WCHQ Expertise as Convener
It’s the time of year to reflect and express gratitude. In that spirit, I’d like to recognize you, our members, for the compassionate, safe care your teams provide every day to your patients and for the work you do beyond your campus to improve community health. It is a privilege to be a partner, a resource and a service to Wisconsin’s health care community.
This past year the WCHQ staff met with nearly every one of our members in their executive offices. Each meeting was unique, ranging from discussions about WCHQ’s improvement collaboratives, in-depth conversations about how our data assets are being deployed in members’ organizations, and gaining member input on the Value Acceleration Initiative (VAI).
Since WCHQ’s inception, we have operated by the precept that you cannot manage what you cannot measure, and what is measured gets improved. That is why Wisconsin has been a health quality leader for more than decade. When members send data to WCHQ and report their results on WCHQ measures, it sets a statewide performance benchmark. That is one tool that serves to inform and accelerate internal quality. On a larger scale, when the WCHQ data is aggregated, it provides a look at how patients statewide are experiencing care.
The VAI, which was approved by the Board earlier this year, leverages WCHQ’s expertise in quality improvement and measurement and reporting to serve as a convener to bring a statewide focus on improving the care and affordability for patients with co-morbidities. Progress has been in made in 2019. (See article in this issue.) The VAI steering team has collected field-proven best practices that have resulted in better, more affordable care to patients with chronic conditions in their organizations. That information, as well as other resources, will be shared with the all members in a report in early 2020.
It is imperative that we collaborate to improve the value and affordability of health care. It’s not new work to WCHQ or to our members. The difference is the VAI brings all stakeholders to the table—providers, purchasers, payers and consumers—to improve value through clinical quality improvement, practice redesign, benefit plan design and patient engagement.
The work ahead will be challenging, but the reward will be to create a healthier Wisconsin
Behavioral Health Steering Team
The Behavioral Health Steering Team met in person in October at Marshfield Clinic Health System. Members continued to work on a new depression screening toolkit aimed at increasing the depression screening rate. The toolkit is set to be released in Spring 2020. If you’re interested in joining the steering team, please contact Sarah Wright.
Adolescent and Child Health Steering Team
The Adolescent and Child Health Steering Team provided input on the agenda for the November 13 Assembly: “Growing Up Healthy.” (See article in this issue.) The presentations are available in WCHQ's Online Community under Education, Assembly Meeting Materials (log in to view). The team is currently seeking new members, contact Abbey Harburn for more information.
Practice Transformation Network (PTN)
The Practice Transformation Network (PTN) grant, a Transforming Clinical Practice Initiative through the CMS, ends this December. WCHQ would like to thank each practice for their commitment to the project over the years and recognize them for their quality improvement achievements. Our appreciation to Associated Physicians, Cumberland Health Center, Divine Savior, Monroe Clinic, OakLeaf Clinics, Reedsburg Area Medical Center, and Southwest Health for participating in the PTN.
ForwardDental became the first oral health organization in the state to join WCHQ in 2018 and publicly report quality measures on WCHQ.org. ForwardDental reported their progress on their processes related to new patients: Caries risk assessment and fluoride treatment. On both reported metrics, ForwardDental’s rate of delivering the recommended care was near or slightly over 90 percent.
“Employers, insurers and health care professionals know good oral health care delivered on a regular schedule can prevent many downstream health care issues,” according to WCHQ President/CEO Chris Queram. “They will appreciate having access to data related to the quality of oral care being delivered to their employees, subscribers and patients.”
Queram said one of the goals of the Oral Health Collaborative is to integrate oral health into primary care to expand access to recommended treatments and promote better health overall.
Jesley Ruff, DDS, MPH, with ForwardDental/American Dental Partners, said their partnership with WCHQ and ability to engage and collaborate with other WCHQ members on quality improvement and measurement has been beneficial and rewarding. Ruff is a WCHQ Board member and chairs the WCHQ Quality Planning Committee.
“Poor oral health is tied to chronic and acute diseases,” according to Dr. Ruff. “Collaborating with an organization that has expertise in improving quality will help bring medical and oral health professionals together for the common good of the community of patients we are all privileged to serve. We are excited to be part of this important initiative.”
