing regions as Without a healthcare-focused according to 2016 data from the Arkansas Department difference is largely attributable to the Northwest it joins the nation’s 100 largest metropolitan areas in 2019. regional strategy, the underperformance of Health, the average age of primary care providers in Arkansas region’s lack of specialty healthcare, medical Northwest Arkansas, in fact, is well positioned to of the healthcare sector will negatively the region is 52 years old and between 50 and 69 years education, and research and development (R&D) focus on eliminating the $950 million that leave the impact future health status, economic old for specialty physicians. spending and commercialization. According to a region due to out-migration. With the right steps to 1 development, and Northwest Arkansas’ recent report entitled “The American Heartland’s advance the healthcare economy, the region can add population growth. Key Finding Position in The Innovation Economy” by the Walton $2 billion to the sector. This strategic growth could Family Foundation, Arkansas is in the 46th position in lead to more than a $3 billion improvement achieved Changing demographics and national Changing demographics and academic R&D and 49th for overall R&D. by 2040. (See Table 1.) healthcare reform strain the region’s strong primary population growth are impacting Further, the Tripp Umbach analysis indicated that The Council’s “Greater Northwest Arkansas care foundation, while continuing to burden its current capacity to provide healthcare when comparing the healthcare economy in Northwest Development Strategy: Targeting Transformational underdeveloped specialty care market. Tripp Umbach services while the healthcare Arkansas to the average economic impact of its peers, Innovation,” a plan made public in July 2018, represents analyzed publicly available data sources and obtained 2 industry nationally and regionally is the regional economy is missing the opportunity to an important milestone in a rich and ongoing planning confidential data from regional health systems specific experiencing dramatic transformation. collect $950 million annually, as well as fill more than a process to create a more collaborative and robust to physician need by service area demand and supply potential 6,000 jobs. This loss to the regional economy infrastructure. The plan focuses heavily on improvements within the region as well as patient migration data. United States Census Bureau statistics show relates to high out-migration and low in-migration of needed to develop, attract, and retain top talent – Without specific, coordinated data showing in- and Northwest Arkansas was the 14th-fastest-growing patients. Tripp Umbach found Northwest Arkansas generating pioneering ideas and growing tomorrow’s out-of-region migration, which is not available in metro area nationwide from 2016-17, and the state’s hospitals do not attract many patients from outside the great companies. Most importantly, the plan emphasizes Arkansas, Tripp Umbach used data showing the fastest-growing region. As the region’s population the need for increased collaboration among healthcare shortage of sub-specialist physicians based on national ages and diversity increases, healthcare organizations 6 The defined peers are either historical peers used by the providers, researchers, universities, and the business are adapting to meet patients’ changing needs. This Northwest Arkansas Council or communities recommended averages as a proxy for measuring the out-migration of by Tripp Umbach based on the firm’s familiarity with their community and the need for a dedicated roadmap for patients and relatively low in-migration. Based on the dramatic change is occurring while the healthcare medical community growth. future healthcare sector investments. aforementioned, Tripp Umbach determined the most sector addresses new health-reform requirements and 6 N Northwest Arkansas Council Northwest Arkansas Council N 7 Table 1: Current and Projected Economic Implications KEY FINDINGS Northwest Arkansas can make significant additions to its $2.7 billion healthcare sector by reducing how many residents seek healthcare services elsewhere. The right combination of community investments can result in AND RECOMMENDATIONS a $3.43 B economic gain by 2040. ECONOMIC LOSS WITHOUT ECONOMIC GAIN WITH This unique study, positioned region for advanced healthcare at the intersection of healthcare, services, largely due to underdeveloped IMPLEMENTATION IMPLEMENTATION education, and economic wellbeing, is sub-specialty service lines, including 2018 intended to guide the transformation advanced cardiology and oncology. -$950 M of Northwest Arkansas healthcare. The region also loses patients to other Current Out-migration for It can serve as the platform for Northwest Arkansas can medical regions in Arkansas and specialty care generating billions of healthcare create more connected, outstanding healthcare destinations such cohesive communities 2030 2030 dollars in the economy. The following as the Mayo Clinic in Rochester, Minn. -$1.2 B $1.2 B key findings form the foundation for that align and and the Houston Medical Center. Projected Out-migration No deficit in specialty a series of recommended actions support monumental, With few people from outside the for specialty care with services factoring to undertake during the next 10 sustainable, regional region making Northwest Arkansas population growth and no population growth years to ensure Northwest Arkansas initiatives focused their healthcare destination, the additional services has a vibrant healthcare economy on both healthcare economic and employment impact of 2040 2040 that grows to become a healthcare transformation and the healthcare sector places Northwest -$1.43 B $2.0 B destination by 2040. community health Arkansas far behind its peers. Feedback Projected Out-migration Surplus in specialty improvement. for specialty care with care services factoring Independent analysis completed obtained from stakeholders during the population growth and no population growth by Tripp Umbach confirmed that assessment presented the reality that additional services $3.43 B the Northwest Arkansas healthcare employers evaluating the region as a Potential sector is underperforming in potential expansion site are examining difference in economic impact compared to the Northwest Arkansas healthcare economic impact peer markets.6 For example, the sector and recognizing its challenges. by 2040 healthcare sector in Spokane, Wash., Less investment from outside the a region with the same population region related to Northwest Arkansas’ as Northwest Arkansas, generates $4.5 billion annually. underperforming healthcare sector have long-term effects Key Finding economically impactful deficits to the regional economy The current economic impact of the healthcare on a region’s overall economic health. Northwest Arkansas are advanced cardiology and oncology. Additionally, sector in Northwest Arkansas is only $2.7 billion. This must either catch up or lose ground to competing regions as Without a healthcare-focused according to 2016 data from the Arkansas Department difference is largely attributable to the Northwest it joins the nation’s 100 largest metropolitan areas in 2019. regional strategy, the underperformance of Health, the average age of primary care providers in Arkansas region’s lack of specialty healthcare, medical Northwest Arkansas, in fact, is well positioned to of the healthcare sector will negatively the region is 52 years old and between 50 and 69 years education, and research and development (R&D) focus on eliminating the $950 million that leave the impact future health status, economic old for specialty physicians. spending and commercialization. According to a region due to out-migration. With the right steps to 1 development, and Northwest Arkansas’ recent report entitled “The American Heartland’s advance the healthcare economy, the region can add population growth. Key Finding Position in The Innovation Economy” by the Walton $2 billion to the sector. This strategic growth could Family Foundation, Arkansas is in the 46th position in lead to more than a $3 billion improvement achieved Changing demographics and national Changing demographics and academic R&D and 49th for overall R&D. by 2040. (See Table 1.) healthcare reform strain the region’s strong primary population growth are impacting Further, the Tripp Umbach analysis indicated that The Council’s “Greater Northwest Arkansas care foundation, while continuing to burden its current capacity to provide healthcare when comparing the healthcare economy in Northwest Development Strategy: Targeting Transformational underdeveloped specialty care market. Tripp Umbach services while the healthcare Arkansas to the average economic impact of its peers, Innovation,” a plan made public in July 2018, represents analyzed publicly available data sources and obtained 2 industry nationally and regionally is the regional economy is missing the opportunity to an important milestone in a rich and ongoing planning confidential data from regional health systems specific experiencing dramatic transformation. collect $950 million annually, as well as fill more than a process to create a more collaborative and robust to physician need by service area demand and supply potential 6,000 jobs. This loss to the regional economy infrastructure. The plan focuses heavily on improvements within the region as well as patient migration data. United States Census Bureau statistics show relates to high out-migration and low in-migration of needed to develop, attract, and retain top talent – Without specific, coordinated data showing in- and Northwest Arkansas was the 14th-fastest-growing patients. Tripp Umbach found Northwest Arkansas generating pioneering ideas and growing tomorrow’s out-of-region migration, which is not available in metro area nationwide from 2016-17, and the state’s hospitals do not attract many patients from outside the great companies. Most importantly, the plan emphasizes Arkansas, Tripp Umbach used data showing the fastest-growing region. As the region’s population the need for increased collaboration among healthcare shortage of sub-specialist physicians based on national ages and diversity increases, healthcare organizations 6 The defined peers are either historical peers used by the providers, researchers, universities, and the business are adapting to meet patients’ changing needs. This Northwest Arkansas Council or communities recommended averages as a proxy for measuring the out-migration of by Tripp Umbach based on the firm’s familiarity with their community and the need for a dedicated roadmap for patients and relatively low in-migration. Based on the dramatic change is occurring while the healthcare medical community growth. future healthcare sector investments. aforementioned, Tripp Umbach determined the most sector addresses new health-reform requirements and 6 N Northwest Arkansas Council Northwest Arkansas Council N 7 As payments to healthcare providers move from the Key Finding volume of care provided to the outcome of such care, the cost of healthcare in the region will be Limited Graduate Medical unsustainable for individuals and employers and Education (GME) in Northwest the financial burden of an unhealthy population Arkansas holds back needed will result in massive losses to the overall healthcare healthcare sector expansion. sector. Patients with medical complexities, who 5 see multiple specialists for more than one chronic The need for GME7 expansion is a national condition, are more likely to have healthcare challenge. The only way to become a practicing needs go unmet and experience poorer outcomes. physician in the U.S. is to complete three to seven years Therefore, a highly coordinated regional healthcare of residency training after graduation from medical delivery system will form the foundation for school. Currently, hospitals throughout Northwest healthcare growth and development. Arkansas are funding and paying more for resident Arkansas is at a great disadvantage at the core of training than is being reimbursed by the federal

pixabay.com national reimbursement methodologies as the payment government. Northwest Arkansas’ teaching hospitals/ formulas for Medicare are based on 60-year-old cost training entities indicated that without additional data when the entire state of Arkansas, including alternative funding, it is unlikely they’ll be able to Northwest Arkansas, was severely disadvantaged add residents and fellows or make bigger investments in most all measures compared to the nation. This in residency programs. Opportunities will continue accumulating impact has been a monumental challenge to be missed if Northwest Arkansas does not devise for growth and development of healthcare services. an efficient system that encourages and incentivizes These payment formulas are built into payment institutions and foundations to participate and fund formulas for private insurers. Currently, reimbursement additional residency training. u methodologies are limited for innovative medical models, which inhibit growth of emerging strategies 7 Graduate Medical Education (GME) refers to any type of financial challenges related to growing both primary Arkansas. Medical costs associated with treating such as virtual care. formal medical education, usually hospital-sponsored or care access and advanced specialty healthcare services. patients with later-stage disease are higher. hospital-based training, pursued after receipt of the M.D. or D.O. degree in the U.S. This education includes internship, A coordinated effort among healthcare, higher Building a healthcare economy based on improving residency, subspecialty, and fellowship programs and leads to education, industry, and government is required to the perception that the region has high quality and state licensure and board certification. advance the healthcare sector to meet current and cost effectiveness provides Northwest Arkansas with future needs. an advantage over other regions. Providing healthcare that is high-quality, low-cost, and accessible to all is ECOMMENDATIONS Key Finding a significant challenge for the U.S. and the world. As R the healthcare sector in Northwest Arkansas leverages Compared to peer markets, strengths in quality and cost and adds specialty Recommendation of care, improved healthcare access, and sustainable Northwest Arkansas has relatively healthcare services, cross-industry collaboration and economic impact; public health organizations; and key high-quality and low-cost inter-professional cooperation are keys to success. Establish a division of the Northwest private and public industry leaders. healthcare services. Developing an innovative platform where research Arkansas Council focused on healthcare On or before July 1, 2019, the Council’s 3 conducted at colleges and universities in the region is transformation by July 1, 2019. Transformation Division should be in place and have focused on healthcare quality and cost effectiveness is a (Immediate Focus Area) a professional staff member working to coordinate Given the relative strengths and weaknesses of the 1 a cohesive, regional-aligned, and connected final winning long-term strategy. regional healthcare sector, the Northwest Arkansas roadmap to deliver improved health and sustained Council should play a leadership role in encouraging Recognizing that no single organization has the economic growth. The new division of the Northwest healthcare-focused innovation and collaboration. As Key Finding resources required to maximize economic development Arkansas Council, funded by a broad range of outlined in this report, Northwest Arkansas is the Improved connectivity among potential, an umbrella organization should be utilized stakeholders, should develop an implementation poorest-performing region among peer markets in to coordinate regional focus areas related to healthcare guide in alignment with this report’s key findings and nearly every measure of healthcare sector economic employers, community health initiatives, and healthcare providers sector economic development. It is recommended recommendations as its initial task. development, having the fewest specialty care services that an “expanded” Steering Committee, hereinafter Foundational elements of the healthcare sector and lowest per-capita health sector economic impact. is important to achieving long-term 4 economic and social outcomes. referred to as the Healthcare Sector Transformation are in place, as evidenced by a strong primary care However, the region has relatively strong healthcare Division or the Transformation Division, be assembled. base. However, gaps in specialty care, trauma care, quality and relatively low healthcare costs compared The Transformation Division will include the direct tertiary subspecialty care, medical and bioscience to its peers. Some of the lower costs are attributable to Employers and healthcare providers lack participation of senior executives and decision-makers of research, virtual care, and graduate medical education residents with advanced cases of non-communicable connectivity related to healthcare coverage that academic, research, and healthcare institutions, as well as must be addressed. As the region’s healthcare sector diseases seeking specialized care outside of Northwest encourages coordinated care across health systems. foundations operating in areas such as improved quality leverages its strengths in high-quality and low-cost 8 N Northwest Arkansas Council Northwest Arkansas Council N 9 As payments to healthcare providers move from the Key Finding volume of care provided to the outcome of such care, the cost of healthcare in the region will be Limited Graduate Medical unsustainable for individuals and employers and Education (GME) in Northwest the financial burden of an unhealthy population Arkansas holds back needed will result in massive losses to the overall healthcare healthcare sector expansion. sector. Patients with medical complexities, who 5 see multiple specialists for more than one chronic The need for GME7 expansion is a national condition, are more likely to have healthcare challenge. The only way to become a practicing needs go unmet and experience poorer outcomes. physician in the U.S. is to complete three to seven years Therefore, a highly coordinated regional healthcare of residency training after graduation from medical delivery system will form the foundation for school. Currently, hospitals throughout Northwest healthcare growth and development. Arkansas are funding and paying more for resident Arkansas is at a great disadvantage at the core of training than is being reimbursed by the federal

pixabay.com national reimbursement methodologies as the payment government. Northwest Arkansas’ teaching hospitals/ formulas for Medicare are based on 60-year-old cost training entities indicated that without additional data when the entire state of Arkansas, including alternative funding, it is unlikely they’ll be able to Northwest Arkansas, was severely disadvantaged add residents and fellows or make bigger investments in most all measures compared to the nation. This in residency programs. Opportunities will continue accumulating impact has been a monumental challenge to be missed if Northwest Arkansas does not devise for growth and development of healthcare services. an efficient system that encourages and incentivizes These payment formulas are built into payment institutions and foundations to participate and fund formulas for private insurers. Currently, reimbursement additional residency training. u methodologies are limited for innovative medical models, which inhibit growth of emerging strategies 7 Graduate Medical Education (GME) refers to any type of financial challenges related to growing both primary Arkansas. Medical costs associated with treating such as virtual care. formal medical education, usually hospital-sponsored or care access and advanced specialty healthcare services. patients with later-stage disease are higher. hospital-based training, pursued after receipt of the M.D. or D.O. degree in the U.S. This education includes internship, A coordinated effort among healthcare, higher Building a healthcare economy based on improving residency, subspecialty, and fellowship programs and leads to education, industry, and government is required to the perception that the region has high quality and state licensure and board certification. advance the healthcare sector to meet current and cost effectiveness provides Northwest Arkansas with future needs. an advantage over other regions. Providing healthcare that is high-quality, low-cost, and accessible to all is ECOMMENDATIONS Key Finding a significant challenge for the U.S. and the world. As R the healthcare sector in Northwest Arkansas leverages Compared to peer markets, strengths in quality and cost and adds specialty Recommendation of care, improved healthcare access, and sustainable Northwest Arkansas has relatively healthcare services, cross-industry collaboration and economic impact; public health organizations; and key high-quality and low-cost inter-professional cooperation are keys to success. Establish a division of the Northwest private and public industry leaders. healthcare services. Developing an innovative platform where research Arkansas Council focused on healthcare On or before July 1, 2019, the Council’s 3 conducted at colleges and universities in the region is transformation by July 1, 2019. Transformation Division should be in place and have focused on healthcare quality and cost effectiveness is a (Immediate Focus Area) a professional staff member working to coordinate Given the relative strengths and weaknesses of the 1 a cohesive, regional-aligned, and connected final winning long-term strategy. regional healthcare sector, the Northwest Arkansas roadmap to deliver improved health and sustained Council should play a leadership role in encouraging Recognizing that no single organization has the economic growth. The new division of the Northwest healthcare-focused innovation and collaboration. As Key Finding resources required to maximize economic development Arkansas Council, funded by a broad range of outlined in this report, Northwest Arkansas is the Improved connectivity among potential, an umbrella organization should be utilized stakeholders, should develop an implementation poorest-performing region among peer markets in to coordinate regional focus areas related to healthcare guide in alignment with this report’s key findings and nearly every measure of healthcare sector economic employers, community health initiatives, and healthcare providers sector economic development. It is recommended recommendations as its initial task. development, having the fewest specialty care services that an “expanded” Steering Committee, hereinafter Foundational elements of the healthcare sector and lowest per-capita health sector economic impact. is important to achieving long-term 4 economic and social outcomes. referred to as the Healthcare Sector Transformation are in place, as evidenced by a strong primary care However, the region has relatively strong healthcare Division or the Transformation Division, be assembled. base. However, gaps in specialty care, trauma care, quality and relatively low healthcare costs compared The Transformation Division will include the direct tertiary subspecialty care, medical and bioscience to its peers. Some of the lower costs are attributable to Employers and healthcare providers lack participation of senior executives and decision-makers of research, virtual care, and graduate medical education residents with advanced cases of non-communicable connectivity related to healthcare coverage that academic, research, and healthcare institutions, as well as must be addressed. As the region’s healthcare sector diseases seeking specialized care outside of Northwest encourages coordinated care across health systems. foundations operating in areas such as improved quality leverages its strengths in high-quality and low-cost 8 N Northwest Arkansas Council Northwest Arkansas Council N 9 The recommended areas of priorities must be undertaken to measurably increase the economic impact, health status, and overall competitiveness of the region. Short Term Mid Term Long Term (1-2 YEARS) (1-5 YEARS) (2-7 YEARS)

Expand Graduate Develop an Expand Medical Medical Education Interdisciplinary Education/Develop (GME) Research Institute a Medical School

healthcare, cross-industry collaboration and inter- Recommendation professional cooperation through the Council will be essential to providing an accelerated, efficient implementation process. Developing an innovative Expand Graduate Medical Education platform where research conducted at universities in (GME) the region is focused on healthcare advances, quality (Short-Term Focus Area) and cost effectiveness is a vital strategy. Specifically, the 2 Transformation Division will develop a comprehensive Graduate medical education and fellowship resource strategy to support key priorities that leverage

photo by Russell Cothren programs to encourage growth in the physician the University of Arkansas for Medical Sciences workforce (in both primary care and medical sub- Northwest, the University of Arkansas, and regional specialties) are critical to long-term success and must healthcare systems. become a regional funding priority. The Healthcare ® While Northwest Arkansas fares better Blue Zones Lastly, Tripp Umbach recommends the Sector Transformation Division should facilitate a than the rest of the state, Arkansas is consistently ranked as one of the Power 9® Transformation Division interface with other regional detailed medical education and advanced graduate- least healthy states in the nation, and the current trends are mostly policy initiatives to align resources. For example, level program strategy that focuses on identifying communities around the globe are developing negative with higher rates of obesity and chronic illnesses projected. 1. Move Naturally alternative funding to support the training of residents “Blue Zone” strategies dedicated to creating healthy and advanced health professionals. The trends will lead to increased healthcare costs in Northwest Arkansas, communities, and economic impact is associated with To support the recommended expansion of GME 2. Purpose 8 and impact workers’ productivity. There is currently high interest in these strategies. The interrelationship between the and advanced health professionals, beyond finances, improving overall well-being and health, and some of the transition is 3. Down Shift healthcare sector and community health improvement, the region must cultivate faculty engagement in evident in the increasing focus on outdoor activities and the growing if strengthened, will enable the region to achieve its clinical practice environments to provide continued 4. 80% Rule popularity in cycling. maximum economic development potential. connection to clinical training environments as a The following priorities must be undertaken to 5. Plant Slant crucial component of recruiting physician faculty That transition led Tripp Umbach to suggest the region consider measurably increase the economic impact, health to teach medical students, residents, and advanced regional collaborations to improve the overall health and well-being. 6. Wine @ 5 status, and the region’s overall competitiveness. The health professionals. Being a “teaching hospital” is a As a result, the Northwest Arkansas Council is working with the Blue implementation of these strategies fills current gaps, mission- and culture-changing decision for a hospital, Zones Project on a potential Northwest Arkansas collaboration. Blue 7. Belong allowing the region to achieve its full economic and almost all of the nation’s top-ranked hospitals are Zones are regions around the world with increased wellness and development potential. The Transformation Division 8. Loved Ones First teaching hospitals. GME must be integrated into the life expectancy. The Blue Zones Project takes lessons from those plays an important role in coordinating efforts clinical enterprise. Thus, the strategy must analyze the exceptional regions, places with increased physical activity, healthier 9. Right Tribe toward implementation and consists of short-term level of physicians that would be interested in resident diet, and reduced stress, and it works with U.S communities to make (1-2 years), mid-term (1-5 years), and long-term training to ascertain current workload and educational healthier options easier for residents. The project has led to measurable (2-7 years) focus areas. obligations with medical students and other learners reductions in obesity, reduced smoking, and increased life expectancy. 8 Blue Zones did pre- and post-testing of the participants in as well as specific concerns and needs related to the its first project in Albert Lea, Minn., and found that Blue Zones integration of expanded GME. added an estimated 3.7 years of longevity to the residents. Great for Business. Great for Life. www.BlueZones.com; apps.BlueZones.com/en/vitality/background.

