For our first Data Spotlight, it seemed fitting that since March is colorectal cancer screening month and March 4 is HPV Awareness Day, that we start with WCHQ results on these two metrics.

We reviewed the most recently available data (June 2020) compared to pre-pandemic data (December 2019). While we saw a decline in performance on these measures (fewer colorectal cancer screenings and fewer HPV vaccinations) we also noted that some providers saw a dramatic drop in the number of patients that qualified for these measures. This means that because fewer patients were seen in the physician office, there were fewer patients that were given the opportunity to receive needed preventive services.

Colorectal Cancer

The number of people screened for colorectal cancer decreased by 2.2% across WCHQ’s total population, meaning more than 24,000 patients were not screened for colorectal cancer compared to pre-pandemic results.

We saw wide variation in the changes to patient population (that is adults seen by a provider who could order the colorectal cancer screening) with some organizations maintaining patient populations and others seeing a decline. Based on pre-pandemic screening rates, the organizations that saw a decrease in qualifying patient visits represent an additional 3,800 patients that went without a colorectal cancer screening.

Human Papilloma Virus (HPV) Vaccine

The number of children vaccinated for HPV decreased by 2.0%, which in this smaller population means over 500 children were not vaccinated compared to pre-pandemic results.

This younger population was significantly impacted by a decrease in qualifying patient visits with nearly every reporting organization showing a decline in qualifying visits. This equates to 1,200 additional children who did not receive this life-saving vaccine based on pre-pandemic vaccination rates.

The results above are early indicators of the effect of avoided patient care. The wide variation in performance also provides an opportunity for learning and sharing of best practices, something WCHQ actively facilitates. WCHQ has an improvement team focused on adolescent health, contact Abbey Harburn to learn more.

Looking ahead, we will be providing more data snapshots to highlight opportunities for improvement. Ideas for additional analyses and questions are always welcome. Send your thoughts to bslattery@wchq.org

WCHQ is broadening its focus to develop tools that will help members assess and increase the value of care.

At a February 22 seminar for members, WCHQ previewed what will be the first of a series of reports for WCHQ provider members that include data related to quality, utilization and cost.

WCHQ President and CEO Gabrielle Rude, PhD noted that Wisconsin health care has consistently ranked among the best in the nation.

“Now, Wisconsin has an opportunity to leverage WCHQ’s improvement strategies into the world of value and focus on how to provide care that is more affordable for patients, payers and employers,” according to Dr. Rude.

The WCHQ Value Acceleration Initiative defined value as higher quality, more affordable care and limited its initial scope to the population of patients with diabetes. This group was selected because of its large size and large number of expensive complications and comorbidities. WCHQ developed value reports based on the Board-endorsed improvement strategies, which included:

• Integrating behavioral health into primary care;
• Integrate pharmacists into primary care;
• Tobacco cessation; and
• Reduce stress testing in stable disease after percutaneous coronary intervention (PCI).

Matt Gigot, WCHQ chief operating officer, shared specifics of the member reports that utilized data from multiple sources to establish a baseline for value measurement. These reports will contain information not previously available on several different indicators of value associated with delivering care to individuals with diabetes. This will include information on clinical quality, hospitalizations and resource utilization.

Gigot noted that the data in the report is blinded and not publicly available, but WCHQ members will be able to identify their own results. The value reports will be shared with provider members in early March.

“The goal of the value report is to introduce this data to WCHQ provider members, identify what current information is helpful to their work to increase value and to identify what additional decision-support information is needed from WCHQ to advance value improvement in their organization,” according to Gigot.

One WCHQ member is already tackling value improvement. Chris Elfner, vice president, clinically integrated networks, described how Bellin Health is using data to increase the value of care.

“We have claims, quality and community organizations that all have data. We need to bring that information together to get good knowledge of our populations across the state,” Elfner said. “This is challenging because we have piles of data, but it might not be the data we need. There are opportunities to mine the data to get to the information that is useful to us.”

Elfner explained that quality, experience and utilization data must be combined to manage a population health program, using internal and external information, with a measurement system that supports the entire process.

Parting thoughts on whether value is the right term from a patient’s perspective were shared by Dirk Steinert, MD, medical director of quality in specialty care at Ascension Wisconsin.

“Effective care is an outcome as understood by and planned for an individual,” according to Dr. Steinert. “Care must be affable, available (access), able to be delivered and affordable. If it is not, then we are not providing effective care. Effective care is a term that is understandable to and has meaning for patients.”

In mid-February, WCHQ began providing unblinded reports to members on their quality measures. The intent behind sharing these unblinded reports is to give WCHQ provider members the information they need to identify and address any measurement areas that may have been impacted as a result of COVID-19.

