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Wisconsin Collaborative for Healthcare Quality

August 2020 Newsletter


President's Column

President Chris Queram
Chris Queram

WCHQ Strategic Planning Session Features Former CMS Administrator Mark McClellen

Even as the COVID-19 pandemic endures, it is becoming possible to see its implications for the health care eco-system in the United States and here in Wisconsin. While the toll being wrought is pervasive, there is an emerging consensus on the major forces we must focus on in the coming months:

  • Address systemic inequities in access to and continuity of care for racial and ethnic minorities who have been disproportionately harmed by COVID.
  • Improve the value of health care services, given the continuing challenge of restraining growth in costs while enhancing clinical quality and the overall patient experience of care.
  • Accelerate the adoption of new modes of care delivery, exemplified by the rapid deployment of telehealth as a means of ensuring access to care during the pandemic.
  • Increase the use of alternative payment models to replace the fee-for-service model and incentive investments in improving health.

In short, we cannot simply go back to the status quo ante for it has proven woefully inadequate in responding to the pandemic.

It is against this backdrop that the WCHQ Board of Directors will convene in September via Zoom for its annual strategic planning session. And, as if COVID is not sufficiently auspicious, 2021 is significant in another way as it marks a transition in leadership with Gabrielle Rude, PhD, assuming the role of President/CEO in January. Accordingly, we have designed the retreat to bring two perspectives together in framing presentations that will guide the Board’s subsequent explorations. To begin, the retreat is a worthy platform for Gabrielle to share with the full Board her vision for WCHQ. Once that context is set, we are honored to hear from Mark McClellan, MD, PhD, of the Margolis Center at Duke University, on the role that WCHQ can play in addressing these forces. Mark is an important thought and opinion leader on a broad range of health policy and healthcare reform topics by virtue of his prior roles as Commissioner of the Food and Drug Administration (FDA) and as Administrator of the Center for Medicare and Medicaid Services (CMS). (Note, we plan share his video presentation with members via Online Community).

Following Mark’s presentation, we will take full advantage of the Zoom platform to allow small groups to pursue in-depth discussion of three key strategic questions. These are:

  1. Given our plans to unveil the 360ValuCounts integrated clinical/claims database in 2021, what is out operational definition of “value”?
  2. Given that WCHQ has welcomed into its membership all of Wisconsin’s provider- owned health plans along with several commercial insurers, what role can we play in fostering collaboration between providers and payers in 2021?
  3. Finally, the retreat will conclude with a session designed to harvest perspectives from Board members on what they see as the primary motivation that drives engagement in WCHQ – namely, is it intrinsic (the desire to pursue a mission and common good that is larger than my institution’s purpose) or extrinsic (to need to derive concrete value though products and services that benefit my organization)?

As has been our custom, the retreat will play a critical role in establishing the strategic priorities and focus for WCHQ in 2021 and beyond. We look forward to sharing more in coming weeks.

- Chris Queram

WCHQ Education: On Demand and Upcoming Events

WCHQ has maintained a very ambitious online education schedule throughout the pandemic to ensure our members have the information they need to continue the high-quality care that Wisconsin is known to deliver.

Ideas for education are always welcome from our members and partners. Sharing best practices is always important to clinicians, but with COVID 19 and the challenges we face every day, collaboration among health care professionals takes on an added urgency.

Contact Tracing Webinar for Clinicians – Available On Demand

Once someone is diagnosed with COVID-19, it is essential that the individuals they have had contact with are identified in order to help prevent further spread of the virus. This is why the Wisconsin Department of Health Services (DHS) is working with local public health departments to build a network of contact tracers who are tasked with interviewing every person confirmed with COVID-19. As of April 21, 2020, the State of Wisconsin has trained nearly 400 contact tracers, with current staffing close to 200 tracers, to support local health departments in their work to identify potential COVID-19 exposures and help them follow appropriate isolation or quarantine guidance for reducing the further spread of the disease.

DHS Epidemiologist Christine Muganda, PhD recorded a webinar for WCHQ members that explains the contact tracing process and protocols the Department has in place for this activity. Download this webinar. To view the webinar, click the download icon at the top right.

WCHQ appreciates Dr. Muganda sharing her expertise in explaining the contact tracing process. For more information on contact tracing, check out this page on the DHS website.

State and National Considerations for Operating Schools During COVID-19 Webinar

On August 21, WCHQ hosted a webinar, “State and National Considerations for Operating Schools During COVID-19”, featuring the Wisconsin Department of Public Instruction’s Louise Wilson and UW Health physicians, Drs. Mala Mathur and Greg DeMuri. View the recording.

