July 2022
President’s Column
The WCHQ Statewide Quality and Value Event has long been my favorite event of the year. It is an opportunity to connect with colleagues across the state, to learn from national experts, and most importantly, to celebrate the successes of WCHQ members. The past two years it has been even more special as in-person opportunities to connect have been infrequent.
I had the honor of presenting the Quality Leadership Award to Fort HealthCare. Mike Wallace, CEO, received the award and shared his story of how Fort HealthCare transformed their organization from focusing primarily on quality care within the health system to striving to make their community the healthiest in the state. Mike reported that the adage “no mission, no margin” should now be “no outcomes, no income.” He emphasized that actionable data is critical to identifying focus areas and emphasized the importance of WCHQ’s data. As the day progressed, the theme of using data to drive decisions and the unsurpassed uniqueness of WCHQ’s data assets was interwoven into every presentation.
Dr. Angela Fitch of Massachusetts General Hospital Weight Center and faculty at Harvard Medical School characterized WCHQ as being ahead of the vast majority of the country in our ability to measure obesity and emphasized the importance of measuring outcomes and treatment methodologies with the same vigor as we apply to other chronic diseases. Dr. Mbonu Ikezuago of ThedaCare demonstrated how his organization uses WCHQ data to drive clinical change and emphasized the need to have data on predictive factors, processes and outcomes.
The day’s patient perspective was provided by Len Elmore, an attorney and former NBA player, who joked that his year with the Buck’s might have been the predictive factor to their later success. Len reminded the audience that data is also important to patients who need direct and clear information to ensure they follow their own treatment regimens. Jackie Rau, program manager of the Michigan Collaborative for Type 2 Diabetes reinforced this point by playing a patient testimonial video where the patient said having data allowed him to set clear goals for his own treatment. The final presentation by Eric Johnson, PharmD of Gundersen Health System, rounded out the day by describing a successful team-based approach to carrying for patients.
This year, WCHQ was able to virtually stream the full day, including video of the speaker, a new adaptation we implemented to better connect with our members across the region. That said, as I watched the dozens of in-person participants connect with each other and our presenters I was also reminded of the importance of in-person networking. Next year I anticipate we will have both options available for attendance and I hope we will see more of you in either forum.
WCHQ In-Person Event Draws Clinicians from Across the State
Members, Sponsors Take Advantage of Networking Opportunities
The WCHQ 2022 Quality and Value Improvement Event and Diabetes Summit brought more than 100 members and partners together on June 22 in Madison. Angela Fitch, MD, with Massachusetts General Hospital Weight Center and on faculty at Harvard Medical School, emphasized that obesity is a chronic, treatable disease. It is a disease in which excess body fat has accumulated in a dysfunctional manner to a level that may have an adverse effect on health. Obesity affects more than 150 million people in the United States.
“We have to get away from the idea that obesity must be treated by a specialist,” according to Dr. Fitch. “We have to develop a better way to treat it.”
What works for treating obesity? Dr. Fitch follows four principles: providing structure, such as weight programs, meal replacements; accountability, includes follow up visits, virtual care; metabolic alterations to promote fat loss, such as surgery, medications, dietary patterns, exercise intensity and sleep; and lastly, environmental stimulus control, which includes meal replacements, CBT and acceptance-based therapy.
People place blame and shame on the disease, which makes it more difficult for the patient to seek treatment. Dr. Fitch recommended asking for the patient’s permission to discuss the disease and how it affects them. There are three aspects to consider: metabolic, physical/functional, and psychological. Above all, she asked everyone to use “people first language and remove the word, ‘obese’ from our vocabularies.”
“Focus on the whole person and optimal outcome, not one treatment or another,” Dr. Fitch said. “And educate patients and the community at large that this is a treatable disease.”
NOTE: For more information on the WCHQ Obesity Advisory Group, which is focused on improving the care for those with obesity, contact Jen Koberstein.
Mike Wallace, President and CEO at Fort HealthCare, believes the role of the hospital of the future is to be immersed in the daily culture of the community it serves. With that, it must manage population health and get upstream if it is going to be effective in mitigating illness. And he believes that this change must start with the hospital’s employees.
Wallace emphasized the importance of having accurate, actionable data that can be used to benchmark performance to monitor progress on measures that are indicators of community health, such as A1c and hypertension control rates and cancer rates.
Dr. Mbonu Ikezuagu, vice president and chief quality officer at ThedaCare, explained how his organization uses WCHQ data to monitor their progress on quality improvement measures and to drive health care value.
“The most important function of a health care system is to improve the health and wellbeing of our population,” said Dr. Ikezuagu. He added that health systems have a responsibility to remove waste in health care. One way to encourage that is to share information with providers that allows them to see how others are doing. Dr. Ike noted that these insights are available in the WCHQ data.
