Our Model

In WCHQ's model, the measure's numerator is identified first. Examples include:

• Mammography every two years (process)
• Blood sugar (A1c) screening every year (process)
• Blood sugar (A1c) result (outcome for diabetes)
• Blood pressure (outcome for hypertension)

For each numerator, parameters of the denominator are carefully constructed to define relevant patients cared for by a physician group. For this denominator to be meaningful, it must identify every such patient for every payer, not just those who were served by a particular payer. For each measure, WCHQ has identified a standard set of three questions to guide construction of the denominator. When answered, a finite, clearly defined group of patients emerges-the denominator for this measure.

Why Use This Model?

• Data collection efforts are more focused. Because the denominator is defined up front, data (e.g., was mammography performed?) need not be collected about patients that will later be excluded. All exclusions are built into the three-question denominator-building methodology.
• These denominators refute a frequent physician objection of "These are not my patients." Because all qualifying patients are "counted," regardless of payer, physicians can trust that the resulting measures reflect actual performance.
• These carefully constructed, population-based denominators overcome many of the sample size issues insurance companies experience.
• Denominators constructed this way can also be used as registries of patients with chronic, episodic or preventive care needs; point out patients with immediate care needs ("check patient's LDL at tomorrow's visit"); and indicate patients who may need additional attention ("contact patient to schedule follow-up; haven't seen her in 18 months; must check A1c").

Measure Validation

A growing number of organizations and individuals are viewing and using the performance measurement results reported here on the WCHQ website. WCHQ staff and member representatives have an established structure and operational policies to ensure that the measures remain accurate and verifiable and that the integrity of the data is maintained.

In addition to policies that address late data submission and reporting, member data correction and third-party data correction, the WCHQ Performance Measurement Audit Committee has in place a validation process that is efficient, effective, complete and helpful for the reporting entities. This validation process involves a three-year schedule with each organization having each measure numerator validated a minimum of one time over a three year period. Denominator validation occurs for measure specification annually. New member organizations are validated for each denominator and numerator measure with their initial data submission. When new measures are introduced, every member organization is validated for each denominator and numerator prior to the initial data publication of the new measure.

Beyond Wisconsin - To the Nation

WCHQ's founding physician leaders understood the need to both develop measures that align with nationally recognized data sets and to provide a smart, easy-to-use methodology for data identification and capture. As a result:

• WCHQ's current and planned measures all align with nationally endorsed measure sets (AQA, NQF).
• Each measure's evidence-based data criteria are presented in a flow chart for ease of use.
• Data are collected through a web-based interface designed in consultation with data submitters.
• WCHQ's data warehouse architecture is dynamic and scalable, to support any number of measures and reporting entities without the need to modify the reporting platform. In other words, as currently configured, WCHQ's system has the capacity to collect performance results for one measure or thousands of measures from one entity or thousands.

The key components of the data submission process include a secure, online data submission application; a dedicated Clinical Information Coordinator, who ensures that all results are accurate and valid; and a board-appointed Performance Measures Audit Committee that, modeled on similar committees serving public companies, is charged with overseeing the audit and validation process and certifying results from reporting entities.

Member organizations harvest their data according to a detailed measure flowchart, which specifies all data criteria, including the three questions used to construct the denominator. Physician groups often construct the needed data from administrative databases, electronic data capture, and manual chart review, if necessary. Results are submitted to WCHQ using an innovative, secure, webbased application.