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Wisconsin Collaborative for Healthcare Quality

November 2020 Newsletter


Message from Chris Queram

President Chris Queram
Chris Queram

As announced earlier this year, I have been planning to step aside as President/CEO of WCHQ at the end of 2020. As our strategic, financial, and governance plans for 2021 come increasingly into focus, the time is right to proceed with the transition.  Accordingly, I am delighted to report that the Board unanimously agreed to move up the date that Gabrielle Rude, PhD, would advance into the President/CEO position to November 7, 2020.  

Gabrielle is a knowledgeable leader who fundamentally embraces WCHQ’s mission. She understands the requirements of leading a membership organization through her years of participation in WCHQ’s work within a member organization and the relationships she has built with our members since joining the organization four years ago. Gabrielle understands the intersection of data and improvement, which will uniquely enable her to optimize the synergies between our performance measurement and practice transformation initiatives.

As I turn toward the future, I do so with a profound sense of gratitude for the opportunity to serve as WCHQ’s President/CEO for the past 15 years. However, I know nothing can be accomplished in a silo. The entire WCHQ team is focused on common goals and a commitment to provide our members with a compelling value proposition coupled with respectful and responsive service and support. Together, we have advanced the science of measurement while demonstrating the power of collaboration in achieving lofty goals that truly make a difference in the lives of the people we collectively serve. I offer sincere thanks to our members and partners for your contributions to our success. I look forward to watching WCHQ scale new heights in the years ahead. 

President's Column

Gabrielle Rude, PhD
WCHQ President/CEO

Looking Ahead to 2021

The times we are facing are nearly unimaginable. As the pandemic ravages our state, our health care and dental professionals are pushed beyond their physical and mental limits to provide patient care. These are untenable conditions where resources are being strained beyond the breaking point. I, along with the entire team at WCHQ, admire the personal courage of our health care workers who are putting the interests of their patients before their own.

At WCHQ we are focused on supporting those on the frontlines while also looking ahead to the future to ensure patients receive the care they need. We are facilitating COVID-19 related dialogues in our medical and dental improvement teams. Nearly all member education in 2020 was focused on the pandemic.

In 2021, one of our top priorities will be focusing on immunizations rates; our members are concerned about the drop in these life-saving immunizations. Obviously, the most pressing immunization is for COVID-19. Wisconsin’s Department of Health Services has a comprehensive COVID-19 Vaccination Plan that was submitted to CDC in early November. If you do not have time to read the entire plan, I highly recommend Section 3: Phased Approach to COVID-19, which addresses three scenarios: limited doses, large doses available, and sufficient supply with a slowing demand. The plan notes that health care workers will “likely be in Phase 1A, health care entities themselves will be key vaccinators for individuals in their organization who fit this category."

Looking ahead, WCHQ will continue to focus on getting patients the care they need by facilitating sharing of best practices for virtual care, creative approaches to preventative screenings, and in general, ensuring that healthcare remains a safe place for patients to get care. To make this possible, right now we support WHA’s call for action November 18 asking state officials to take “quick, decisive actions aimed at slowing the spread of COVID-19.” We further endorse the sentiments shared by so many of our member health systems, as stated in the Open Letter from UW Health, “we can rally together” to ensure we are able to provide the “life saving care you need, whether for COVID-19, cancer, [or] heart disease.”

Over the next few months, we hope that Wisconsin residents will heed the warnings of our health care organizations to stay safe and stay home. Our lives and the lives of those we love, depend on it.

- Gabrielle Rude, PhD 

WCHQ Report Identifies Health Disparities in Rural, Urban Locations

More than 200 WCHQ members participated virtually in a November 12 webinar for the release of WCHQ’s 2020 Wisconsin Health Disparities Report: Rural and Urban Populations . The report identifies where disparities in health outcomes and care exist in rural and urban areas in Wisconsin. The report uses a unique categorization system developed by investigators at the University of Wisconsin Health Innovation Program (HIP) and provides important data to inform and accelerate the work statewide aimed at eliminating health disparities.