Jackie Rau, program manager at the Michigan Collaborative for Type 2 Diabetes explained how their providers are collaborating, not competing, and working together similar to how WCHQ improvement teams are functioning in Wisconsin. She said the Michigan group is trying to shift the paradigm of type 2 diabetes from accepting that the risk is genetic, and it is hard to change behaviors, to one of prevention and reversal.
Dr. Melanie Smith, a family practice physician with Advocate Aurora and a member of the WCHQ Obesity Advisory Group, introduced Len Elmore, Novo Nordisk Patient Ambassador. Elmore is a former NBA player, sportscaster, attorney and senior lecturer at Columbia University. As a type 2 diabetic, Elmore shared his personal journey that led to his recognition that the disease requires a person to commit to being vigilant and committed to managing it.
Eric Johnson, Pharm.D., clinical pharmacy, at Gundersen Health, is part of a team that provides care to those with type 2 diabetes. In his presentation, Dr. Johnson explained the role of the pharmacist in educating and helping a patient manage their disease.
WCHQ President and CEO Gabrielle Rude, PhD, presided over the day. In her President’s Column in this issue, Dr. Rude provides an excellent summary of the day and notes that attendance at in-person events is slowly edging upwards.
“The range of topics featured at this event demonstrates the breadth and depth of knowledge that WCHQ can access in our own membership. Everyone of the speakers was excellent, demonstrating innovative approaches to improving the quality and value of health care,” according to Dr. Rude. “WCHQ was built on collaboration, sharing what works, and using data to guide our patient care decisions. Together, we can make health care better for everyone.”
WCHQ thanks Novo Nordisk for supporting the WCHQ Diabetes Summit
And the following partners and sponsors for their education displays:
Fort HealthCare Receives WCHQ Top Quality Award
The Wisconsin Collaborative for Healthcare Quality (WCHQ) presented Fort HealthCare with its top award for excellence in quality improvement leadership at a celebration held June 22, 2022. Gabrielle Rude, PhD, WCHQ President and CEO, presented the award at the WCHQ Quality and Value Improvement Event and Diabetes Summit. Accepting on behalf of Fort HealthCare was President and CEO Michael Wallace.
WCHQ annually recognizes a select number of member organizations for superior clinical performance and patient outcomes. This award, however, honors one organization for exceptional quality improvement, active engagement with WCHQ’s work and mentorship of other organizations. One of the attributes that is considered for this award was Fort HealthCare’s notable improvement across many of the WCHQ measures and their participation on and willingness to serve in leadership positions on committees, work groups and on the WCHQ Board of Directors.
“Fort HealthCare performs well across many of the quality measures that WCHQ scores, but it is their willingness to share what they know with other organizations that is truly invaluable,” according to Dr. Rude. “Sharing with other organizations how they are improving patient care demonstrates their commitment to ensuring that everyone in Wisconsin has access to high quality care, no matter where they live.”
WCHQ is dedicated to helping health care professionals improve the quality and value of health care through collaboration, sharing best practices and by publicly reporting information that health care organizations can use to benchmark and compare their performance. To join an improvement team, contact Abbey Harburn.
SPOTLIGHT: A Deeper Dive into Immunization Data
A Deeper Dive into Immunization Data: What’s Happening to Rates in Wisconsin?
Immunization rates took a hit during the pandemic as in-patient visits fell in primary care settings across the country. Wisconsin rates were no exception. According to data collected by the Wisconsin Department of Health (DHS), fewer people received routine vaccines during the COVID-19 pandemic compared to the average number of people vaccinated in 2015-2019. The fewest number of people were vaccinated between March and April 2020. Among all age groups, children aged 5-6 years had the biggest decline in the number of routine vaccines received. See the DHS map.
WCHQ data tells the story from a different perspective, taking the WCHQ denominator definition into account. WCHQ uses a denominator that includes only patients who are seen in the clinic twice over two years and once within the last 12 months. The number of patients seen in the clinic over the pandemic dropped, reflecting a 4% - 14% decrease in the number of patients included in the immunization denominator.
“While it appears the proportion of patients who were up-to-date on vaccines increased in Wisconsin in 2020, the reality is significantly fewer patients were seen in primary care to qualify for these measures and fewer patients were vaccinated,” according to Abbey Harburn, quality improvement specialist. “In a typical year, we expect the number of children included in these measures to remain relatively stable. In 2020, we saw the number of children who were eligible for these measures and who were seen in primary care drop.”
The graphs below include data collected between 2017 and 2020.
Immunization is a member driven WCHQ priority. To join your colleagues on the Adolescent and Child Health Improvement Team and help to increase immunization rates in your community, contact Abbey Harburn.