10 N Northwest Arkansas Council Northwest Arkansas Council N 11 The recommended areas of priorities must be undertaken to measurably increase the economic impact, health status, and overall competitiveness of the region. Short Term Mid Term Long Term (1-2 YEARS) (1-5 YEARS) (2-7 YEARS)

Expand Graduate Develop an Expand Medical Medical Education Interdisciplinary Education/Develop (GME) Research Institute a Medical School

10 N Northwest Arkansas Council Northwest Arkansas Council N 11 Through expanded GME, the region will not only learning environment for disciplines that include health secure more high-level specialists, but the additional professions, biomedical engineering, science, and business. physicians will work to grow future physicians in Purposeful collaborative research among the disciplines and service lines most needed in Northwest University of Arkansas, UAMS Northwest, regional Arkansas. Tripp Umbach recommends that a goal health systems, and industry will generate knowledge be set to establish a minimum of 200 additional and translate discoveries into useful applications in the residency positions. It is important to acknowledge clinical and community settings. Innovation stemming that recruitment and development of physicians to from the research institute will serve as a regional teach medical residents is a high priority and financial magnet for patients, providers, faculty, researchers, incentives must be in place to encourage physicians to and health technology companies. Lastly, the research engage in medical education and research. institute will provide a collaborative platform for Lastly, a key consideration, stated by steering Northwest Arkansas to attract external and internal committee members during the study process as an resources to support research and growth. immediate strategy to address access to specialists, is strengthening referrals, specifically subspecialty Recommendation rotations between health systems to enhance quality and build trust. This strategy can establish a strong platform for collaboration to support expanding Expand Medical Education/ medical education expansion. Develop Medical School (Long-Term Focus Area) Recommendation 4 Based on Tripp Umbach’s national experience, Develop an Interdisciplinary expanded medical education serves as the capstone Research Institute for a vibrant healthcare sector. While all of the peer of Department Arkansas photo courtesy and Tourism Parks markets studied currently have four-year medical (Mid-Term Focus Area) 3 schools, several of the communities have only recently added a school or expanded medical education as part Conclusion An institute focused on quality, access, and cost- of a regional healthcare sector development strategy. effective care can become a national destination for The peer markets developed medical education population health improvement, outcome evaluation, strategies around identified strengths. Therefore, The economic future of Northwest Arkansas Development and implementation and improvement in the economic design of the Tripp Umbach recommends that Northwest Arkansas will benefit from the careful planning and healthcare delivery system. The concentration of medical education be expanded within seven years implementation of health-sector growth initiatives, of a healthcare transformation roadmap Fortune 500 companies in Northwest Arkansas suggests either through the expansion of the existing medical and regional leaders should act to align its distinctive will result in: the opportunity for a higher ratio of industry-backed education program at UAMS Northwest or through the advantages to grow and strengthen the healthcare 9 u research. A foundational element of the research institute development of an independent medical school. The sector. Northwest Arkansas has the significant benefit Higher quality of care through collaboration should be a coordinated data-sharing infrastructure region should keep in mind that the process to become of timing as upcoming changes in healthcare align and innovation. to bridge all segments of the healthcare industry. a practicing physician in the U.S. requires four years of well with the region’s strengths. The region has a u Interoperability among key segments of the industry has college, four years of medical schooling, and three to long history of offering quality, affordable healthcare, Stronger fiscal health of each organization been a limiting factor, and a unified regional platform seven years of graduate medical education training. which provides a valuable and necessary foundation by retaining and attracting new dollars into capable of linking these segments together can have Tripp Umbach’s analysis identified that Northwest for expansion through existing infrastructure and a significant impact on the economic impact of the Arkansas’ regional strengths exist within biomedical assets with multiple partners. Expanding medical the region. healthcare sector. The University of Arkansas and the engineering, biological sciences, computer science, education and related population health research u Economic benefits associated with University of Arkansas for Medical Sciences should and population health management. The regional focused on the strengths of quality and cost- increase collaboration with each other and with healthcare health systems will be required to collaborate with effectiveness will help establish Northwest Arkansas quality outcomes. providers to heighten health sciences research productivity universities to drive growth in medical education, as a premier national health-sector growth market. u Billions of dollars that remain in the regional and provide clinical care education experiences. The innovation, and population health research. The region The region will have a platform for community partnership should be leveraged through the development should evaluate expanding highly specialized medical health and quality that will be sustainable through a economy and that come to the region, as it of research labs as well as clinical spaces designed to education programs as additional clinical training sites commitment to long-term collaboration. All parties becomes a healthcare destination. deliver advanced care to the community. The clinical and residency programs are in place and the research will play an important role in communicating the u space should also afford an important research and institute is established. needs and benefits of attracting and fostering talent Better health and quality of life for Northwest to advance healthcare delivery and research in Arkansas’ growing population. u 9 Greater Northwest Arkansas Development Strategy: Northwest Arkansas. The 2018 Blueprint. Northwest Arkansas Council.

12 N Northwest Arkansas Council Northwest Arkansas Council N 13 Through expanded GME, the region will not only learning environment for disciplines that include health secure more high-level specialists, but the additional professions, biomedical engineering, science, and business. physicians will work to grow future physicians in Purposeful collaborative research among the disciplines and service lines most needed in Northwest University of Arkansas, UAMS Northwest, regional Arkansas. Tripp Umbach recommends that a goal health systems, and industry will generate knowledge be set to establish a minimum of 200 additional and translate discoveries into useful applications in the residency positions. It is important to acknowledge clinical and community settings. Innovation stemming that recruitment and development of physicians to from the research institute will serve as a regional teach medical residents is a high priority and financial magnet for patients, providers, faculty, researchers, incentives must be in place to encourage physicians to and health technology companies. Lastly, the research engage in medical education and research. institute will provide a collaborative platform for Lastly, a key consideration, stated by steering Northwest Arkansas to attract external and internal committee members during the study process as an resources to support research and growth. immediate strategy to address access to specialists, is strengthening referrals, specifically subspecialty Recommendation rotations between health systems to enhance quality and build trust. This strategy can establish a strong platform for collaboration to support expanding Expand Medical Education/ medical education expansion. Develop Medical School (Long-Term Focus Area) Recommendation 4 Based on Tripp Umbach’s national experience, Develop an Interdisciplinary expanded medical education serves as the capstone Research Institute for a vibrant healthcare sector. While all of the peer of Department Arkansas photo courtesy and Tourism Parks markets studied currently have four-year medical (Mid-Term Focus Area) 3 schools, several of the communities have only recently added a school or expanded medical education as part Conclusion An institute focused on quality, access, and cost- of a regional healthcare sector development strategy. effective care can become a national destination for The peer markets developed medical education population health improvement, outcome evaluation, strategies around identified strengths. Therefore, The economic future of Northwest Arkansas Development and implementation and improvement in the economic design of the Tripp Umbach recommends that Northwest Arkansas will benefit from the careful planning and healthcare delivery system. The concentration of medical education be expanded within seven years implementation of health-sector growth initiatives, of a healthcare transformation roadmap Fortune 500 companies in Northwest Arkansas suggests either through the expansion of the existing medical and regional leaders should act to align its distinctive will result in: the opportunity for a higher ratio of industry-backed education program at UAMS Northwest or through the advantages to grow and strengthen the healthcare 9 u research. A foundational element of the research institute development of an independent medical school. The sector. Northwest Arkansas has the significant benefit Higher quality of care through collaboration should be a coordinated data-sharing infrastructure region should keep in mind that the process to become of timing as upcoming changes in healthcare align and innovation. to bridge all segments of the healthcare industry. a practicing physician in the U.S. requires four years of well with the region’s strengths. The region has a u Interoperability among key segments of the industry has college, four years of medical schooling, and three to long history of offering quality, affordable healthcare, Stronger fiscal health of each organization been a limiting factor, and a unified regional platform seven years of graduate medical education training. which provides a valuable and necessary foundation by retaining and attracting new dollars into capable of linking these segments together can have Tripp Umbach’s analysis identified that Northwest for expansion through existing infrastructure and a significant impact on the economic impact of the Arkansas’ regional strengths exist within biomedical assets with multiple partners. Expanding medical the region. healthcare sector. The University of Arkansas and the engineering, biological sciences, computer science, education and related population health research u Economic benefits associated with University of Arkansas for Medical Sciences should and population health management. The regional focused on the strengths of quality and cost- increase collaboration with each other and with healthcare health systems will be required to collaborate with effectiveness will help establish Northwest Arkansas quality outcomes. providers to heighten health sciences research productivity universities to drive growth in medical education, as a premier national health-sector growth market. u Billions of dollars that remain in the regional and provide clinical care education experiences. The innovation, and population health research. The region The region will have a platform for community partnership should be leveraged through the development should evaluate expanding highly specialized medical health and quality that will be sustainable through a economy and that come to the region, as it of research labs as well as clinical spaces designed to education programs as additional clinical training sites commitment to long-term collaboration. All parties becomes a healthcare destination. deliver advanced care to the community. The clinical and residency programs are in place and the research will play an important role in communicating the u space should also afford an important research and institute is established. needs and benefits of attracting and fostering talent Better health and quality of life for Northwest to advance healthcare delivery and research in Arkansas’ growing population. u 9 Greater Northwest Arkansas Development Strategy: Northwest Arkansas. The 2018 Blueprint. Northwest Arkansas Council.

12 N Northwest Arkansas Council Northwest Arkansas Council N 13 Assessment

ADVANCING THE QUALITY OF AND ACCESS TO healthcare is a - Springdale is the only acute-care hospital offering adult behavioral Designers of Arkansas Children’s Northwest, recognized priority for health inpatient services in the region. which opened early last year in Springdale, Hospitals in Northwest Arkansas ensured that the hospital’s spaces are Northwest Arkansas The region is not are consistently recognized by comfortable for the patients. The area community leaders. without resources Healthgrades for Hospital Quality that houses the CT scanner, for example, providing quality Awards. Healthgrades ratings was designed to calm children, who often Since 2015, the Northwest Arkansas care, but it is without demonstrate how well a hospital experience anxiety during imaging exams. Council’s strategy included a goal a cohesive, integrated performed in providing patient care The room is equipped with lighting that of establishing Northwest Arkansas healthcare quality (See Appendix A). The region has 10 changes to a patient’s favorite color, intended as a “healthcare destination.” initiative that spans Federally Qualified Health Centers to keep the patient relaxed and engaged. Working in partnership with local healthcare providers, the University organizations and (FQHCs)11 and three Rural Health of Arkansas for Medical Sciences, county boundaries. The Clinics. Notably, Community Clinic Great for Business. and other partners, the region has magnitude of challenges and Boston Mountain Rural Health made improvements surrounding the and the importance Center are the two largest FQHC quality and availability of healthcare. to success demand providers in the region, serving Great for Life. Providers continue to expand services engagement of all forces more than 50,000 patients with the to keep pace with population growth, and a regional view. majority of those patients being and workforce development efforts are under 200 percent of the federal ongoing. Nevertheless, service offerings poverty level. In February 2018, the in specialized medical areas fall first and only pediatric emergency short relative to local needs. Focused room in Northwest Arkansas opened. work going forward needs to be The region is not without accomplished to meet the “healthcare resources providing quality care, but destination” goal of the region. it is without a cohesive, integrated Northwest Arkansas has a wealth of resources healthcare quality initiative that spans organizations dedicated to serving medical needs, including and county boundaries. The magnitude of challenges hospitals, physicians, clinicians, community leaders, and the importance to success demand engagement of and supporters. Specifically, the region has more than all forces and a regional view. 1,400 beds among a variety of hospital types, including In March 2018, the Northwest Arkansas Council general acute care, critical access, psychiatric, military, Executive Committee approved the development of rehab, and women’s care. Additionally, Mercy Northwest an independent, comprehensive healthcare needs Arkansas is investing $277 million on capital projects and economic impact analysis. The scope included and equipment between 2016 and 2021, an expansion in developing an understanding of the healthcare service healthcare facilities and services that is expected to create offerings; the projected state of growth of those 1,000 healthcare jobs.10 Washington Regional Medical offerings; the economic impact of healthcare, including Center is completing a $43 million Core Renewal Project the economic impact of expanded healthcare offerings; that includes interior renovation with technology updates and the potential expansion of a research-based, and also will include adding approximately 20,000 biosciences industry. Tripp Umbach was hired by the square feet (atop its existing footprint) for patient rooms. Northwest Arkansas Council to complete the analysis Lastly, Northwest Medical Center - Springdale recently and needs assessment. completed a major expansion of its behavioral health The analysis presented is intended to guide unit, adding 18 adult behavioral health beds for acute decisions by healthcare providers, government officials, care to the existing 29 beds. Northwest Medical Center business leaders, nonprofit organizations, and other

10 A 190,000-square-foot patient tower will grow Mercy Hospital Northwest Arkansas from 200 beds to more than 11 Federally Qualified Health Centers are nonprofit clinics that 300 beds. It will accommodate future growth with the goal of provide primary and preventative healthcare to medically

photo courtesy Arkansas Children’s Northwest photo courtesy Arkansas Children’s 360 beds. underserved regions.

14 N Northwest Arkansas Council Northwest Arkansas Council N 15 Assessment

photo courtesy Arkansas Children’s Northwest photo courtesy Arkansas Children’s 360 beds. underserved regions.

14 N Northwest Arkansas Council Northwest Arkansas Council N 15 Study Findings

STUDY FINDINGS

Results from the assessment of quality services.13 As the occurrences secondary data; healthcare industry of chronic diseases rise due to a and trend analysis, including growing elderly population, the benchmarking analysis; market demand for specialists will increase. needs; and in-depth stakeholder Demographics, specifically population feedback during the planning process growth and aging, will continue to be identified the following driving primary drivers of increasing demand factors that guided Tripp Umbach in from 2016 to 2030. formulating strategic focus areas. A national study conducted by Doximity indicated that in Study Finding 2017, geriatrics saw the most growth, at 164 percent, compared to only 23 percent increase in cardiology.14 Technicians with Mercy Heart and Vascular Changing demographics and According to a 2017 AAMC study: “Currently, 43 Center demonstrate equipment in Mercy national healthcare reform strain percent of physicians in the U.S. are 55 years or older, Hospital’s hybrid catheterization laboratory the region’s strong primary care which means along with the age wave, a retirement and operating room. The lab was one of foundation while continuing to wave is looming. In addition, certain specialties have the first projects completed in Mercy’s 1 burden a historically underdeveloped a higher percentage of physicians over the age of 55. ongoing $277 million expansion. Among specialty care market. Pulmonology has the highest number of physicians the procedures performed in the lab is Northwest Arkansas photo courtesy Mercy over 55 years old (73 percent), followed by psychiatry transcatheter aortic valve replacement, Without a regional strategy to address the (60 percent), non-invasive cardiology (54 percent), and Great for Business. also known as TAVR, in which a cardiology healthcare sector, the relatively weak position of orthopedic surgery (52 percent).” team replaces a patient’s heart valve without healthcare services may affect future economic According to 2016 data from the Arkansas Great for Life. open-heart surgery. development and population growth in Northwest Department of Health, the average age of primary care Arkansas. When considering physician supply, analysts providers working in Northwest Arkansas is 52 years stakeholders to ensure that the healthcare sector is a communities. Platforms such as the development of and academics are near unanimous in their projection old and the average age for specialty physicians is 58. defining contributor to the region’s success. The report a comprehensive health science education research of current and growing doctor shortages in primary Furthermore, although quality payment programs such serves to answer important questions, such as: center, expanded medical education, and regionally care (i.e., family medicine, general internal medicine, as a merit-based incentive payment system (MIPS) and • Professional and business services industries integrated information systems are catalyzing pediatrics, etc.). Less known is that medical specialist alternative payment models (APMs) technically started in Northwest Arkansas are growing, but is the innovation, insight, entrepreneurship, and investment shortages are challenging the ability of the United several years ago, 2018 was expected to be the year healthcare sector growing and evolving at the in communities across the U.S. These initiatives States healthcare system to provide patients with timely, when the programs had a tangible impact on patient same pace? provide the foundation for opportunities to launch new appropriate care. The U.S. primary care physician care. With the penalty phase for MIPS beginning • How can the region position itself to serve the industries and add value to existing industries, creating shortfall for 2030 will range from 14,800 to 49,300 full- in 2019, it is likely that more independent specialty healthcare needs of its growing, increasingly new, high-paying jobs in healthcare, higher education, time-equivalent (FTE) physicians, according to a 2017 physicians, particularly those 65 years old and older, diverse population while strengthening its and related industries. study by the Association of American Medical Colleges may take steps to end their practice by retiring, selling healthcare delivery and population health Population health improvement and other (AAMC). Projected shortfalls in non-primary care the practice or merging with another practice rather improvement? innovations in healthcare delivery will result in specialties by 2030 range from 20,700 to 30,500 for than make the changes necessary to operate under a • How can the health of the region drive future efficiencies as well as increased access to high-quality surgical specialties and 20,300 to 36,800 for the “other” value-based reimbursement model. 15 economic development and quality of life? healthcare. Providing efficiencies in the healthcare physician specialties category.12 delivery system and increasing access to high-quality, Patients with medical complexities, who see 13 Cooper RA. Testimony at: Delivery Reform: The Roles Coordinated efforts among healthcare of Primary and Specialty Care in Innovative New Delivery cost-effective care for the underserved will have multiple specialists for more than one chronic Models: Hearing before the U.S. Senate Committee on Health, organizations, higher education institutions, economic and social benefits. However, the economic condition, are more likely to have a healthcare need go Education, Labor, and Pensions. 111th Cong., 1st sess. (2009). government entities, and research-intensive and social benefits projected in this report cannot unmet. Moreover, gaps in quality and connectivity due Google Scholar. bioscience companies become the springboard for 14 Doximity is the largest secure medical network in the occur without broad-based public and private financial to workforce shortages threaten the provision of nation with more than 70 percent of U.S. physicians as strong healthcare sector economic development. support and active involvement from community members, enabling collaboration across specialties and Peer communities Evansville, Ind., and Spokane, leaders dedicated to making the investments required to 12 The Complexities of Physician Supply and Demand: major medical centers. Wash., have successfully transformed their healthcare Projections from 2016 to 2030 – 2018 Update. Prepared for: 15 Trends That Will Affect Specialty Health Care into the achieve the full vision of a complete transformation of Association of American Medical Colleges. Submitted by: IHS Future. Bruce Feinberg, DO, Vice President and Chief Medical sectors by identifying key initiatives to galvanize their healthcare and the economy. u Markit Ltd. March 2018. Officer, Cardinal Health Specialty Solutions | March 15, 2018.

16 N Northwest Arkansas Council Northwest Arkansas Council N 17 Study Findings

STUDY FINDINGS

16 N Northwest Arkansas Council Northwest Arkansas Council N 17 Table 2: Impactful Deficits in Specialty Shortage for Northwest Arkansas Table 3: Peer Market Medical Specialty Comparisons (Physician statistics per 1,000 population) Information from the National Center for the Analysis of Healthcare and the U.S. Census Bureau indicates Information from the National Plan and Provider Enumeration System shows Northwest Arkansas exceeds Northwest Arkansas counties have deficits in cardiologists, endocrinologists, and oncologists. the national average in its number of family medicine physicians per 1,000 residents, but it’s below average NATIONAL TOTAL SHORTAGE and behind peer regions when it comes to medical specialists. SHORTAGE IN SHORTAGE IN SHORTAGE IN SPECIALTY SPECIALTY IN NORTHWEST DURHAM- NORTHWEST BENTON CO. MADISON CO. WASHINGTON CO. SPECIALIST NATIONAL AUSTIN BOISE DES MOINES EVANSVILLE MADISON SPOKANE RATIO ARKANSAS CHAPEL HILL ARKANSAS Cardiologist 1:16,854 -5.54 -0.97 -2.03 -8.54 Family Medicine 4.81 5.75 8.95 10.29 8.70 9.82 8.90 6.52 8.07 Endocrinologist 1:79,555 -0.77 -0.2 -1.55 -2.52 OB/GYN 1.49 1.86 1.74 1.42 3.89 2.50 1.90 0.97 1.35 Oncologists 1:28,900 -7.48 -0.56 -0.6 -8.64 Internal Medicine 5.85 5.64 4.59 6.55 16.14 4.98 7.83 3.07 5.61 Hematology/ 0.45 0.3 0.36 0.4 2.56 0.48 0.88 0.3 0.49 Oncology Cardio Disease 1.0 0.92 0.66 1.02 3.99 1.99 1.70 0.5 1.44 Workforce projections are often difficult to calculate sub-specialties, including cardiology, endocrinology and Endocrinology 0.29 0.25 0.18 0.3 0.39 0.29 0.74 0.17 0.28 as healthcare is changing at a tremendous pace, often neurology. While the Northwest Arkansas Neuroscience Neurology 0.68 0.65 0.52 0.54 2.56 0.74 1.45 0.37 0.99 in unpredictable ways. The projected ranges reflect Institute provides a variety of highly specialized Psychiatry 1.79 2.13 1.07 1.09 7.40 1.67 3.62 1.45 2.08 uncertainties about how emerging care-delivery services, feedback from stakeholders indicated that Geriatric FM 0.08 0.08 N/A N/A 0.18 0.10 N/A 0.12 0.06 and financing models might change healthcare use many patients are leaving the region for neurosurgery.17 and delivery patterns, as well as uncertainties about Therefore, by adding additional neurosurgeons and Table 4: Advanced Health Professionals participation patterns in the physician labor force. related support services and state-of-the-art technology (Ranked by Top Location Quotient Nationally and Compared by Peer Markets) This high level of uncertainty, combined with the and equipment, the region could support Level 1 need to incorporate new research and updated data trauma care. Tripp Umbach found that the region Information from the U.S. Bureau of Labor Statistics shows Northwest Arkansas trails some of its peers in its number of nurse practitioners, physician assistants and registered nurses. A location quotient greater on physician supply and demand, underscores the ranks last or near the bottom among seven peer than 1 indicates the occupation has a higher share of employment compared to the national average, and less importance of continually monitoring the projected markets in every area of primary and specialty care. than 1 indicates the occupation is less prevalent than average. future adequacy of physician and other healthcare Though primary care physicians are in strong NURSE DURHAM- NORTHWEST 16 AUSTIN BOISE DES MOINES EVANSVILLE MADISON SPOKANE provider supply. demand, a growing volume of recruitment activity is PRACTITIONER CHAPEL HILL ARKANSAS Tripp Umbach analyzed public data sources and shifting toward medical specialists, according to an Employed (Employment per 800 (0.799) 260 (8.57) 290 (7.88) 760 (2.542) 290 (1.875) 330 (0.850) 320 (1.342) 360 (1.548) obtained confidential data from regional health systems annual report by Merritt Hawkins that tracks physician 1,000 Jobs) 18 specific to physician need by service area demand starting salaries and recruiting trends. Location Quotient 0.69 0.73 0.69 2.18 1.61 0.73 1.15 1.33 and supply as well as patient migration data. Without Nationally, part of the decline in primary care searches PHYSICIAN DURHAM- NORTHWEST specific coordinated data showing in- and out-of-region is attributed to the growing use of nurse practitioners AUSTIN BOISE DES MOINES EVANSVILLE MADISON SPOKANE ASSISTANT CHAPEL HILL ARKANSAS migration, which is not available in Arkansas, Tripp (NPs) and physician assistants (PAs). Mandates create Employed Umbach used data showing the shortage of sub- the impetus in many states to expand payment policies (Employment per 400 (4.13) 190 (0.616) 280 (0.77) 390 (1.139) 120 (8.09) 420 (1.082) 110 (0.441) 140 (0.622) specialist physicians based on national averages as a for non-physician practitioners. State Medicaid 1,000 Jobs) Location Quotient 0.54 0.80 1.00 1.72 1.06 1.41 0.58 0.81 proxy for measuring the out-migration of patients and payment policies are often less restrictive than those

