Wisconsin Collaborative for Quality Healthcare

WCHQ Begins Its Transformation to Support Practice Transformation

The past month has been one of transformation from the cold, snowy days of winter to the up and down temperatures of a Wisconsin spring. Each day brings a few new steps in the process of becoming spring with a warmer, sunny day or a few tulips beginning to peek out of the earth.

Much like the transformation taking place outside our windows, WCHQ is beginning to take steps toward its transformation also. Over the next few months we will be engaging in a series of conversations with the Board, the Assembly, our members and stakeholders around broadening our focus and putting quality improvement and practice transformation into a bigger context.

Many questions will need to be answered during the course of these conversations, and a number of pieces of our work will have to be integrated so we are able to best support our members on their quality improvement and, specifically, their practice transformation journeys. A first step will be to operationally define practice transformation within the context of the Collaborative's work. We look to the definition and description from the work of the Centers for Medicare & Medicaid Innovation (CMMI or Innovation Center) as a starting point.

"Practice transformation is a process that results in observable and measurable changes to practice behavior. These behaviors include core competencies: engaged leadership and quality improvement; empanelment and improved patient health outcomes; business and financial acumen; continuous and team-based healing relationships that incorporate culture, values and beliefs; organized, evidence-based care; patient-centered interactions; enhanced access; progression toward population- based care management; state of the art, results-linked care; intentional approach of practices to maximize the systematic engagement of patients and families; and systematic efforts to reduce unnecessary diagnostic testing and procedures with little or no benefit."

This definition is an ideal for practice transformation and may seem overwhelming at first read, but it boils down to transformed practices being characterized by the delivery of high quality care, population-based care, cost-savings, and improved workflow. It also helps to keep in mind that such change does not happen overnight. It is a process, much like that of the Wisconsin winter into spring, or WCHQ's transformation to a broader quality improvement context. It takes a series of steps or phases over time to make such dramatic changes. Under its Transforming Clinical Practices Initiative, CMMI has prescribed five steps or phases to be undertaken to achieve practice transformation.

Phase 1 includes setting aims and developing basic capabilities, such as having the full support of leadership for developing and committing to a clear statement of the goals of transformation; learning and integrating a planned care model; using data to better understand practice flow, performing measurement to identify improvement opportunities, and testing rapid cycle changes. In the second phase practices would report and use data to generate improvements not only for care measures but to understand and improve on quality, financial, and utilization goals to enhance patient experience, eliminate waste, and decrease costs. In Phase 3 the practice will achieve aims of lower costs, better care, and better health through the optimization of its care team as well as technology. At Phase 4 the practice will be reaching benchmark status across its goals and finally in Phase 5 the practice will demonstrate the capability to generate better care and better health at lower cost through sustainment of improvements in key metrics and use of alternative payment models.

These phases of practice transformation will take time and commitment on behalf of clinicians and their practices, but we believe the Collaborative can be an indispensable partner to our members on their transformation journeys. WCHQ's strength has been measurement and data from its inception, and it will continue to be as we move toward a broader quality improvement context. Practice changes must be grounded in and driven by data, positioning the Collaborative to create a practice transformation model that will tightly tie together measurement and quality improvement and also align with and support other ongoing initiatives in which WCHQ is engaged.

We look forward to having you join the conversations in the next few months about how we put improvement into a broader context for WCHQ and how we can develop a model to support and guide your practice transformation. I will leave you with a few questions to help start those conversations: As your indispensable partner, what is WCHQ's role for you in the broader quality improvement context and in practice transformation? What does a transformed clinical practice look and act like? What form should practice transformation take for your practice? What support from the Collaborative would be most valuable in your practice transformation process?

Enjoy the transformation to spring! I look forward to our upcoming conversations.