"We listened to our members and know how important access to timely information is to guiding clinical decision-making," explained WCHQ's Director of Performance Measurement Brian Slattery. "While WCHQ is working toward a return to regular, pre-pandemic reporting cadence, we thought we could extend some additional value to the members by sharing this unblinded information so that they can have the information they need to inform the important work of improving the quality of the care they provide to patients."

Overall, the unblinded reports have been well received by the members.

“At the end of the day, the WCHQ Board of Directors, Measurement Advisory Committee and WCHQ staff recognize that to continue to drive improvement, our members need more timely and actionable information,” according to Slattery. “We feel these reports, while still a work in progress, achieve those objectives.”

Questions about data submission and reports can be directed to Brian Slattery.

Since its inception, the WCHQ Oral Health Collaborative’s (OHC) mission to improve oral health care has aligned with the Wisconsin Dental Association’s (WDA) commitment to quality oral care.

On February 18, WCHQ CEO Gabrielle Rude, PhD, was invited to present to the WDA Board of Trustees at their meeting in Kohler, Wisconsin. Dr. Rude presented an overview of WCHQ as an organization that has facilitated improvement and public reporting of information submitted by medical providers for nearly 20 years. The Oral Health Collaborative, created in 2018, is following a similar path and that is to use data to inform improvement.

Dr. Rude described the progress that the OHC has made to date, which includes the development of several measures of quality, submitting data to WCHQ and using that information in their improvement work. The discussion with WDA centered on how the two organizations can work together to support future work at both WDA and in the WCHQ oral health collaborative.

Dr. Rude emphasized how WCHQ sees itself as operating in support of the WDA’s mission to promote professional excellence through education, encourage thought leadership, and advocate on behalf of the oral health community. Dr. Rude shared how members in the OHC have a focus on building integrative measures between oral and medical care and she emphasized that “the WDA is an important stakeholder in WCHQ’s work as we integrate medical and dental to provide holistic care.”

The two organizations will continue to collaborate and share information that support their mutual missions of service to oral health providers.

For more information about the Oral Health Collaborative contact Jen Koberstein.‍

“Understanding and Treating Obesity: A Clinical Overview”

(virtual)

March 23, 2022

Noon – 1:30 PM

Agenda

‍Register

‍

WCHQ Behavioral Health Assembly

(virtual)

April 21, 2022

9 AM - Noon

Agenda

Register

‍

“Community and Clinical Strategies for Increasing HPV Rates”  

(virtual)

May 5, 2022

Noon – 1 PM

Dr. Katherine Price, Mayo Clinic 

‍

WCHQ Statewide Quality Improvement Event and Diabetes Summit

(hybrid)

June 22, 2022

9 AM – 4 PM

Monona Terrace, Madison

‍

WCHQ Obesity Summit

(hybrid)

October 13, 2022

9 AM – 4 PM

The Retlaw, Fond du Lac

WCHQ Disparities Assembly

(Format: TBD)

November 10, 2022

Behavioral Health

Upcoming Behavioral Health Education Event          

Registration is now open for the WCHQ Behavioral Health Assembly April 21 from 9 AM – Noon. View the agenda.

Speakers and topics include:

• “The Therapeutic Application of Psilocybin and MDMA-Assisted Therapy” presented by Dr. Christopher Nicholas. Dr. Nicholas is an Assistant Professor in the UW Department of Family Medicine and Community Health. His research focuses on the clinical efficacy and therapeutic mechanisms of psychedelic and other psychoactive compounds for addiction (opioid and methamphetamine use disorders), trauma, chronic pain, and depression. Learn more here.
  Dr. Nicholas provides specialty clinical services in the overlapping areas of chronic pain, addiction, and trauma and is a behavioral health supervisor for the UW Addiction Medicine Fellowship Program. 

• “The Yin and Yang of Integrated Behavioral Health Integration” presented by Martha Saucedo, LCSW. Martha Saucedo graduated from UW-Madison master’s in social work program and obtained her LCSW in 2013 after immigrating from Monterrey, Mexico where she obtained a degree in psychology. She is currently a behavioral health consultant at Access Community Health Center and partners with a Latinx community liaison to understand mental health in the Latinx population. Ms. Saucedo was an assistant professor in the master’s program in social work in UW-Madison teaching, “Working with Race and Ethnic groups in Social Work” for the last five years. She is a strong advocate in the Latinx community working toward equality, educating the community and providing mental health services.