relatively low levels of in-migration. of the Medicare program. However, not all states REGISTERED DURHAM- NORTHWEST AUSTIN BOISE DES MOINES EVANSVILLE MADISON SPOKANE Tripp Umbach determined the most impactful are receptive to policy expansions and do not cover NURSE CHAPEL HILL ARKANSAS Employed deficits to the regional economy are advanced non-physician practitioner services to the extent that (Employment per 12,990 (13.037) 6,040 (19.587) 7,310 (20.104) 11,700 (39.185) 4,450 (28.967) 7,570 (19.537) 3,490 (14.535) 5,200 (22.317) cardiology and oncology. Deficits range widely based professional practice acts allow. For instance, the state 1,000 Jobs) on the data collection mechanisms and specialty focus. of Arkansas does not credential PAs in the care of the Location Quotient 0.64 0.96 0.99 1.92 1.42 0.96 0.71 1.09 However, the confidential data supplied by the health Medicaid population. Medicaid is the single largest systems generally supports the findings, showing a health insurer for children. It is also the primary source health-reform requirements and maintaining financial current surplus of family medicine/general practice of healthcare for low-income parents and other non- Study Finding sustainability. As Northwest Arkansas becomes larger, based on demand; a slight surplus in neurological elderly adults, the elderly, and people with disabilities. Changing demographics and older, and more diverse, the ever-evolving composition surgeons; and deficits in cardiologists, endocrinologists, In Arkansas, Medicaid covers: 1 in 7 adults (ages 19- population growth are impacting of the population will continue to have profound effects oncologists, and neurologists. 64), 4 in 9 children, 2 in 3 nursing home residents, 1 current capacity to provide healthcare on the healthcare sector and its residents. Furthermore, in 2 individuals with disabilities, and 1 in 5 Medicare services while the healthcare parts of the three counties that comprise the region Peer Market Comparisons beneficiaries.19 Northwest Arkansas’ employment of 2 industry nationally and regionally is for purposes of this study are federally designated While Northwest Arkansas is above the national PAs is less prevalent than the national average and a experiencing dramatic transformation. as primary care, mental health, and dental Health average in family medicine providers and geriatric majority of peer markets. (See Table 4.) Professional Shortage Areas (HPSAs) by the U.S. specialists, it is below the national average in multiple 20 17 Washington Regional offers the only neurosurgeons in Changes in population size, age, race, and ethnicity Department of Health and Human Services (HHS). Northwest Arkansas who perform brain surgeries. impact a region’s healthcare resources needed, the 18 Merritt Hawkins is a national healthcare search and 20 HPSAs are designated as having shortages of primary 16 The Complexities of Physician Supply and Demand: consulting firm specializing in the recruitment of physicians cost of care provided, and even the health conditions care, dental care, or mental health providers and may be Projections from 2016 to 2030 – 2018 Update. Prepared for: in all medical specialties, physician leaders, and advanced associated with each population group. Northwest geographic (a county or service area), population (e.g., Association of American Medical Colleges. Submitted by: IHS practitioners. Arkansas’ healthcare organizations have adapted to low income or Medicaid eligible) or facilities (e.g., federally 19 Markit Ltd. March 2018. Medicaid in Arkansas. September 2018. Henry J. Kaiser meet patients’ changing needs – all while addressing qualified health centers, or state or federal prisons) – more Family Foundation. about shortage areas.

18 N Northwest Arkansas Council Northwest Arkansas Council N 19 Table 2: Impactful Deficits in Specialty Shortage for Northwest Arkansas Table 3: Peer Market Medical Specialty Comparisons (Physician statistics per 1,000 population) Information from the National Center for the Analysis of Healthcare and the U.S. Census Bureau indicates Information from the National Plan and Provider Enumeration System shows Northwest Arkansas exceeds Northwest Arkansas counties have deficits in cardiologists, endocrinologists, and oncologists. the national average in its number of family medicine physicians per 1,000 residents, but it’s below average NATIONAL TOTAL SHORTAGE and behind peer regions when it comes to medical specialists. SHORTAGE IN SHORTAGE IN SHORTAGE IN SPECIALTY SPECIALTY IN NORTHWEST DURHAM- NORTHWEST BENTON CO. MADISON CO. WASHINGTON CO. SPECIALIST NATIONAL AUSTIN BOISE DES MOINES EVANSVILLE MADISON SPOKANE RATIO ARKANSAS CHAPEL HILL ARKANSAS Cardiologist 1:16,854 -5.54 -0.97 -2.03 -8.54 Family Medicine 4.81 5.75 8.95 10.29 8.70 9.82 8.90 6.52 8.07 Endocrinologist 1:79,555 -0.77 -0.2 -1.55 -2.52 OB/GYN 1.49 1.86 1.74 1.42 3.89 2.50 1.90 0.97 1.35 Oncologists 1:28,900 -7.48 -0.56 -0.6 -8.64 Internal Medicine 5.85 5.64 4.59 6.55 16.14 4.98 7.83 3.07 5.61 Hematology/ 0.45 0.3 0.36 0.4 2.56 0.48 0.88 0.3 0.49 Oncology Cardio Disease 1.0 0.92 0.66 1.02 3.99 1.99 1.70 0.5 1.44 Workforce projections are often difficult to calculate sub-specialties, including cardiology, endocrinology and Endocrinology 0.29 0.25 0.18 0.3 0.39 0.29 0.74 0.17 0.28 as healthcare is changing at a tremendous pace, often neurology. While the Northwest Arkansas Neuroscience Neurology 0.68 0.65 0.52 0.54 2.56 0.74 1.45 0.37 0.99 in unpredictable ways. The projected ranges reflect Institute provides a variety of highly specialized Psychiatry 1.79 2.13 1.07 1.09 7.40 1.67 3.62 1.45 2.08 uncertainties about how emerging care-delivery services, feedback from stakeholders indicated that Geriatric FM 0.08 0.08 N/A N/A 0.18 0.10 N/A 0.12 0.06 and financing models might change healthcare use many patients are leaving the region for neurosurgery.17 and delivery patterns, as well as uncertainties about Therefore, by adding additional neurosurgeons and Table 4: Advanced Health Professionals participation patterns in the physician labor force. related support services and state-of-the-art technology (Ranked by Top Location Quotient Nationally and Compared by Peer Markets) This high level of uncertainty, combined with the and equipment, the region could support Level 1 need to incorporate new research and updated data trauma care. Tripp Umbach found that the region Information from the U.S. Bureau of Labor Statistics shows Northwest Arkansas trails some of its peers in its number of nurse practitioners, physician assistants and registered nurses. A location quotient greater on physician supply and demand, underscores the ranks last or near the bottom among seven peer than 1 indicates the occupation has a higher share of employment compared to the national average, and less importance of continually monitoring the projected markets in every area of primary and specialty care. than 1 indicates the occupation is less prevalent than average. future adequacy of physician and other healthcare Though primary care physicians are in strong NURSE DURHAM- NORTHWEST 16 AUSTIN BOISE DES MOINES EVANSVILLE MADISON SPOKANE provider supply. demand, a growing volume of recruitment activity is PRACTITIONER CHAPEL HILL ARKANSAS Tripp Umbach analyzed public data sources and shifting toward medical specialists, according to an Employed (Employment per 800 (0.799) 260 (8.57) 290 (7.88) 760 (2.542) 290 (1.875) 330 (0.850) 320 (1.342) 360 (1.548) obtained confidential data from regional health systems annual report by Merritt Hawkins that tracks physician 1,000 Jobs) 18 specific to physician need by service area demand starting salaries and recruiting trends. Location Quotient 0.69 0.73 0.69 2.18 1.61 0.73 1.15 1.33 and supply as well as patient migration data. Without Nationally, part of the decline in primary care searches PHYSICIAN DURHAM- NORTHWEST specific coordinated data showing in- and out-of-region is attributed to the growing use of nurse practitioners AUSTIN BOISE DES MOINES EVANSVILLE MADISON SPOKANE ASSISTANT CHAPEL HILL ARKANSAS migration, which is not available in Arkansas, Tripp (NPs) and physician assistants (PAs). Mandates create Employed Umbach used data showing the shortage of sub- the impetus in many states to expand payment policies (Employment per 400 (4.13) 190 (0.616) 280 (0.77) 390 (1.139) 120 (8.09) 420 (1.082) 110 (0.441) 140 (0.622) specialist physicians based on national averages as a for non-physician practitioners. State Medicaid 1,000 Jobs) Location Quotient 0.54 0.80 1.00 1.72 1.06 1.41 0.58 0.81 proxy for measuring the out-migration of patients and payment policies are often less restrictive than those

18 N Northwest Arkansas Council Northwest Arkansas Council N 19 Table 5: The Blue Cross Blue Shield Health Index Specifically, according to results In addition, while advancements in The Blue Cross Blue Shield Health Index is derived from claims data of the company’s commercially insured from the Arkansas 2016 Behavioral diagnostic technology and the use members. Tripp Umbach considers it to to be a compelling proxy measure of health in counties. Risk Surveillance Survey, 20.2 of physician assistants and nurse percent of Benton County residents practitioners may help alleviate the (approximately 38,000 people) and As Northwest Arkansas shortage of primary care physicians, Conditions with greatest impact 17.6 percent of Washington County becomes larger, older, the advancements are less likely to do National Benton County Madison County Washington on health of the residents (approximately 30,000 and more diverse, so in specialty care. Impact Impact Impact County Impact the ever-evolving commercially people) stated they had no doctor or The Institute of Medicine 26 healthcare provider. composition of the defined primary care as “the insured Northwest Arkansas is among the population will continue provision of integrated, accessible Hypertension 12.5% 11.4% 15.2% 12.2% fastest growing regions in the U.S. In to have profound effects healthcare services by clinicians Major depression 9.0% 10.7% 6.7% 10.8% addition, economic growth has led to on the healthcare sector who are accountable for addressing an increasingly diverse population. and its residents. a large majority of personal Coronary disease 8.6% 9.2% 9.0% 7.4% This diverse community includes healthcare needs, developing a High cholesterol 7.0% 7.4% 6.9% 6.3% a large Hispanic population and a sustained partnership with patients, burgeoning Marshallese community and practicing in the context of Diabetes Type 2 5.5% 6.2% 8.3% 6.0% of more than 11,000 people, family and community.”24 The Health Index* 0.915 0.921 0.921 0.92 representing one of the largest primary care clinician not only communities of Marshallese in the functions as a patient’s point of * In this index, optimal health is 1.0 U.S.. More than half of the region’s entry to the healthcare system but residents were not born in Arkansas, also coordinates care among any and about one-third came from specialists that the patient may significantly higher in populations with multiple chronic the highest risk for Type II diabetes of any population other countries, primarily Mexico, need to see. Studies have shown, by conditions. According to the Blue Cross Blue Shield in the world. Health screenings by UAMS found that El Salvador, India, or China.21 fulfilling these functions, primary (BCBS) Health Index, which provides a comprehensive 41 percent have diabetes, compared to the national Simultaneously, important indicators care clinicians can mitigate the measure of health by quantifying how more than 200 average of 9.3 percent of the U.S. population. such as gross domestic product, business establishment fragmentation of the healthcare system, dramatically health conditions impact the health and well-being of Since 2014, more than $10 million has been growth, average annual wages, and university R&D reduce costs caused by redundant or unnecessary commercially insured Americans26, the top five conditions awarded to the UAMS Northwest to reduce health expenditures show strong increases from the previous procedures, and produce better within the region that have the greatest impact on both disparities in Marshallese and Hispanic residents year, while improvements in poverty rate and higher patient outcomes. the health and cost of the commercially insured are of Benton and Washington counties.27 Additionally, education attainment were more limited.22 Based on findings from a recent physician needs hypertension, major depression, coronary disease, high according to the Arkansas Behavioral Risk Factor The health and wellness of older people must remain assessment shared with Tripp Umbach by a Northwest cholesterol, and Type 2 diabetes. (See Table 5.) Surveillance System 2016 county estimates, more a priority, as the 21st Century will be characterized by Arkansas health system, the primary care workforce The health impact of a condition is the proportion than 29,000 residents in the three Northwest Arkansas active aging. Nearly 20 percent of the region’s population in the region will experience shortages within the next of adverse health that specific condition contributes counties in this assessment were informed by a is age 60 or older. According to the Centers for Disease few years. According to the Arkansas Department of to a defined population (by national, state, or county healthcare provider that they have coronary heart Control and Prevention (CDC), people age 65 or older Health, the Central and Northwest regions accounted groupings). The national impact is derived from disease or angina. visit physicians at three times the rate of those age 30 or for approximately 75 percent of the primary care insurance claims data of more than 41 million BCBS younger. Many inpatients, who typically have acute medical physicians in the state in 2016. Data obtained from commercially-insured members per year, with all Study Finding problems, receive care from expensive medical specialists stakeholders during this assessment shows a slight identifying information removed. Despite its focus trained to deal with serious medical conditions. Growth surplus of family medicine/general practice physicians on the commercially insured population, the BCBS Northwest Arkansas lags in of the senior population will accelerate the need for more compared to demand and a deficit for internal Health Index serves as a compelling proxy measure healthcare sector economic impact specialists. It is largely specialists such as cardiologists, medicine and pediatrics. However, the data displays a of a county’s overall population health. The BCBS but has relatively high quality and orthopedic surgeons, neurologists, rheumatologists and deficit in all primary care specialties by 2021 and 2023 Health Index assigns defined populations a health low costs healthcare services. vascular surgeons who care for the declining health of as the supply of healthcare services struggles to keep index core of 0 to 1, where 1 represents optimal health 3 elderly patients and a growing number will be needed as pace with the rising population.25 and anything less than 1 represents the adverse impact the population ages. Statewide, 56 counties have no actively As the population grows and ages, primary care of illness or disease on longevity and quality of life. Healthcare is the largest sector in the U.S. economy. licensed cardiology specialist (MD/DO).23 caseloads will include more people with multiple The Health Index of .915 at the national impact level It accounts for 17.8 percent of Gross Domestic Product chronic conditions and disabilities. This is significant means that Americans lived at 91.5 percent of their (GDP), or $3.2 trillion in 2017.28 Healthcare accounts 21 Kim Souza, Talk Business & Politics. Income inequality in for many reasons; notably, the cost of healthcare is optimal health in 2016. NWA widens, child poverty rates remain high. Sept. 13, 2018. Disparities in health and healthcare affect the 27 UAMS Northwest Awarded $2.1 Million for Marshallese 22 2018 State of the Northwest Arkansas Region Report. 24 National Research Council. “Front Matter.” Primary Care: Diabetes Prevention Research. Medicine.uams.edu/news/ Northwest Arkansas Council and University of Arkansas America’s Health in a New Era. Washington, DC: The groups, and they also limit overall gains in quality of 2-1-million-for-marshallese-diabetes-prevention-research/ Sam M. Walton College of Business Center for Business and National Academies Press, 1996. care and health for the broader population and result in May 23, 2017. Economic Research. 25 Primary care specialties are family medicine/general unnecessary costs. For instance, Marshallese are among 28 U.S. Centers for Medicare & Medicaid Services, U.S. 23 National Center for the Analysis of Healthcare Data practice, internal medicine, obstetrics/gynecology, pediatrics, Department of Health and Human Services, NHE Fact Sheet. (NCAHD), 2016-17. and geriatric medicine. 26 Excludes Medicaid/Medicare Baltimore: 2017.

20 N Northwest Arkansas Council Northwest Arkansas Council N 21 Table 5: The Blue Cross Blue Shield Health Index Specifically, according to results In addition, while advancements in The Blue Cross Blue Shield Health Index is derived from claims data of the company’s commercially insured from the Arkansas 2016 Behavioral diagnostic technology and the use members. Tripp Umbach considers it to to be a compelling proxy measure of health in counties. Risk Surveillance Survey, 20.2 of physician assistants and nurse percent of Benton County residents practitioners may help alleviate the (approximately 38,000 people) and As Northwest Arkansas shortage of primary care physicians, Conditions with greatest impact 17.6 percent of Washington County becomes larger, older, the advancements are less likely to do National Benton County Madison County Washington on health of the residents (approximately 30,000 and more diverse, so in specialty care. Impact Impact Impact County Impact the ever-evolving commercially people) stated they had no doctor or The Institute of Medicine 26 healthcare provider. composition of the defined primary care as “the insured Northwest Arkansas is among the population will continue provision of integrated, accessible Hypertension 12.5% 11.4% 15.2% 12.2% fastest growing regions in the U.S. In to have profound effects healthcare services by clinicians Major depression 9.0% 10.7% 6.7% 10.8% addition, economic growth has led to on the healthcare sector who are accountable for addressing an increasingly diverse population. and its residents. a large majority of personal Coronary disease 8.6% 9.2% 9.0% 7.4% This diverse community includes healthcare needs, developing a High cholesterol 7.0% 7.4% 6.9% 6.3% a large Hispanic population and a sustained partnership with patients, burgeoning Marshallese community and practicing in the context of Diabetes Type 2 5.5% 6.2% 8.3% 6.0% of more than 11,000 people, family and community.”24 The Health Index* 0.915 0.921 0.921 0.92 representing one of the largest primary care clinician not only communities of Marshallese in the functions as a patient’s point of * In this index, optimal health is 1.0 U.S.. More than half of the region’s entry to the healthcare system but residents were not born in Arkansas, also coordinates care among any and about one-third came from specialists that the patient may significantly higher in populations with multiple chronic the highest risk for Type II diabetes of any population other countries, primarily Mexico, need to see. Studies have shown, by conditions. According to the Blue Cross Blue Shield in the world. Health screenings by UAMS found that El Salvador, India, or China.21 fulfilling these functions, primary (BCBS) Health Index, which provides a comprehensive 41 percent have diabetes, compared to the national Simultaneously, important indicators care clinicians can mitigate the measure of health by quantifying how more than 200 average of 9.3 percent of the U.S. population. such as gross domestic product, business establishment fragmentation of the healthcare system, dramatically health conditions impact the health and well-being of Since 2014, more than $10 million has been growth, average annual wages, and university R&D reduce costs caused by redundant or unnecessary commercially insured Americans26, the top five conditions awarded to the UAMS Northwest to reduce health expenditures show strong increases from the previous procedures, and produce better within the region that have the greatest impact on both disparities in Marshallese and Hispanic residents year, while improvements in poverty rate and higher patient outcomes. the health and cost of the commercially insured are of Benton and Washington counties.27 Additionally, education attainment were more limited.22 Based on findings from a recent physician needs hypertension, major depression, coronary disease, high according to the Arkansas Behavioral Risk Factor The health and wellness of older people must remain assessment shared with Tripp Umbach by a Northwest cholesterol, and Type 2 diabetes. (See Table 5.) Surveillance System 2016 county estimates, more a priority, as the 21st Century will be characterized by Arkansas health system, the primary care workforce The health impact of a condition is the proportion than 29,000 residents in the three Northwest Arkansas active aging. Nearly 20 percent of the region’s population in the region will experience shortages within the next of adverse health that specific condition contributes counties in this assessment were informed by a is age 60 or older. According to the Centers for Disease few years. According to the Arkansas Department of to a defined population (by national, state, or county healthcare provider that they have coronary heart Control and Prevention (CDC), people age 65 or older Health, the Central and Northwest regions accounted groupings). The national impact is derived from disease or angina. visit physicians at three times the rate of those age 30 or for approximately 75 percent of the primary care insurance claims data of more than 41 million BCBS younger. Many inpatients, who typically have acute medical physicians in the state in 2016. Data obtained from commercially-insured members per year, with all Study Finding problems, receive care from expensive medical specialists stakeholders during this assessment shows a slight identifying information removed. Despite its focus trained to deal with serious medical conditions. Growth surplus of family medicine/general practice physicians on the commercially insured population, the BCBS Northwest Arkansas lags in of the senior population will accelerate the need for more compared to demand and a deficit for internal Health Index serves as a compelling proxy measure healthcare sector economic impact specialists. It is largely specialists such as cardiologists, medicine and pediatrics. However, the data displays a of a county’s overall population health. The BCBS but has relatively high quality and orthopedic surgeons, neurologists, rheumatologists and deficit in all primary care specialties by 2021 and 2023 Health Index assigns defined populations a health low costs healthcare services. vascular surgeons who care for the declining health of as the supply of healthcare services struggles to keep index core of 0 to 1, where 1 represents optimal health 3 elderly patients and a growing number will be needed as pace with the rising population.25 and anything less than 1 represents the adverse impact the population ages. Statewide, 56 counties have no actively As the population grows and ages, primary care of illness or disease on longevity and quality of life. Healthcare is the largest sector in the U.S. economy. licensed cardiology specialist (MD/DO).23 caseloads will include more people with multiple The Health Index of .915 at the national impact level It accounts for 17.8 percent of Gross Domestic Product chronic conditions and disabilities. This is significant means that Americans lived at 91.5 percent of their (GDP), or $3.2 trillion in 2017.28 Healthcare accounts 21 Kim Souza, Talk Business & Politics. Income inequality in for many reasons; notably, the cost of healthcare is optimal health in 2016. NWA widens, child poverty rates remain high. Sept. 13, 2018. Disparities in health and healthcare affect the 27 UAMS Northwest Awarded $2.1 Million for Marshallese 22 2018 State of the Northwest Arkansas Region Report. 24 National Research Council. “Front Matter.” Primary Care: Diabetes Prevention Research. Medicine.uams.edu/news/ Northwest Arkansas Council and University of Arkansas America’s Health in a New Era. Washington, DC: The groups, and they also limit overall gains in quality of 2-1-million-for-marshallese-diabetes-prevention-research/ Sam M. Walton College of Business Center for Business and National Academies Press, 1996. care and health for the broader population and result in May 23, 2017. Economic Research. 25 Primary care specialties are family medicine/general unnecessary costs. For instance, Marshallese are among 28 U.S. Centers for Medicare & Medicaid Services, U.S. 23 National Center for the Analysis of Healthcare Data practice, internal medicine, obstetrics/gynecology, pediatrics, Department of Health and Human Services, NHE Fact Sheet. (NCAHD), 2016-17. and geriatric medicine. 26 Excludes Medicaid/Medicare Baltimore: 2017.