A Fond Farewell to a Valued Colleague: Mary Gordon
Mary Gordon joined the WCHQ team in 2006, when the Collaborative was in its early development stage. Over the years, she became invaluable to the organization as members began submitting data on what was then, a starter set of measures. From the start, Mary has played a key role in the development of WCHQ’s measure set and helped WCHQ members collect and submit data on what has grown to include more than 40 measures.
Among the many examples of Gordon’s contributions to WCHQ is the acceptance of a measure that she developed that was included in the PQRS/MIPS national set of measurements. A go-to on issues related to data mapping and coding, Mary was always available to assist members.
“Mary has been an incredibly valuable team member. Her focus was always on supporting our members, whatever their needs may have been related to data submission and reporting," according to WCHQ COO Matt Gigot. “Mary was a strong believer in WCHQ’s mission, and that was reflected in her day-to-day work.”
Mary announced her retirement effective June 30, 2022. In a parting email to the WCHQ staff, Mary noted that when she was first approached to work with WCHQ in 2006, she initially hesitated because “it was a small organization…that was so different and fairly new.” Now, 20 years later, Mary described what an honor it was to have been able to meet people in the health systems throughout Wisconsin as WCHQ grew in membership to include every health system in the state.
The WCHQ team will deeply miss Mary and we wish her all the best in the future.
Improvement Teams
Obesity
WCHQ Partners with Payers to Offer Employers Information on Obesity
WCHQ partnered with The Alliance, Health Payment Systems and M3 to offer a webinar to employers with the goal of creating a better understanding of the disease of obesity. Dr. Christopher Weber, a physician specializing in obesity at Ascension Wisconsin, said obesity is at epidemic levels nationally and in Wisconsin. He said obesity is sometimes “glossed over” by providers, they do not always associate it as a disease, but he said, that attitude is quickly changing. He described the various treatments that are available and emphasized that untreated, obesity can drive medical costs for employers.
Dr. Melanie Smith, a physician from Aurora, discussed the association between obesity and the link to type II diabetes. She had data on the cost of not treating obesity as the chronic disease that it is. Dr. John Briggs explained the psychological impacts of obesity and described how treatment can be a life-changing event for people. He said the cost of obesity in 2017 was $1.4 trillion with twice as many sick days and significantly higher pharmaceutical costs unrelated to those used for the treatment of obesity. He said there is not one approach to treating obesity, rather it requires customizing a plan that will work for the individual.
A panel of employers explained what they currently do to support employees and their families who have the disease of obesity. WCHQ and the payers developed a document employers can share with their broker or consultants to discuss the options for covering obesity treatment.
To learn more about the WCHQ Obesity Advisory Group, contact Jen Koberstein.
Chronic Disease
CKD Advisory Group Completes Charter, Invites More Health Systems to Join
The Chronic Kidney Disease (CKD) Advisory group finalized the committee’s charter early June and quickly moved into the discussion around measurement development. This initial step is significant as the data collected for this measure will guide future work toward early identification and slowing the progression of chronic kidney disease.
WCHQ developed and released a draft measurement specification to the advisory group and their data counterparts for their review. This measure is one of several that will support future quality improvement efforts. The new measure is a combination of specifications from the WCHQ diabetic measurement suite and NCQA’s Kidney Evaluation HEDIS measure.
The draft measure for kidney evaluation is currently under review and will be discussed further at the July 7 meeting. To learn more or to join, contact Sheryl Pierce.
Team-Based Care
Intuition might suggest a slight pause on quality improvement efforts with the obstacles faced within today’s landscape, but there is no break for Wisconsin health systems. Strong efforts are clearly underway based on a recent discussion from a highly engaged WCHQ Chronic Disease Learning Collaborative (CDLC), Team-Based Care (TBC) Workgroup.
At the June meeting, workgroup members shared Team-Based Care goals that clearly support achieving efficiencies as part of a team as well as encouraging care gap closures. This group will continue to meet and report out on goal progress with plans of sharing the overall results with a larger group of their peers at an upcoming CDLC meeting in January 2023.
Team-Based Care is proven to provide high quality, accessible care– further supporting Quadruple Aim. Many health systems are in the process of taking a closer look at a TBC approach and are eager to discuss next steps. Reach out to Sheryl Pierce to get involved in a Chronic Disease Learning Collaborative Workgroup.
Behavioral Health
WCHQ Participates in MCW Event Poster Session
WCHQ and MCW co-presented a poster June 6 on the work being done on Integrated Behavioral Health. The poster was presented at the 31st Annual MCW Department of Family and Community Medicine Research Forum as a project in progress. A description of the work the poster illustrated follows:
Poster Title: Developing a Team Training Program to IncreaseIntegrated Behavioral Health in Primary Care Settings
Introduction: Integrating behavioral health (IBH) into primary care has proven a successful strategy to decrease the burden on health care, government and community systems that are already overwhelmed by the demand for mental health services. Compared to other insured populations, Medicaid patients experience a disproportionate lack of access to behavioral health. To address the gap, this three-year quality improvement project aims to increase the adoption of IBH by Wisconsin health systems into their primary care clinics.
