The Coming Evolution of Practice Transformation
When CMS launched its “Transforming Clinical Practice Initiative” (TCPI) several years ago, the term “practice transformation” soon joined such seminal phrases as “performance measurement,” “benchmarking” and “quality improvement” as a standard part of the health care lexicon. In fact, as CMS operationally defined the term, it integrated these well-established activities into the following stepwise progression toward a “transformed” practice:
- Initiate data collection to…
- ...Generate measures of quality that...
- ...Enable benchmarking of performance to...
- ...Identify opportunities for improvement that...
- ...Allow the practice to thrive under new models of payment for outcomes.
Through our relationship with the Iowa Healthcare Collaborative and its Compass Practice Transformation Network, WCHQ has had the privilege of working with over 300 clinicians and professionals in their journey through each step of this model. Our team of highly motivated and skilled quality professionals – Gabrielle Rude, PhD, Jill Lindwall, MSN, RN, Cara Winsand, and our newest staff member, Sarah Wright, MPH, RN (see article below) – have formed a deep and durable partnership yielding improvements that have directly benefited patients and families while earning recognition by CMS.
As we celebrate these successes, it is important to build on this foundation by expanding the focus of transformation to include defining and understanding the cost of care. Indeed, while we can all reflexively recite the definition of “value” as being the ideal combination of quality, cost and appropriateness, we lack a standard definition that can be used by all stakeholders to systematically take steps to help make care more affordable.
That reality lies at the heart of WCHQ’s “value acceleration” initiative that I previewed last month. Look for more details of this important work in the coming months.
– Chris Queram
February In-Person Assembly Derailed by Weather – but Webinar Continued
For the first time in more than a decade, WCHQ’s regularly scheduled Assembly was disrupted by a winter storm. This time, however, members were able to join by webinar February 12 to hear Dr. Lisa Simpson and Dr. Tom Evans explain how federal policies, innovation and data are transforming the health care delivery system. The recording of their presentation is here.
- Drug Prices
- Health care costs
- Innovation in health care in the private sector and state government
- Social determinants of health (SDOH)
Focusing on social determinants, Simpson said they are the biggest factors influencing population health. Disparities are embedded within SDOH.
“Income, in fact, is a greater determinant than ethnicity in the quality of health care a patient receives,” she said.
The three SDOH’s that are most commonly being addressed are housing, food insecurity and adverse childhood experiences (ACES). While ensuring a person has stable housing and food has been shown to decrease their health care costs, ACES are much more difficult to address and are associated with lifetime higher health care costs.
Data is critically important to transforming the health care delivery system and Simpson recognized WCHQ and its members for collecting, submitting and sharing data.
“Data is the life blood of research and innovation,” according to Simpson.
Dr. Tom Evans, president/CEO, Iowa Healthcare Collaborative (IHC), presented after Dr. Simpson and he also emphasized the importance of data.
“Your medical practices need data, it’s the currency for improvement,” Evans said.
WCHQ is a partner with IHC in the Practice Transformation Network. WCHQ works with more than 300 practitioners in Wisconsin and offers resources and technical assistance to help them be successful in the pay-for-value environment. (See President’s column, above, for more information)
Evans said while CMS and others are tying quality improvement to incentive payments, over time it has been shown that while incentives improve quality, they have not been shown to improve outcomes.
Bottom line – health care transformation is being driven by economics, according to Evans. The growth in the Medicare budget continues, and that is crowding out funding for other national priorities. And while the focus of quality improvement work has been on hospitals, and now clinics, it will move to nursing homes and then to community-based coalitions. The goal is to pay for value, have better care and healthier people.
SAVE THE DATE: WCHQ Assembly, April 16, Monona Terrace, Madison
Sarah Wright, MPH, RN, joined the WCHQ team February 4 as a quality improvement specialist. In her new position, Wright will work with the Behavioral Health Steering Team and assist WCHQ members within the Practice Transformation Network to implement quality improvement initiatives.
In her previous position, Wright was with Wisconsin Primary Health Care Association (WPHCA) where she led the Quality and Behavioral Health Peer Learning Networks, assisted WPHCA members with Patient-Centered Medical Home recognition, and worked with primary care teams on chronic conditions quality improvement initiatives. Prior to her role at WPHCA, Wright worked as a Registered Nurse in various department settings, including Medical/Surgical and Long-Term Acute Care.
“We are excited to have Sarah join our team. Her experience with leading peer learning networks, her knowledge of behavioral health and chronic conditions and her education are assets to WCHQ, but more importantly, these skills are of great value to our members,” according to Gabrielle Rude, PhD, WCHQ director of practice transformation.