20 N Northwest Arkansas Council Northwest Arkansas Council N 21 Table 6: Healthcare Sector Economy by Peer Market Spokane, Wash., and other The key to long-term success in DURHAM- NORTHWEST AUSTIN BOISE DES MOINES CHAPEL HILL EVANSVILLE MADISON ARKANSAS SPOKANE peer markets, for example, analyzed healthcare sector transformation is how their healthcare economies are the identification of platforms for $14.3 B $5.0 B $5.2 B $12.4 B $3.4 B $6.3 B $2.7 B $4.5 B clustered, how these clusters align with The “missing” $950 economic growth and development existing infrastructure or physical/ that are rooted in historical strengths HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE million in the healthcare SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT locational assets, and which areas are economy is mostly and future aspirations. Tripp Umbach most ripe for healthcare innovation attributable to patients identified specific healthcare growth $228.0 B $66.1 B $83.0 B $72.9 B $56.0 B $82.8 B $48.0 B $44.0 B and strategic investment. Collaborative leaving the region for platforms within the seven peer OVERALL OVERALL OVERALL OVERALL OVERALL OVERALL OVERALL OVERALL innovation is necessary to advance specialty care services markets. The table in Appendix B OUTPUT OUTPUT OUTPUT OUTPUT OUTPUT OUTPUT OUTPUT OUTPUT in healthcare; thus, within the peer and relatively few summarizes the various platforms for markets, coalitions and councils to build patients traveling to peer markets and the relative position on both the innovation and place- Northwest Arkansas of the healthcare sector within their Table 7: Healthcare Sector Employment by Peer Market making strengths within the healthcare overall economies. NORTHWEST to receive DURHAM- sector of that region have been Table 8 (next page) shows that all ARKANSAS healthcare services. AUSTIN BOISE DES MOINES CHAPEL HILL EVANSVILLE MADISON SPOKANE developed. Specifically, in healthcare, life of the peer markets have healthcare science breakthroughs are coupling with or higher education among their top information technology in areas such as two employment sectors. Northwest personalized medicine and health IT to Arkansas, however, has retail trade and redefine the care continuum, creating manufacturing as its top sectors. It’s wide openings for technology and life likely that those two sectors will remain science capitals such as Austin, Texas. centerpieces of the future Northwest Durham-Chapel Hill, N.C., Arkansas economy as the region’s and Madison, Wis., are metros with largest employers are making new, historically strong academic health- strong commitments to the region. related research platforms and world-renowned healthcare Walmart, for example, plans to build a world-class new facilities. Those have led to strong foundations of medical headquarters in Bentonville and expects that project to specialties per capita and relatively high percentages of take several years. Tyson Foods opened a new technology employment and economic output from their healthcare hub in downtown Springdale in 2017, and J.B. Hunt sectors. Des Moines, Iowa, Evansville, Ind.-Ky., and the Transport Services completed an impressive expansion for approximately one in every 10 jobs.29 In 2017, Cooperation and regional goal-setting are present Spokane metro are mature healthcare markets that have that same year, which led to new jobs in Northwest healthcare became the economy’s largest employment in Northwest Arkansas as evidenced by recent planning recognized the need to make investments in health science, Arkansas. In 2018, J.B. Hunt began work on a new sector for the first time, exceeding retail and employing and prioritization of infrastructure assets. Through the medical education, and health-related research. technology center that will house hundreds of workers. 12.4 million healthcare professionals.30 Northwest Arkansas Council, there’s a strong history The Austin, Texas, metro has a strong technology The concentration of Fortune 500 companies in Peer market benchmarking indicates that of considering regional priorities and pursuing them foundation and is an up-and-coming healthcare market. Northwest Arkansas suggests the opportunity for a Northwest Arkansas lags behind peers in the economic collaboratively. Past collaborative successes include the It made investments in research and medical education higher ratio of industry-backed research.32 impact of its healthcare sector, with a healthcare sector opening of the Northwest Arkansas Regional Airport, the through a new medical school and in a teaching hospital However, according to the recent report by The impact of $2.7 billion in 2017. Des Moines, Iowa has establishment of the Benton/Washington Regional Public through a community integrated partnership with the American Heartland’s Position in The Innovation twice as much impact from healthcare and there’s five Water Authority, and the consistent development and county (See Appendix B). Meanwhile, the Boise City- Economy | Walton Family Foundation, Arkansas, is in times as much in Durham-Chapel Hill. To meet the updating of regional highway priorities at the Northwest Nampa, Idaho metro is a relatively weak healthcare the 46th position in academic R&D and 49th for overall median of peer markets per population, the Northwest Arkansas Regional Planning Commission. However, market, related to specialty care. However, the area is now R&D. Additionally, the National Science Foundation Arkansas healthcare economy would equal $3.6 billion the region is lagging in the arena of healthcare-focused making investments in research and medical education ranks 900 universities on annual R&D expenditures. annually – approximately $950 million more than collaboration to foster service growth and meet the needs with the addition of the only medical school in the state. The University of Arkansas ranked 130th out of 900 currently. An economic impact assessment by Tripp of a growing population with innovation. Metros across To evaluate and benchmark Northwest Arkansas’ universities in 2016. Compared with other flagship, Umbach shows the “missing” $950 million in the the nation have their own innovation assets, requiring healthcare sector to peer markets, Tripp Umbach land-grant universities, Arkansas ranked near the healthcare economy is mostly attributable to patients leaders to employ unique strategies to leverage them. developed an industry sector for “Healthcare” based bottom in terms of industry-funded R&D. Additionally, leaving the region for specialty care services and The peer markets analyzed for this assessment have strong on the IMPLAN industry codes that apply to the the 2016 study by the Arkansas Department of Health relatively few patients traveling to Northwest Arkansas anchor institutions surrounding academic medicine and a healthcare industry. 31 regarding projected job growth for 2022 stated that to receive healthcare services. high concentration of health-related research, with deep healthcare jobs will grow dramatically in Northwest specializations in areas such as health information technology. 31 Scientific research and development services, offices Arkansas, but the growth in that sector is still less than Peer markets noted in this report are successfully of physicians, offices of dentists, offices of other health the national level growth. 29 “Health Care Employment as a Percent of Total practitioners, outpatient care centers, medical and diagnostic Employment.” The Henry J. Kaiser Family Foundation. Last expanding their healthcare sectors in big ways, making laboratories, home healthcare services, other ambulatory modified: May 2015. positive impacts on the economies, healthcare services, healthcare services, hospitals, nursing and community care KFF.org/other/state-indicator/health-care-employment-as-total. and quality of life. facilities, and residential mental retardation, mental health, 32 Greater Northwest Arkansas Development Strategy: 30 The Atlantic. Jan. 10, 2018. substance abuse, and other facilities. The 2018 Blueprint. Northwest Arkansas Council. .

22 N Northwest Arkansas Council Northwest Arkansas Council N 23 Table 6: Healthcare Sector Economy by Peer Market Spokane, Wash., and other The key to long-term success in DURHAM- NORTHWEST AUSTIN BOISE DES MOINES CHAPEL HILL EVANSVILLE MADISON ARKANSAS SPOKANE peer markets, for example, analyzed healthcare sector transformation is how their healthcare economies are the identification of platforms for $14.3 B $5.0 B $5.2 B $12.4 B $3.4 B $6.3 B $2.7 B $4.5 B clustered, how these clusters align with The “missing” $950 economic growth and development existing infrastructure or physical/ that are rooted in historical strengths HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE HEALTHCARE million in the healthcare SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT SECTOR OUTPUT locational assets, and which areas are economy is mostly and future aspirations. Tripp Umbach most ripe for healthcare innovation attributable to patients identified specific healthcare growth $228.0 B $66.1 B $83.0 B $72.9 B $56.0 B $82.8 B $48.0 B $44.0 B and strategic investment. Collaborative leaving the region for platforms within the seven peer OVERALL OVERALL OVERALL OVERALL OVERALL OVERALL OVERALL OVERALL innovation is necessary to advance specialty care services markets. The table in Appendix B OUTPUT OUTPUT OUTPUT OUTPUT OUTPUT OUTPUT OUTPUT OUTPUT in healthcare; thus, within the peer and relatively few summarizes the various platforms for markets, coalitions and councils to build patients traveling to peer markets and the relative position on both the innovation and place- Northwest Arkansas of the healthcare sector within their Table 7: Healthcare Sector Employment by Peer Market making strengths within the healthcare overall economies. NORTHWEST to receive DURHAM- sector of that region have been Table 8 (next page) shows that all ARKANSAS healthcare services. AUSTIN BOISE DES MOINES CHAPEL HILL EVANSVILLE MADISON SPOKANE developed. Specifically, in healthcare, life of the peer markets have healthcare science breakthroughs are coupling with or higher education among their top information technology in areas such as two employment sectors. Northwest personalized medicine and health IT to Arkansas, however, has retail trade and redefine the care continuum, creating manufacturing as its top sectors. It’s wide openings for technology and life likely that those two sectors will remain science capitals such as Austin, Texas. centerpieces of the future Northwest Durham-Chapel Hill, N.C., Arkansas economy as the region’s and Madison, Wis., are metros with largest employers are making new, historically strong academic health- strong commitments to the region. related research platforms and world-renowned healthcare Walmart, for example, plans to build a world-class new facilities. Those have led to strong foundations of medical headquarters in Bentonville and expects that project to specialties per capita and relatively high percentages of take several years. Tyson Foods opened a new technology employment and economic output from their healthcare hub in downtown Springdale in 2017, and J.B. Hunt sectors. Des Moines, Iowa, Evansville, Ind.-Ky., and the Transport Services completed an impressive expansion for approximately one in every 10 jobs.29 In 2017, Cooperation and regional goal-setting are present Spokane metro are mature healthcare markets that have that same year, which led to new jobs in Northwest healthcare became the economy’s largest employment in Northwest Arkansas as evidenced by recent planning recognized the need to make investments in health science, Arkansas. In 2018, J.B. Hunt began work on a new sector for the first time, exceeding retail and employing and prioritization of infrastructure assets. Through the medical education, and health-related research. technology center that will house hundreds of workers. 12.4 million healthcare professionals.30 Northwest Arkansas Council, there’s a strong history The Austin, Texas, metro has a strong technology The concentration of Fortune 500 companies in Peer market benchmarking indicates that of considering regional priorities and pursuing them foundation and is an up-and-coming healthcare market. Northwest Arkansas suggests the opportunity for a Northwest Arkansas lags behind peers in the economic collaboratively. Past collaborative successes include the It made investments in research and medical education higher ratio of industry-backed research.32 impact of its healthcare sector, with a healthcare sector opening of the Northwest Arkansas Regional Airport, the through a new medical school and in a teaching hospital However, according to the recent report by The impact of $2.7 billion in 2017. Des Moines, Iowa has establishment of the Benton/Washington Regional Public through a community integrated partnership with the American Heartland’s Position in The Innovation twice as much impact from healthcare and there’s five Water Authority, and the consistent development and county (See Appendix B). Meanwhile, the Boise City- Economy | Walton Family Foundation, Arkansas, is in times as much in Durham-Chapel Hill. To meet the updating of regional highway priorities at the Northwest Nampa, Idaho metro is a relatively weak healthcare the 46th position in academic R&D and 49th for overall median of peer markets per population, the Northwest Arkansas Regional Planning Commission. However, market, related to specialty care. However, the area is now R&D. Additionally, the National Science Foundation Arkansas healthcare economy would equal $3.6 billion the region is lagging in the arena of healthcare-focused making investments in research and medical education ranks 900 universities on annual R&D expenditures. annually – approximately $950 million more than collaboration to foster service growth and meet the needs with the addition of the only medical school in the state. The University of Arkansas ranked 130th out of 900 currently. An economic impact assessment by Tripp of a growing population with innovation. Metros across To evaluate and benchmark Northwest Arkansas’ universities in 2016. Compared with other flagship, Umbach shows the “missing” $950 million in the the nation have their own innovation assets, requiring healthcare sector to peer markets, Tripp Umbach land-grant universities, Arkansas ranked near the healthcare economy is mostly attributable to patients leaders to employ unique strategies to leverage them. developed an industry sector for “Healthcare” based bottom in terms of industry-funded R&D. Additionally, leaving the region for specialty care services and The peer markets analyzed for this assessment have strong on the IMPLAN industry codes that apply to the the 2016 study by the Arkansas Department of Health relatively few patients traveling to Northwest Arkansas anchor institutions surrounding academic medicine and a healthcare industry. 31 regarding projected job growth for 2022 stated that to receive healthcare services. high concentration of health-related research, with deep healthcare jobs will grow dramatically in Northwest specializations in areas such as health information technology. 31 Scientific research and development services, offices Arkansas, but the growth in that sector is still less than Peer markets noted in this report are successfully of physicians, offices of dentists, offices of other health the national level growth. 29 “Health Care Employment as a Percent of Total practitioners, outpatient care centers, medical and diagnostic Employment.” The Henry J. Kaiser Family Foundation. Last expanding their healthcare sectors in big ways, making laboratories, home healthcare services, other ambulatory modified: May 2015. positive impacts on the economies, healthcare services, healthcare services, hospitals, nursing and community care KFF.org/other/state-indicator/health-care-employment-as-total. and quality of life. facilities, and residential mental retardation, mental health, 32 Greater Northwest Arkansas Development Strategy: 30 The Atlantic. Jan. 10, 2018. substance abuse, and other facilities. The 2018 Blueprint. Northwest Arkansas Council. .

22 N Northwest Arkansas Council Northwest Arkansas Council N 23 Table 8: Occupation and Industry Profiles by Peer Market nursing, community health promotion, human Study Finding Information about Northwest Arkansas and its peer regions provided by Data USA, which shares resource development, kinesiology, recreation and sport government statistics, indicates the largest industries and the college majors that are most prevalent. management, and communication disorders. Other Improved connectivity among schools, including NorthWest Arkansas Community Largest Industries (2016) Most Popular Majors (2015) employers, community health College (NWACC) and John Brown University (JBU), initiatives, individuals, and Northwest Arkansas Retail trade, General Finance, Registered Nursing, also play important roles in the region. healthcare providers is critical to Manufacturing, and and General Biological Sciences The UAMS Northwest campus is an extension of 4 achieving long-term economic and Healthcare & Social the UAMS medical education, research, and clinical social outcomes. Assistance mission in Northwest Arkansas. Academic programs Peer Regions: through the Colleges of Medicine and Pharmacy allow The U.S. healthcare delivery system has been evolving UAMS third- and fourth-year students to complete over decades, from the “golden age” of fee-for-service in Austin-Round Rock, Professional, Scientific, Tech General Biological Sciences, General their degrees in Northwest Arkansas. Medical students the 1960s, ‘70s, and ‘80s to the proliferation of managed Texas Services, Retail Trade, and Psychology, and Other Multidisciplinary Studies spend a significant portion of the third and fourth care in the ‘90s to the increasingly corporatized and Healthcare & Social Assistance years of medical school in hospitals and clinics learning value-driven system in place today.33 Throughout the Boise City-Nampa, Healthcare & Social Registered Nursing, Speech Communication under the supervision of experienced physician U.S., health insurance premiums are expected to rise in Idaho Assistance, Retail Trade, and & Rhetoric, and Other Health Professions & educators. In addition, the regional campus includes the coming years and the number of people covered by Manufacturing Related Clinical Sciences graduate-level nursing programs, a doctoral physical insurance exchanges is likely to decline. Rather than more therapy program, and an undergraduate program in uniform coverage and regulations, insurance costs, options, Des Moines- Finance & Insurance, Liberal Arts & Sciences, Registered Nursing, radiologic imaging. UAMS Northwest offers residencies and regulations are expected to vary more from state to Healthcare & Social and Criminal Justice - Police Science West Des Moines, Iowa in family medicine, internal medicine, psychiatry, and state. Nationally, a modern managed healthcare model is Assistance, and Retail Trade pharmacy, along with a fellowship in sports medicine. growing out of a desire to reform the traditional healthcare Durham-Chapel Hill, Educational Services; General Biological Sciences, General Strong academic and research programs serve system, or the fee-for-service method of charging for N.C. Professional, Scientific, Tech Psychology, and General Economics. as a catalyst with hospitals and health systems in healthcare. The U.S. healthcare system continues to evolve Services; and Healthcare & a region, leading to medical education expansion, its focus on quality care and population health. Social Assistance clinical research, basic science, and new sub-specialty Arkansas is moving to a value-based system and Evansville, Ind.-Ky Manufacturing, Healthcare & Registered Nursing, Health Care programs. A strong academic medicine base that has utilized creative solutions to expand healthcare Social Assistance, and Retail Administration & Management, and includes clinical and industry affiliations leverages and coverage to individuals. The Arkansas Department of Trade Kinesiology & Exercise Science enhances a region’s healthcare sector, including but not Human Services has made quality improvement and limited to the bio/life science and tech industry, which performance assessment a cornerstone in its efforts Madison, Wis Healthcare & Social General Economics, General Biological diversifies its offerings. This approach creates jobs by to improve healthcare delivery for all Arkansans. Assistance, Educational Sciences, and General Psychology attracting and retaining quality workforce and sparking Most notably, Arkansas was the first state to receive Services, and Retail Trade potential commercialization and spinoff business, and a Medicaid 115 waiver from the Patient Protection it simultaneously keeps residents from seeking services and Affordable Care Act, and studies conducted by elsewhere. It helps capture and keep dollars in the region. the Commonwealth Fund indicate Arkansas is on the Spokane-Spokane Valley, Healthcare & Social General Psychology, General Biological The benchmarked peer markets in this assessment road to success with its waiver program for low-income 34 Wash. Assistance, Retail Trade, and Sciences, and General Business have moved beyond the traditional model where adults. Additionally, the Arkansas Foundation for Educational Services healthcare entities interface only with academic Medical Care (AFMC) is a leading quality improvement Note: For a map of peer regions, see page 4. medicine to provide clerkships for undergraduate organization committed to improving healthcare. medical students and/or sponsorship of a residency AFMC works in collaboration with Arkansas Medicaid program. They have evolved to a model where to help the state’s healthcare professionals and hospitals expansion of clinical programs and services are closely offer the best quality care. As recently stated within the Greater Northwest major research universities, academic medical centers, tied to both teaching and research programs. Research In 2014, the Centers for Medicare & Medicaid Arkansas Development Strategy, prepared by the and research-oriented medical hospitals with extensive opportunities between faculty at academic institutions Services (CMS) transitioned the Quality Improvement Northwest Arkansas Council, the entrepreneurial research and development, and in some cases, strong and physicians translate into expanded clinical Organization program to a regional structure, now support system is fractured and must be regionalized industry anchors in technology. programs for patients in the region as well as those who referred to as the Quality Innovation Network-Quality to build critical mass in industry clusters, talent, and Northwest Arkansas is home to one major research travel to the area for advanced care. The attraction Improvement Organization program. The new region, capital. Additionally, the strategy stated the region must university and several other institutions of higher of increased volumes of patients from outside of the led by the Texas Medical Foundation Health Quality build better connectivity among regional employers, the education. The University of Arkansas educates region due to “destination healthcare” stimulated by Institute and including Arkansas, Missouri, Oklahoma University of Arkansas, and entrepreneurial support about 70 percent of the more than 38,000 students state-of-the-art, specialized clinical care and integrated and Puerto Rico, is responsible for assisting providers in organizations to capitalize on the organic growth enrolled in the region’s higher education institutions. research and teaching support increased economic potential of the region’s three Fortune 500 companies The university’s College of Education and Health activity throughout the peer regions. 33 2018 Review of Physician and Advanced Practitioner Recruiting Incentives. Merritt Hawkins. and a Class I Carnegie research institution. The peer Professions focuses on two important areas – education 34 www.CommonwealthFund.org/publications/issue- markets evaluated for this study have strengths within and health – with diverse disciplines including teaching, briefs/2017/feb/evidence-private-option-arkansas-experience 24 N Northwest Arkansas Council Northwest Arkansas Council N 25 Table 8: Occupation and Industry Profiles by Peer Market nursing, community health promotion, human Study Finding Information about Northwest Arkansas and its peer regions provided by Data USA, which shares resource development, kinesiology, recreation and sport government statistics, indicates the largest industries and the college majors that are most prevalent. management, and communication disorders. Other Improved connectivity among schools, including NorthWest Arkansas Community Largest Industries (2016) Most Popular Majors (2015) employers, community health College (NWACC) and John Brown University (JBU), initiatives, individuals, and Northwest Arkansas Retail trade, General Finance, Registered Nursing, also play important roles in the region. healthcare providers is critical to Manufacturing, and and General Biological Sciences The UAMS Northwest campus is an extension of 4 achieving long-term economic and Healthcare & Social the UAMS medical education, research, and clinical social outcomes. Assistance mission in Northwest Arkansas. Academic programs Peer Regions: through the Colleges of Medicine and Pharmacy allow The U.S. healthcare delivery system has been evolving UAMS third- and fourth-year students to complete over decades, from the “golden age” of fee-for-service in Austin-Round Rock, Professional, Scientific, Tech General Biological Sciences, General their degrees in Northwest Arkansas. Medical students the 1960s, ‘70s, and ‘80s to the proliferation of managed Texas Services, Retail Trade, and Psychology, and Other Multidisciplinary Studies spend a significant portion of the third and fourth care in the ‘90s to the increasingly corporatized and Healthcare & Social Assistance years of medical school in hospitals and clinics learning value-driven system in place today.33 Throughout the Boise City-Nampa, Healthcare & Social Registered Nursing, Speech Communication under the supervision of experienced physician U.S., health insurance premiums are expected to rise in Idaho Assistance, Retail Trade, and & Rhetoric, and Other Health Professions & educators. In addition, the regional campus includes the coming years and the number of people covered by Manufacturing Related Clinical Sciences graduate-level nursing programs, a doctoral physical insurance exchanges is likely to decline. Rather than more therapy program, and an undergraduate program in uniform coverage and regulations, insurance costs, options, Des Moines- Finance & Insurance, Liberal Arts & Sciences, Registered Nursing, radiologic imaging. UAMS Northwest offers residencies and regulations are expected to vary more from state to Healthcare & Social and Criminal Justice - Police Science West Des Moines, Iowa in family medicine, internal medicine, psychiatry, and state. Nationally, a modern managed healthcare model is Assistance, and Retail Trade pharmacy, along with a fellowship in sports medicine. growing out of a desire to reform the traditional healthcare Durham-Chapel Hill, Educational Services; General Biological Sciences, General Strong academic and research programs serve system, or the fee-for-service method of charging for N.C. Professional, Scientific, Tech Psychology, and General Economics. as a catalyst with hospitals and health systems in healthcare. The U.S. healthcare system continues to evolve Services; and Healthcare & a region, leading to medical education expansion, its focus on quality care and population health. Social Assistance clinical research, basic science, and new sub-specialty Arkansas is moving to a value-based system and Evansville, Ind.-Ky Manufacturing, Healthcare & Registered Nursing, Health Care programs. A strong academic medicine base that has utilized creative solutions to expand healthcare Social Assistance, and Retail Administration & Management, and includes clinical and industry affiliations leverages and coverage to individuals. The Arkansas Department of Trade Kinesiology & Exercise Science enhances a region’s healthcare sector, including but not Human Services has made quality improvement and limited to the bio/life science and tech industry, which performance assessment a cornerstone in its efforts Madison, Wis Healthcare & Social General Economics, General Biological diversifies its offerings. This approach creates jobs by to improve healthcare delivery for all Arkansans. Assistance, Educational Sciences, and General Psychology attracting and retaining quality workforce and sparking Most notably, Arkansas was the first state to receive Services, and Retail Trade potential commercialization and spinoff business, and a Medicaid 115 waiver from the Patient Protection it simultaneously keeps residents from seeking services and Affordable Care Act, and studies conducted by elsewhere. It helps capture and keep dollars in the region. the Commonwealth Fund indicate Arkansas is on the Spokane-Spokane Valley, Healthcare & Social General Psychology, General Biological The benchmarked peer markets in this assessment road to success with its waiver program for low-income 34 Wash. Assistance, Retail Trade, and Sciences, and General Business have moved beyond the traditional model where adults. Additionally, the Arkansas Foundation for Educational Services healthcare entities interface only with academic Medical Care (AFMC) is a leading quality improvement Note: For a map of peer regions, see page 4. medicine to provide clerkships for undergraduate organization committed to improving healthcare. medical students and/or sponsorship of a residency AFMC works in collaboration with Arkansas Medicaid program. They have evolved to a model where to help the state’s healthcare professionals and hospitals expansion of clinical programs and services are closely offer the best quality care. As recently stated within the Greater Northwest major research universities, academic medical centers, tied to both teaching and research programs. Research In 2014, the Centers for Medicare & Medicaid Arkansas Development Strategy, prepared by the and research-oriented medical hospitals with extensive opportunities between faculty at academic institutions Services (CMS) transitioned the Quality Improvement Northwest Arkansas Council, the entrepreneurial research and development, and in some cases, strong and physicians translate into expanded clinical Organization program to a regional structure, now support system is fractured and must be regionalized industry anchors in technology. programs for patients in the region as well as those who referred to as the Quality Innovation Network-Quality to build critical mass in industry clusters, talent, and Northwest Arkansas is home to one major research travel to the area for advanced care. The attraction Improvement Organization program. The new region, capital. Additionally, the strategy stated the region must university and several other institutions of higher of increased volumes of patients from outside of the led by the Texas Medical Foundation Health Quality build better connectivity among regional employers, the education. The University of Arkansas educates region due to “destination healthcare” stimulated by Institute and including Arkansas, Missouri, Oklahoma University of Arkansas, and entrepreneurial support about 70 percent of the more than 38,000 students state-of-the-art, specialized clinical care and integrated and Puerto Rico, is responsible for assisting providers in organizations to capitalize on the organic growth enrolled in the region’s higher education institutions. research and teaching support increased economic potential of the region’s three Fortune 500 companies The university’s College of Education and Health activity throughout the peer regions. 33 2018 Review of Physician and Advanced Practitioner Recruiting Incentives. Merritt Hawkins. and a Class I Carnegie research institution. The peer Professions focuses on two important areas – education 34 www.CommonwealthFund.org/publications/issue- markets evaluated for this study have strengths within and health – with diverse disciplines including teaching, briefs/2017/feb/evidence-private-option-arkansas-experience 24 N Northwest Arkansas Council Northwest Arkansas Council N 25 Table 9: Hospital Referral Region by Employer-Sponsored Insurance Table 10: Hospital Referral Region by Medicare Enrollee Data collected by the Commonwealth Fund compares healthcare spending and quality. The chart shows how The Commonwealth Fund maintains a database about the quality of care and healthcare spending in regions Northwest Arkansas compares to its peers when it comes to employer-sponsored insurance. across the U.S., including people who are Medicare enrollees.

