Wisconsin Partnership Program celebrates 20 years of moving health forward

Her days at the Elroy Family Medical Center are varied and full. She may do a well-baby checkup, perform a colposcopy, and help an elderly patient find supportive care to continue living at home. Sebranek also assists with social needs that affect patients’ health; this role is often supported by social workers in the country but not usually within her Medicare-Certified Rural Health Clinic, where she helps patients with social needs that affect their health. Further, she delivers babies and is chief of staff at Mile Bluff Medical Center in nearby Mauston. Elroy, located in picturesque Juneau County, is home to fewer than 1,500 people, and Mauston around 4,300.

As she drives for 40 minutes via winding, country roads to her home in Richland Center, Wisconsin, she is eager to catch up with her twin children, who soon will enter first grade. Sebranek delivered nearly half of their classmates. This is exactly the life she dreamed of when she joined the third class of the Wisconsin Academy for Rural Medicine (WARM), a University of Wisconsin School of Medicine and Public Health (SMPH) program that helps address the physician shortage in rural areas by training medical students who are committed to improving the health of rural communities.

“I truly believe there’s no better place to practice medicine than a small town,’’ said Sebranek. “I’m proud to be a graduate of a school that stresses public health, and I am very proud to be a graduate of WARM.”

WARM is one of many public health improvements and education investments supported by the Wisconsin Partnership Program (WPP) since it was established 20 years ago — and one of the many ways WPP has helped SMPH transform into the nation’s first combined school of medicine and public health.

Charged with the mission to improve the health of the people of Wisconsin — in ways such as training health care providers and public health leaders; promoting innovative research and discovery; and creating community partnerships that address health disparities and advance health equity — WPP has awarded 636 grants totaling more than $300 million since 2004. These awards have resulted in a remarkable return on investment, with grantees leveraging more than $776 million in additional funding from other sources to sustain the projects.

History

In 2024, as the Wisconsin Partnership Program celebrates 20 years of grantmaking, it is reflecting on its roots and impact on improving health for the people of Wisconsin. WPP’s roots go back to 1999, when Blue Cross & Blue Shield United of Wisconsin announced it was converting from a non-profit organization to a for-profit corporation, with the proceeds to be donated equally to Wisconsin’s two medical schools.

“The origins and history of the Wisconsin Partnership Program are truly remarkable  and reflect the dedication of many visionary, talented leaders who came together united by a common goal of serving the people of Wisconsin,” said Golden.

“The purpose of the gift,” said Thomas Hefty, retired chief executive officer of Blue Cross & Blue Shield United of Wisconsin, “was for public health, scholarship, and faculty support.”

A committee comprised of Blue Cross & Blue Shield United of Wisconsin board members was charged with facilitating the conversion and gift. Hefty credits them for — as committee member and spokesperson James Hickman, emeritus dean of the Wisconsin School of Business, stated — “doing the right thing in the right way,” and deciding to give the assets to Wisconsin’s two medical schools: the UW Medical School (now the UW School of Medicine and Public Health) — in Madison and the Medical College of Wisconsin in Milwaukee. This decision was unique to Wisconsin; other states that went through a Blue Cross & Blue Shield United conversion set up foundations or directed the money into other state budgetary needs.

“The law in Wisconsin was different. Wisconsin had good medical schools and good doctors but was lacking in public health. So, I think they made the right decision to have the biggest impact on the state’s health,” said Hefty.

“Many individuals and groups were instrumental in establishing the Wisconsin Partnership Program,” recalled Golden. “First and foremost, former Dean Philip Farrell, MD, led the overall process of transforming the ‘dream’ into ‘a dream that came true’, and Eileen Smith, the Wisconsin Partnership Program’s inaugural director, transformed that dream into a wonderful reality.  Those two leaders worked tirelessly and effectively in building the strong foundation that continues to support and advance the vision.”

Other key parties include Blue Cross & Blue Shield United of Wisconsin and its leaders, Tom Hefty, former president and CEO, and Steven Bablitch, former chair and CEO. Vitally important roles were also played by Mark Lefebvre, former senior vice president at the UW Foundation; Katherine Lyall, former president of the Universities of Wisconsin; David Walsh, former chair of the Universities of Wisconsin Board of Regents — who also helped navigate the board’s approval of the UW Medical School’s transformation to the UW School of Medicine and Public Health — and David Ward, former chancellor of UW-Madison.

