Achieving the “Holy Grail” of Quality and Cost: An Update on 360ValuCounts
Over the past 20 years, Wisconsin has established itself as a leader nationally for the consistently high quality of health care services in virtually all settings where patient care is delivered. The evidence of this is borne out in multiple ways, ranging from the annual rankings published by the Agency for Healthcare Research and Quality (AHRQ), through observing longitudinal trends on public websites (www.wchq.org, www.wicheckpoint.org), and by studies of Wisconsin initiatives published in the peer-reviewed literature – most notably those profiling WCHQ in Health Affairs (Smith, Lamb, and Queram, 2013; and, Lamb, Smith, Weeks and Queram, 2014).
These results reflect the cumulative efforts of a broad array of stakeholders including health systems, multi-specialty and primary care physician practices, payers, public and private sector purchasers, state and federal policymakers, consumer organizations and advocates. Indeed, this collaborative spirit is deeply embedded in the culture of our state. While this achievement is a source of enduring pride, it is important to recognize that the pursuit of a high performing health care sector is a journey, not a destination, and requires a shared purpose enabled and supported by information, innovation and continued commitment.
As estimable as our record of improving quality may be, Wisconsin stakeholders have long been interested in marrying WCHQ’s measures of clinical quality with measures of resource utilization and cost-of-care generated by claims data collected and maintained by the Wisconsin Health Information Organization (WHIO) to create a composite measure of health care “value.” Today, thanks to the foresight and leadership of the Boards of Directors of both WCHQ and WHIO, we are closer to that goal than ever before with the planned launch of the “360ValuCounts,”an integrated clinical/claims database.
Between now and the end of 2020, staff from WCHQ and WHIO will begin the intensive design phase of an interactive dashboard comparing system quality and cost for two populations – diabetes and behavioral health. Among the critical methodological questions to be addressed include minimum sample sizes as well as models for patient attribution and risk adjustment. The goal is to prepare the dashboard for release in early 2021.
We are recruiting a handful (no fewer than five, no more than seven) of WCHQ members to participate in this design process. The requirements of participation are straight-forward, as we are asking members to agree to the following: contribute data; submit the personal health information (PHI) elements necessary for the WCHQ and WHIO data to be integrated at the patient level; and, provide input to and feedback on the dashboard. The primary benefits include the opportunity to influence the design of the dashboard along with early access to the finished product.
If you are interested in participating as a member of the alpha group – or would like more information on 360ValuCounts generally – please contact Matt Gigot, director of performance measurement and analytics at firstname.lastname@example.org.
- Chris Queram
The Wisconsin Collaborative for Healthcare Quality (WCHQ) recognized several of its member health systems and clinics as top performers in the state based on their reported rates on measures that are WCHQ priority areas.
WCHQ annually honors a select number of member organizations for superior clinical performance and patient outcomes. Normally, the awards would be presented at WCHQ’s Statewide Quality Improvement Event, but the pandemic changed that plan, and awards were presented at virtual events in late July.
“We stand in honor of these health professionals for their clinical excellence and top performance on measures that are associated with managing chronic disease, prevention and depression. And, in a state with as many excellent providers as Wisconsin, it is not surprising that the difference between first and second was very slim in many cases,” according to WCHQ President/CEO Chris Queram. “It is indeed a privilege for WCHQ to recognize our award winners — and all our members — for their efforts to deliver excellent care across region.”
Gabrielle Rude, PhD, director of practice transformation and incoming WCHQ President/CEO, presented the awards, listed below:
WCHQ 2020 Quality Leadership Award
Bellin Health received the WCHQ 2020 Quality Leadership Award recognized for exceptional quality improvement and leadership. Accepting on behalf of Bellin Health was Brad Wozney, MD.
WCHQ annually honors a select number of member organizations for superior clinical performance and patient outcomes. This award, however, recognizes one organization for exceptional quality improvement, active engagement with WCHQ’s work, and mentorship of other organizations. One of the attributes that WCHQ’s Quality Planning Committee took into consideration in their criteria for this award was Bellin Health’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.
“Bellin Health performs well across many of the quality measures WCHQ scores, but their willingness to share what they know with other organizations and help them improve the quality of their patient care demonstrates their commitment to ensure all the people they serve have access to high quality care, no matter where they live,” according to WCHQ President/CEO Chris Queram.