Total spending per enrollee Hospital 30-day Potentially Preventable Total inpatient Inpatient spending Hospital 30-day Patients received All four conditions and affect on overall quality readmission avoidable ED hospitalization, per spending per per beneficiary vs readmission patient-centered combined score rate, per 1,000 visits, per 1,000 1,000 enrollees beneficiary and hospital quality rate; care (i.e., heart enrollees vs. enrollees vs. affect on overall score Percent of attack, heart quality score quality quality score hospitalizations failure, stroke, pneumonia): Total spending Quality Quality Quality Prevent- Quality 30-day mortality Referral Region per enrollee score Rate score Visits score ables score among hospitalized Austin $4,423 2% 3.2 1% 141.2 1% 6.6 0% patients (7% lower) higher lower lower difference Referral Quality Quality Quality Quality Quality Boise $5,403 0% 5.2 2% 136.6 2% 6.4 3% Region: Total score Amount score Rate score Rate score Rate score (13% higher) difference lower higher higher Austin $9,890 2% $2,350 3% higher 15.4% 5% 71.1% 4% 13.8% 4% Des Moines $4,023 9% 3.3 3% 120.7 15% 6.3 5% higher (7% higher) higher (6% lower) higher higher higher (16% lower) higher lower higher Boise $7,812 22% $2,048 7% higher 12.6% 28% 70% 2% 14.4% 1% Durham-Chapel Hill $4,261 1% 2.9 7% 145.8 5% 6.5 2% higher (15% lower) higher (19% higher higher lower (11% lower) higher higher lower lower) Evansville $5,352 4% 3.5 10% 144.7 4% 7 6% lower Des Moines $7,624 12% $2,087 3% higher 13.8% 17% 70.3% 3% 15.2% 6% (12% higher) lower lower lower (17% lower) higher (17% higher higher lower lower) Madison $6,517 0% 3.4 8% 147.1 5% 6.6 0% (37% higher) difference lower lower difference Durham- $8,747 5% $2,558 2% lower 17.2% 6% 66.7% 2% 14.5% 1% Chapel Hill (5% lower) lower (2% higher) lower lower lower Northwest Arkansas $3,694 2% 2.9 9% 127.9 9% 6.0 10% (23% lower) higher higher higher higher Evansville $9,524 6% $2,688 0% 16.6% 3% 70.8% 4% 14.8% 3% (3% higher) lower (7% higher) difference lower higher lower Spokane $4,334 13% 2.5 26% 121.5 14% 5.6 18% (9% lower) higher higher higher higher Madison $7,185 14% $2,049 5% higher 14.7% 10% 72.9% 7% 14.4% 1% (22% lower) higher (18% lower) higher higher lower

Arkansas.35 Arkansas has emerged as a leader through In spite of dramatic healthcare transformation at Northwest $8,808 5% $2,433 3% higher 14.3% 13% 67.3% 1% 15.7% 9% the design and implementation of its innovative the national and state levels, hospitals in Northwest Arkansas (4% lower) higher (3% lower) higher lower lower Arkansas Payment Improvement Initiative (APII) in Arkansas are still largely funded through a fee-for- Spokane $7,778 16% $2,047 5% higher 13.4% 21% 69.7% 2% 15.2% 6% 2011. From its onset, APII has been a collaborative service model, where doctors and hospitals get paid (16% lower) higher (19% lower) higher higher lower effort among Arkansas Medicaid, Arkansas Blue Cross for each service performed. According to interviews *Note: all metrics are based on relative to US median and Blue Shield, and QualChoice of Arkansas. and work sessions completed by Tripp Umbach with

Working with hundreds of physicians, hospital top regional healthcare leaders, local hospitals are in a 37 executives, patients, families, and advocates, the APII crucial transition period from a historic fee-for-service technology, as well as defined referral processes, have been all other economy sectors. On the other hand, the team created a new patient-centered healthcare system. payment model to a value-based payment model in somewhat successful toward population management – nation’s healthcare costs continue to rise faster than The system will transition Arkansas from a passive which healthcare systems receive payment for providing managing both utilization and overall hospitalization cost. incomes and corporate profits. Nationally, healthcare payer for medical services to an active purchaser quality care and managing a set patient population. Continued improvement through the aforementioned costs have increased at a higher rate than GDP each of healthcare that embraces the “Triple Aim” of Managing a set population of patients is challenging efforts along with connectivity among employers and year for three decades – an unsustainable pace, improving the health of populations and communities, in Northwest Arkansas, where the majority of insurance healthcare providers related to healthcare coverage although the rate of growth in healthcare costs has enhancing the patient experience of care, and reducing plans provided by employers allow patients to choose that encourages coordinated regional care is critical. slowed significantly in recent years. the rapidly rising and unsustainable costs of care specialty care from multiple providers in and outside the Leaders from healthcare and industry must share insights, Productivity growth in healthcare is lower than in through quality improvement. Though some aspects of region. In an environment with mixed primary-specialty, expertise, and responsibility for population health and any other sector of the economy, with the exception the initiative exist elsewhere in the country, Arkansas mixed-employee, and mixed-systems, it is difficult to quality outcomes. of construction, and a significant body of research has is the first Medicaid program to use this approach control where patients go to see specialists. Furthermore, a Healthcare is both an asset and liability to highlighted areas of weakness in quality of care, the statewide with both public and private payers.36 lack of coordinated care makes efforts to improve overall metropolitan regions and the nation. On the one hand, prevalence of medical errors, and inconsistent access employment and spending in the sector has outpaced population health difficult. Northwest Arkansas’ efforts 37 In the 10 years preceding 2014, employment in the 35 AFMC.org/quality/ toward strengthening the region’s integrated medical healthcare sector grew 24.8 percent, while the economy as 36 HumanServices.arkansas.gov/about-dhs/dms/aqg/aqg- a whole grew 5.8 percent. Brookings Institution analysis of state-of-health-care practices, patient home structure and deployment of Moody’s Analytics estimates.

26 N Northwest Arkansas Council Northwest Arkansas Council N 27 Table 9: Hospital Referral Region by Employer-Sponsored Insurance Table 10: Hospital Referral Region by Medicare Enrollee Data collected by the Commonwealth Fund compares healthcare spending and quality. The chart shows how The Commonwealth Fund maintains a database about the quality of care and healthcare spending in regions Northwest Arkansas compares to its peers when it comes to employer-sponsored insurance. across the U.S., including people who are Medicare enrollees.

26 N Northwest Arkansas Council Northwest Arkansas Council N 27 to care and outcomes.38 Hospitals are evaluated across healthcare markets, called hospital referral regions a wide range of conditions and procedures. Within (HRRs). Within all tables, the data is shown relative to that range, hospitals perform differently. Viewed most the median for the U.S. In some instances, HRRs spend broadly, the purpose of quality measurement is to less but achieve higher quality, and some spend more secure the most healthcare value for society’s very large but achieve lower quality. As capitated payments to investment. Knowledge about the state of quality is healthcare providers in the future are tied to healthcare essential if policymakers are to understand the effects quality and outcomes, it is important for quality and of health of services that are provided and how these outcome scores to remain higher than the U.S. median effects may differ for different patient populations, as Northwest Arkansas adds subspecialty services.40 health conditions, and settings of care.39 Quality is Northwest Arkansas has slightly above average related but not identical to good outcomes. Services healthcare quality compared to the U.S. median provided will offer more benefit than harm, based on among the employer-sponsored insurance enrollees and photo courtesy UAMS Northwest the best available information about the patient and significantly lower healthcare spending, due in large part about the effectiveness of a particular kind of treatment to a high percentage of the insured population leaving the for patients with similar health problems. region for high-cost specialty care. Quality is slightly higher, In terms of clinical quality, such measurement often but cost is only slightly lower for the Medicare population focuses on the diagnosis and management of disease and as more than 80 percent41 of Medicare enrollees remain in will address preventive care such as screening for disease. Northwest Arkansas for their inpatient care. Performance measures may include interpersonal aspects of The benchmarked metros studied by Tripp care, service, timeliness, and convenience. Technical aspects Umbach with the highest percentage of specialty Great for Business. of care include the timeliness and accuracy of diagnosis, care such as Madison, Wis., have significantly higher the appropriateness of therapy, complications and mishaps spending per employer-sponsored insurance and only Great for Life. during treatment and coordination of care across delivery average quality. One of the methods for higher quality At the Jean Tyson Child Development Study Center in Fayetteville, settings, episodes of care, and professional disciplines. of care is a strong network of integrated primary care Kemmian Johnson and Anna Nguyen, fourth-year medical students The Robert Wood Johnson Foundation publishes and specialty physicians. Currently, network integration at the University of Arkansas for Medical Sciences (UAMS), talk annual county health rankings for each state. Health in Northwest Arkansas is scattered throughout the with preschoolers about healthy eating and staying active as part outcomes in the three Northwest Arkansas counties that region, and continued movement toward closer of a balanced life. UAMS is an important part of expanding the are the focus of this assessment represent a wide variance. integration is critical. Lastly, most commercial payers healthcare economy in Northwest Arkansas. Health rankings are based on two measures: how long are moving to additional reimbursements for quality people live and how healthy people feel while alive. compliance, and patient satisfaction. Commercial Similarly, the foundation ranks counties based on payers account for the majority (61 percent) of the medical school keeps increasing. Some 21,000 first- 60 percent chance that a person who completes medical health factors that influence the county. The ranking Northwest Arkansas population. Medicare has the most year students enrolled in allopathic medical schools in school and graduate medical education training in is based on four measures: health behaviors, clinical growth at 1 percent, while commercial and uninsured 2016-17, which amounts to a 28 percent increase since a region will remain in the region to practice. It’s care, social and economic factors, and physical are expected to decrease 1 percent.42 2002-03, the AAMC reports in an annual survey of even more challenging when a person completes environment. Benton and Washington counties rank medical school deans. During that same 14-year period, only medical school in a region. The chance of that No. 1 and No. 2 in Arkansas for Health Outcomes, Study Finding first-year enrollment at osteopathic schools increased person remaining to practice in the area drops to 2018 County Health Rankings show, but it is 148 percent, reaching 7,369 in 2017. approximately 20 percent. important to note that Arkansas is ranked among the Limited Graduate Medical There are many new medical colleges in the Although there has been a significant increase bottom in all these measures (See Appendix C). Education (GME) in Northwest pipeline. By 2022, when full enrollment occurs at in medical school enrollment in the past decade, the Because comparisons to Arkansas have limitations Arkansas is holding back needed Kansas City College of Osteopathic Medicine in Joplin, number of governmental-funded residency training due to the state’s low national rankings in health quality healthcare sector expansion. Mo., a new medical school in Fort Smith, Ark., and a positions available to new medical school graduates has and health outcomes, Tripp Umbach benchmarked 5 new regional campus of the Oklahoma State University remained almost flat.43 That limitation, and the move to Northwest Arkansas with national averages and the College of Osteopathic Medicine in Tahlequah, a single accreditation process for American Osteopathic seven peer regions. Data tools available through the approximately 300 medical student graduates will be Association (AOA) and Accreditation Council on Commonwealth Fund provide ways to compare The need for GME expansion is a challenge within a 70-mile radius of the Northwest Arkansas city Graduate Medical Education (ACGME) graduate training healthcare spending, relative to quality of care, in all facing the entire country, not just Northwest Arkansas. of Springdale. Additionally, the New York Institute of programs, will increase the competition for residency states, as well as in the nation’s 300-plus local Nationally, the number of students graduating from Technology opened a College of Osteopathic Medicine training positions among graduates. If new medical at the Jonesboro campus of Arkansas State University school graduates do not matriculate into residencies, 38 Brookings Metropolitan Policy Program | August 2016 40 Revenue under these arrangements is earned as a result of in 2016, and some of those students may be interested 39 Measuring the Quality of Health Care. 1999. A policy agreeing to provide services to enrollees for a per-member, in careers in Northwest Arkansas. 43 Effective Oct. 1, 1997, to the extent the number of allopathic paper that extended the Institute of Medicine’s efforts to per-month fee without regard to the actual amount of or osteopathic residents being trained at a teaching hospital inform policymakers, provider organizations and clinicians, services provided. It’s worth noting that simply increasing the number exceeds the 1996 limit, teaching hospitals receive no purchasers, and consumers about the measurement of 41 Percent obtained through non-disclosure agreement data of medical students does not lead to more physicians additional Independent Medical Evaluation or Direct Graduate healthcare quality—its uses, methods, promise and current presented by a hospital-specific assessment. remaining in a region to practice. Nationally, there is a Medical Education payments. Podiatry and dental residents challenges. 42 Source: IBM Insurance Coverage Estimates, 2018-2023. are excluded from the resident limits.

28 N Northwest Arkansas Council Northwest Arkansas Council N 29 to care and outcomes.38 Hospitals are evaluated across healthcare markets, called hospital referral regions a wide range of conditions and procedures. Within (HRRs). Within all tables, the data is shown relative to that range, hospitals perform differently. Viewed most the median for the U.S. In some instances, HRRs spend broadly, the purpose of quality measurement is to less but achieve higher quality, and some spend more secure the most healthcare value for society’s very large but achieve lower quality. As capitated payments to investment. Knowledge about the state of quality is healthcare providers in the future are tied to healthcare essential if policymakers are to understand the effects quality and outcomes, it is important for quality and of health of services that are provided and how these outcome scores to remain higher than the U.S. median effects may differ for different patient populations, as Northwest Arkansas adds subspecialty services.40 health conditions, and settings of care.39 Quality is Northwest Arkansas has slightly above average related but not identical to good outcomes. Services healthcare quality compared to the U.S. median provided will offer more benefit than harm, based on among the employer-sponsored insurance enrollees and photo courtesy UAMS Northwest the best available information about the patient and significantly lower healthcare spending, due in large part about the effectiveness of a particular kind of treatment to a high percentage of the insured population leaving the for patients with similar health problems. region for high-cost specialty care. Quality is slightly higher, In terms of clinical quality, such measurement often but cost is only slightly lower for the Medicare population focuses on the diagnosis and management of disease and as more than 80 percent41 of Medicare enrollees remain in will address preventive care such as screening for disease. Northwest Arkansas for their inpatient care. Performance measures may include interpersonal aspects of The benchmarked metros studied by Tripp care, service, timeliness, and convenience. Technical aspects Umbach with the highest percentage of specialty Great for Business. of care include the timeliness and accuracy of diagnosis, care such as Madison, Wis., have significantly higher the appropriateness of therapy, complications and mishaps spending per employer-sponsored insurance and only Great for Life. during treatment and coordination of care across delivery average quality. One of the methods for higher quality At the Jean Tyson Child Development Study Center in Fayetteville, settings, episodes of care, and professional disciplines. of care is a strong network of integrated primary care Kemmian Johnson and Anna Nguyen, fourth-year medical students The Robert Wood Johnson Foundation publishes and specialty physicians. Currently, network integration at the University of Arkansas for Medical Sciences (UAMS), talk annual county health rankings for each state. Health in Northwest Arkansas is scattered throughout the with preschoolers about healthy eating and staying active as part outcomes in the three Northwest Arkansas counties that region, and continued movement toward closer of a balanced life. UAMS is an important part of expanding the are the focus of this assessment represent a wide variance. integration is critical. Lastly, most commercial payers healthcare economy in Northwest Arkansas. Health rankings are based on two measures: how long are moving to additional reimbursements for quality people live and how healthy people feel while alive. compliance, and patient satisfaction. Commercial Similarly, the foundation ranks counties based on payers account for the majority (61 percent) of the medical school keeps increasing. Some 21,000 first- 60 percent chance that a person who completes medical health factors that influence the county. The ranking Northwest Arkansas population. Medicare has the most year students enrolled in allopathic medical schools in school and graduate medical education training in is based on four measures: health behaviors, clinical growth at 1 percent, while commercial and uninsured 2016-17, which amounts to a 28 percent increase since a region will remain in the region to practice. It’s care, social and economic factors, and physical are expected to decrease 1 percent.42 2002-03, the AAMC reports in an annual survey of even more challenging when a person completes environment. Benton and Washington counties rank medical school deans. During that same 14-year period, only medical school in a region. The chance of that No. 1 and No. 2 in Arkansas for Health Outcomes, Study Finding first-year enrollment at osteopathic schools increased person remaining to practice in the area drops to 2018 County Health Rankings show, but it is 148 percent, reaching 7,369 in 2017. approximately 20 percent. important to note that Arkansas is ranked among the Limited Graduate Medical There are many new medical colleges in the Although there has been a significant increase bottom in all these measures (See Appendix C). Education (GME) in Northwest pipeline. By 2022, when full enrollment occurs at in medical school enrollment in the past decade, the Because comparisons to Arkansas have limitations Arkansas is holding back needed Kansas City College of Osteopathic Medicine in Joplin, number of governmental-funded residency training due to the state’s low national rankings in health quality healthcare sector expansion. Mo., a new medical school in Fort Smith, Ark., and a positions available to new medical school graduates has and health outcomes, Tripp Umbach benchmarked 5 new regional campus of the Oklahoma State University remained almost flat.43 That limitation, and the move to Northwest Arkansas with national averages and the College of Osteopathic Medicine in Tahlequah, a single accreditation process for American Osteopathic seven peer regions. Data tools available through the approximately 300 medical student graduates will be Association (AOA) and Accreditation Council on Commonwealth Fund provide ways to compare The need for GME expansion is a challenge within a 70-mile radius of the Northwest Arkansas city Graduate Medical Education (ACGME) graduate training healthcare spending, relative to quality of care, in all facing the entire country, not just Northwest Arkansas. of Springdale. Additionally, the New York Institute of programs, will increase the competition for residency states, as well as in the nation’s 300-plus local Nationally, the number of students graduating from Technology opened a College of Osteopathic Medicine training positions among graduates. If new medical at the Jonesboro campus of Arkansas State University school graduates do not matriculate into residencies, 38 Brookings Metropolitan Policy Program | August 2016 40 Revenue under these arrangements is earned as a result of in 2016, and some of those students may be interested 39 Measuring the Quality of Health Care. 1999. A policy agreeing to provide services to enrollees for a per-member, in careers in Northwest Arkansas. 43 Effective Oct. 1, 1997, to the extent the number of allopathic paper that extended the Institute of Medicine’s efforts to per-month fee without regard to the actual amount of or osteopathic residents being trained at a teaching hospital inform policymakers, provider organizations and clinicians, services provided. It’s worth noting that simply increasing the number exceeds the 1996 limit, teaching hospitals receive no purchasers, and consumers about the measurement of 41 Percent obtained through non-disclosure agreement data of medical students does not lead to more physicians additional Independent Medical Evaluation or Direct Graduate healthcare quality—its uses, methods, promise and current presented by a hospital-specific assessment. remaining in a region to practice. Nationally, there is a Medical Education payments. Podiatry and dental residents challenges. 42 Source: IBM Insurance Coverage Estimates, 2018-2023. are excluded from the resident limits.