Methods: Preliminary data was collected through phone interviews and online surveys with health system team leads to identify: 1) stage of IBH integration; 2) barriers to integration; and 3) goals to advance IBH. Qualitative content analysis informed development of a 12-month webinar series to train teams in IBH best practices and provide technical assistance to attain goals along a continuum of integration.
Results: This project is in progress. Preliminary data from 10 teams, comprised of primary care clinicians, psychologists, social workers and clinic managers reflect IBH across five stages of integration. Major barriers include a limited return on investment, leadership buy-in, and culture change.
Conclusion: Preliminary results suggest that health care systems require training and technical support to advance integrated behavioral health. WCHQ anticipates that IBH will increase the number of patients with a diagnosis who access care in these primary care settings mitigating the disproportionate mental health disparities invulnerable Medicaid populations. Future analysis will evaluate increase in behavioral health appointments and patient outcomes.
Disparities
Disparities Improvement Team Works Toward Health System Goals
The Disparities Improvement Team met in June with a focus on setting organization-level goals and identifying interventions to improve health equity in Wisconsin. Health systems from across the state shared the goals that they have set for their health systems to reduce or eliminate racial and geographic disparities in their patient populations related to cancer screenings and chronic disease. Team members discussed the strategies they are implementing in their health systems with a focus on improving community engagement and providing culturally appropriate care.
Over the next several months, Disparities Improvement Team participants will share best practices and lessons learned as they implement interventions targeted towards health disparities.
To participate in this work, please contact Abbey Harburn.
WCHQ, UW Health Featured Presenters on Rural Health Disparities at Rural Health Conference
Abbey Harburn, who is leading the WCHQ statewide disparities improvement team, presented at the Wisconsin Rural Health Conference June 16 in Green Bay. She was joined by Dr. Jennifer Weiss, a UW Health physician and leading researcher in colorectal cancer and rural health at the University of Wisconsin-Madison. WCHQ is in the initial stages of disparities improvement work. At a WCHQ executive summit earlier this year, WHA/WCHQ rural health system members selected colorectal cancer screening as their focus area. Dr. Weiss and Harburn described novel classifications for identify rural geographic areas and described how rural health systems can use WCHQ data to identify health disparities.
Adolescent and Child Health
Seeking Participants for Study to Increase HPV Vaccination Rates
Is adolescent vaccination a topic of special interest to you?
In collaboration with WCHQ, Elizabeth Cox, MD, PhD, a pediatrician and health services researcher at the University of Wisconsin, and Melissa Gilkey, PhD, a professor of health behavior at the University of North Carolina, are preparing to offer primary care clinics in WI an evidence-based intervention to increase HPV vaccination rates. As a first step, the research team is conducting a study to understand how the intervention can best be implemented in organizations like yours.
The project is currently seeking providers (MD, DO, APPs), clinic staff (nurses, MAs), QI staff, system leaders, and adolescent vaccine champions (formal or informal) from WCHQ’s membership who serve patients ages 9-12 years in Wisconsin pediatric or family medicine clinics to participate in a one-time 45-minute interview. The interview will be done remotely, by phone or Zoom, at a time of the participant’s choosing.
To participate, email prokids@pediatrics.wisc.edu or sign up here: Interview Interest Form. Your participation helps ensure suggestions for improving vaccination are informed by the people who actually do this work every day.
Share information about this opportunity with others who maybe interested via email, at staff meetings, or by posting in clinics. For questions, contact the research team, prokids@pediatrics.wisc.edu or 608-263-1202, or Jen Koberstein.
Oral Health Collaborative
WCHQ and NIH Talk Oral Health Disparities
Dr. Jennifer Webster-Cyriaque, deputy director of the National Institute of Dental and Craniofacial Research at National Institutes for Health, is passionate about disparities and is determined to develop public-private partnerships to develop a plan to address them in oral health. Dr. Webster-Cyriaque and WCHQ staff met in June to discuss the importance of documenting the evidence of oral health disparities. She was enthusiastic about WCHQ’s work and mission and was anxious to learn more about the work that has been done in Wisconsin on the medical side to address disparities. WCHQ shared the WCHQ Health Disparities Reports that were released over the past two years.
Dr. Webster-Cyriaque plans to convene a group of stakeholders in a planning session later this year and said that WCHQ will be invited to the table. Disparities continues to be a priority for WCHQ. To learn more about or to participate in WCHQ’s disparities work contact Abbey Harburn.
To learn more about oral health, contact Jen Koberstein.
