Gallup polls have shown that while trust in individual physicians remains high, trust in the medical system fell rapidly from 80 percent in 1975 to 37 percent in 2017. Health care is not the only target. Trust in institutions, government and science has also been in a downward spiral.
The lack of trust in our health system is concerning because it influences personal health decisions, such as whether to have your kids vaccinated or follow through on a care plan. In a commentary published March 9 in Modern Healthcare, Daniel Wolfson, executive vice president of the American Board of Internal Medicine Foundation (ABIMF), cited a 2018 peer-reviewed paper that said, “Patients who have more trust in their health care professionals are more satisfied with their treatment, have fewer symptoms and pursue healthier behaviors.” He goes on to say, “For patients, the trust deficit invites lower rates of treatment compliance leading to potentially dangerous impacts on health.”
Earlier this summer, WCHQ was one of eight organizations recognized by the ABIMF's Trust Practice Challenge. The ABIMF honored WCHQ for its substantial contributions to building trust among providers and with the public. The Foundation considers trust to be the backbone of patient, physician and health care system relationships.
WCHQ was pleased to be recognized for the work it has done over the past 15 years to promote data collection, transparency and collaboration. Through an iterative series of trust-building conversations, WCHQ members agreed to voluntarily submit patient-level billing and clinical data to create the first true population-based measure of diabetes process and control in 2004. Since that time, WCHQ members have submitted data and created a robust data warehouse. Members trust that WCHQ will be a faithful and diligent steward of their data and that, in return, WCHQ will generate valid and reliable measure results that are used in the spirit of public accountability, collaboration and improvement. The information is shared with the public on WCHQ.org.
This newsletter has several examples of member trust-building initiatives and programs: Members are actively contributing to and engaging in our work to make care better and more affordable for patients with multiple chronic conditions; Dental Associates has joined our growing dental collaborative with a goal of integrating oral and physical health; and in September, WCHQ will release its first report that identifies where disparities in health outcomes and care exist in Wisconsin, which will inform and accelerate programs that are working to eliminate them.
Trust in health care systems may be faltering nationwide, but in Wisconsin and at WCHQ, rebuilding trust in our health care institutions and professionals in the field, is a priority.
- Chris Queram
Features Dr. K. Wisdom from Henry Ford Health System, Detroit
Variation in how patients experience health care exist, and it impacts outcomes. The first step in eliminating disparities is to identify where the differences are occurring to help inform and accelerate multi-stakeholder programs in the community that foster equity.
At its Assembly September 19, WCHQ will release the findings of its new report that examines disparities in Wisconsin across a select set of health outcomes and care measures that are relevant in the primary care setting. Differences in statewide performance are presented separately for populations defined by race/ethnicity, payer and by geography.
The report, jointly developed by WCHQ and the Health Innovation Program (HIP), utilizes member-submitted, standardized and recent clinical data (2018), which was aggregated to provide a statewide snapshot that identifies health disparities.
The findings will be presented by Matt Gigot, WCHQ director of performance measurement and analysis; and, Maureen Smith, MD, MPH, PhD, Professor, Departments of Population Health Sciences and Family Medicine & Community Health at the University of Wisconsin School of Medicine and Public Health.
Michigan has made progress in mitigating disparities, an issue that Kimberlydawn Wisdom, MD, has personally been involved with across her career. Dr. Wisdom, who will keynote the September 19 Assembly, was the first Surgeon General for the State of Michigan and is now Senior Vice President of Community Health & Equity and Chief Wellness & Diversity Officer at Henry Ford Health System. Dr. Wisdom will describe work at Henry Ford focused on health disparities/health care equity, infant mortality, maternal and child health, chronic disease, unintended pregnancy, physical inactivity, unhealthy eating habits and tobacco use. She has worked collaboratively with school districts, faith-based organizations and the business community.
In Wisconsin, health systems and community organizations are also collaborating to improve health outcomes and eliminate health disparities. Four Wisconsin health care systems and organizations will present their strategies and initiatives at the WCHQ event:
- Eliminating Disparities: A Health System View - Cristy Garcia-Thomas, Advocate Aurora Health
- The Impact of Housing on Health - Caroline Gomez-Tom, Sixteenth Street Clinic, Milwaukee
- Reducing Barriers: The Barbershop Health Initiative - Aaron Perry, Rebalanced Life Wellness Assoc.
- Improving Access for People in Rural Wisconsin - Greg Nycz, Family Health Center of Marshfield
Registration is open for the WCHQ Assembly, “Creating a Healthy Wisconsin: Identifying and Eliminating Health Disparities,” September 19, 9 a.m. – 3 p.m., Monona Terrace, Madison. For information contact Mary Kay Fahey, email@example.com.
Following months of deliberating the pros and cons of aligning WCHQ’s measures with those used nationally in the CMS programs (ACO, MIPS), the WCHQ Measurement Advisory Committee (MAC) recommended to not make any changes.
Driven by the thinking that alignment could reduce measurement burden and line up improvement efforts with payment, the WCHQ Measurement Advisory Committee (MAC) discussions focused on what patients should be included, which is the primary source of mis-alignment between WCHQ and CMS. WCHQ requires two office visits over two years; CMS programs generally require one visit in the measurement year.
As part of this conversation, the MAC performed a denominator test and applied the MIPS eCQM denominator to the WCHQ data for two measures: Diabetes: Optimal Control and Colorectal Cancer Screening.