The initial Blue Cross & Blue Shield United of Wisconsin gift totaled more than $301 million to each school and had specific terms that are still followed today; these include provisions that 35 percent of its grants go to community health projects and 65 percent to research and education. The organization also required five-year plans, audits and an initial oversight group called Wisconsin United for Health Foundation, in addition to oversight by the Universities of Wisconsin Board of Regents. Another requirement was that Farrell and Medical College of Wisconsin president Mike Bolger jointly lead a series of listening sessions to learn about health needs around the state in the summer of 1999.

“We traveled the entire state, meeting with communities all the way up to Ashland on Lake Superior,’’ Farrell recalled. “We talked about the community-academic partnership theme. This was a natural for SMPH — our school was pursuing the Wisconsin Idea.”

In March 2000, the Wisconsin Commissioner of Insurance approved the Blue Cross & Blue Shield United of Wisconsin conversion and the distribution of funds to the medical schools. But the two schools could not receive the money until the resolution of a lawsuit filed by one of many groups that also wanted a piece of the Blue Cross & Blue Shield United conversion funds. It would be early 2004 before the Wisconsin Supreme Court dismissed the lawsuit, and the funds could be transferred to the schools.

While waiting at UW-Madison, Farrell continued planning for that day. It was his dream, as a pediatrician and cystic fibrosis expert, to create the country’s first combined school of medicine and public health.

“Prevention is the passion of pediatrics,’’ Farrell said, “And I realized that with our excellent Department of Population Health Sciences, world-class epidemiologists like Drs. Bruce Klein [PG ’89] and Dennis Maki [MD ‘67] already on our faculty, and the Wisconsin State Laboratory of Hygiene on our campus, we already had a strong core to become a school of medicine and public health. For me, it was a dream come true. Would we have been able to do it without the Blue Cross & Blue Shield United money? Absolutely not.”

About hiring Eileen Smith to become WPP director in 2004, Farrell reflected, “We were very fortunate to have Eileen in that leadership position.”

Smith came to the school from UW Hospital and Clinics (now UW Health), where she played a significant role in the complex conversion of the hospital from a state agency into a public authority — a situation that allowed the organization to grow into the UW Health system of today.

Smith pored over the insurance commissioner’s directives for disbursing the Blue Cross & Blue Shield United grant money, a document that was more than 40 pages long. At her side was Tonya Mathison, who had recently graduated from the Wisconsin School of Business; following a two-decade career with WPP, Mathison is now WPP’s administrative director.

“We were setting up a program from the ground up, and there were no models in the medical school for what we were trying to do,’’ Smith recalled, adding that they had to figure out how to track grants, measure outcomes and set expectations.

The insurance commissioner also had specific plans for what would become the Oversight and Advisory Committee (OAC), which oversees the community grants.

“We ensure that the community’s voice is represented through our governance committees,’’ Smith said. One stalwart OAC member since the beginning is Greg Nycz, chief executive officer of the Family Health Center of Marshfield, Inc.

“Greg is rural health’s biggest advocate,’’ Smith shared. “He knows all the problems and all the issues, and he was very instrumental in helping us understand them, and in making grants to help the rural areas.”

Nycz — who also serves on OAC’s sister committee, WPP’s Partnership Education and Research Committee (PERC), which oversees grants for research and education — said he has worn out a car making the monthly commute from Marshfield to meetings in Madison. He recalled that, initially, some people expressed distrust about the university conducting research in northern Wisconsin.

“I think we’ve gone a long way to allay the distrust we heard about,’’ Nycz said. “I think the program has done a lot more to engender pride about being from Wisconsin and having a great university. We’re getting out there with our health programs, working collaboratively with communities. We’re thinking through the impact of the work on the people of Wisconsin. We’re always asking: What does success look like?”

Nimbleness

Another message from early discussions has proven prophetic. Hefty recalled renowned cancer researcher Paul Carbone, MD, telling the audience at one session that while he may have treated some of the audience members’ loved ones for cancer, he would not advocate for the money to be devoted exclusively to cancer.

“Paul Carbone said that medical science changes rapidly, and we don’t know what issues will be important in ten or twenty years, but Blue Cross & Blue Shield United of Wisconsin has given UW the resources and the freedom to follow the science,’’ Hefty recalled.

The COVID-19 pandemic showed why it is critical for WPP to be able to pivot quickly to meet a sudden threat to the health of the state, said Amy Kind, MD, PhD, associate dean for social health sciences and programs at SMPH and the current executive director of the Wisconsin Partnership Program.

