On September 27, the WCHQ Board of Directors gathered on the shore of Green Lake, Wisconsin for our annual strategic planning retreat. This year’s theme was, “Building upon our Foundation.” 

Imran Andrabi, MD, Board Chair, began by thanking the board members for coming in person and reminding the board that this work is important and unique to Wisconsin, stating that he “belong(s) to this collaborative because its mission is personally important to me.” 

The first presenter, President and CEO Gabrielle Rude, PhD, shared that WCHQ has evolved tremendously since its start with seven founding members to today including the majority of health providers in the state. Dr. Rude stated, “Twenty years ago we began as an idea, a tiny seedling … today we serve as a broad canopy, protecting and growing quality across the region.”

Jerry Zoloto, PhD, of Anova Partners, engaged the board in an interactive exercise to build a high performing team. He challenged participants to build trust by sharing personal experiences about the best team they had even been on to develop those same characteristics in the WCHQ board. Dr. Zoloto shared that high performing teams are ones built on trust and with a common and challenging purpose. At the final reflections, several members indicated this exercise was the best part of the day despite initial reservations. Board Member Cheryl DeMars, President and CEO of The Alliance, shared that this was an incredible way to build relationships and she, “sincerely appreciated getting to know other board members better.” The board left the exercise feeling better prepared to address our challenges ahead.

The board spent the remainder of the day engaged in discussions on critical priorities for the future. One topic was the importance of discussing how to further promote our collective work in Wisconsin. As an improvement collaborative, WCHQ carefully guards its work to ensure members are comfortable sharing results - even less than optimal ones. The board identified some standards on promotional work, namely that promotions cannot be done in a way that disparages any other member. Overall, the board reflected that WCHQ members have exceptional improvement results, and we should be sharing how these results were achieved in order to drive further improvement and encourage further participation in WCHQ.  WCHQ will be incorporating these concepts into the upcoming Value Acceleration report, which includes deeper analysis of drivers of health outcomes and cost savings that resulted from WCHQ member interventions.

The board was pleased to hear an announcement that the upcoming public reporting of quality measures will include data from Sixteenth Street Community Health Centers. Board members celebrated the addition of this data, noting that we need to have complete data to truly understand population health needs. Board members thought carefully about the meaning of vulnerable populations and WCHQ’s role and responsibilities in evaluating the health of all patients. Ultimately, the board determined that populations of patients are not uniformly vulnerable to all topics but have different needs and opportunities. WCHQ is uniquely positioned to evaluate whole population health given that we have patient level data and can generate information at a more granular level than most other community partners.

Dr. Andrabi closed the day reminding the board of the unique asset we collectively have built here in Wisconsin. Together we will continue to improve quality for the patients we serve.

‍Navigating health disparities, racism, and stigma to get mental health access

WCHQ has partnered with the Medical College of Wisconsin to increase access to behavioral health services for patients with Medicaid.  As part of this project, patients tell the stories of their experience receiving services.

These contemporary portraits of people living with mental illness provide brief glimpses into the experience of navigating the US health system as Medicaid recipients. They share their stories of seeking care, engagement with clinicians, therapeutic treatment, peer support, and recovery. The 3-minute personal vignettes point to the impact of social-cultural and institutional determinants on health, and the resilience it takes to access care and get better.  
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Imani – “Beyond Validation”
‍It’s about empathy and understanding

‍Being seen and heard can be a powerful source for personal transformation. In her video portrait, Imani shares how having someone “just listen” can alter the course for someone facing the challenges of mental illness and substance use. She talks about how peer support helped her to catalyze change.

‍Possible topics for discussion: peer support, compassionate care, and cultural humility.

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WCHQ member Bellin Health reports increases after using the program in 2023

WCHQ is inviting member health systems to increase their HPV vaccination rate by participating in an evidence-based communication workshop.