Top Performing Members
Aspirus – Depression Screening
Accepting the Award: Billi Jo Leopold, interim clinic director, Aspirus Medical Group
Associated Physicians – Colorectal Cancer Screening
Accepting the Award: Jennifer Everton, MD, director of quality; Kim Zielke, director, clinical operations; Sherry Schneider, quality care manager
Primary Care Associates of Appleton – Diabetes Control and Hypertension Control (2 Awards)
Accepting the Award: CEO James VanderMissen and Ann Taake, quality improvement specialist
Top Performing Clinics
UW Health 20 S. Park, 5th Floor, Internal Medicine – Colorectal Cancer Screening
Accepting the Award: Lea Veltum, RN, internal medicine clinic manager
Aspirus Endocrinology Clinic – Depression Screening
Accepting the Award: Billi Jo Leopold, interim clinic director, Aspirus Medical Group
Bellin Health Escanaba – Hypertension Control
Accepting the Award: Ashley Young, team facilitator
Ascension Columbia St. Mary’s Ozaukee- Cedarburg – Diabetes Control
Accepting the Award: Dirk Steinert, MD
NCQA released updated measure specifications for 2020 and 2021 on July 1, 2020, including the expansion of telehealth related criteria. Below is a high-level summary of the NCQA changes and how they parallel decisions made by WCHQ’s Measurement Advisory Committee (MAC) earlier this year.
NCQA removed the denominator requirement that one of the visits in their Diabetes, CAD and Controlling High BP measures need be a face-to-face office visit if the other visit was a telehealth visit. Now both visits can be a telehealth visit. This aligns with the MAC decision and is what WCHQ has incorporated into its specifications. Per the MAC’s direction WCHQ has incorporated telehealth visits into all WCHQ ambulatory measure specifications, not just the chronic care measures. NCQA does not have visit-based denominators for their preventive care measures so they did not add telehealth visits to other measures.
The codes that WCHQ uses for telehealth, telephone, and online/eVisits now match NCQA’s specifications exactly.
NCQA has removed the previous requirements for blood pressure remote monitoring devices, and now allows blood pressures taken by any digital device. Additionally, NCQA now allows for blood pressure readings to be reported directly by the patient to the provider. This matches the MAC’s decision regarding the use of home monitored blood pressures.
“The high degree of alignment between NCQA’s changes and those adopted by WCHQ reaffirm that our process for developing, adopting, implementing and monitoring our metrics for accuracy, reliability and applicability are solid,” according to WCHQ President/CEO Chris Queram.
Addressing Intimate Partner Violence During the COVID19 Pandemic
August 6, 1-2 PM
Presenter: Stacy A. Ogbeide, PsyD, MS, ABPP
COVID-19 has created isolation, job losses and increased stress. All these factors increase the risk of domestic violence, which has risen sharply with the pandemic.
Stacy A. Ogbeide is a Board-certified clinical health psychologist who focuses on identifying, screening and referring to treatment for intimae partner violence. Dr. Ogbeide will help clinicians address intimate partner violence in their practice so patients can connect to the help they need to be safe at home.
Acting on the “ACT” Score: What an Asthma Control Test Can Do for You
The first in a series of webinars focused on treating, managing and measuring asthma
Featuring: Dr. Nicholas Antos, Children’s Wisconsin
August 17, 2020, Noon – 1 PM
Asthma affects over 400,000 adults and more than 100,000 children in Wisconsin. Helping people with asthma properly manage and control their disease is a top public health priority.
WCHQ and the Wisconsin Department of Health Services, Asthma Program are hosting a series of webinars to help clinicians measure and improve care for their patients with asthma.
The first webinar on August 17 will feature Nicholas J. Antos, MD. Dr. Antos, a pediatric pulmonologist at Children’s Wisconsin, will present the ACT measure, which is a new measure developed by WCHQ. Dr. Antos will describe how the ACT is used in practice, explain why the ACT makes a difference with patients, how it can be utilized by health systems and, using a personal story, he will describe how it is used in the clinic.
The pandemic put a temporary hold on in-clinic visits, which impacted the delivery of preventive services. A very important aspect of keeping adolescents and children healthy involves well care. WCHQ members have been sharing their best practices related to bringing children back up to date on well-child visits and immunizations. This webinar will focus on immunizations, well-child and preventive care for children and adolescents while coping with the challenges of COVID-19.