The report shows where gaps in health outcomes and care exist in Wisconsin by urban or rural location. The data were submitted to WCHQ by 25 health systems and medical clinics and it represents the most complete and recent (2018) data available for this work.

“With this second report, WCHQ is providing the information that is necessary to create, implement and measure the results of interventions and programs aimed at reducing health disparities,” according to report co-author Matt Gigot, WCHQ director of performance measurement and analysis. “This information makes it possible to benchmark current performance and measure progress over time. Reliable data that are collected in a standardized and consistent way are essential when the goal is improving performance.”

The report found that some people in Wisconsin are experiencing a wide range of substantial disparities across several measures. Substantial was defined as 10 percent lower than the population group with the highest rate on the measure.

The results show:

  • People living in rural underserved areas are experiencing substantial disparities in colorectal cancer screening and are much less likely to be tobacco-free if they have heart disease;
  • Rural areas classified as advantaged have a much lower HPV vaccination rate;
  • There were substantial disparities in the urban underserved population in two areas: childhood vaccinations and optimal control of heart disease, which includes blood pressure control, use of statin and daily aspirin, and no tobacco use; and,
  • Those who are categorized as urban advantaged were screened for depression significantly less often than the highest performing group.

“Disparities in health outcomes and health care exist across and within rural and urban areas. In the 2019 Wisconsin Health Disparities Report, we found that simply defining an area as rural or urban was masking disparities in health outcomes and care. We needed to account for the unique characteristics that influence health across and within rural and urban areas,” according to HIP investigator, Jennifer Weiss, MD, MS, a UW-Health tenured associate professor in the division of gastroenterology and hepatology at the University of Wisconsin School of Medicine and Public Health.

In the new report, the UW-Madison Health Innovation Program (HIP) presented six new and distinct rural and urban groupings: rural underserved, rural, rural advantaged, urban underserved, urban, and urban advantaged. These six groups were identified by examining health-related characteristics (i.e. health care capacity, economic status, and health status) of every ZIP code in Wisconsin. The results show that across and within rural and urban areas, there are significant variations in these health-related resources. Health care providers can use these geographical groupings to identify ways to better treat patients based on the characteristics of where patients live.

In the past, rural and urban definitions have been limited to broad descriptions that did not capture the difference between, for example, rural areas with few resources related to health and rural areas that are more affluent. That lack of specificity has hampered the creation or application of explicit policies and programs that address a specific area of the state.
“People experience health care in different ways, which are influenced by multiple factors. We know where people live is one of the biggest determinants of their health,” according to Weiss. “To close those gaps and improve care for everyone will require a community-wide response from multiple stakeholders who can address issues such as poverty, housing, food insecurity and many other factors that have an impact on overall health.”

Funding for the WCHQ Health Disparities Report was provided by the Wisconsin Partnership Program at the UW School of Medicine and Public Health (SMPH), which is committed to improving the health of Wisconsin residents and reducing health disparities through research, education and community partnerships.

“This project represents an important strategic investment for the Wisconsin Partnership Program,” said Richard Moss, PhD, SMPH senior associate dean. “It aligns directly with our goal to advance health equity and improve health in Wisconsin. By identifying the unique ways individuals experience health disparities in both urban and rural settings, this data will guide health systems and others in developing approaches to addressing these gaps.”

While the data can be used to calculate a statewide average, WCHQ President/CEO Gabrielle Rude, PhD, said the goal is not to achieve a benchmark.

“The goal is not to be average. The goal is to eliminate disparities in our state, and the best way to do that is to start with reliable data that can be used to develop quality improvement initiatives, and then to monitor progress and see what works,” according to Dr. Rude. “The health systems are committed to raising the health status of every person living in Wisconsin, which requires a broad coalition of community stakeholders working together toward the same goal. We know it must and can be done.”