“In March 2020, the entire world shut down. None of us could have predicted it,’’ Kind said. “Here at WPP, we were one of the first entities to move forward to get funding out to address pandemic-related needs. We were able to allocate more than $6 million for rapid dissemination to support research and education and to help community groups address this horrible pandemic.”

On May 1, 2020, WPP awarded its first round of 24 COVID-19 response grants, totaling $2.9 million. These included grants for virus screenings in homeless shelters; support for people with food insecurity in Green Bay and Madison; and community health outreach programs in Hmong, Latino, American Indian and Black communities. On the research side, WPP funded genetic surveillance of the virus, as well as projects that looked at issues ranging from monoclonal antibodies to vaccine development to personal protective equipment enhancements for health care workers.

“To be part of the Wisconsin Partnership Program at that time seared into my soul the importance of nimbleness. When the health of the state requires us to move quickly, we must do so,” Kind shared.

As the pandemic progressed, WPP awarded another $1.6 million in grants to statewide organizations that were working to support adolescent mental health, plus $1.1 million in research grants to address the ongoing health impacts of the pandemic and $500,000 to bolster the health care workforce through a partnership with Universities of Wisconsin nursing schools.

Community

Since it began awarding grants in 2004, the Wisconsin Partnership Program has allocated nearly $100 million for 363 community grants to address a wide range of complex health challenges facing Wisconsin communities.

Tracking these grants over the years is one way to chart the changing health challenges in Wisconsin, including through these examples that represent just a small selection of the hundreds of projects funded through WPP’s community grant programs.

For example, the first round of grants in 2004 did not address opioid use, but more recent grants now address this statewide crisis, including a grant to Marinette County-based Biehl Bridges to Recovery to support recovery-friendly workplaces. WPP also supports a collaboration between the Wisconsin Hospital Association and Randall Brown, MD, PhD and professor in the SMPH Department of Family Medicine and Community Health, to improve access to treatment and care for people struggling with substance-use disorders in rural Wisconsin. Brown recently also earned a PERC grant to prevent opioid addiction in people recovering from traumatic injury. Further, a grant to the Southwestern Wisconsin Community Action Program (SWCAP) is focused on opioid treatment and recovery in Grant, Green, Iowa, Lafayette and Richland Counties.

Other issues have remained constant and aligned with WPP’s focus on health equity. The Wisconsin Partnership Program has been dedicated to reducing maternal and child health disparities in newborns, including Black infant mortality, which remains a serious health disparity in Wisconsin. A $1 million grant supports the ConnectRx Wisconsin initiative, led by the Foundation for Black Women’s Wellness and the Dane County Health Council. The initiative provides community health workers (CHWs) and doulas to support maternal care and healthy birth outcomes. Through ConnectRx, doulas and CHWs address essential perinatal and non-medical health factors and provide social support, including things like rental and job assistance, mental health care and food-pantry referrals. Already, 90 percent of babies supported by the doulas and CHWs reached their full gestational age, and 84 percent were born at healthy weights.

In addition, WPP has awarded grants totaling $2.6 million through its maternal and child health grant program for efforts such as expanding community-based doula services; strengthening postpartum care and family supports; and expanding early-childhood programs.

WPP also funds work to address the needs of Wisconsin’s aging population. A grant to the United Community Center supports dementia-related health care and caregiver support for Latinos in southeastern Wisconsin, including Milwaukee, Waukesha, Racine and Kenosha.

In northern Wisconsin, WPP funds food-sovereignty initiatives led by the Oneida and Menominee Nations to help tribal communities improve access to nutritious food and promote traditional food practices and cultural identity.

Rural public health issues were the focus of a $1 million grant to Marshfield Clinic Health System for its innovative Community Connections Team. Through this funding, when providers in central and northern Wisconsin learn that patients need help with nonmedical needs, they connect those patients with Universities of Wisconsin health professions students, who help find community resources. In five years, the project has resulted in 17,000 referrals to agencies such as food banks; women, infant, and children programs; dental clinics; and more. Another grant to SWCAP addresses farmers’ mental health, aiming to reduce the number of farmer suicides.

And in Dane County, innovative projects seek to reduce racial health disparities. The Rebalanced Life Wellness Association received funding to collaborate with Black barbershops to address health disparities that Black men face. Nehemiah Community Development Corporation is improving health outcomes for Madison’s Black community through innovative models of community education, leadership training, and social and cultural connection.