WCHQ will continue to align oral health measures to specific care processes and procedures common to dental offices to benchmark performance. The WCHQ Oral Health Collaborative members include: Marshfield Clinic Health System; HealthPartners, MN; Dental Associates; Children’s Wisconsin; and ForwardDental.
WCHQ has an established and successful process for identifying and improving clinical health care quality. The path to higher value and more affordable health care is not as well defined, but that is the space where innovation and creativity happens.
The Value Acceleration Initiative (VAI) is aimed at delivering better patient care at lower cost. This year, the Board-appointed Value Acceleration Advisory Group selected patients with multiple morbidities with a focus on diabetes, hypertension and depression.
The WCHQ Value Acceleration Steering Team, charged with developing the implementation plan for the VAI, has been reviewing strategies and interventions for inclusion in a final recommendation report that will be presented to the WCHQ Board of Directors for approval in early 2020. The strategies, submitted by WCHQ members, focus on tangible actions payers, providers and patients can implement that will increase health care value.
After the Board reviews the report and makes its final determinations on the recommendations, WCHQ staff will develop a regional implementation plan that reflects the heterogeneity of the payer marketplace in Wisconsin and leverages the role of employers and providers.
To say the presentations at the November Assembly were good is an understatement—they were outstanding! Every speaker touched on an important aspect of child and adolescent health, from vaping to creating adolescent-friendly environments. Here is a brief summary of each presentation. The presentations are available in WCHQ's Online Community under Education, Assembly Meeting Materials (log in to view).
Megan Piper, PhD, is a researcher at the Center for Tobacco Research and Intervention
- 14% of adult Americans smoke
- Smoking is responsible for about $300 billion in medical care and lost productivity
- It accounts for 10% of annual health care costs
- It takes nicotine seven seconds to reach the brain
- By 2017, researchers identified more than 15,500 unique e-cigarette flavors available online
- 66% of teens think they are just vaping flavor when they use e-cigarettes
Dr. Piper said she is concerned that potential cases of electronic-cigarette/vaping associated lung injury (EVALI) could be missed because it mimics influenza symptoms.
Jon Temte, MD, PhD, associate dean for public health and community engagement at the UW School of Medicine and Public Health showed WCHQ members how to “Find Flu in the Electronic Health Record.”
- Acute respiratory infections are common in the primary care practice and comprise 7% of all visits
- Influenza hides in the constellation of Acute Respiratory Infections
- There is not a clear definition of influenza outbreak, however outbreaks can be reliably detected by EMR data
Amy Olejniczak, MS, MPH, associate director, Wisconsin Alliance for Women’s Health described the Providers and Teens Communicating for Health Program (PATCH). Here are teen’s responses when asked: What are the most important things you wish all health care professionals would do to make you feel more comfortable during a visit?
- Build a relationship with us
- Explain confidentiality
- Don’t make judgements/assumptions about me
- Communicate clearly in language I can understand
- Show me respect
Health care professionals can learn more about PATCH for providers workshops at www.wipatch.org.
Penny Funk, RN, MSN, pediatric quality nurse specialist for the Institute for Quality Innovation and Patient Safety at Marshfield Clinic Health System explained MCHS’s Journey to Become a Certified Adolescent-Centered Environment. A few of the certification requirements are:
- Extended hours for adolescents including some evenings and weekends
- Multiple visual cues throughout the waiting area or exam room that indicate adolescents are a welcomed and valued population
- Staff and providers received training on confidentiality for minor patients
- Adolescent confidentiality and minor consent rights are displayed in the waiting and/or exam rooms or provided to patient
- Offers on-site integrated behavioral health services
Michelle Kelly, MD, pediatric hospitalist and faculty, UW School of Medicine and Public Health shared the results of a pediatric bedside project at American Family Children’s Hospital. Tablets were given to pediatric patients and their families that could be used to communicate with the care team, receive test results, order food and play a selected number of games. While staff was concerned the tablets would impede communication with the families and patient, nearly all those who used the tablets, staff included, reported it was a positive experience.