WCHQ has been collecting data from their members, sharing results and publicly reporting progress on specific measures of health quality for more than 15 years. Dr. Rude said Wisconsin health care organizations have consistently shown that what is measured, can be improved.

“Health equity is a community strength and an economic development asset. We all want to live and work in an area where there are equal opportunities to be healthy,” Dr. Rude said. “This report and the work that it will support statewide will help us get a step closer to that goal.”

Two nationally recognized experts on disparities were featured at the Assembly. Leonard Egede, MD, MS is general internist, tenured Professor of Medicine, and Chief of the Division of General Internal Medicine at the Medical College of Wisconsin (MCW). He is also the Director of the MCW Center for Advancing Population Science (CAPS), and the Associate Director of Cancer Disparities at the MCW Cancer Center.

As a nationally recognized health disparities researcher, Dr. Egede has focused on developing and testing innovative interventions to reduce and/or eliminate health disparities related to race/ethnicity, socioeconomic status, and geographic location for chronic medical and mental health conditions. His career started with diabetes as a template disease, but he has since worked with other physical and mental illnesses.

Malia Jones, PhD, MPH is a social epidemiologist with expertise in rural and urban social factors related to infectious disease, demography and geospatial research methods. She is an associate scientist in health geography at the UW-Madison Applied Population Laboratory, where she directs the Healthy Geography program. Her research is funded by grant support from NIAID and focuses on the social and spatial determinants of health at the population level.
Dr. Jones is especially interested in the social forces that influence infectious disease outbreaks and disease transmission, and how those forces are located in geographic space.

Matt Gigot, WCHQ director of performance measurement and analysis and Jennifer Weiss, MD, MS, a faculty member of the Division of Gastroenterology and Hepatology within the Department of Medicine, presented the report. Following them, Jessica Bonham-Werling, MBA, director of the Neighborhood Health Partnerships Program and the associate director of research operations at the Health Innovation Program within the University of Wisconsin, shared new reports that are available to WCHQ members that are useful in managing population health.

Krueger to Lead WCHQ Board in 2021

Kori Krueger, MD

Kori Krueger, MD, medical director for the Institute of Quality, Innovation and Patient Safety at Marshfield Clinic Health System, will chair the WCHQ Board of Directors in 2021. Dr. Krueger practices internal medicine and pediatrics and serves as the medical director for the Institute for Quality, Innovation and Patient Safety at Marshfield Clinic Health System. He has served on the WCHQ Board for seven years and chaired the Quality Planning Committee from 2017 to 2018.

Joining the WCHQ Board for his first term and serving as Vice Chair is ThedaCare President/CEO Imran Andrabi, MD. Dr. Andrabi has chaired WCHQ’s Value Acceleration Advisory Group since 2019, which is focused on improving care for patients with multiple morbidities.

Dirk Steinert, MD, is medical director for quality at Ascension-Wisconsin. Dr. Steinert has served on the Board since 2014, and is a member of the Executive, Finance and Measurement Advisory Committees. As Board treasurer, Dr. Steinert will chair the WCHQ Finance Committee in 2021.

Rushlow Recognized for WCHQ Board Service
Stepping in a year early as WCHQ Board chair, David Rushow, MD, chair, of family Medicaid for Mayo Clinic practice in the Midwest, was recognized for his service at the November 12 WCHQ Board Meeting. Rushlow led WCHQ through the search process for a new President/CEO and helped ensure a smooth leadership transition. He also provided guidance for the decisions that staff and the Board made as WCHQ modernized its data collection platform, paving the way for a new system that will better meet members’ future needs for actionable, reliable data.

“It was an honor to work with Wisconsin medical and dental leaders who are committed to improving not only how health care is delivered, but also dedicated to helping people in our communities live healthier lives,” Dr. Rushlow said. “We are all focused on acute care at this moment, but as the pandemic abates, we will turn our attention to preventive care, including screenings, immunizations and managing chronic conditions. WCHQ will have an important role to play as we return to a new normal by providing the data required to monitor our progress in meeting our improvement goals.”