September 17 Webinar - 9-11:45 AM: WCHQ Adolescent and Child Health Assembly Featuring Dr. L.J. Tan

COVID-19 has impacted our health care delivery system, but one area that continues to concern all of us is the affect that COVID has had on our immunization rates. With a vaccine in development for COVID and influenza season coming soon, WCHQ invited Dr. L.J. Tan, an international expert on vaccines and immunization, to keynote the September 17 virtual Assembly on Child and Adolescent Health. His presentation, “The Critical Importance of Improving Immunization Rates During COVID-19,” will be of broad interest to our clinicians working in ambulatory and acute care settings.

In addition, Yolanda Wolff, MD, pediatric specialist at Children’s Wisconsin, will explain how her health system has been “Maintaining Well-Child Visits through Telehealth and Immunization Clinics.” Alexandria Cull Weatherer, MPH outreach specialist with the Wisconsin Cancer Collaborative, will discuss “The Importance of HPV Vaccination During COVID-19.”

REGISTRATION is free to WCHQ members, learn more in the FLYER.

September 29 WEBINAR - 12-1 PM: Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT)
in the Clinical Setting

On September 29 Laura Saunders, MSSW, Great Lakes Addiction Technology and Transfer Center, will discuss how early intervention for those at risk for substance use disorders can avoid more severe consequences later.

During these times of job losses, isolation and uncertainty, residents may be at higher risk for substance use disorders. SBIRT is a comprehensive, integrated public health approach to the delivery of early intervention and treatment services for persons with substance use disorders as well as those who are at risk of developing these disorders. Primary care providers are in a unique position of identifying and intervening substance use disorders:

  • The screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
  • Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
  • Referral to treatment providers those identified as needing more extensive treatment with access to specialty care.

REGISTRATION is free to WCHQ members, learn more in the FLYER.

If you have questions, contact Mary Kay Fahey

Flu Vaccine During a Pandemic

The influenza (flu) season is fast approaching and WCHQ members are exploring how they will manage both the flu and COVID-19 among their patients. In Wisconsin, a total of 17,210 flu cases were reported during the 2018-2019 flu season. Infectious disease experts expect that we may see fewer influenza cases this year due to best practices related to COVID-19, such as social distancing and wearing masks; however, influenza immunizations are the best strategy to control the virus.

The CDC recently released updates regarding the flu vaccine, including the 2020-2021 flu vaccine viral compositions, newly licensed vaccines for patients 65 and older, availability of egg-free vaccines, the effects of the flu during the pandemic, guidelines for talking to patients and planning for vaccination clinics. Access CDC’s informational presentation for an overview or visit the Morbidity and Mortality Weekly Report regarding the flu vaccine.

WCHQ has been collating and sharing best practices of influenza vaccination among members at various improvement meetings. Health systems will need to be more creative this year in how they implement clinics, WCHQ members are exploring various options, including leasing local business property, renting trailers, or sending out mobile units throughout the community.

Communication with patients is a critical strategy during any flu season and that is now complicated by the existence of a pandemic. WCHQ members are using educational pamphlets, patient portal messages, text messaging, and offering self-scheduling online. Registering health system vaccination services through Vaccine Finder is another effective method to increase vaccination rates. To help with such planning and communication, the CDC has issued a revised Guidance for Planning Vaccination Clinics Held at Satellite, Temporary, or Off-Site Locations.

August is National Immunization Awareness Month, and the CDC has updated additional immunization toolkits for reaching healthcare professions and patients and adult vaccination recommendations and resources for healthcare professionals. For more local state-level information, visit the Wisconsin Department of Health Services’ flu web page.

August 17 Webinar Focused on Asthma Management Tools and Implementation Strategies

According to the Wisconsin Asthma Plan, asthma is a chronic lung condition that affects 15 percent of adults and 10 percent of children in Wisconsin. The burden of asthma in Wisconsin is not equally shared. Certain minority groups, age groups and geographic regions are disproportionately affected. Too many people with asthma in Wisconsin struggle to thrive at work or school and are subject to reduced quality of life because their asthma remains poorly controlled. Taking a comprehensive approach to asthma management is one way your health care system can begin to make a difference with your patients with asthma.

Dr. Nicholas Antos from Children’s Wisconsin shared asthma management tools and implementation strategies with WCHQ members at an August 17 webinar, “Acting on the “ACT” Score: What an Asthma Control Test Can Do for You.” A screening tool, such as the Asthma Control Test (ACT), is a validated way to screen for and document asthma control. An asthma management plan is an important part of implementing an overall management strategy. WCHQ is working on developing a new asthma measure that will look at use of asthma assessments among patients with asthma. To join in WCHQ’s quality improvement work, contact us.