WCHQ is pleased to announce Dr. L. J. Tan as our keynote speaker. Dr. Tan is an internationally recognized expert on issues ranging from vaccine safety to emerging infection diseases. Dr. Yolanda Wolff, MD will share how Children’s Wisconsin has maintained well-child visits through telehealth and immunization clinics. Alexandria Cull Weatherer, MPH with the Wisconsin Cancer Collaborative will explain the importance of HPV vaccination during COVID-19.
Screening, Brief intervention. Referral. With early intervention, those at risk for substance abuse disorders can avoid more severe consequences later. Laura Saunders is an expert at SBIRT. She has designed, facilitated and delivered motivational interviewing and SBIRT training in person and online. Join her to learn more about this important clinical tool.
WCHQ quickly pivoted to meet members’ needs for collaboration and information sharing on COVID-19 related issues.
Members asked to meet more frequently as the situation unfolded and urgent issues arose related to telehealth, closing and reopening clinics, continuing care for patients with chronic illnesses, well childcare and immunizations and behavioral health issues.
WCHQ will continue to facilitate collaboration among members throughout the COVID response, including best practices for implementing vaccination clinics and administering the vaccine to staff, patients and in the community, as that information becomes available.
Here is a brief summary of the July improvement work, by clinical topic:
Adolescent and Child Health
This month members discussed best practices related to procedures during the pandemic, including scheduling well child visits through telehealth and in the clinic, best practices related to immunization clinics for this population and testing. WCHQ members reported a significantly higher demand for COVID-19 testing consistent with statewide trends. Wisconsin has worked toward expanding its capacity to complete and process testing. The number of labs performing testing went from 2 in March to 83 in July (WI DHS, 2020). The testing capacity of the state went up from 120 in March to 24, 156 in July (WI DHS, 2020).
Members shared information on methods to help meet the demand for testing, such as opening more testing sites and implementing drive-through testing. There remain concerns about the availability of testing kits and supplies as well as the delay in receiving testing results. To address delays, many members are utilizing in-house lab testing rather than depending solely on outsourced lab results. WCHQ is focused on supporting members to continuously adapt and modify clinical practice and testing workflows as the pandemic continues.
To join the conversation, please contact Sarah (Wright) Sky.
WCHQ members are continuing to reopen clinics and increasing face-to-face visits while taking necessary extra precautions to ensure patient and staff safety. As clinics catch up on the backlog of patients from the past few months, staff are working extra hours or extending clinics hours to see more patients in a day.
In July, WCHQ facilitated a presentation from researchers at the University of Wisconsin Institute for Clinical and Translational Research (UW ICTR) Neighborhood Health Partnerships Program (NHP). Interested WCHQ members have the opportunity to design new health system and clinic-level diabetes reports for this program. The reports will provide local, timely and actionable data to support community health in Wisconsin. WCHQ members interested in joining in the co-design process for these reports should contact Lauren Bednarz.
WCHQ members are welcome to join the Chronic Disease meetings at any time. Contact Cara Winsand to learn more about this team.
Members of the WCHQ Oral Health Collaborative are meeting frequently to help dental practices continue to reopen safely. WCHQ facilitated sharing of best practices and discussion of strategies to address challenge. This month’s focus was on how to support staff who are struggling with the “new normal.”
Both Delta Dental of Wisconsin and the Health Policy Institute (HPI) at the American Dental Association (ADA) have been tracking re-opening statistics. According to claims data and practice reported data from Wisconsin, general dental practitioners have recovered to a level very near pre-COVID, close to last year’s levels of production. Preventive services are at or above last year’s level and the number of insured visits per provider are a bit higher than last year or pre-COVID 2020. The levels of recovery, however, appear very different by dental specialty. Pediatric dentists have experienced a robust recovery at or even above last year’s trends. Endodontists have also experienced a near complete recovery with visits per week only slightly below last year. Periodontist appear to be lagging last year’s production levels by about 25% despite an increase in maintenance services per visit, but a decrease in treatment services. Oral surgery has currently only recovered about 40% of last year’s production after experiencing early growth to nearly 75% of last year when dental offices first opened, followed by a second decline to the 40% level in the last several weeks.
Personal Protective Equipment (PPE) supplies remain a concern for oral health providers as they return to normal business. Providers have expressed the desire to be good stewards of PPE thereby ensuring medical providers have what they need. The American Dental Association reported in a recent survey that more than 75% of dental offices surveyed in Wisconsin have more than 14 days’ worth of PPE available and this issue seems to be resolving for dentists in Wisconsin.