“The Wisconsin Partnership Program has made such a positive impact on Wisconsin by funding essential initiatives that are innovative, move health forward and fund the most intractable challenges for our state,’’ Kind said. “We work very carefully to ensure that a wide range of applicants hear about the program and have the opportunity to submit proposals. We are honored to have funded a broad portfolio of highly impactful community projects.”

Education and Research

With $201 million allocated since 2004 to research grants and education initiatives,  WPP’s investments have been catalytic in transforming research and education at SMPH.

“WPP has helped truly transform the way medical students are taught at SMPH,” said Elizabeth Petty, MD, senior associate dean for academic affairs. “It has been very helpful in terms of our entire MD curriculum in ways that people may not completely realize. When we transformed our curriculum, which launched in 2016, WPP was essential in helping us develop and deliver innovative and integrated strategies to help address health equity issues across our statewide campus.”

In 2007, WPP helped launch the Wisconsin Academy for Rural Medicine (WARM), which has had a warm reception throughout Wisconsin. Now, WPP is helping SMPH envision ways to make it even warmer. Petty says WPP is supporting a new initiative called WARMeRR, which will add a rural residency to the mix. Rather than four years of medical school followed by a three-or-more-year residency, students in WARMeRR will begin their residency after their third year of the MD curriculum.

“WPP has helped us implement a shorter track that allows selected, interested WARM students to start residency in Wisconsin a year earlier,’’ Petty said. “It will allow WARMeRR graduates to become practicing physicians sooner. We are hopeful this approach will help address access issues in rural Wisconsin communities by getting well-trained students invested in rural medicine into residencies quicker. By shaving off a year, it will give them earlier exposure to the community they would like to serve and may reduce the students’ debt burden.”

Through its financial support and critical review of grant applications by members of PERC and OAC, WPP has similarly influenced research in the school, increasing both the breadth and depth of inquiry by faculty and research trainees.

Richard Moss, PhD, emeritus professor of cell and regenerative biology and past chair (2009-23) of PERC, said, “WPP funding and the grant program reviews by WPP committee members have further strengthened what is now a robust continuum that spans basic, translational, clinical and public health research, all in the interests of scientific discovery and ultimate application to improve health and health care.”

Consistent with Farrell’s observation that SMPH already had a strong core in public health, PERC awarded a grant for a project to investigate microbiological areas of public health importance, headed by Klein, an expert in fungal diseases. Leveraging foundations established via this initial WPP funding, the research team went on to successfully compete for a five-year, $16 million Center for Excellence in Translational Research grant from the National Institutes of Health (NIH); this grant was recently renewed. Led by David Andes, MD, PhD (PG’96), an expert in antibacterial diseases, this NIH center has identified hundreds of drug candidates, some of which are under active development.

What’s more, said Moss, the center’s work focuses on public health problems in Wisconsin, including antibiotic-resistant bacteria and blastomycosis, a human fungal disease endemic in northern Wisconsin.

“Now, Wisconsin is the epicenter of antifungal research and antimicrobial development,’’ Moss said. “This research is a powerful example of the sustained impact that is possible through WPP funding.”

WPP’s research grants include innovative community-academic partnerships like the Oneida Stroke Prevention Program. Robert Dempsey, MD, FASC, chair of the SMPH Department of Neurological Surgery, and a team of researchers, clinicians and medical students partner with the Oneida Nation to reduce stroke risk factors among tribal members. Participants receive a health assessment and work with health coaches to reduce their risk of major strokes, as well as smaller strokes that can lead to cognitive decline. The tribe’s Elder Council contributes its traditional knowledge of holistic health care.

Another research project aims to foster “food as medicine” to cure Wisconsin’s twin epidemics of obesity and diabetes. Dudley Lamming, PhD, and associate professor in the SMPH Department of Medicine, says 70 percent of the people in the state are overweight and another 30 percent are diabetic or prediabetic. WPP funded a New Investigator Grant which allowed Lamming to demonstrate that eliminating certain branched-chain amino acids (BCAAs) from the diet of overweight, sedentary mice dramatically improved their health without reducing their total caloric intake.

“When we restricted the BCAAs, the fat mass and weight dropped dramatically, and the mice became more insulin tolerant,’’ explained Lamming. “It was dramatic, and it was important that the partnership program funding allowed us to do those studies.”

The WPP-funded pilot study led to an additional award from the Veterans Administration. Now, a second WPP grant is allowing Lamming and Jacob Brunkard, PhD and assistant professor in the UW College of Agricultural and Life Sciences, to develop corn and soybean varieties without the problematic BCAAs.