Rushlow recognized the following WCHQ Board members who will be completing their terms at the end of 2020:

  • Betsy Clough, vice president/chief human resources officer, UW Health
  • Michelle Graham, MD, United Healthcare, representing the Alliance for Health Insurers (AHI)
  • Jerry Ward, retired, Seats, Unlimited
  • Ruth Yarbrough, vice president, MercyHealth System

Julie Mitchell, MD, senior medical director at Anthem Blue Cross Blue Shield, will represent AHI in 2021.

WCHQ Board Selects 2021 Improvement Priorities 

The WCHQ Board announced the selection of the 2021 improvement priorities. The 2021 priorities are: behavioral health, colorectal cancer screening, chronic disease management, and adolescent and child health. In addition, WCHQ will also direct resources to increasing immunization rates as members are concerned about the dramatic decline in the administration of life-saving vaccines. WCHQ currently publicly reports four immunization measures; including, childhood and adolescent immunization status, human papillomavirus vaccine (HPV) and adults with pneumococcal vaccination.

These priorities represent the clinical improvement topics of highest importance to WCHQ members and will be supported by WCHQ staff, broadly promoted to the membership and they will be regularly monitored by the Board. The priorities were vetted by the WCHQ Quality Planning Committee (QPC), which is a member-led Board subcommittee chaired by Jesley Ruff, DDS, MPH, ForwardDental.

Throughout 2020, the QPC was committed to improving health care value and to incorporating concepts such as affordability, appropriateness and utilization in all improvement initiatives. In recognition of this transition, the QPC has changed its name to the Improvement Advisory Committee (IAC), allowing it to focus broadly on improvement of both quality and health care value.

The Board further tasked the Committee with supporting improvement work related to oral health and health disparities. These broad strategies for improvement cross many clinical priorities. Regular reports on the improvement areas will be brought to the IAC for discussion as WCHQ continues to work with members to improve these areas.
If you are interested in joining the Improvement Advisory Committee, contact Cara Winsand.

Member Access to WCHQ Measure Results Coming Soon

WCHQ members will soon be able to begin accessing WCHQ measure results in the Data Voyager platform. Starting the week of November 30, members who have successfully uploaded data to the Data Voyager platform will be able to review results for both the Spring 2020 and Fall 2020 reporting periods, which will allow members to begin reviewing and validating results generated in the new platform.

WCHQ staff will reach out directly to individual members to let them know when their data is available and to grant them login credentials to the User Acceptance Testing (UAT) environment. At that time, WCHQ staff will also schedule a time to set up a demo of the UAT and walk members through the reports produced by the new platform. WCHQ members are encouraged to review their results in the Data Voyager platform and then provide WCHQ staff with feedback on both the user interface and the measure results.

If you have questions related to Data Voyager and the use of the new platform, contact Matt Gigot.

WCHQ Improvement Priorities

Adolescent and Child Health
In November, the Adolescent and Child Health Improvement Team was joined by Kristine Alaniz, MPH, Manager of maternal and child health programs at Wisconsin Women’s Health Foundation. Alaniz described the Well Badger Resource Center, operated by the Wisconsin Women’s Health Foundation in partnership with the Wisconsin Department of Health Services. The Well Badger Resource Center provides health information and referral services to individuals, families and health professionals in Wisconsin. Well Badger has three primary aims: to increase utilization of existing health programs, to improve health literacy and to advance health equity. They provide information and referral services from certified resource specialists via phone, text, email, Facebook, and live chat. These services can be used by individuals and families directly or health professionals on behalf of a patient or client. Well Badger also provides an online searchable directory for information on over 4,000 local services and programs. Visit www.wellbadger.org to learn more. For information on the Adolescent and Child Health Improvement team, contact Abbey Harburn.