28 N Northwest Arkansas Council Northwest Arkansas Council N 29 mechanisms to support GME.46 industry and individuals have funded Ultimately, regional economies have GME programs across the country. a strong stake in developing GME Without additional alternative programs to meet the needs. funding, Northwest Arkansas’ GME is an essential More than 20 years ago, the teaching hospitals/training entities public investment federal government decided to reported they are unlikely to add in tomorrow’s limit the number of residents residents or make further investments healthcare system Medicare helped subsidize to curb in programs. Opportunity will that furthers the associated costs. The number of continue to be missed if Northwest nation’s goal of residents a hospital was teaching Arkansas does not devise an attaining the Triple Aim at the end of 1996 is the cap to efficient system that encourages and of better health, which that hospital is limited today; incentivizes institutions to participate better healthcare, meaning fast-growing regions such in residency training. Ultimately, and lower costs. as Northwest Arkansas must find the overall shortage in residency other ways to pay for their medical positions means fewer Arkansas residents. Since 1997, there have medical students and talented out-of- been many federal government state students have the opportunity proposals where increasing GME to remain in the state to complete funding was considered, including training and to practice medicine. Abbi Hopper and Elizabeth the Medicare Payment Advisory With the most recent GME Reynebeau, who work in the Commission (MedPAC) 2010 report, residency match in 2018, 66 neonatal intensive care unit at the 2011 Joint Committee on Deficit UAMS medical student seniors Washington Regional Medical Reduction (“Super Committee”), matched with Arkansas residency Center in Fayetteville, are the Simpson-Bowles Commission, positions and 89 received out-of- among the 3,490 registered photo courtesy Washington Regional Medical Center photo courtesy Washington and the Obama Administration’s state residencies in 33 states. Fifty- nurses who work in Northwest 2013 budget.47 In Congress, a bill that would increase one percent of the students received residencies in a Arkansas. There are more Medicare-funded residency slots for hospitals continues primary care specialty. Only four graduates matched than 22,450 healthcare workers Great for Business. Great for Life. to circulate. Regardless, the GME spending cap to a residency in Northwest Arkansas (three in internal in the region, accounting for remains in place. medicine, one in family medicine). Providing the third 7 percent of the workforce. Currently, hospitals throughout Northwest Arkansas and fourth years of undergraduate medical education are funding and supporting residents beyond their in Northwest Arkansas allows students to gain valuable federally funded cap. Although Medicare remains the skills and training. Once they graduate from medical primary formal financier of programs, contributing a school, these students then apply to GME programs. they won’t practice, offering no relief to the nation’s closely to research infrastructure, providing essential majority of all tax-financed support, it is not the only Residency training is a critical component of the physician shortage. Additionally, the number of non- training in research methods directly relevant to funding option. Other federal payers include Medicaid, medical education continuum and is critical for the physician providers is growing steadily. Almost 28,000 discovering new ways to keep patients healthy, diagnose 45 the U.S. Department of Veterans Affairs, the U.S. retention of physicians. UAMS has extensive history nurse practitioners graduated in 2017 alone. However, and treat illness, and improve the delivery of care. Department of Defense, and the Bureau of Health in medical education and provides resources to current the potential of non-physician providers to deliver care is In the past few years, the debate on how to best Professions. States are realizing they must develop and potential statewide partners. The presence of hindered by state-to-state laws that can limit their ability to fund and reform GME has moved up the health innovative funding mechanisms for GME expansion. For regional medical campuses in Northwest Arkansas diagnose and treat patients on their own. policy agenda. The dominant public funder of example, beyond traditional and non-traditional federal provide administrative infrastructure to support the The future of medical education and healthcare GME is Medicare, with Medicaid and the Veterans and state funding sources, private insurers, hospitals, development of new residency programs and should requires innovation and collaboration. Patients, Administration also contributing significantly to GME universities, physicians’ organizations, collaborative be leveraged through public and private investment providers, academic institutions, community funding. Proposals to reform GME have focused consortium efforts, and private philanthropy from beyond the federal government. u organizations, and industry must work together in on funding, governance, and the prioritization of innovative ways to provide high-quality care with better specialties. Most proposals come from national 46 Spero JC, Fraher EP, Ricketts TC, Rockey PH. GME in the outcomes at lower costs. That’s especially important organizations offering national solutions. Generally United States: A Review of State Initiatives. Cecil G. Sheps considering healthcare’s transition to value-based care. absent from the discussion is the important role state, Center for Health Services Research, The University of North GME is an essential public investment in tomorrow’s regional, and local leaders play in reforming GME. A Carolina at Chapel Hill. September 2013. 47 Holt KD, Miller RS, Philibert I, Nasca TJ. Effects of potential healthcare system that furthers the nation’s goal of few states have pioneered methods and organizational federal funding cuts on graduate medical education: results of attaining the Triple Aim of better health, better structures to target GME positions relative to state a survey of designated institutional officials. J Grad Med Educ. healthcare, and lower costs.44 Ideally, GME is tied health workforce needs and have offered creative 2014;6(1):183-188. Holt KD, Miller RS, Philibert I, Nasca TJ. Patterns of change in ACGME-accredited residency programs 44 Berwick DM, Nolan TW, Whittington J. The Triple Aim: and positions: implication for the adequacy of GME positions care, health, and cost. Health Aff (Millwood). May-Jun and supply of physicians in the United States. J Grad Med 2008;27(3):759-769. 45 COGME: Twenty-first Report, August 2013. Educ. 2014;6(2):399-403.

30 N Northwest Arkansas Council Northwest Arkansas Council N 31 mechanisms to support GME.46 industry and individuals have funded Ultimately, regional economies have GME programs across the country. a strong stake in developing GME Without additional alternative programs to meet the needs. funding, Northwest Arkansas’ GME is an essential More than 20 years ago, the teaching hospitals/training entities public investment federal government decided to reported they are unlikely to add in tomorrow’s limit the number of residents residents or make further investments healthcare system Medicare helped subsidize to curb in programs. Opportunity will that furthers the associated costs. The number of continue to be missed if Northwest nation’s goal of residents a hospital was teaching Arkansas does not devise an attaining the Triple Aim at the end of 1996 is the cap to efficient system that encourages and of better health, which that hospital is limited today; incentivizes institutions to participate better healthcare, meaning fast-growing regions such in residency training. Ultimately, and lower costs. as Northwest Arkansas must find the overall shortage in residency other ways to pay for their medical positions means fewer Arkansas residents. Since 1997, there have medical students and talented out-of- been many federal government state students have the opportunity proposals where increasing GME to remain in the state to complete funding was considered, including training and to practice medicine. Abbi Hopper and Elizabeth the Medicare Payment Advisory With the most recent GME Reynebeau, who work in the Commission (MedPAC) 2010 report, residency match in 2018, 66 neonatal intensive care unit at the 2011 Joint Committee on Deficit UAMS medical student seniors Washington Regional Medical Reduction (“Super Committee”), matched with Arkansas residency Center in Fayetteville, are the Simpson-Bowles Commission, positions and 89 received out-of- among the 3,490 registered photo courtesy Washington Regional Medical Center photo courtesy Washington and the Obama Administration’s state residencies in 33 states. Fifty- nurses who work in Northwest 2013 budget.47 In Congress, a bill that would increase one percent of the students received residencies in a Arkansas. There are more Medicare-funded residency slots for hospitals continues primary care specialty. Only four graduates matched than 22,450 healthcare workers Great for Business. Great for Life. to circulate. Regardless, the GME spending cap to a residency in Northwest Arkansas (three in internal in the region, accounting for remains in place. medicine, one in family medicine). Providing the third 7 percent of the workforce. Currently, hospitals throughout Northwest Arkansas and fourth years of undergraduate medical education are funding and supporting residents beyond their in Northwest Arkansas allows students to gain valuable federally funded cap. Although Medicare remains the skills and training. Once they graduate from medical primary formal financier of programs, contributing a school, these students then apply to GME programs. they won’t practice, offering no relief to the nation’s closely to research infrastructure, providing essential majority of all tax-financed support, it is not the only Residency training is a critical component of the physician shortage. Additionally, the number of non- training in research methods directly relevant to funding option. Other federal payers include Medicaid, medical education continuum and is critical for the physician providers is growing steadily. Almost 28,000 discovering new ways to keep patients healthy, diagnose 45 the U.S. Department of Veterans Affairs, the U.S. retention of physicians. UAMS has extensive history nurse practitioners graduated in 2017 alone. However, and treat illness, and improve the delivery of care. Department of Defense, and the Bureau of Health in medical education and provides resources to current the potential of non-physician providers to deliver care is In the past few years, the debate on how to best Professions. States are realizing they must develop and potential statewide partners. The presence of hindered by state-to-state laws that can limit their ability to fund and reform GME has moved up the health innovative funding mechanisms for GME expansion. For regional medical campuses in Northwest Arkansas diagnose and treat patients on their own. policy agenda. The dominant public funder of example, beyond traditional and non-traditional federal provide administrative infrastructure to support the The future of medical education and healthcare GME is Medicare, with Medicaid and the Veterans and state funding sources, private insurers, hospitals, development of new residency programs and should requires innovation and collaboration. Patients, Administration also contributing significantly to GME universities, physicians’ organizations, collaborative be leveraged through public and private investment providers, academic institutions, community funding. Proposals to reform GME have focused consortium efforts, and private philanthropy from beyond the federal government. u organizations, and industry must work together in on funding, governance, and the prioritization of innovative ways to provide high-quality care with better specialties. Most proposals come from national 46 Spero JC, Fraher EP, Ricketts TC, Rockey PH. GME in the outcomes at lower costs. That’s especially important organizations offering national solutions. Generally United States: A Review of State Initiatives. Cecil G. Sheps considering healthcare’s transition to value-based care. absent from the discussion is the important role state, Center for Health Services Research, The University of North GME is an essential public investment in tomorrow’s regional, and local leaders play in reforming GME. A Carolina at Chapel Hill. September 2013. 47 Holt KD, Miller RS, Philibert I, Nasca TJ. Effects of potential healthcare system that furthers the nation’s goal of few states have pioneered methods and organizational federal funding cuts on graduate medical education: results of attaining the Triple Aim of better health, better structures to target GME positions relative to state a survey of designated institutional officials. J Grad Med Educ. healthcare, and lower costs.44 Ideally, GME is tied health workforce needs and have offered creative 2014;6(1):183-188. Holt KD, Miller RS, Philibert I, Nasca TJ. Patterns of change in ACGME-accredited residency programs 44 Berwick DM, Nolan TW, Whittington J. The Triple Aim: and positions: implication for the adequacy of GME positions care, health, and cost. Health Aff (Millwood). May-Jun and supply of physicians in the United States. J Grad Med 2008;27(3):759-769. 45 COGME: Twenty-first Report, August 2013. Educ. 2014;6(2):399-403.

30 N Northwest Arkansas Council Northwest Arkansas Council N 31 Recommended Approach

Council acts as a convener for multiple parties. The and engage community leaders, foundations, Council’s 2018 Targeting Transformational Innovation employers, and healthcare sector leaders to blueprint suggests new foundations for success through raise awareness and encourage participation an expanded role for the Northwest Arkansas Council and financial contributions. as regional stewards. Throughout this assessment, the RECOMMENDED APPROACH u Commission a feasibility and business plan Council was mentioned as a strong asset through its for expanding GME in Northwest Arkansas Recognizing that no one ability to convene key leaders who have the power Northwest Arkansas to ensure that undergraduates from multiple organization has the resources to and influence for affecting change. The ability to partner medical schools are able to complete should establish an maximize economic development convene and view progress on a regional level, across their residency training in Northwest Arkansas. ongoing, coordinated potential, an umbrella organization all stakeholders and across “the system” recognizing its The key to transforming Healthcare Sector is needed to coordinate regional diverse components and interdependencies, is unique u Commission feasibility studies, funding, the economic and focus areas related to healthcare and demonstrates value. Strengthening the regional planning, design, and construction of a Transformation Division health benefits of the sector economic development. It is healthcare sector relies on actively demonstrating collaborative research institute. through the Northwest Arkansas healthcare sector is recommended that an expanded how the region can collaboratively align to maximize Council to develop a Healthcare strong alignment among Steering Committee, hereinafter resources and expertise. For the healthcare sector to be u Within three to five years: commission Sector Roadmap and collaborative healthcare, education, referred to as the Healthcare Sector sustained at an economically and fiscally responsible feasibility studies, funding, planning, and design strategy to transform the healthcare industry, research, Transformation Division or the pace, it must be a collaborative effort, requiring of a new medical school focused on population sector into a driver of the regional and community Transformation Division, be developed. input from diverse stakeholders and key players in health research. economy and to establish Northwest health programs. The Transformation Division should the industry. A collaborative model that includes u Arkansas as a healthcare destination. include the direct participation of information sharing, cross-industry cooperation, Develop a comprehensive resource strategy to Based on stakeholder interviews senior executives and decision-makers and open innovation can lead to beneficial industry support key priorities in the roadmap such as and the collective experience of of academic, research, healthcare practices such as cost reduction and time efficiency. GME expansion, a national population health seven peer regions, the key to institutions, and foundations operating Together, these practices set a precedent for growth and research institute, and a future medical school transforming the economic and in areas such as improved quality of development at a more rapid pace. focused on healthcare quality, access, and cost health benefits of the healthcare care, improved healthcare access, and Even though health policy may be set at the that leverages UAMS Northwest, the University sector is strong alignment among sustainable economic impact; public national level, healthcare is transformed at local and of Arkansas, and regional healthcare systems. regional levels. To make measurable impacts, an all- healthcare, education, industry, health organizations; and key private To accomplish the tasks, Tripp Umbach inclusive and neutral group that understands the local research, and community health and public industry leaders. recommends that the Transformation Division of culture can work with systems in place and leverage programs. For example, the Nashville Health Care The aforementioned will develop the foundation the Northwest Arkansas Council have dedicated relationships to make positive changes in the healthcare Council, founded in 1995, has an annual budget of toward the Northwest Arkansas Health Sector Roadmap staff focused on initiatives that will impact better sector. Regional health collaborative models play $3.3 million to bring together dozens of healthcare by providing a framework for an effective tool to achieve health and healthcare with the goal being to a critical role across the country to implement and CEOs monthly for meetings, hold public forums, alignment and enhance accountability. Tripp Umbach establish a thriving community of health excellence execute healthcare transformation at a local level.50 and host a leadership fellowship that grooms up-and- recommends as a vital next step that the Transformation and economic development. The formal, multi- 48 The Transformation Division will have the mission coming executives for their challenge. Division evaluate individual strategic plans to discover stakeholder committee’s core foundation should to mobilize strong partnerships with business, higher Additionally, the Austin Healthcare Council (AHC) alignment areas and, where appropriate, identify shared be established to address solutions to health and education, and healthcare organizations to coordinate is a non-profit organization created by healthcare resources to avoid duplication. healthcare problems that can be found and designed and drive implementation of all healthcare education, industry leaders working together to further establish The Transformation Division must leverage at a regional level, accelerating regional competitive Austin’s position as a global healthcare innovation shared data, expertise, resources, and local leadership research activities, and economic development. 49 advantages and sustainability. center. The AHC recently looked to Nashville for perspectives and priorities to implement elements By July 1, 2019, the Transformation Division Key short-term and long-term objectives of the guidance – healthcare leaders are trying to replicate through a collaborative approach. It should flesh out should be in place and have a professional staff Healthcare Sector Transformation Division the success that Nashville has enjoyed as a national the recommended key strategic areas with more specific member working to coordinate a cohesive, region- should be as follows: incubator of healthcare innovation and services. The feasibility studies, capital and operational budgets, and aligned and connected final roadmap to deliver AHC facilitates collaboration as an agent of change to outcome evaluation methods focusing on the return u Establish a staff position at the Northwest improved health and sustained economic growth. Tripp improve health for the community, educates and grows on investment for dollars invested in such strategies. Umbach estimates that a fully staffed Transformation leadership to move Austin toward better healthcare, Details will continue to emerge and evolve through Arkansas Council responsible for healthcare transformation activities related to the Division will require an annual operating budget as and supports the entrepreneurial and technology focused work sessions. This will further efforts already determined by stakeholders. It is recommended that the ecosystem to advance the development of better underway to meet the demands of the new healthcare development of a comprehensive strategy to communicate the vision to build strong regional Transformation Division be initially funded through products and services. Members represent a spectrum landscape, with a specific focus on population health. annual contributions from various stakeholders.u of organizations, including hospitals, academia, digital Tripp Umbach recommends that the support for enhancing the healthcare sector, health, medical technology, government agencies, and organizational infrastructure for ongoing development device manufacturers. and implementation of the recommended areas of 50 Regional Health Collaboratives Are Key to Healthcare priority outlined below be rooted in the Northwest Transformation. Dec. 30, 2013. Patricia Montoya, MPA, BSN - 48 HealthCareCouncil.com/about/ Executive Director New Mexico Coalition for Healthcare Value, 49 AustinHealthcareCouncil.org/ Arkansas Council. Currently, the Northwest Arkansas HealthInsight.

32 N Northwest Arkansas Council Northwest Arkansas Council N 33 Recommended Approach

32 N Northwest Arkansas Council Northwest Arkansas Council N 33 Areas of Priority

trained, deployed, and incented, residents comprise a and topic-related, bringing researchers and various talented workforce that can help achieve institutional public and private stakeholders together to develop goals to improve quality, safety and efficiency. fundable research. Density and proximity help facilitate It is not uncommon for shortages to arise in certain this type of collaboration. While labor moves within specialty areas of medicine, such as in Northwest a shed of approximately 40 miles, knowledge sharing AREAS OF PRIORITY Arkansas, due to changes in medicine, technology, occurs at a scale of less than one mile.52 and practice. In these instances, some areas of the Alignment of the partners that comprise the country may have a shortage of training positions for institute anchored in the region is critical. In a fully these specialties due to the dynamics of the medical aligned organization, entities share common goals. The marketplace and the longitudinal development of value added from a research institute is the creation teaching programs.51 Increasing GME positions in of a central, unified platform for all interested entities the right distribution of specialties to meet needs through one administration structure. Furthermore, is an important component of the ideal medical it is intended the institute be used as a platform to education expansion plan and requires a great deal of disseminate knowledge broadly to government policy coordinated regional effort. makers, health professionals, and all other interested Nationally, communities are developing and parties because steps must be taken to ensure that Short-Term Area of Priority: positions in the next seven years, with the expanding GME through a consortium model with knowledge has a real impact on the interventions, acknowledgement that recruitment and development of hospitals, FQHCs, clinics, and academic institutions. services, and products that can promote overall health (1-2 years) faculty to teach is a high priority. Additionally, financial GME consortia are formal associations of medical and wellness. incentives must be in place to encourage physicians schools, teaching hospitals, and other organizations The research institute should build on the Expand Graduate Medical Education (GME) to engage in medical education and research. It is involved in residency training, with central support, University of Arkansas’ and UAMS Northwest’s clear that balanced and cooperative efforts among direction, and coordination allowing members to current framework and support and promote the those involved in medical education and advanced function collectively and act as the vehicle to expand excellence and relevance of research to respond to The number of graduate medical education positions health professionals’ workforce expansion throughout physician training in the region. expressed needs and to achieve tangible impacts. For in Northwest Arkansas is limited. The importance of Northwest Arkansas is needed. This includes providing The consortium can be an independent 501(c)3 not- instance, in the areas of prevention and of care and developing undergraduate medical education (UME) necessary funding for graduate medical education and for-profit corporation that establishes bylaws, financial services, the institute should support and assist research and graduate medical education (GME) through a advanced health professionals training on the federal, participation agreements, and contractual agreements. and the scientific community in the development coordinated approach is critical to long-term economic state, and private level, as all three need to work Consortium models increase opportunities to attract of creative, effective solutions, emphasizing impacts success. This approach is a proven model to ensure together to support the physician training. funding from federal and state sources and private and that can have a positive influence on the health medical students receive a quality education and Another important element to consider is the public funders looking for collaborative initiatives. For and wealth of the region. An initial focus should be eventually increase the physician workforce through need for extensive faculty development that is critical example, the Southwestern Indiana Graduate Medical engaging and networking with researchers, strategic a defined regional pipeline. Thus, a regional effort to medical education expansion’s long-term success. Education Consortium (SIGMEC) in Evansville community partners, and other stakeholders to foster among key healthcare, medical education, industry, and Faculty at teaching hospitals must thrive while fulfilling represents four independent hospitals that have come implementation and dissemination of evidence-based foundation partners is recommended to evaluate and productivity expectations related to the institutional together with the Indiana University School of Medicine approaches in the community and clinical settings. identify funding streams beyond federal CMS dollars to missions. Those faculty members should have to provide GME, attract new physician residents, and Furthermore, a strategy internally to reach out to provide additional opportunities for current graduates, exemplary clinical skills so they can serve as mentors increase the potential of retaining healthcare providers. community partners to identify and understand their graduates from newly developed medical schools, and and role models for students and residents as well as The SIGMEC represents a number of newly formed needs and address value in healthcare service delivery graduates from a potential medical school. being sources of referrals. Ideally, they also would be ACGME residency programs slated to begin accepting will be required. An important aspect of GME is the impact the involved in clinical research as part of their clinical and residents in 2019. The research institute should focus on diversifying training program has on residents’ decisions about research mission. Being a teaching hospital is a mission- the region’s research workforce. It will be crucial to where to continue the practice of medicine. Increasing and culture-changing decision for a hospital. GME address current barriers to cross-campus adjunct or the number of GME positions in the right distribution must be integrated into the clinical enterprise. Mid-Term Area of Priority: joint appointments. These barriers must be addressed, of specialties to meet regional needs is an important It is recommended that health systems engage (1-5 years) and mechanisms to encourage faculty to pursue component of the ideal medical education expansion physicians who would be interested in resident such appointments should be implemented. The plan and will require a great deal of coordinated training to ascertain current workload and educational Develop an Interdisciplinary Research Institute appointments can lead to greater access to journals, regional effort as it relates to public and private funding obligations with medical students and other learners core infrastructures, and more across campuses. It mechanics and resource development. Nationally, as well as specific concerns and/or needs related to the is important to provide volunteer faculty and office various models and strategies for addressing GME integration of expanded GME. In the setting of limited Providing a platform that enables knowledge to staff inter-professional training with clear, measurable funding gaps are being evaluated and should be resources, appreciating a resident’s relative importance flow freely, an interdisciplinary research institute has outcomes for both learning and patient benefit. further reviewed and discussed at the regional level by from the physician’s perspective is crucial. Ultimately, the opportunity to gather widely divergent groups with Currently, the University of Arkansas and UAMS healthcare and educational leadership. residents can be empowered to improve the quality and little common ground and establish an aligned research Northwest serve the region by educating health Tripp Umbach recommends setting a goal to value of care. Leaders of healthcare organizations need community with a wealth of initiatives, both structural professionals, conducting applied research in health establish a minimum of 200 additional residency to see them as part of the solution. When appropriately 51 AAMC.org/advocacy/gme/71178/gme_gme0012.html 52 Carlino & Kerr, 2014.