Wright holds a Master’s in Public Health with a concentration in Community Health Sciences from University of Illinois at Chicago and a Bachelor of Science degree in Nursing from Northern Illinois University.
Greg Blommel, MD, has accepted a part-time position as WCHQ’s Medical Director. Dr. Blommel brings extensive knowledge to this role by virtue of the many leadership roles he has played in support of WCHQ, including Chair of the Measurement Advisory Committee and Vice Chair and Chair of the Board of Directors. In addition to his new position, Dr. Blommel maintains an active clinical practice with Froedtert and the Medical College of Wisconsin Physicians.
Dr. Blommel is the Medical Director of Quality and Outcomes for Froedtert & the Medical College of Wisconsin (F&MCW) Community Physicians. He leads F&MCW’s WCHQ Choosing Wisely initiatives to reduce overutilization. Dr. Blommel served as Chair of the WCHQ Board of Directors prior to accepting the position as medical director.
Dr. Blommel has served as chief Medical Officer (CMO) for Froedtert Health Medical Group and previously for West Bend Clinic. He has been involved with clinical quality and measurement for much of his leadership career including designing incentive programs involving payer and provider organizations.
Dr. Blommel received his medical degree from the Medical College of Wisconsin and is board certified in Internal Medicine.
Over the past 15 years, WCHQ members have committed to improving quality through education, application and collaboration. Wisconsin has demonstrated incredible improvement on clinical quality; however, there remain significant opportunities to improve the affordability of health care. In January, the WCHQ Board approved a “value acceleration” strategy to help members and partners address both quality and affordability of healthcare.
This new initiative was developed with a commitment to partner with the Wisconsin Health Information Organization (WHIO) to develop an integrated clinical and claims database. This integrated database will be utilized to identify value improvement priorities under the oversight of an Advisory Group that includes:
- Imran Andrabi, MD, ThedaCare, Board Member (CHAIR)
- Tim Bartholow, WEA Insurance Corporation, Measurement Advisory Committee Chair
- Bill Cannon, MD, Fort Healthcare, Board Member
- Cheryl DeMars, The Alliance, Board Member
- Chris Elfner, Bellin, Board Member
- Michelle Graham, MD, United Health Care, Board Member
- Kori Krueger, MD, Marshfield Clinic, Quality Planning Committee Chair
- Andrew Resnick, MD, Froedtert and the Medical College of Wisconsin, Board Member
- Dave Rushlow, MD, Mayo Clinic Health System, Board of Directors Chair
- Michelle Schreiber, MD, CMS Center for Clinical Standards and Quality
The Advisory Group will recommend one priority for approval by the WCHQ Board later this Spring with the expectation that all members will commit to actions that accelerate value in the chosen area. If all WCHQ members commit to working on the priority selected, WCHQ will be successful in helping to accelerate our progress as a state to address the affordability of health care.
As the value acceleration strategy is deployed, WCHQ will continue to work on the improvement projects already in place, including hypertension, diabetes, the integration of behavioral health into primary care, adolescent and child health and practice transformation. Over the coming months, WCHQ will begin to align these projects with the value acceleration initiative.
Making health care more affordable is imperative as we continue to use quality improvement, transparency and collaboration as the foundation for creating a better health care system for our citizens. Watch for more information on value acceleration project over the coming months.
Kori Krueger, MD, announced at the last WCHQ Board meeting that Jesley Ruff, DDS, MPH will serve as vice chair of the WCHQ Quality Planning Committee (QPC). Dr. Krueger currently chairs the QPC. Dr. Ruff is with ForwardDental and is a senior vice president, chief professional officer, at American Dental Partners, Inc. ForwardDental was the first organization to join WCHQ’s Dental Collaborative and Dr. Ruff serves as an advisor to staff on dental-related issues.
The Centers for Medicare and Medicaid Services (CMS) recognized Bellin Health as the top performer in 2017 based on the second year of its performance in the Next Generation Accountable Care Organization model.
Through the program, providers oversee the health of a Medicare population during a year. They are expected to hit quality marks and keep health care spending below a certain threshold. If they save enough money, they receive some back.
Three participating Wisconsin health systems – Bellin Health, ProHealth Care and ThedaCare – earned shared savings through the program.
Bellin not only earned money back, they received a quality score of 98.4 percent, the top score among providers who completed their second year of the program.
Experts tracking ACO performance said based on the positive 2017 results, it’s possible CMS will consider moving the Next Generation model from a Center for Medicare and Medicaid Innovation demonstration to the mainstream Medicare program and invite more provider organizations to sign up.