Tim Size, BSE, MBA [Preceptor]

What is your role in the WI Population Health Fellowship program? 
This is my first time as a preceptor for the WI Population Health Fellowship program. I am very excited about the opportunity to work with Kristen Audet during her placement at the Rural Wisconsin Health Cooperative (RWHC). Together with rural public health directors, public schools, clinics and RWHC hospitals, we will be developing a consortium to improve low childhood immunization rates.

What inspired you to become involved with the Fellowship program? 
Several things came together: Marion Ceraso knew of my interest and offered Kristen and I the opportunity for the placement. I have enjoyed and personally benefited from prior experiences as a preceptor. The timing was ideal; the immunization project had just got to the point where it was ideal to have a Fellow available to help get it off the ground.

The Fellowship program is part of the University of Wisconsin’s Population Health Institute and I have had the pleasure of serving as a member of the Institute’s external advisory board since its beginning in 1994. In that capacity, I have long advocated for the Program to be broad in its vision for placements–to also include sites with a focus on rural health and with organizations that serve their communities but are not public health departments. Last but not least, I had the opportunity of participating in the Kellogg National Leadership Program in the late 1980s so I know first hand the value of fellowship programs.

What are a few highlights of your background in public health? 
I started in Wisconsin in the mid 1970’s as an Assistant “Superintendent” at the University of Wisconsin Hospital & Clinics. That led almost immediately to engagement with the broader public health community, and my first experience with collaboration. I was asked to serve (as I was new to Madison and “unaligned”) as the chair of the newly formed Dane County Chemical Dependencies Consortium. Then as now, the Consortium worked to better serve a complex array of health and human service needs in an area chronically under funded. Since then my career has always been based in hospitals but linked to community. In the late 1970’s, I left the UW to become the first director of RWHC and for over thirty years have worked as an advocate for rural health and a developer of shared services amongst rural hospitals.

What are your main areas of interest within public health?
I sometimes joke about being a rural “mercenary as I live in Madison and work from home and at our offices in Sauk City. I work for a board of rural hospital CEOs on issues related to the availability, access, quality and cost of rural health. As you might guess, over time, this constitutes a broad array of issues and opportunities.

If I have had a focus, it has been in trying to “connect the dots” from a systems perspective. That has led me to lots of opportunities to weigh in on behalf of a rural perspective with many state and national boards and commissions. Most notably I had the opportunity to serve two separate terms on the federal National Advisory Committee on Rural Health & Human Services as well as the Institute of Medicine’s Committee on the Future of Rural Health.

What is one project you are working on right now that you are really excited about?
In cooperation with Dean Health Plan (DHP) and Unity Health Insurance, Rural Wisconsin Health Cooperative (RWHC) staff identified a particular low childhood immunization rate for Dean and Unity enrollees in rural southern Wisconsin. A task force of RWHC members and the health plans vetted both the measures and numbers and found them to be credible.

The health plan data showed that the combined Childhood Immunization Status rate for children age two in urban Dane County was 81% and the average in the rural counties* studied was 63%. The average rural on-time immunization rate using county health department data showed similar results. These rates were measured using specifications outlined by the Healthcare Effectiveness Data and Information Set (HEDIS). Rates in all counties were well below the 90th percentile–the frequently cited national Healthy People 2010 target.

The above data is unfortunately consistent with The Health of Wisconsin Report Card 2010 was released on March 23rd. Wisconsin’s grade for overall health is good compared to the other states in the nation—a “B-.” But Wisconsin receives a barely passing grade of D for its efforts to promote health for rural children and young adults.

RWHC asked primary care physicians, clinics, schools and public health departments for their assistance in identifying ideas to close the identified gap in childhood immunizations. The suggestion came back to from county public health directors to form a multi-county consortium to work together across the multiple sectors to achieve higher immunization rates, particular for children. The interim working title for this collaboration is the Southern Wisconsin Immunization Consortium (SWIC). Thirteen local immunization consortia exist in Wisconsin but only one of these consortia impacts a rural county in southern Wisconsin (Columbia). Advice will be sought from the Consortium in Columbia County as well as others nearby while the SWIC is in its formative stage.

Do you read a public health journal/blog/website regularly?
I am addicted to Google as it allows you to quickly look at an issue using multiple sources. I also am a fan of a two daily emails: Kaiser Health News and an instate subscription service, Wisconsin Health News, that also has a web presence at <http://wisconsinhealthnews.com/>. [Under full disclosure, I am on an informal advisory council for WHN.]

Do you have a public health role model/hero?
Dr. David Kindig, the founder of the UW Population Health Institute has long been a role model and hero. While an “emeritus” member of the UW faculty, he is still actively engaged as a national thought leader and moving the field of population health forward with help from a major grant from the Robert Wood Johnson Foundation. David thinks deeply and is not afraid to challenge conventional wisdom from the left or the right. Over several decades, he has been generous as a mentor, not a task for the faint of heart, both professionally and as a friend.

What is one public health-related activity in your community that you are proud about?
I am very proud that in Wisconsin, holes are beginning to be punched in both “medical” and “traditional” public health silos–that the two sectors are beginning to work more with each other.

What is one public health achievement you think will happen in the next 25 years? What is one you would like to see in the next 25 years?
I am at my roots an optimistic, so I would give the same answer to both questions. I believe we will continue to make significant progress in aligning our individual and collective investments with what we know most affects our individual and collective health.