34 N Northwest Arkansas Council Northwest Arkansas Council N 35 Areas of Priority

34 N Northwest Arkansas Council Northwest Arkansas Council N 35 providing new ways for care innovations, and identify providers to connect with patients opportunities to make care more and streamline workflows. The accessible, more affordable, and integration of virtual care is the more comprehensive. The system is National trends require next major step in restructuring care collaborating with bedside clinicians, delivery – a true patient-focused that both insurgent and primary providers, and specialists to care continuum. Access to a large maximize patient data in real time. patient population, talent, and a incumbent healthcare The research institute could use this cohesive business community are companies take their framework as a springboard to adopt critical factors for health and life digital technologies that will establish science companies as they grow in an capabilities seriously a digital health infrastructure in environment characterized by price and adopt new levels Northwest Arkansas. pressures, fast technological changes, A foundational element of the and increasingly sophisticated of sophistication in the research institute is a coordinated,

consumers. Northwest Arkansas’ collection, analysis, and data-sharing infrastructure, designed rapid population growth provides the to collate big data and bridge the patient population; however, talent use of health data. distant segments of the healthcare and a cohesive community must industry, which will mark up the be enhanced. To say Information necessity of innovation in the sector. Technology (IT) has disrupted nearly One of the great opportunities for every other sector of the economy our 21st-Century health and care is an understatement. Yet its most system is harnessing the power of disruptive opportunities are yet to integrated and coordinated data, come in healthcare, a field that has research, and technology, as currently historically lagged in adopting IT data is collected from fragmented and data-driven innovation.53 sources. A coordinated, data-sharing infrastructure Nationally, research institutes provide a foundation provides a platform for the region to move the needle to house a variety of initiatives, each representing on health outcomes. The effort will identify specific different yet interconnected areas of focus. Driven characteristics and follow a controlled population of photo courtesy Northwest Medical Center by their inquisitive nature, investigators have the patients until the conclusion of treatment, research, freedom to follow their research wherever it leads and or study to improve the delivery of effective health Clint Weigel, cardiovascular services director at Northwest Medical Center in Springdale, work closely with their colleagues to probe important and care services. National trends require that both talks with members of the Springdale Chamber of Commerce’s Experience Springdale questions in biomedicine. Most importantly, this insurgent and incumbent healthcare companies take class about what happens in a cardiac catheterization laboratory. The Northwest Arkansas framework champions highly interactive, creative, their capabilities seriously and adopt new levels of hospital has expanded its facilities in recent years to keep up with population growth. and mold-breaking approaches to science as they seek sophistication in the collection, analysis, and use of prevention, treatments, and cures for major diseases. health data. Great for Business. Great for Life. Research institutes should be supported by state-of-the- Interoperability between key segments of the art core facilities and professionally-trained staff who industry has always been a limiting factor. A unified fields, and in some instances, delivering healthcare can increase scientific productivity, enhance academic rely on the latest technologies to advance their work regional platform capable of linking these segments through various mechanisms. These areas are strategic visibility and leadership role opportunities, and, and to deliver results to patients, as urgently as possible. together can have a significant impact on the healthcare assets that provide invaluable service to residents of eventually, lead to meaningful changes in healthcare For instance, Mercy, as a system, opened the sector. Therefore, regions such as Northwest Arkansas Northwest Arkansas. However, its individual initiatives delivery. In addition to contributing ultimately toward world’s first virtual care center in 2015. The four-story, must invest in coordinated framework for data sharing and efforts must be leveraged to have a stronger a healthier Northwest Arkansas, the institute will 125,000-square-foot building is the cornerstone of among all healthcare providers. Currently, related impact on the regional healthcare sector. As a first provide a platform to generate knowledge and training Mercy’s virtual care program and serves as a nationally initiatives planned within the state include a program step, leadership could develop a pilot grant program to opportunities for professionals across health, medical, recognized center for developing and delivering that will collect and analyze hospital discharge data, support faculty and staff across institutions to collaborate social service, and industry. telehealth. Mercy designed the Virtual Care Center including patient migration trends. and in developing protocols and collecting feasibility data Concurrently, the world continues to adopt digital to bring together the best minds to provide patient- An example of such is in Kansas. The Kansas to prepare them for submitting competitive grants to technologies that have led to the rapid expansion of the centered care, advance technological Hospital Association (KHA) provides data, information, NIH, NSF, and foundations. digital healthcare market – an expansion fostered by and assistance for hospitals, healthcare organizations, The recommendation for the creation of a collaboration. The partnership between major players 53 For a comprehensive review of the impact of IT on and the public. KHA collects, analyzes, and presents research institute provides a pathway to make a in the private and public sectors has engineered a these industries, see Robert Atkinson and Daniel Castro, “Digital Quality of Life: Understanding the Personal and data to illustrate where patients obtain hospital care national model in integrated healthcare education, growing list of innovative digital healthcare solutions. Social Benefits of the Information Technology Revolution” when they seek care in Kansas. In 40 of the 105 delivery of healthcare, and research. The institute Technology is reshaping the healthcare industry, (Washington: Information Technology and Innovation Kansas counties, more than 50 percent of the residents Foundation, 2008).

36 N Northwest Arkansas Council Northwest Arkansas Council N 37 providing new ways for care innovations, and identify providers to connect with patients opportunities to make care more and streamline workflows. The accessible, more affordable, and integration of virtual care is the more comprehensive. The system is National trends require next major step in restructuring care collaborating with bedside clinicians, delivery – a true patient-focused that both insurgent and primary providers, and specialists to care continuum. Access to a large maximize patient data in real time. patient population, talent, and a incumbent healthcare The research institute could use this cohesive business community are companies take their framework as a springboard to adopt critical factors for health and life digital technologies that will establish science companies as they grow in an capabilities seriously a digital health infrastructure in environment characterized by price and adopt new levels Northwest Arkansas. pressures, fast technological changes, A foundational element of the and increasingly sophisticated of sophistication in the research institute is a coordinated,

36 N Northwest Arkansas Council Northwest Arkansas Council N 37 sharing. Expanding opportunities academics, industry, and health Innovation capacity can take many forms and originate for engineers, researchers, and systems exist to help support research medical students to learn side-by- into areas such as machine learning from many places, from research hospitals that side in Northwest Arkansas will and advanced analytics, with the Academic excellence cure disease to engineering schools that reduce local leverage existing resources and wider ecosystem of government enhance regional infrastructure, is recognized as the and corporations to help bring fresh emissions and from socially conscious startups that while at the same time provide capacity to deliver innovations to market. opportunities for greater access With respect to strengthening education, research, create new ways to educate children to smart city to quality and cost-effective the healthcare workforce, Northwest partnerships that deploy technology to help workers get healthcare. This concept can and service delivery Arkansas has many assets. First, also serve as a platform for the programs that best Northwest Arkansas is the home to development of a research institute one major research university and to jobs. Industry leaders are scouting extensively for respond to health that can focus on translational several other institutions of higher academics and startups around the world that can lend research to boost the growing challenges and needs education. The University of Arkansas biomedical industry and beyond. in society and have educates about 70 percent of the more insights to the care they provide to patients, whether Additionally, several biomedical than 38,000 students enrolled in the positive health impacts. in raising understanding of the diseases, improving engineering students at the region’s higher education institutions. University of Arkansas and local The university’s College of Education diagnoses, enhancing treatment, or supporting long- healthcare providers joined forces to and Health Professions focuses on try to solve everyday problems for education and health, officering term management. providers and their patients. The disciplines as diverse as teaching, program sent 16 students to watch nursing, community health promotion, University of Arkansas for Medical human resource development, Great for Business. Great for Life. Sciences therapists and residents at kinesiology, recreation and sport work. The program is growing, with management, and communication the next group expected to number 25-30 students. disorders. As mentioned earlier in this report, both remained within their county for hospital care. Twenty this report that a four-year medical school in Northwest Philanthropic funding associated with this concept has NWACC and JBU are important to strengthening the Kansas counties with hospitals retained 25 percent Arkansas should be a long-term goal, increasing already been received. In 2018, University of Arkansas healthcare workforce as well. or fewer of their county discharges, and 12 Kansas academic excellence, innovation, and increasing the researchers received $500,000 to continue work at Finally, UAMS Northwest has an opportunity to counties retained more than 75 percent. Nine Kansas availability of healthcare can be addressed, at least the Membrane Science, Engineering and Technology greatly impact the education, research, and clinical counties do not have hospitals. partly, through other key initiatives. Center, a multi-campus partnership between academic programs in Northwest Arkansas. Currently, academic The data also provides a mechanism to analyze For example, the University of Arkansas and and industry partners.54 programs through the College of Medicine and College patients leaving Kansas for care. For instance, recent data UAMS Northwest should expand collaborations Increasing these collaborations is also a priority for of Pharmacy allow UAMS third- and fourth-year showing the migration to surrounding states for inpatient in engineering and medicine where there is strong the state given that Arkansas ranks near the bottom of students to complete degrees in Northwest Arkansas. services found a slight decrease from 25,123 patients in expertise. The University of Arkansas College of states in research and commercialization. According to Medical students spend a significant time hospitals and 2016 to 24,908 in 2017. The in-migration from Missouri Engineering offers access to faculty and infrastructure the State Technology and Science Index Report, which clinics, learning under the supervision of experienced increased from 25,053 in 2016 to 26,666 in 2017. that has the potential to shape the development of measures state performance in the areas of research physician educators. In addition, the regional campus physicians who know how to harness the power of and development, risk capital, entrepreneur support, includes graduate-level nursing programs, a doctoral technology and “big data” to improve cost-effective and human capital investment, Arkansas ranked 49th physical therapy program, and an undergraduate care. The region has the opportunity to forge together in 2016. Innovation capacity can take many forms and program in radiologic imaging. UAMS Northwest Long-Term Area of Priority: two of its assets – engineering and medicine – leading originate from many places, from research hospitals offers residencies in family medicine, internal medicine, to practical applications for scientific discoveries, a (2-7 years) that cure disease to engineering schools that reduce psychiatry, and pharmacy, along with a fellowship in critical resource for developing a stronger biomedical local emissions and from socially conscious startups sports medicine. industry. Program alignment can lead to exponential Expand Medical Education/Develop Medical School that create new ways to educate children to smart city The question at hand is whether UAMS Northwest, growth in clinical trials due to innovations resulting partnerships that deploy technology to help workers with existing constraints, can expand its role in Academic excellence is recognized as the capacity from engineering approaches. get to jobs. Industry leaders are scouting extensively for Northwest Arkansas and have a greater impact on to deliver education, research, and service delivery The University of Arkansas’ College of academics and startups around the world that can lend health systems performance and on people’s health. programs that best respond to health challenges and Engineering is uniquely situated to collaborate with insights to the care they provide to patients, whether Medical schools, which are often key parts of successful needs in society and that have positive health impacts. healthcare providers and researchers to train physicians in raising understanding of the diseases, improving healthcare expansions, must recognize the various And, as Northwest Arkansas continues to strive for who can deliver high-quality, cost-effective care by diagnoses, enhancing treatment, or supporting long- social determinants of health – political, demographic, excellence in the medical field, it becomes clear that the developing and using new technologies that allow for term management. Extensive partnerships among epidemiological, cultural, economic, and environmental region will need to expand its capacity in each key area. earlier and more accurate detection and diagnoses, in nature – and direct their education, research, and While it is the view of the working group preparing more efficient patient monitoring, and seamless data 54 News.uark.edu/articles/42699/center-receives-500-000- u from-nsf-to-continue-membrane-research service delivery programs accordingly.

38 N Northwest Arkansas Council Northwest Arkansas Council N 39 sharing. Expanding opportunities academics, industry, and health Innovation capacity can take many forms and originate for engineers, researchers, and systems exist to help support research medical students to learn side-by- into areas such as machine learning from many places, from research hospitals that side in Northwest Arkansas will and advanced analytics, with the Academic excellence cure disease to engineering schools that reduce local leverage existing resources and wider ecosystem of government enhance regional infrastructure, is recognized as the and corporations to help bring fresh emissions and from socially conscious startups that while at the same time provide capacity to deliver innovations to market. opportunities for greater access With respect to strengthening education, research, create new ways to educate children to smart city to quality and cost-effective the healthcare workforce, Northwest partnerships that deploy technology to help workers get healthcare. This concept can and service delivery Arkansas has many assets. First, also serve as a platform for the programs that best Northwest Arkansas is the home to development of a research institute one major research university and to jobs. Industry leaders are scouting extensively for respond to health that can focus on translational several other institutions of higher academics and startups around the world that can lend research to boost the growing challenges and needs education. The University of Arkansas biomedical industry and beyond. in society and have educates about 70 percent of the more insights to the care they provide to patients, whether Additionally, several biomedical than 38,000 students enrolled in the positive health impacts. in raising understanding of the diseases, improving engineering students at the region’s higher education institutions. University of Arkansas and local The university’s College of Education diagnoses, enhancing treatment, or supporting long- healthcare providers joined forces to and Health Professions focuses on try to solve everyday problems for education and health, officering term management. providers and their patients. The disciplines as diverse as teaching, program sent 16 students to watch nursing, community health promotion, University of Arkansas for Medical human resource development, Sciences therapists and residents at kinesiology, recreation and sport work. The program is growing, with management, and communication the next group expected to number 25-30 students. disorders. As mentioned earlier in this report, both remained within their county for hospital care. Twenty this report that a four-year medical school in Northwest Philanthropic funding associated with this concept has NWACC and JBU are important to strengthening the Kansas counties with hospitals retained 25 percent Arkansas should be a long-term goal, increasing already been received. In 2018, University of Arkansas healthcare workforce as well. or fewer of their county discharges, and 12 Kansas academic excellence, innovation, and increasing the researchers received $500,000 to continue work at Finally, UAMS Northwest has an opportunity to counties retained more than 75 percent. Nine Kansas availability of healthcare can be addressed, at least the Membrane Science, Engineering and Technology greatly impact the education, research, and clinical counties do not have hospitals. partly, through other key initiatives. Center, a multi-campus partnership between academic programs in Northwest Arkansas. Currently, academic The data also provides a mechanism to analyze For example, the University of Arkansas and and industry partners.54 programs through the College of Medicine and College patients leaving Kansas for care. For instance, recent data UAMS Northwest should expand collaborations Increasing these collaborations is also a priority for of Pharmacy allow UAMS third- and fourth-year showing the migration to surrounding states for inpatient in engineering and medicine where there is strong the state given that Arkansas ranks near the bottom of students to complete degrees in Northwest Arkansas. services found a slight decrease from 25,123 patients in expertise. The University of Arkansas College of states in research and commercialization. According to Medical students spend a significant time hospitals and 2016 to 24,908 in 2017. The in-migration from Missouri Engineering offers access to faculty and infrastructure the State Technology and Science Index Report, which clinics, learning under the supervision of experienced increased from 25,053 in 2016 to 26,666 in 2017. that has the potential to shape the development of measures state performance in the areas of research physician educators. In addition, the regional campus physicians who know how to harness the power of and development, risk capital, entrepreneur support, includes graduate-level nursing programs, a doctoral technology and “big data” to improve cost-effective and human capital investment, Arkansas ranked 49th physical therapy program, and an undergraduate care. The region has the opportunity to forge together in 2016. Innovation capacity can take many forms and program in radiologic imaging. UAMS Northwest Long-Term Area of Priority: two of its assets – engineering and medicine – leading originate from many places, from research hospitals offers residencies in family medicine, internal medicine, to practical applications for scientific discoveries, a (2-7 years) that cure disease to engineering schools that reduce psychiatry, and pharmacy, along with a fellowship in critical resource for developing a stronger biomedical local emissions and from socially conscious startups sports medicine. industry. Program alignment can lead to exponential Expand Medical Education/Develop Medical School that create new ways to educate children to smart city The question at hand is whether UAMS Northwest, growth in clinical trials due to innovations resulting partnerships that deploy technology to help workers with existing constraints, can expand its role in Academic excellence is recognized as the capacity from engineering approaches. get to jobs. Industry leaders are scouting extensively for Northwest Arkansas and have a greater impact on to deliver education, research, and service delivery The University of Arkansas’ College of academics and startups around the world that can lend health systems performance and on people’s health. programs that best respond to health challenges and Engineering is uniquely situated to collaborate with insights to the care they provide to patients, whether Medical schools, which are often key parts of successful needs in society and that have positive health impacts. healthcare providers and researchers to train physicians in raising understanding of the diseases, improving healthcare expansions, must recognize the various And, as Northwest Arkansas continues to strive for who can deliver high-quality, cost-effective care by diagnoses, enhancing treatment, or supporting long- social determinants of health – political, demographic, excellence in the medical field, it becomes clear that the developing and using new technologies that allow for term management. Extensive partnerships among epidemiological, cultural, economic, and environmental region will need to expand its capacity in each key area. earlier and more accurate detection and diagnoses, in nature – and direct their education, research, and While it is the view of the working group preparing more efficient patient monitoring, and seamless data 54 News.uark.edu/articles/42699/center-receives-500-000- u from-nsf-to-continue-membrane-research service delivery programs accordingly.

38 N Northwest Arkansas Council Northwest Arkansas Council N 39 Economic Considerations and Impacts

ECONOMIC CONSIDERATIONS Table 11: Estimated Northwest Arkansas Economic Loss Due to Out-migration Information about Northwest Arkansas and its peer regions provided by Data USA, which shares AND IMPACT government statistics, indicates the largest industries and the college majors that are most prevalent.

SPECIALTY SERVICE DIRECT LOSS TO ECONOMY TOTAL LOSS TO ECONOMY TOTAL EMPLOYMENT LOSS A thriving healthcare sector can contribute Oncology $219 Million $438 Million 2,920 billions to a regional economy and create Cardiology $180 Million $360 Million 2,400 If growth in advanced Other Sub-Specialties $76 Million $152 Million 1,013 thousands of jobs. specialty healthcare TOTAL $475 Million $950 Million 6,333 This section of this assessment outlines multiple economic considerations and services increases to impacts for the region to consider as it implements a comprehensive 20-year exceed regional demand healthcare sector roadmap. and attract patients from outside Northwest services showed at least $180 million is being lost. When Continued growth in specialized healthcare services For the purpose of this report, economic impacts are organized Arkansas, the local accounting for total deficits in sub-specialty care, Tripp by 2040 could result in Northwest Arkansas not only to match four recommendations: healthcare sector can Umbach estimates $475 million in annual revenue is satisfying the demands of the growing region but also be at par with peer being lost in the region. serving as a magnet for patients from outside the region u Grow specialty care in the region markets by 2040. Using the assumption that every dollar lost to to seek services. Tripp Umbach estimates more than u Grow graduate medical education hospitals and physicians for in-patient sub-specialty $2 billion can be added to the regional healthcare care equals another dollar in total loss in the healthcare economy by 2040, if specialty services are added to u Develop an interdisciplinary research institute sector, Tripp Umbach estimates the Northwest satisfy regional demand and the region becomes a focused on population health management Arkansas healthcare economy missed out on $950 healthcare destination. If growth in advanced specialty million in activity in 2018. The healthcare sector healthcare services increases to exceed regional demand u Develop a new medical school economy would be significantly strengthened if sub- and attract patients from outside Northwest Arkansas, specialty care services matched local patient demand. the local healthcare sector can be at par with peer markets by 2040.

Economic Impact of Growing Specialty Care Northwest Arkansas is well positioned to reverse economic losses through Economic Impact of Expanding Graduate The healthcare sector in Northwest Arkansas $950 million out-migration. With the right steps to Medical Education generates approximately $2.7 billion annually in leaves Northwest Arkansas the region and supports more than 22,000 jobs. advance the healthcare economy, Increasing residency programs in the region is a key As mentioned earlier in this report, the Northwest each year as residents travel the region strategy to growing the physician workforce, increasing Arkansas economy is missing out on $950 million to hospitals and physicians can add $2 billion quality of care, and adding specialty healthcare annually and more than 6,000 additional jobs largely in other regions to provide to the sector. services. Residency training programs carry the added because of high out-migration and low in-migration of This strategic growth benefit of growing the economy as regional investments patients. Additionally, Steering Committee members the services they seek. made in faculty, staff, capital improvements, and stated technological equipment required to support could lead to more than a goods and services to develop and operate residency advanced specialty care is expensive and requires a programs generate economic activity. The benefits stem higher density of patients to justify purchases. The For example, a deficit of 10 surgical oncologists in from the spending by residency programs on capital region currently does not possess this diagnostic the region results in 5,840 hospital stays for advanced $3 billion improvements and goods and services, as well as the equipment because of the out-migration of patients. cancer care occurring outside of the region. At $37,000 spending of staff and faculty; the spending of residents; However, by 2030, more than $1.2 billion could in revenue per hospital stay, the total loss to the and the spending of visitors to programs, staff, faculty, be added to the region’s healthcare economy from Northwest Arkansas economy just from advanced cancer improvement and residents. increasing specialty care services at a level required care is $219 million. The annual revenue loss for cancer Economic benefits include increased business to satisfy regional needs. Having sufficient specialty alone would support 1,460 direct jobs if 10 more surgical volume, job creation, and tax revenue being generated services by 2030 would create 8,360 new jobs in the oncologists were in practice. Similar analysis completed achieved by 2040. for local and state governments. Those benefits grow healthcare sector. by Tripp Umbach focused on deficits for cardiology annually in size and scope.