Mile Bluff Medical Center in Mauston, where Sebranek practices, was a testing ground for another WPP grant designed to prevent blindness in rural patients at risk of diabetic retinopathy. Under a system designed by Yao Liu, MD, assistant professor in the SMPH Department of Ophthalmology and Visual Sciences, patients can have retinal photos taken in Mauston and sent via teleophthalmology to Madison, where specialists read them and identify patients for follow-up care. Liu and her research team have leveraged their findings from this study to obtain a $4.4 million grant from the National Eye Institute to expand their work.

Michael Koenigs, PhD, associate professor in the SMPH Department of Psychiatry, is leading a project to bring therapy for post-traumatic stress disorder to Wisconsin’s prison system, where the disorder is ten times more common compared to the general population.

WPP also funds a wide range of cancer research. A grant to Shigeki Miyamoto, PhD, professor in the SMPH Department of Oncology, supported studying a cellular pathway used by T-cells that fight against cancer and viral infections. Meanwhile, Jennifer Weiss, MD, associate professor in the SMPH Department of Medicine, is working to improve colorectal cancer screening rates in rural Wisconsin, where the rates lag behind those in urban communities. Heather Neuman, MD, FACS, associate professor in the SMPH Department of Surgery, has a WPP-funded project to improve follow-up care for Wisconsin’s 70,000 breast cancer survivors.

Noting that WPP leaders take to heart Carbone’s 1999 advice that the Wisconsin Partnership Program remain free to follow the science, Kind observed, “Times change, and if we were addressing only the health needs that were recognized in 2000, we would not be where the people of Wisconsin need us to be.’’

Transformation

Public health has become deeply woven into the fabric of SMPH. However, before WPP funding became available, the following educational programs did not exist: the Master of Public Health (MPH) program, the Population Health Service Fellowship, the Preventive Medicine Residency, the MD/MPH track in the Medical Scientist Training Program, and WARM. The latter has graduated 273 physicians as of 2023.

The first assignment for Patrick Remington, MD, MPH, at the beginning of the planning for an integrated school of medicine and public health, was to establish the MPH program. Demand was strong from physicians, veterinarians, nurses, and public policy professionals who wanted to add a public health degree to their expertise.  In fact, Ann O’Rourke, MD, MPH, associate professor in the SMPH Department of Surgery and director of trauma care at UW Health, was among that first class.

“We wanted to become a school of medicine and public health, but how do you start an MPH program or a fellowship program without resources? WPP was the catalyst,” said Remington, the school’s inaugural associate dean for public health. “I think the real wins were in the transformation of the educational mission. We are now known around the country as a medical school that really does walk the public health talk.”

Today, the Population Health Service Fellowship is 20 years old, and the MPH program is 19 years old. Paula Tran, MPH, the state health officer for the Wisconsin Department of Health Services (DHS) Division of Public Health, is a graduate of both. The Preventive Medicine Residency is ten years old and counts among its graduates Jasmine Zapata, MD, MPH, chief medical officer and state epidemiologist for community health, Wisconsin DHS, and assistant professor, SMPH Department of Pediatrics; Karina Atwell, MD, MPH, assistant professor, SMPH Department of Family Medicine and Community Health; and Maria Mora Pinzon, MD, MS , assistant professor, SMPH Department of Medicine.

From educational transformation to research innovation to community health, WPP is positively impacting the health of Wisconsin; its latest five-year plan sets the course to continue this vital work.

“The Wisconsin Partnership Program is novel,” Kind said. “When I travel all over the country for my research and groups hear about this program, they are absolutely awestruck. A program like this at SMPH truly is a tremendous asset. It allows us to engage in service activities, fundamental research; innovations around education and workforce development; in ways that few other institutions can do — in true alignment with the Wisconsin Idea. We can truly put our money where our mouth is in terms of our vision. The service component of SMPH is real, it is actualized, and it moves forward in no small part because of the Wisconsin Partnership Program.”

“The incredible gift that is the Wisconsin Partnership Program,” said Golden, “has enabled our school to take the Wisconsin Idea and amplify it across the state, in ways that are accountable, measurable and transparent, in true service to the people of Wisconsin.”

He added, “When I reflect upon the Wisconsin Partnership Program’s past 20 years, the ‘P’ in Partnership fills me with pride and gratitude. The partnership between medicine and public health, coupled with our partnerships with communities, educators and researchers, make the Wisconsin Partnership Program possible.”