• “Support Programs to Promote Workforce Psychological Wellness” will be presented by Myra West, PsyD. Dr. West is a clinical psychologist and director of organizational trauma and resilience in Marshfield Clinic Health System. She specializes in severe stress and trauma reactions with a secondary specialization in organizational psychology, combining the two to promote wellness, resilience, and psychological health throughout the MCHS workforce.
  Dr. West received doctoral and master’s degrees in Clinical Psychology from the University of Denver, a master’s degree in Child and Family Studies and a postgraduate certificate in Organizational Psychology from The Chicago School of Professional Psychology. Dr. West has provided services within hospitals, organizations, and private practice settings including a children’s hospital, Level One Burn and Wound Care Center.

For information on the Assembly, contact Mary Kay Fahey. To join the Behavioral Health Improvement team, contact Jen Koberstein.

Obesity

Education Series on Obesity Targets Employers

The WCHQ Obesity Advisory Group met in February with the sub-group working on payer and provider issues to begin designing an education series for employers in Wisconsin. The series will focus on providing medical information about obesity as a disease, treatment options and how employers can support employees who are seeking support for their condition. The series will feature presentations from payers that offer comprehensive obesity coverage. The group expects to launch this series in June.

On March 23, the Obesity Advisory Group will present a virtual education event from 12:00-1:30 PM, “Obesity Treatment: A Pathway to a Healthier Wisconsin.” Dr. Samantha Pabich, assistant professor, Division of Endocrinology, Diabetes and Metabolism, University of Wisconsin. She will discuss “The State of the State’s Body Composition: Obesity and Diabetes in Wisconsin in 2022.”  Dr. Melanie Smith, Board-Certified Family Medicine; Diplomate, Obesity Medicine, Advocate Aurora, will present “Treating Obesity to Reduce Cardiovascular Risk in Type 2 Diabetes.”

Following Dr. Smith’s presentation, WCHQ staff will describe measurement and other related activities that are supporting obesity improvement. Find more information and register here.

Disparities

Advancing Health Equity and Reducing Disparities

The Disparities Improvement Team met in February to finalize their charter and identify the roles, responsibilities and activities needed to advance health equity and reduce disparities in Wisconsin. Of particular focus was the need to involve stakeholders and communities that are experiencing disparities in this work. The Disparities Improvement Team will be reaching out to community groups and organizations to identify appropriate participants. In future meetings, the Improvement Team will participate in focus groups facilitated by the Health Innovation Program and WCHQ to learn more about the process for selecting interventions for addressing health disparities. The Team also plans to share current priorities and strategies implemented at member health systems as a starting point for identifying best practices in reducing health disparities.

For more information, contact Abbey Harburn.

Adolescent and Child Health

The Current State of Blood Lead Poisoning Testing in Wisconsin

The Childhood Lead Poisoning Prevention Program presented at the February meeting of the Adolescent and Child Health Improvement Team on the status of blood lead testing in Wisconsin. Routine blood lead testing is recommended between the ages of one and five depending on several risk factors, including city of residence, age of housing and Medicaid status. Prior to the pandemic, Wisconsin struggled to test every recommended child. In 2019, only 67.2 percent of one-year-old children enrolled in Medicaid were tested for blood lead levels, even though 100 percent of those children are required to be tested by Medicaid. As a result of the pandemic and a recall of point-of-care blood lead tests, Wisconsin has seen a drastic decrease in blood lead testing. To increase the rate of testing, the Wisconsin Childhood Lead Poisoning Prevention Program sent Medicaid provider reports to every primary care provider in the state who saw at least five Medicaid patients in calendar year 2020. This data allows providers to compare themselves to the best performer in the state and provides a list of specific patients who were not tested.

To increase the rate of blood lead testing, the Lead Poisoning Prevention Program recommends that clinics take the following steps: audit office performance, reduce dependence on WIC clinics for lead testing, collect blood samples in-office and utilize electronic medical record prompts. The Adolescent and Child Health Improvement Team spent the February meeting reviewing strategies that members have implemented in their electronic medical records and within their clinics to increase the rates of lead testing. Strategies employed by members include electronic alerts based on risk factor and standing orders for blood lead testing. For more information or to participate in the Adolescent and Child Health Improvement Team, please contact Abbey Harburn.

Chronic Disease

Chronic Disease Learning Collaborative, Team-Based Care Workgroup

With nearly 1 in 2 US adults (47.3 percent) diagnosed with high blood pressure, the Centers for Disease Control and Prevention recognizes team-based care (TBC), medication therapy management (MTM), and self-measured blood pressure monitoring (SMBP) as effective ways to manage high blood pressure.

WCHQ member health systems have expressed interest in implementing or enhancing team-based care efforts as well as initiatives that support SMBP programs within their health systems. Several health systems are preparing SMART goals for an upcoming workgroup meeting March 28, 2022. WCHQ is facilitating this work and continues to support members as they collaborate to improve care for patients with high blood pressure.

To join the WCHQ Team-Based Care workgroup series, contact Sheryl Pierce.