Looking ahead, the Oral Health Collaborative is focused on the development of meaningful, publicly reported measures in the dental environment.
WCHQ’s Behavioral Health work has been focused on facilitating member discussions on best practices to adapt to the COVID-19 impacts on daily practice, including telehealth visits during COVID-19, and the integration of behavioral health and primary care.
WCHQ will begin publicly reporting several new behavioral health measures in the Fall of 2020 and 2021 including a PHQ-9 utilization measure, and measures of depression remission and response. These measures are challenging to achieve but essential parts of good clinical care. Soon, WCHQ will facilitate improvement meetings to share best practices to achieve success on these measures.
One avenue for success that WCHQ is already promoting through its Value Acceleration Initiative (VAI) is Integrated Behavioral Health (IBH). Using SAMHSA’s 6-Levels of Integrated Care, achieving higher levels of collaboration between primary care and behavioral health can improve patient health outcomes. The collaborative care model shown to better manage the many steps necessary during a patient’s depression treatment continuum (Pence, O’Donnell, & Gaynes, 2012). Having a team approach with an on-demand or in-clinic behavioral health consultant increases the capacity of a primary care practice to routinely screen patients for depression, clinically recognize depression, begin adequate and timely treatment, and track patients with treatment progress (Pence, O’Donnell, & Gaynes, 2012).
To join the conversation or to ask WCHQ for assistance while implementing integrated behavioral health, please contact Sarah (Wright) Sky.
Pence, B. W., O'Donnell, J. K., & Gaynes, B. N. (2012). The depression treatment cascade in primary care: a public health perspective. Current psychiatry reports, 14(4), 328–335. https://doi.org/10.1007/s11920-012-0274-y
It was another successful year for Delta Dental of Wisconsin Foundation’s Cool Water Program, with 56 schools from around the state applying for a water bottle filling station. The selection committee met and choose the top 20 schools, which was extremely difficult considering the time and effort put into each school’s implementation plan to get students to drink more water.
After CDC guidelines were released suggesting turning off or not using standard water fountains during the upcoming school year to prevent the spread of germs, the selection committee met again. It was decided to forego giving water bottles and toothbrushes to each student, and instead select more schools to receive water bottle filling stations this cycle. These stations are touch-free and sensor-activated, meaning more students will have access to drinking water during the school day.
While we all navigate through the COVID-19 pandemic knowing our schools will look different this fall, we can be confident in knowing students in these schools will have access to clean drinking water during the school day:
- Notre Dame School of Milwaukee - Blessed Theresa Campus, Milwaukee
- Maple Tree Elementary, Milwaukee
- Riley School, Milwaukee
- St. Joan Antida High School, Milwaukee
- Hawthorne Elementary, Milwaukee
- Vernon Elementary, Kenosha
- John Marshall Elementary, Wausau
- Grove Elementary, Wisconsin Rapids
- Yeshiva Elementary, Milwaukee
- Madison Elementary, Marshfield
- Lincoln Elementary, Whitewater
- Lincoln Elementary, New London
- Northwoods Elementary, Eau Claire
- Star Center Elementary, Lake Geneva
- Tomahawk Elementary, Tomahawk
- Whitehorse Middle School, Madison
- Spring Hill Elementary, Wisconsin Dells
- Iron River Elementary, Iron River
- Mellen School, Mellen
- Marion Elementary, Marion
- St. Joseph Academy, Milwaukee
- Lincoln Elementary, Wausau
- Franklin Elementary, West Allis
- Humke Elementary, Nekoosa
- Good Shepherd Lutheran, Watertown
- Horace Mann Middle School, Wausau
- Gordon L. Wilson, Baraboo
Schools were selected based on the following criteria:
- Schools need to be within a community with optimally fluoridated water
- Schools must have a free-and-reduced meal rate of 40% or higher
- Schools can apply if they currently do not have a water bottle filling station installed
- Selection will be based on the most creative and impactful implementation plans that will encourage students and staff to drink more water
Applications for the third cycle of the program will be available in February 2021 on the Delta Dental of Wisconsin Foundation’s website, www.deltadentalwi.com/foundation. Schools will be selected and awarded the grants in April, with installation planned for the summer. For information on this project contact Megan Tenpas.