2015–17 Robert Wood Johnson Clinical Scholar
Assistant Professor, Departments of internal medicine and pediatrics, University of Minnesota
Tyler Winkelman, M.D., M.S., completed the Robert Wood Johnson Clinical Scholars (CSP) program in 2017, and is now an assistant professor in the departments of internal medicine and pediatrics at the University of Minnesota.
He is also the division director for general internal medicine at Hennepin Healthcare in Minneapolis, Minnesota, a public teaching hospital serving a large percentage of low-income patients, many of whom transition in and out of the Hennepin County Jail, one of the locations where Winkelman provided primary care for five years after fellowship.
Winkelman’s experiences as a clinician have long shaped his research interests across incarceration, homelessness, and health, with a particular focus on substance use and Medicaid. At the Hennepin Healthcare Research Institute, Winkelman co-directs the Health, Homelessness, and Criminal Justice (HHCJ) Lab, which he co-founded with another CSP alum, Katherine Diaz Vickery, M.D., M.Sc.
“We’ve positioned a lot of our work at the intersection of research, program evaluation, quality improvement, and implementation science, so that we're informing policy and practice change quickly,” Winkelman says.
The Lab’s research and collaboration efforts are focused on improving health for people experiencing homelessness and criminal justice involvement, where many themes overlap.
For example, the HHCJ Lab recently collaborated on a report with the Minnesota Department of Health (MDH), which found the death rate among individuals experiencing homelessness to be three times that of the general population, and is largely driven by high rates of drug overdose – adding evidence to the argument that improving care, treatment, prevention for people experiencing homelessness is a crucial component for reversing the opioid epidemic.
Winkelman and colleagues also have a body of work demonstrating that most people who are using fentanyl or heroin (both opioids) will come in contact with the criminal legal system during their lifetimes.
In 2019, Winkelman started an opioid use disorder treatment program at the Hennepin County Jail and helped expand its model of care for treating people with substance use during incarceration to over 100 people per day at the Hennepin County Jail. He is also involved in an NIH-funded study to understand how to help people stay in treatment after they leave jail or prison. “Understanding what's happening with substance use treatment during incarceration and the transition afterwards is critical to addressing the opioid crisis,” Winkelman says.
Winkelman is also active around the issue of Medicaid and criminal justice involvement. He has published a number of papers showing that Medicaid expansion under the Affordable Care Act improved health insurance coverage for people involved in the criminal legal system, but did not make a substantial difference in their rates of substance use or mental health treatment indicating that Medicaid expansion appears necessary but yet likely not sufficient to meaningfully change access to this type of care for this population.
Winkelman and collaborators have also written perspective pieces in the New England Journal of Medicine, Lancet Public Health, and elsewhere about the potential benefits of “turning on” Medicaid during incarceration. Until recent guidance from the Biden administration, Medicaid was prohibited from covering health care services provided in jails or prisons. That is slowly changing as more states adopt 1115 Medicaid waivers that allow for coverage of transitional services prior to and during the transition out of incarceration.
Winkelman also co-founded the Minnesota Electronic Health Record Consortium, which is a partnership among the largest health systems in Minnesota and MDH. The collaboration was built during the pandemic to track COVID-19 prevalence, testing, and vaccination, with a particular focus on health equity indicators to determine the impact on different populations (including those experiencing homelessness and/or incarceration) and inform equitable deployment of public health resources.
Reflecting on his journey since his time as a Clinical Scholar, Winkelman says that the program “has allowed me to have a very diverse job. I've been able to blend research, policy, and health systems administration in ways that then make sustainable change.”
Winkelman found the CSP after medical school and residency training at the University of Minnesota Medical School in looking for the best way to advance as both a clinician and a health services researcher. “I needed a concrete set of skills so I wouldn’t be limited to contributing to the work of others or relying on others to do the analysis. I wanted to learn to design and oversee a project start to finish.” Winkelman was impressed by the quality of U-M’s program and the caliber of its scholars. “By far, Michigan offered the best learning environment for me,” he says. “There was no comparison.”
Winkelman returns again and again to the importance of collaboration fostered through the program. “Many of the people I collaborate with today are through different CSP connections,” he says, noting that at least 30 of his papers have been written with CSP colleagues, mentors, faculty, or alumni.
“Essentially none of the work that I do would be possible had I not done the fellowship. The policy training and quantitative skills that I developed have been critical, but the network and relationships that I built were just as if not more important.”
– Tyler Winkelman