Behavioral Health
The COVID-19 pandemic created a major shift in behavioral health services and affected how care is delivered to patients. Many WCHQ health systems continue to provide most behavioral health care services virtually. The WCHQ Behavioral Health Improvement Team members will continue to meet monthly in 2021 to share best practices for providing telehealth services to behavioral health patients.

The pandemic has accelerated the opioid crisis in Wisconsin and across the country. Behavioral Health Improvement Team members have expressed a desire to address this crisis and focus on the integration of behavioral health into primary care, access to care, depression and suicide prevention in 2021. The pandemic has increased suicides nationwide and a continued focus on decreasing the rate of suicide in Wisconsin is an important member priority.

If you are interested in joining the Behavioral Health Improvement Team, contact Jenifer Koberstein.

Chronic Disease
According to the American Diabetes Association, more than 34 million Americans are living with diabetes. Among those who have died from COVID-19, 40 percent were living with diabetes. This month in recognition of National Diabetes Awareness month, the Chronic Disease Learning Collaborative showcased two members’ diabetes care programs. Lois Kuehl, BSN, CDCES from ThedaCare and Kelly Charapata RN, CDCES from Bellin Health shared their health systems’ coordinated approaches to managing their patient populations who are living with diabetes.

Kuehl said ThedaCare has had an American Diabetes Association accredited program in place since 1999; however, they have seen enrollment decline in the program due to increased costs for participants who have less time to attend appointments. ThedaCare has become innovative in their approach to patient outreach by implementing outpatient physician dual visits three years ago. ThedaCare providers travel to a variety of clinics to meet patients where it is convenient for them. They focus on patients with high A1cs and meet with them to discuss barriers to treatment, provide education and adjust their medication regimens. Of the patients seen during these visits, 50 percent have improved A1c levels at their next appointment. Kuehl shared that they use their EHR to generate daily reports for inpatients who have an A1c greater than 8. Each week, time is blocked on diabetic educators’ calendars to work with these inpatients. Many of these patients have never attended diabetic education and the educators are able to use motivational interviewing to identify barriers and solutions to assist patients with lowering their A1c levels.

Similarly, Bellin Health has diabetic educators working in their system and they are present in 23 of their 29 primary care clinics with extended care teams in all 29 clinics. Bellin is well-known for their comprehensive approach to health care delivery transformation, known as team-based care. This model greatly expands the roles of CMAs, LPNs, RNs and other team members. Charapata said Bellin has a team of RNs and dieticians specifically trained in diabetes education who work directly with each patient’s primary care provider. This allows the patient to learn about the disease and how to best manage their condition. When someone has a visit with a diabetic educator or endocrinology, they can access a medication adjustment phone line. A person who visits a diabetic educator in person typically shows a 1.67 percent decrease in their A1c level, someone who calls the medication adjustment line sees an average decrease of 1.99 percent. Since the pandemic began, and patients are coming into the clinic less frequently, Bellin has seen an increase in calls to the medication adjustment call line, which now receives about 1500 calls per month.

If you are interested in joining the Chronic Disease Learning Collaborative, contact Jenifer Koberstein.

Oral Health
The Oral Health Measure Development Group met in November to review cross-cutting oral health and medical measures. The group chose to begin with measures of oral health for patients with diabetes and decided to measure oral health evaluations for adults with diabetes. The measurement group chose this measure because it is rooted in strong clinical evidence linking regular oral health care with improved diabetes outcomes and consists of data elements that all oral health members currently collect. This measure, developed by the Dental Quality Association, measures the percentage of adult patients with diabetes who received a comprehensive oral health evaluation. The group is in the initial stages of examining data collection strategies and reviewing additional cross-cutting measures for potential future reporting. This measurement work complements the core work of the Oral Health Collaborative and is funded by GSK . For more information or to get involved with oral health measurement, contact Jen Koberstein.