Dr. Antos shared an additional educational opportunity, School-Based Asthma Management Program (SAMPRO) usage. This webinar is approved for Part 4 MOC. This webinar can be accessed here.

The August 17 webinar is available to members in Online Community.

WCHQ Webinar Addressed How to Identify and Assist Patients Experiencing
Domestic Violence

Dr. Ogbeide

For some, the home is not a safe place. For those experiencing intimate partner violence (IPV), the home has become even more dangerous during the pandemic.

A WCHQ-sponsored webinar August 6, “Addressing Intimate Partner Violence During the COVID-19 Pandemic,” focused on the tools and strategies clinicians can use to address IPV in their practices. Stacy Ogbeide, Psyd, MS, is a Board-certified clinical health psychologist at UT Health San Antonio, where she serves as director of behavioral health education. During the pandemic, Dr. Ogbeide said rates of Intimate Partner Violence (IPV) have increased dramatically in some communities. She encouraged primary care practices to screen and provide follow-up care for patients who are experiencing IPV, and she shared several tools she uses in her practice.

The prevalence of IPV among women in primary care clinic panels, according to Dr. Ogbeide, is between 5.5-22 percent. However, the screening rate in primary care clinics is very low, at only 1.5-12 percent. Telehealth can be useful in improving the screening rate, but patient safety and the patient’s ability to access care safely must be a consideration. It is imperative to remember that those who are being abused are often being closely watched by their abuser.  “A person’s ability to participate on a telehealth call related to domestic violence from a clinic can be compromised if the person they fear has access to their phone or even their call history,” she cautioned.

Members can access Dr. Ogbeide’s webinar presentation, including her slides, in WCHQ's Online Community.

Representatives from End Domestic Abuse Wisconsin were also available during Dr. Ogbeide’s presentation to offer state-specific input. Resources were provided and can be found here or you can visit their website at endabuseWI.org.

Steering Team Updates

Adolescent and Child Health

WCHQ members have seen a dramatic increase in human papilloma virus (HPV) vaccinations rates, with nearly two thirds of eligible adolescents getting at least two doses (63%) compared to 48% in 2017. The Adolescent and Child Health Steering Team supports this work and has accelerated this improvement by sharing best practices among members.

The U.S. Department of Health and Human Services is prioritizing vaccines with a new campaign called “Catch-Up to Get Ahead.” They’ve created a toolkit for providers and health systems to utilize in efforts to increase the number of vaccines among their patients. The confluence of seasonal influenza and COVID-19 is prompting HHS to also push out messaging on the importance of getting a flu vaccination. Across the state, health systems and medical clinics are collaborating to ensure their communities are protected. For example, here is a news conference clip from the Madison health systems and public health department at a press conference August 24.

WCHQ will continue to facilitate conversations among our members to share best practices related to vaccinations for all ages and issues related to adolescent and child health. Contact Sarah (Wright) Sky to join this group.

Behavioral Health

Healthy People 2030 was released in August, which includes a new goal for depression to “increase the proportion of adults with major depressive episodes (MDEs) who receive treatment” to 69.5%. WCHQ’s members are already focusing on this topic and have seen a sizeable rate increase of screening by more than 37 percentage points in three years. As of 2019, WCHQ members have screened 77% of patients annually for depression and we expect further improvement in the future.

Depression screening is an essential first step in diagnosing and treating depression, and WCHQ’s next publicly reported behavioral health measures will focus on improving treatment outcomes such as depression remission and response. WCHQ’s Behavioral Health Quality Improvement Team meets monthly and focuses discussions on depression as well as the integration of behavioral health into primary care. Contact Sarah (Wright) Sky to join this team.

Oral Health

WCHQ is planning to publicly report three quality measures of oral health in September. These measures include an adult measure addressing periodontitis and two measures addressing children’s oral health. Consistent with WCHQ’s mission of publicly reporting to improve the quality and affordability of healthcare in Wisconsin, these measures will be among the first public measures of oral health quality at the dental practice level in the nation. The Oral Health Collaborative is also planning the development of a measure that crosses both the oral and medical health fields. Next month’s newsletter will feature an in-depth description of this novel project.

Oral Health Collaborative members continue to meet regularly to share best practices related to safely reopening practices during the COVID-19 pandemic. Currently, a major focus is providing support to the dental care team to ensure they remain safe while providing the best care possible to their patients.

For more information or to join the Oral Health Collaborative team meetings, contact Jen Koberstein.