40 N Northwest Arkansas Council Northwest Arkansas Council N 41 Economic Considerations and Impacts

40 N Northwest Arkansas Council Northwest Arkansas Council N 41 National Examples of Economic Impact in Areas Recommended for Northwest Arkansas The Translational Genomics Research Institute (TGen) to create economic and societal impact by attracting new Since its inception, TGen has established itself as a research dollars, researchers, and investment into the state. global genomics leader. In 2002, an assembly of more than 50 leaders and visionaries in science, medicine, government, The Carle Illinois College of Medicine and business gathered at the state capitol in Arizona to The Carle Illinois College of Medicine is envisioning discuss establishing Arizona as a player in the biotechnology a future where, by leveraging engineering and advanced industry. The goal was to set up a one-of-a-kind genomics technology, doctors provide more humanistic care for research institute. A positive group consensus decided the idea patients. As the first college of medicine in the world was not only feasible but represented a unique opportunity with a curriculum that fuses engineering, medicine, and for Arizonans to rally together for a shared vision. With an the humanities, it is creating an innovative future. unprecedented cooperative spirit, the group rallied to the task The Carle Illinois College of Medicine is a of securing support for TGen on the order of $90 million. partnership between Carle Health System, an Urbana- The fundraising goal was achieved in five months.Less than a based system of hospitals and physician groups, and the year after the gathering at the capitol, TGen began operations. University of Illinois in Urbana-Champaign. In 2013, a TGen serves as one of the anchors of the Phoenix Biomedical $100 million gift from The Grainger Foundation57 went Campus and is an economic engine, providing a significant to the university’s College of Engineering. The funds are return on investment to the state and region.56 being used to support faculty, students, and facilities at In 2006, the TGen Foundation Board commissioned the College of Engineering to increase the university’s Tripp Umbach to conduct a comprehensive study of ability to attract and retain top-tier faculty and students, TGen’s economic impact. To ensure the continuing which will ultimately benefit the new College of viability of the data, TGen commissioned updates to the Medicine. In addition, $100 million was secured from the report in 2009, 2011, 2015, and 2018. Carle Health System for the new College of Medicine.

photo courtesy Department Arkansas of and Tourism Parks TGen continues its role as an important economic The economic impact of the new College of engine for Phoenix, the region, and Arizona. TGen Medicine enterprise on the state of Illinois is expected operations generated $93 million in economic impact in to exceed $1 billion annually by 2035, when the College Tripp Umbach research indicates: 2014 and provided a substantial return on investment. One of Medicine is at maturity. Further, the new College of of the most important findings in the economic impact Medicine is expected to sustain more than 7,600 jobs58 u u Cost Saving of Hiring Residents: Economic Impact Related to Specialists: studies came in 2014. That study shows that even in an statewide by 2035. The projections are based on analysis Each retained physician in the region from a Communities within 100 miles of a primary increasingly competitive funding environment, TGen’s completed by Tripp Umbach using benchmarks for regional residency training program creates care residency program have more physicians impact had increased significantly since 2010. The total mature academic medical centers in the U.S. $50,000 in cost savings for a health system. per capita than communities with identical impact of TGen operations, the operations of business Economic benefits of the new College of Medicine will demographics but without such programs. That’s spinoffs, and the commercialization of research equaled accrue from the spending by the new College of Medicine, u because the programs lead to the recruitment Economic Impact of Each New Physician: $174 million in business volume impact for Arizona. Carle Health System, and related research institutes on Each retained physician generates $1.8 million and retention of subspecialty physicians who Research and medical innovation provide multiple capital improvements and goods and services, as well as each year in regional economic impact. not only train medical students but also provide benefits beyond the economic and employment impacts the spending of staff and faculty, the spending of medical clinical services not available previously in the generated by the operations of TGen. TGen and its trainees, and the spending (external to the institution) of u : community. These physicians often prefer to Economic Impact of Resident Training collaborating partners, the employment of world-class visitors to the new College of Medicine. The College of If the region expanded GME to the level practice in an academic medicine environment. researchers, and the attraction of additional federal research Medicine offers new opportunities for securing federal of peers, 200 additional residents would be Subspecialty physicians provide health systems funding create significant additional economic expansion research funds from numerous agencies, including the working in the region. The cost associated with with the opportunity to expand access to care and employment through the commercialization of research National Institutes of Health, Department of Defense, supporting these new slots55, provided that and to generate significant clinical revenue activities in Arizona. Department of Energy, and the Defense Advanced Research federal funds are not available, would equal $30 associated with this care. TGen is strategically focused on collaborative Projects Agency, which will drive innovation and technology- million. Assuming that 75 percent of graduates translational research efforts with biomedical research, driven growth. Startups formed through research and from residency stay in the region to practice, u GME programs Healthcare Cost Savings: education, and healthcare stakeholders in Arizona and innovation from the new technology-driven College of the economic impact of additional physicians are drivers of healthcare quality, access, and throughout the nation and world. It serves as a catalyst Medicine will attract private equity funding to the region.u would be more than $100 million annually and economic development. Each resident in a would support 750 jobs. community-based residency program generates $200,000 in direct economic benefits to the 56 The Phoenix Biomedical Campus (PBC) is an urban medical 57 The Grainger Foundation has donated millions to University and bioscience campus planned for more than 6 million square of Illinois College of Engineering projects, including $100 million community while completing the program feet of biomedical-related research, academic, and clinical for the Grainger Engineering Breakthroughs Initiative in 2013. 55 A residency slot is defined as one year of residency training. and $3.4 million in healthcare cost savings facilities. Located in downtown Phoenix, the PBC is a premier The gift funded student scholarships, faculty positions, research For example, if a family medicine program enrolls eight every year that he or she remains in the area to and dynamic environment for research activities. The PBC and new facilities, including $20 million for renovation of Everitt residents per year and the program takes three years to contains among the highest concentrations of research scientists Lab to house Department of Bioengineering. practice after training. u 58 complete, this program would have 24 slots. and complementary research professionals in the region.. Includes direct, indirect, and induced jobs.

42 N Northwest Arkansas Council Northwest Arkansas Council N 43 National Examples of Economic Impact in Areas Recommended for Northwest Arkansas The Translational Genomics Research Institute (TGen) to create economic and societal impact by attracting new Since its inception, TGen has established itself as a research dollars, researchers, and investment into the state. global genomics leader. In 2002, an assembly of more than 50 leaders and visionaries in science, medicine, government, The Carle Illinois College of Medicine and business gathered at the state capitol in Arizona to The Carle Illinois College of Medicine is envisioning discuss establishing Arizona as a player in the biotechnology a future where, by leveraging engineering and advanced industry. The goal was to set up a one-of-a-kind genomics technology, doctors provide more humanistic care for research institute. A positive group consensus decided the idea patients. As the first college of medicine in the world was not only feasible but represented a unique opportunity with a curriculum that fuses engineering, medicine, and for Arizonans to rally together for a shared vision. With an the humanities, it is creating an innovative future. unprecedented cooperative spirit, the group rallied to the task The Carle Illinois College of Medicine is a of securing support for TGen on the order of $90 million. partnership between Carle Health System, an Urbana- The fundraising goal was achieved in five months.Less than a based system of hospitals and physician groups, and the year after the gathering at the capitol, TGen began operations. University of Illinois in Urbana-Champaign. In 2013, a TGen serves as one of the anchors of the Phoenix Biomedical $100 million gift from The Grainger Foundation57 went Campus and is an economic engine, providing a significant to the university’s College of Engineering. The funds are return on investment to the state and region.56 being used to support faculty, students, and facilities at In 2006, the TGen Foundation Board commissioned the College of Engineering to increase the university’s Tripp Umbach to conduct a comprehensive study of ability to attract and retain top-tier faculty and students, TGen’s economic impact. To ensure the continuing which will ultimately benefit the new College of viability of the data, TGen commissioned updates to the Medicine. In addition, $100 million was secured from the report in 2009, 2011, 2015, and 2018. Carle Health System for the new College of Medicine.

42 N Northwest Arkansas Council Northwest Arkansas Council N 43 Appendix A

Increasing numbers of young Appendix A: CMS Quality Measures: Northwest Arkansas professionals are moving to Information from the Centers for Medicare and Medicaid Services shows what patients who visited Mercy Northwest Arkansas to work Northwest Arkansas, Northwest Medical Center and Washington Regional Medical Center experienced as and take advantage of the compared to patients at hospitals nationwide. region’s high quality of life. Intentional steps to expand Quality Measure Nationally Northwest Arkansas the region’s healthcare economy would lead to Average median time patients spent in the emergency department, before lower healthcare costs and 334 minutes 234-276 minutes they were admitted to the hospital. improved wellness for those (The lower, the better.) who live in the region. Average median time patients spent in the emergency department 26 minutes 14-34 minutes before they were seen by a Great for Business. healthcare professional.

Rate of readmission after discharge 15.3 15.3 Great for Life. from hospital.

Deaths among patients with serious treatable complications 161.73 161.73 after surgery.

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 73% 71-76% (lowest) to 10 (highest).

Patients who reported, “YES, they would definitely 72% 72-78% recommend the hospital.”

The most expedient of Northwest Arkansas’ emergency departments boast a median patient wait time that is 12 minutes shorter than the national average. All Northwest Arkansas’ emergency departments come in under the national average for median patient wait time in the emergency department, before they were admitted to the hospital. Shorter wait times give Northwest Arkansas residents a chance to enjoy life on their terms. Great for Business. Great for Life.

44 N Northwest Arkansas Council photo courtesy Department Arkansas of and Tourism Parks Northwest Arkansas Council N 45 Appendix A

Rate of readmission after discharge 15.3 15.3 Great for Life. from hospital.

Deaths among patients with serious treatable complications 161.73 161.73 after surgery.

Patients who gave their hospital a rating of 9 or 10 on a scale from 0 73% 71-76% (lowest) to 10 (highest).

Patients who reported, “YES, they would definitely 72% 72-78% recommend the hospital.”

44 N Northwest Arkansas Council photo courtesy Department Arkansas of and Tourism Parks Northwest Arkansas Council N 45 Appendix B

Peer Region Market Platform Highlights

u Founded North Carolina Biotechnology Center in Research Triangle Park (1984) Durham- u University of North Carolina in Chapel Hill established nation’s first university-sponsored School of Ark. Dept. ofArk. and Tourism Parks Chapel Hill Medicine (1879) Medical research u UNC School of Medicine ranked No. 1 in nation for Appendix B: Peer Market Platforms primary care by U.S. News & World Report (2018)

u The Northwest Arkansas Council worked with Tripp Umbach to identify peer regions to use for comparisons Duke University School of Medicine in Durham throughout this report. The traditional group of Northwest Arkansas peers were selected (Austin, Des Moines, ranked No. 10 in nation in research (2018) Durham-Chapel Hill, and Madison) as well as regions where intentional steps are occurring to expand healthcare in significant ways (Boise, Evansville, and Spokane). For a map of peer regions, see page 4. u Duke opened first physician assistant program in nation (1965)

Peer Region Market Platform Highlights u Three Indiana universities opened Evansville hub for u Focused on remaking medical campus to benefit health sciences education (2018) adjacent communities while facilitating innovation Health sciences Evansville education u Evansville campus is one of nine Indiana University u Welcomed first class at Dell Medical School (2016) School of Medicine campuses statewide Biotech and community-based u Opened Dell Seton Medical Center, school’s 211-bed u Downtown Evansville campus expected to have as Austin medical education teaching hospital (2017) much as $340 million economic impact by 2020

u Life and physical scientists account for 5,100 people in Austin metro’s workforce u University of Wisconsin School of Medicine and Public Health ranked No. 24 in nation for primary care Population health training and No. 28 for research by U.S. News & World u Invested $34 million to open 94,000-square-foot Idaho Madison leader Report (2018) College of Osteopathic Medicine (2018) Agriculture u Study in 2018 showed hospitals received $1.5 billion Boise technology u Idaho was the nation’s largest state without med school of the $24 billion a year in economic impact from and bioscience University of Wisconsin System bechnology u State ranks No. 49 in physicians per capita

u Largest healthcare, health sciences and medical u Creating Iowa Bioscience Development Center with education hub between Seattle and Minneapolis, Iowa Economic Development Authority providing $4.5 Calgary and Salt Lake City Bio-life science million for the project (2018) Des Moines Health science u 240 first- and second-year medical students are u State’s research and development spending is 12 education and attending one of two state university-operated medical percent higher than national average Spokane research schools in Spokane u Des Moines University is home of nation’s second u Spokane’s University District is a globally-recognized oldest college of osteopathy hub of education, innovation, research, and healthcare

46 N Northwest Arkansas Council Northwest Arkansas Council N 47 Appendix B

Peer Region Market Platform Highlights

46 N Northwest Arkansas Council Northwest Arkansas Council N 47 Appendix C Appendix D

Appendix C: 2018 Arkansas Health Rankings by County Appendix D: County-Related Funding for Medical School

Arkansas counties were ranked (1-75), according to research by the Robert Wood Johnson Foundation, based on the metrics of Health Outcomes and Health Factors. Benton, Faulkner, Saline, and Washington Dell Medical School at the University of Texas at Austin counties lead the state. Health Factors represents what can influence peoples’ health, including the county’s The Dell Medical School at The University of the medical school. Since Dell Med opened, its healthcare quality, air and water quality, residents’ education, physical activity, tobacco use, and diet. Health Texas at Austin used a transformative public investment community-focused origins and distinct mission have Outcomes represents the overall health of people who live in the county regardless of the health factors. 59,60 Outcomes includes how long residents live as well as residents’ quality of life. to improve health in Austin and Travis County. Dell attracted healthcare leaders from around the country who Med is an active partner with Central Health – the want to help improve the way communities receive care. healthcare district serving Travis County. The shared Also, The Design Institute for Health, a unique Health Health Health Health goal is better health for the people of Austin and Travis collaboration between Dell Med and the UT Austin Arkansas County: Outcomes Factors Arkansas County: Outcomes Factors County, especially those with low incomes or without College of Fine Arts, practices a human-centered design Arkansas 57 27 Lee 64 74 insurance. In 2014, the University of Texas created approach that actively invites new voices to co-design Ashley 48 59 Lincoln 19 56 the medical school with an ongoing $35 million annual solutions to health system challenges.62 The Design Baxter 24 3 Little River 43 33 investment from the Community Care Collaborative Institute seeks out partners in every part of the community, Benton 1 1 Logan 55 35 (CCC), the nonprofit partnership of Central Health especially patients, to gather perspectives about how to Boone 5 6 Lonoke 6 8 and Seton Healthcare Family, which is a member design to the specific needs within the community. of Ascension. That happened less than two years Additionally, Dell Med and the McCombs School Bradley 73 69 Madison 34 41 after Travis County voters approved a tax increase to of Business created the Value Institute for Health Calhoun 30 40 Marion 39 17 create and support the school and other health-related and Care. The Value Institute at Dell Med guides Carroll 13 12 Miller 28 49 priorities.61 Every year, in accordance with Proposition outcome- and cost-measurement efforts for their Chicot 69 70 Mississippi 72 73 1 – the ballot measure Travis County voters approved clinical services. The institute also develops and delivers Clark 29 30 Monroe 63 64 in 2012 that supports the school and other health- education on high-value healthcare strategy for clinical Clay 46 52 Montgomery 18 50 related priorities through a higher tax rate – Dell Med and administrative leaders. The institute’s courses Cleburne 10 18 Nevada 70 55 receives $35 million in funding from the CCC that is offer healthcare leaders in Central Texas specific guaranteed by Central Health. tools to implement value-based care. Additionally, Cleveland 36 13 Newton 9 15 As part of this partnership, Dell Med is working the institute is exploring ways to provide strategic Columbia 54 54 Ouachita 65 37 closely with the CCC to implement models of care in resources to Central Health and the Community Care Conway 27 46 Perry 38 28 hospitals and community health centers serving the Collaborative and their clinical initiatives as they plan Craighead 14 7 Phillips 75 75 underserved. The school has used local funding to for the transformation toward a value-based system. Crawford 15 16 Pike 45 32 launch and build out programs that will define its work Lastly, in January 2018, it was announced the Dell Crittenden 66 67 Poinsett 67 63 to create a model healthy city and community in Austin Med will lead a $15.5 million redesign of the Austin Cross 51 58 Polk 32 31 and Travis County. The funds are committed, as part State Hospital – taking it from a critical but outdated and Dallas 58 34 Pope 7 10 of the budgeting process, to supporting the school’s deteriorating mental health facility to the cornerstone growing capacity and scope of work, consistent with for an improved system of collaborative, community- Desha 74 72 Prairie 17 29 the permitted uses in their affiliation agreement. focused care that helps people across Central Texas.63 Drew 50 53 Pulaski 21 11 Increasing the number of physicians in the The planning funds come through a 2018-19 budget Faulkner 4 4 Randolph 40 22 community – providers who are focused on patients’ provision, championed by state Sens. Kirk Watson and Franklin 44 21 St. Francis 59 71 diverse needs – is a primary reason Travis County voters Charles Schwertner, aimed at improving failing mental Fulton 25 19 Saline 3 2 approved the proposition in 2012 to create and support health facilities across the state. 64 u Garland 41 24 Scott 33 44 Grant 8 9 Searcy 31 25 Greene 37 23 Sebastian 11 14 Hempstead 56 62 Sevier 20 57 Hot Spring 47 26 Sharp 52 48 Howard 42 36 Stone 68 45 Independence 26 20 Union 60 47 Izard 23 39 Van Buren 16 51 Jackson 53 68 Washington 2 5 59 Dellmed.utexas.edu/about Jefferson 62 66 White 22 38 60 Travis County is in south central Texas. As of the 2010 census, the population was 1,024,266; the estimated 62 Dellmed.utexas.edu/units/design-institute-for-health Johnson 12 43 Woodruff 61 61 population in 2017 was 1,226,698. It is the fifth-most populous 63 A 299-bed psychiatric hospital located in Austin, Texas. It is Lafayette 71 65 Ye l l 35 60 county in Texas. Austin is the capital of Texas. the oldest psychiatric facility in the state. 61 Central Health Proposition 1 – Approved by Travis County 64 Dellmed.utexas.edu/news/15-million-for-austin-state- Lawrence 49 42 voters, Nov. 6, 2012 hospital-redesign. January 2018.

48 N Northwest Arkansas Council Northwest Arkansas Council N 49 Appendix C Appendix D

Appendix C: 2018 Arkansas Health Rankings by County Appendix D: County-Related Funding for Medical School

48 N Northwest Arkansas Council Northwest Arkansas Council N 49 Appendix E Appendix F

Appendix E: Regional Healthcare Steering Committee Appendix F: Glossary of Abbreviated Terms

The Northwest Arkansas Council identified stakeholders from across the region to become members of its Regional Healthcare Steering Committee. The steering committee members met as a group with Tripp Acronyms are common in healthcare and familiar to medical professionals, but they may be unfamiliar to Umbach and Council staff throughout 2018 to discuss aspects of the work that was being conducted. many readers. This page defines all the acronyms used in this report. Arkansas Children’s Northwest NOWDiagnostics u Trisha Montague, Senior Vice President u Kevin Clark, CEO AAMC – Association of American Medical Colleges and Administrator ACGME – Accreditation Council on Graduate Medical Education OurPharma AFMC – Arkansas Foundation for Medical Care Arvest Bank u Peter Kohler, CEO, President Emeritus at AHC – Austin Healthcare Council u Craig Rivaldo, President, Benton County Oregon Health & Science University AOA – American Osteopathic Association Ascendant Diagnostics Simmons Food APII – Arkansas Payment Improvement Initiative u Omid Moghadam, CEO u Mark Simmons, Chair of the Board APMs – Alternative payment models Community Care Collaborative Better Medicine Tyson Foods CCC – u Daniel Stein, CEO u Archie Schaffer III, consultant and retired CDC – Centers for Disease Control and Prevention Executive Vice President at Tyson Foods CMS – Centers for Medical & Medicaid Services Boston Mountain Biotech DO – Doctor of osteopathy u , Founder and CEO, Senior University of Arkansas for Medical Ellen Brune FQHCs – Federally Qualified Health Centers Entrepreneur in Residence at Startup Junkie Sciences u Stephanie Gardner, Senior Vice Chancellor for FTE – Full-time equivalent Community Clinic Academic Affairs and Provost GDP – Gross Domestic Product u Kathy Grisham, Chief Executive Director Graduate Medical Education University of Arkansas GME – HHRs – Hospital referral regions HARK at the Center for Collaborative u Daniel Sui, Vice Chancellor for Research and Care/Endeavor Foundation Innovation at the University of Arkansas HHS – U.S. Department of Health and Human Services u Dr. Nick Ogle, Executive Director, Program u Dan Ferritor, Chancellor Emeritus HPSAs – Health Professional Shortage Areas Director of Behavioral Health at Mercy IT – Information technology University of Arkansas, College of JBU – John Brown University Lineus Medical Education and Health Professions KHA – Kansas Hospital Association u Spencer Jones, CEO u Reed Greenwood, Dean Emeritus MD – Doctor of Medicine Mercy Hospital Northwest Arkansas Walton Family Foundation MedPAC – Medicare Payment Advisory Commission u Martine Pollard, Executive Director, u Ross DeVol, Walton Fellow Community and Public Relations, Northwest MIPS – Merit-based incentive payment system Arkansas Communities Nurse practitioners Washington Regional Medical Center NPs – u Eric Pianalto, President u Larry Shackleford, CEO NWACC – NorthWest Arkansas Community College PAs – Physical assistants u Susan Barrett, CEO Emeritus u Dr. Mark Thomas, Family Medicine, Vice President and Medical Director of PBC – Phoenix Biomedical Campus Northwest Arkansas Regional Campus of the Population Health R&D – Research and development University of Arkansas for Medical Sciences SIGMEC – Southwestern Indiana Graduate Medical Education Consortium u Pearl McElfish, Vice Chancellor Northwest Arkansas Council TGen – The Translational Genomics Research Institute u Nelson Peacock, President and CEO Northwest Medical Center UAMS – University of Arkansas for Medical Sciences u Denten Park, CEO u Rob Smith, Communications and Policy Director UME – Undergraduate medical education 50 N Northwest Arkansas Council Northwest Arkansas Council N 51 Appendix E Appendix F

Appendix E: Regional Healthcare Steering Committee Appendix F: Glossary of Abbreviated Terms

CURRENT AND PROJECTED ECONOMIC IMPLICATIONS CONSULTANT CONCLUSIONS Northwest Arkansas can make significant additions to its $2.7 billion healthcare sector by reducing how many residents seek healthcare services elsewhere. The right combination of community investments can result in a $3.43 B economic gain by 2040.

ECONOMIC LOSS WITHOUT ECONOMIC GAIN WITH IMPLEMENTATION IMPLEMENTATION 2018 -$950 M Current Out-migration for specialty care 2030 2030 -$1.2 B $1.2 B Northwest Arkansas should act to align its distinctive Projected Out-migration No deficit in specialty for specialty care with services factoring advantages to grow and strengthen the regional population growth and no population growth additional services healthcare sector. Distinguished faculty, researchers, 2040 2040 and other physicians, as well as their next-generation -$1.43 B $2.0 B Projected Out-migration Surplus in specialty equipment and other advanced technologies, should for specialty care with care services factoring population growth and no population growth be leveraged to become the preferred providers in the additional services $3.43 B region. With healthcare reform dramatically shifting how Potential difference in hospitals operate, industry experts believe traditional economic impact by 2040 academic medical centers could become obsolete if they don’t quickly adapt to today’s economic realities. Northwest Arkansas has the distinct advantage of timing. The region has a long history of providing medical education, which provides a valuable and necessary The analysis, recommendations, and statistical Northwest Arkansas Council data for this report were prepared by: foundation for expansion through existing infrastructure and assets with multiple partners. Expanding medical The Northwest Arkansas Council is a private, nonprofit organization founded in 1990 by regional business education and related population health research focused leaders to advance economic prosperity through on regional strengths of quality and cost-effectiveness will enhanced collaboration. The Council works to advance trippumbach.com economic vitality and improve the quality of life in help establish Northwest Arkansas as a premier national Northwest Arkansas. It partners with stakeholders Visual messaging and communication strategy, healthcare market by 2040.u across the region, state, and nation in priority areas including layout and design by: including workforce development, infrastructure improvement, talent recruitment, and education. Amanda Cothren Great for Business. creative communication strategiﬆ nwacouncil.org Great for Life. amandacothren.com

52 N Northwest Arkansas Council Consultant Conclusions

52 N Northwest Arkansas Council Great for Business. u Great for Life.