The workshop has been shown to increase HPV vaccination by five percentage points (Brewer et al, Pediatrics, 2017). WCHQ members currently have an HPV immunization rate of 69% and the goal in Wisconsin, set by the Wisconsin Cancer Collaborative, is 80%. The project is now enrolling systems to receive workshops in the spring of 2024.

The communication workshop, called The Announcement Approach Training, is for all clinical staff who have a role in adolescent vaccination. Content includes traditional and new approaches, such as how to start discussions about HPV vaccination with families starting at age 9. It will also help clinical staff build relationships with families and defuse conflict.

Twenty primary care clinics from three systems have already participated in 2023. Jill Spejcher, MSN, RN, Primary Care Clinical Operations Team Leader at Bellin Health, had this to say about Bellin’s experience: “The project was a really great success within Bellin. We had great staff engagement, and the communication approach taught in the training was very easy for our staff to use. It didn’t slow down the rooming process and fit in with the workflow. Since the trainings, we’ve been seeing improvements in HPV vaccination rates that add up to an additional 250-350 vaccines per month.”

Health systems receive a 1-hour CME/CNE communication workshop for providers and clinical staff in primary care clinics, as well as additional training for one or more vaccine champions. Champions will deliver the HPV vaccine communication workshops to half of the health system’s participating clinics, facilitating project sustainability, and experts from the project team will deliver workshops to the remaining clinics. WCHQ data will be used to track improvements.

The project is led by Elizabeth Cox, MD, PhD, a pediatrician and health services researcher, and Meghan Brennan MD, MS, an infectious disease physician and health services researcher, from the University of Wisconsin, and Melissa Gilkey, PhD, a behavioral scientist specializing in adolescent health at the University of North Carolina. 

To learn how your health system can get involved, contact Jen Koberstein or the UW-UNC project team at prokids@pediatrics.wisc.edu or 608-263-1202.

WCHQ is partnering with Katinka Hooyer, PhD, Medical Anthropologist at the Medical College of Wisconsin, to better understand the barriers the Hispanic, Black, Hmong, Asian/Pacific Islander, and American Indian/Alaska Native communities encounter to get their children vaccinated. Who better to gain this perspective than to interview the Community Health Workers (CHW) who are immersed in these communities? CHWs help these communities daily to overcome barriers and amplify the voices of the population. 

This information will be used to educate clinical staff, providers and in community health worker training. It will be utilized in toolkits to help increase awareness and break down the barriers that lead to lower immunization rates with these populations. The result of this project will be a series of mini-documentaries, made publicly available for training and to bring awareness to these barriers. 

We are inviting CHWs to share their experiences related to barriers around childhood and adolescent vaccines in the communities they represent. We would like to invite four people to participate in this project, from any of the identified communities, to share their experiences, opinions, and suggestions. Compensation of $500.00 is available for 6-7 hours of time over three months. Participation includes completing the initial interview and videotaping, review of footage, providing feedback, sharing the finished documentary within your network and post project follow-up. This will be your story and you have shared authority over the final product before it is shared with any others.

If you are interested in participating in this project and have a story to tell, please reach out to Lori Bue, Quality Improvement Specialist.

The WCHQ Chronic Kidney Disease Seminar, “Chronic Kidney Disease: Early Detection and Treatment” provided strategies to increase early screening and treatment of chronic kidney disease.

Member organizations who participate in the CKD advisory group received reports showing their performance on screening and treatment for CKD. These measures, developed with the CKD Advisory Group, are not publicly available but can be provided to any members that submit the required data to WCHQ.

Abbey Harburn, WCHQ Director of Analytics and Practice Transformation, reported that people living in rural underserved areas of Wisconsin have the lowest rates of CKD screening (34.1%) while urban underserved patients are screened at the highest rate of 43.1%, a gap of nearly 1,300 patients. For more information on WCHQ’s disparities work and the definitions for where people live, visit www.wchq.org/disparities.