- Main denominator differences are the number of visits required, and the type of visits allowed - WCHQ allows for 19 more office visits types than CMS
- Observed: Slight average decrease in performance across both measures
- Increase in Diabetes denominator and decrease in colorectal cancer rate
The MAC concluded:
- If the goal is reduction in measurement burden, measure alignment would not achieve that goal. CMS has several different programs that members are involved in, all of which define seemingly identical measures differently. It would be impossible to align exactly.
- WCHQ members, including MAC representatives, have high confidence in WCHQ measures and are concerned that using CMS measure definitions would jeopardize confidence. Given similar measure results, not much would be gained by switching to CMS. Several MAC members spoke of the distractions that CMS measures can cause when deploying QI efforts.
- Members do have a desire to have more information about patients seen infrequently – as the CMS measures are able to do.
The MAC recommendation to the WCHQ Board, which approved it, is to not alter the WCHQ denominator. WCHQ and the MAC will continue to track this issue closely. The MAC instructed WCHQ staff to begin the exploration of developing tools/measures the provide more information about patients who are infrequently seen. WCHQ will keep its members apprised of its work in this area.
Work is progressing at WCHQ on the Value Acceleration Initiative, which is aimed at driving greater value for patients, employers, insurers and providers. The priority selected this year is to improve care for patients with multiple morbidities, with an emphasis on diabetes, hypertension and depression.
The WCHQ Value Acceleration Steering Team (VAST) is currently identifying interventions applicable to this patient population that can be reasonably implemented by all WCHQ members and are aligned with the priorities of providers, purchasers and payers. When interventions are received from the members, the VAST will develop criteria it can use to prioritize and evaluate the submissions.
The VAST is reporting to the Value Acceleration Advisory Group, which is overseeing and guiding the overall initiative.
WCHQ members are encouraged to submit interventions they have in place that are improving care for patients with diabetes and multiple morbidities. If you would like to submit an intervention, contact Cara Winsand at WCHQ, firstname.lastname@example.org or call 608-826-6838.
Maureen Smith, MD, PhD, developed a model that illustrates the cascade of chronic conditions that develops in patients with diabetes. The “cascade” model was of interest to VAST because it groups patients according to the interventions that most effectively increase value-based care. The groupings were: patients with diabetes and no cardiac disease; patients with diabetes and cardiac complications; and, patients with diabetes and advanced cardiac complications.
The VAST and Advisory Group will continue to meet regularly to review available literature and data, to consult with specialists and specialty organizations, and ultimately determine best practice recommendations for broad distribution and implementation. The best practice recommendations will span the health care continuum, including clinical workflows, benefit design, and contract language and provisions. The recommendations of the Steering Team will be collated into a formal report that will be approved by the Advisory Group and then presented to the Board of Directors for endorsement. The recommendation report will be distributed to WCHQ members and stakeholders early next year.
Dental Associates joins ForwardDental and the dental practices based in the Marshfield Clinic Health System, Health Partners (MN), and Children’s Hospital Health System as WCHQ members. WCHQ has formed one of the first regional oral health collaboratives in the country.Dental Associates has joined the Wisconsin Collaborative for Healthcare Quality. Dental Associates will be among the first dental practices in the nation to publicly report a set of metrics specifically designed for oral health.
"WCHQ has proven that ‘what gets measured and reported publicly, improves faster,’” according to WCHQ President/CEO Chris Queram. “We are pleased to welcome Dental Associates to the Collaborative. It is exciting to see dentists work with our organization and join physician practices and health systems to set a new standard of overall, holistic care. Our goal is to see a closer alignment between oral and medical health providers in our state because a number of serious health issues must be managed in both settings.”
Thomas Manos, DDS, MS, is owner and President of Dental Associates. Dental Associates has 14 locations in Wisconsin and is accredited by the Accreditation Association of Ambulatory Health Care (AAAHC).
Collecting data and using it to improve quality is not new to Dental Associates. A data-driven and patient-centric practice, Dr. Manos said they are looking forward to working with WCHQ as a partner to help create a starter set of quality metrics related to oral health.
“There is a critical link between oral health and general health and well-being. We know poor dental hygiene is linked to an increase in chronic and acute diseases,” according to Dr. Manos. “We are looking forward to working with our colleagues in both the medical and oral health communities to improve the overall health of the people we all serve.”
Queram said the oral health collaborative members are currently developing a starter set of measures that are reliable and useful for benchmarking clinical performance in dental practice settings. The practices will then collect and send data to WCHQ. The Collaborative’s goal is to align the oral health measures to specific processes that are common to all dental offices to benchmark performance. In 2020, dental organizations will begin to publicly report their progress on WCHQ.org. The initial set of dental metrics will focus on preventive services for patients under the age of 18, as well as the identification and treatment of periodontal disease.
WCHQ welcomed the following organizations as new partners:
Nordic Healthcare organizations are challenged to deliver higher quality care at a lower cost. Nordic’s award-winning team provides consulting services focused on strategy, technology, and operations, as well as managed services, that result in a stronger business with better patient outcomes.
Pfizer believes every individual deserves the opportunity to live the healthiest life possible. They strive to strengthen health systems, increase access to our medicines and foster socially responsible entrepreneurship to help find sustainable solutions for patients in need around the world.
Health Payment Systems (HPS) offers the most effective independent provider-based network in Eastern Wisconsin to deliver significant savings and choices for self-funded and level-funded employers.
NeuGen supports both WEA Trust and Health Tradition health insurance companies, in addition to providing medical management and administrative services to other healthcare companies.
Wipfli ranks among the top 20 accounting and business consulting firms in the nation. Wipfli offers an integrated approach to help meet health care organizations’ needs for stability and compliance while looking for new avenues for growth.