Dr. Chitra Bhosekar, Clinical Nephrologist and Service Line Lead for Nephrology at Bellin Health System, and Vice Chair of the WCHQ CKD Advisory Group, explained how end stage renal disease negatively impacts the lives of patients. Her call to action was to drive earlier detection as it is critical to improving quality of life.

The seminar included an expert panel that emphasized the importance of seeing the patient as a whole person, addressing their dietary needs, psychological impact of the disease, and experience of being transitioned to dialysis, and, again, the importance of early detection. Panel participants included:

• Molly Spaulding, a registered dietitian (RD) and certified diabetes care and education specialist of Advocate Aurora Healthcare.
• Courtney Barry, a licensed clinical psychologist and assistant professor from the Medical College of Wisconsin.
• Crystal Anderson Schmidt, nephrology clinical manager at Gundersen Health System.

Quin Taylor, a CKD patient advocate through the National Kidney Foundation of Illinois, provided a patient perspective. Quin explained the emotional turn of events she experienced in her twenties when she was diagnosed with end stage renal disease. She reinforced the importance of understanding the patient experience, remaining hopeful, and gratitude.

Dr. Sarang Baman, a primary care physician and Medical Director for Population Health with Advocate Health and the Chair of the WCHQ CKD Advisory Group, spoke on the primary care physician’s role in early detection and treatment of CKD. He shared that fifteen percent of US adults have chronic kidney disease and ninety percent of those people do not know that they have CKD. Dr. Baman reminded attendees that screening is important in people with diabetes or hypertension and highlighted additional care options including smoking cessation, dietitian referral, treating high blood glucose levels, hypertension control, and organ preserving medications.

Elizabeth Montgomery from the National Kidney Foundation presented collaborative projects that have worked to increase screening and decrease progression of kidney disease. She told the attendees about a project by Indian Health Services to decrease diabetes-related end stage renal disease (ESRD). Over 20 years of effort, they were able to reduce ESRD by 54%. Her message was loud and clear; reducing ESRD is possible.

Dr. George Bakris of the University of Chicago shared clinical information about how to stop the progression of kidney disease. He emphasized the use of a holistic approach and reminded everyone that we need to work together to get the best outcomes for patients. Best practices include:

• Screening patients at high risk due to a diagnosis of diabetes or hypertension
• Prescribing organ-preserving medications when appropriate
• Referring to ancillary services such as a dietitian
• Continued monitoring and medication management as appropriate

Attendees left with ideas for turning data into action with comments including:

"Tons of ideas to implement in primary care.”

“I will be sharing this information with other primary care providers at my organization.”

“More innovative ideas to share with my team.”

WCHQ has a CKD Advisory Group which meets regularly to review CKD data and deep dive into all of the strategies highlighted here. If you are interested in joining this work, including obtaining your own custom reports, contact Jen Koberstein at JKoberstein@wchq.org

WCHQ would like to thank Bayer for sponsoring this event.

‍Behavioral Health

WCHQ Members Innovate to Increase Access to Behavioral Health Care 

WCHQ held a virtual education event on October 5, 2023 to share effective strategies to increase access to behavioral health care.  ‍

Leverage Data

WCHQ’s data can be used to identify the population that is most in need of help and to design strategies that are specific to the population. As part of WCHQ’s work in Healthy Metric, we have produced numerous reports on health disparities, available on our disparities page. 

Lauren Bednarz, MPH, of UW-Madison Health Innovation Program, also a partner in Healthy Metric, showcased Healthy Metric’s Behavioral Health Report. The report seeks to make data actionable by telling a more complete story of the population’s needs. For example, while telehealth has been promoted as a strategy to improve access to behavioral health, not all patients are accessing it equally. Bednarz noted: 

• Medicaid participants in Wisconsin have the highest rate of depression and anxiety diagnoses, but the lowest rates of telehealth usage. 
• Rural patients tend to utilize less telehealth than urban areas.

Visit www.healthymetric.org for more information on Healthy Metric and additional reports. 

Integrated Behavioral Health (IBH) Training 

WCHQ has partnered with the Collaborative Family Healthcare Association (CFHA) to produce a video training series on IBH. CFHA is a multi-guild organization whose mission is to make IBH the standard of care across America. The 12-webinar series was developed after consulting with health systems to understand barrier and strategies for success. The series includes strategies to move forward with IBH even with the current widely seen staffing challenges.  These trainings, which have already been used by nine WCHQ member health systems are available for free here.  

This work is funded by the Advancing Healthier Wisconsin Endowment

Use Empathy to Build Resilience in Patients

WCHQ has worked with Katinka Hooyer, PhD of the Medical College of Wisconsin to produce a mini documentary series on resilience and recovery to help care providers understand the impact they have on patients during each interaction. The series features patients discussing the impacts of healthcare interactions on both their behavioral and physical health. The series can be utilized as a training opportunity, to show providers how they can use empathy and trust building in their interactions to build resilience in patients. Peggy Michaelis, Peer Advocate, shared stories of recovery and resilience in the context of behavioral health diagnoses and symptoms.  Peggy explains, “Illness is a part of you, you are not the illness.” The mini documentary video series is located here. 

The education event wrapped up with a panel of psychologists consisting of Elizabeth Zeidler Schreiter PsyD, Chief Behavioral Health Officer at Access Community Health Center, Kelsie-Marie Offenwanger, PsyD, Child and Adolescent Psychologist at Marshfield Clinic Health System Stephanie Kohlbeck, PhD, Pediatric Psychologist at Marshfield Clinic Health System. The panel discussed how to help health systems focus on IBH as a tool for providers in addition to patients. “We are there to help to serve pediatric providers,” said Dr. Offenwanger. “It starts with them.” IBH services within the health system improve outcomes for providers by decreasing appointment times and supporting the providers’ workload. Dr. Zeidler-Schreiter talked about how the “transfer of trust” between the provider and Behavioral Health Consultant (BHC) can ensure quick building of rapport with the patient. Drs. Kohlbeck and Offenwanger described the innovative ways they are seeing youth, including seeing them at school by telehealth during a study hall period, decreasing burden on parents and school absenteeism for the youth themselves. Dr. Zeidler Schreiter reminded the audience it is not “if,” but rather “when,” it is time to implement IBH.

The next steps for WCHQ member health systems in behavioral health improvement work will be publicly reporting on depression remission and response rates in the Spring of 2024. IBH can be a great tool to support improved penetration of depression treatment within health systems. WCHQ has many resources, including IBH implementation training and patient impact mini documentaries focused on patient recovery, as resources.  

If you are interested in learning more about the work WCHQ is doing on behavioral health, contact Renee Sutkay.

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Colorectal Cancer

Colorectal Cancer Screening Interventions: Using Technology to Close Screening Gaps

Members of the WCHQ Colorectal Cancer Advisory Group are leveraging their electronic health record (EHR) to alert patients to their routine screening needs. Recently, Advisory Group members shared successful interventions to improve screening, specifically in rural communities. 

• Primary Care Associates of Appleton is using a team-based approach to leverage the health maintenance section in the EHR. The staff member rooming the patient starts the conversation by telling the patient when they are due for colorectal screening, allowing the patient to begin considering their options before the provider comes in. PCAA also uses population health dashboards and empowers staff to independently schedule patients based on overdue screenings. “Utilizing health maintenance has been one of the biggest call outs,” says Ann Taake, Quality Improvement Specialist at PCAA
• Fort HealthCare shares unblinded, provider-level colorectal cancer screening rates with care teams monthly. Health outcomes specialists utilize population health dashboards and get patients in for preventative screening, offering all screening options, including fecal immunochemical tests (FIT), Cologuard, and colonoscopy. “This really helps us close care gaps” says Chris Barron, Executive Director, Population Health & Clinical Services. Barron also highlighted Fort HealthCare’s connection in the community an important aspect of building trust for patients to complete ongoing prevention efforts and reducing disparities.
• Watertown Regional Medical Center (WRMC) is focused on ensuring patients come in for their well visits as patients who attend annual visits get screened for colorectal cancer at higher rates. “One of the priorities as an organization is making sure patients come in for annual visits,” says Nathan Neuman, Quality Analyst. WRMC recently began using the campaign function in the EHR, which allows health systems to organize and gather lists of patients in the context of certain conditions and automatically send e-mail and text messages for colorectal cancer screening reminders. 
• Prevea Health, talked about the importance of using the campaign function in Prevea’s EHR to list patients who are not only overdue for their colorectal cancer screening, but also patients who will be due soon for screening. “The campaign function is automated and runs annually,” says Julia Langer, RN Clinical Navigator. Prevea’s goal is to ensure all patients eligible in the next year will be alerted proactively to schedule their colorectal cancer screening.

This WCHQ Colorectal Cancer Advisory Group is specifically focused on improving colorectal cancer in rural populations. If you’re interested in this work, please reach out to Quality Improvement Specialist Renee Sutkay.

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Disparities

WCHQ Member Bellin Health Includes Community Health Workers to Reduce Healthcare Disparities Work

WCHQ works with member health systems to understand the drivers of disparity reduction in their work. Together with implementation scientists from UW Madison’s Health Innovation Program, we identify and disseminate successful strategies to reduce disparities. 

One tactic utilized by a WCHQ member, Bellin Health, is to engage Community Health Workers (CHWs) in disparity reduction work. CHWs often have lived experiences they can share with patients to effectively serve as a supportive liaison between patients and providers.  They can, as in Bellin’s example, also be engaged directly in evaluating disparities and designing interventions. Bellin is working with CHWs to understand what other factors can impact these interventions positively and support patients at a community level to achieve improved health outcomes. 

Maggie Koch, BSN, RS, RN, Director of Bellin’s Care Beyond Walls Program, remarks, “I think it is vital we integrate Community Health Workers into the health system and ensure they are utilized in a way that helps positively impact our patients’ lives in the community.”  Bellin’s collaboration with CHWs fosters trust and impacts outcomes positively. The support of CHWs on Bellin’s team also allows staff to work at the highest level of their licensure, focusing on clinical work, while CHWs can focus on work related to social drivers of health.  Koch says, “This work is a continual, plan-do-study-act initiative for us, always evolving and improving!”

The WCHQ Disparities Improvement Team will continue to examine specific interventions, and also consider social factors that influence those interventions. If you’re interested in this work, please reach out to Renee Sutkay.

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Immunizations

WCHQ Seeks Community Health Workers to Tell Their Story

WCHQ is partnering with Katinka Hooyer, PhD, Medical Anthropologist at the Medical College of Wisconsin, to better understand the barriers the Hispanic, Black, Hmong, Asian/Pacific Islander, and American Indian/Alaska Native communities encounter to get their children vaccinated. Who better to gain this perspective than to interview the Community Health Workers (CHW) who are immersed in these communities? CHWs help these communities daily to overcome barriers and amplify the voices of the population. 

This information will be used to educate clinical staff, providers and in community health worker training. It will be utilized in toolkits to help increase awareness and break down the barriers that lead to lower immunization rates with these populations. The result of this project will be a series of mini-documentaries, made publicly available for training and to bring awareness to these barriers. 

We are inviting CHWs to share their experiences related to barriers around childhood and adolescent vaccines in the communities they represent. We would like to invite four people to participate in this project, from any of the identified communities, to share their experiences, opinions, and suggestions. Compensation of $500.00 is available for 6-7 hours of time over three months. Participation includes completing the initial interview and videotaping, review of footage, providing feedback, sharing the finished documentary within your network and post project follow-up. This will be your story and you have shared authority over the final product before it is shared with any others.

If you are interested in participating in this project and have a story to tell, please reach out to Lori Bue, Quality Improvement Specialist.

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