This week, five WCHQ members became the first dental practices in the United States to publicly report oral health measures. WCHQ is extremely proud to have facilitated this important step for the dental community in our region. (See article in this issue.) Working together as an “oral health collaborative” within WCHQ, ForwardDental, Dental Associates, Marshfield Clinic Health System, Children’s Wisconsin and HealthPartners (MN) readily coalesced around a shared commitment to launch the country’s first set of publicly reported dental measures. These are (1) Caries Risk Assessment in Children, (2) Topical Fluoride Application, and (3) Ongoing Care in Adults with Periodontitis. The measures are reported at WCHQ.org in our performance reports.
While the Oral Health Collaborative wasn’t designed to respond to a crisis, it took on that purpose when COVID-19 hit, which rapidly changed the delivery of dental care. In an instant, PPE took the place of routine masking and schedules were adjusted to accommodate the new cleaning standards between patients to ensure the safety of patients and staff. The Oral Health Collaborative meetings became the forum where members could present issues, share their solutions and offer personal support.
Through conversations that began with the adoption of a starter set of measures, which then pivoted to forums to discuss COVID-19 protocols and office re-openings, the members of the WCHQ Oral Health Collaborative formed strong personal and professional bonds as they worked together to improve the delivery, safety and access to dental care for all residents, young and old, no matter where they live.
Much as with the public reporting of WCHQ’s inaugural measure of diabetes care in the fall of 2004, we view this as just the beginning; indeed, we expect to expand the number of dental health members and oral health measures in the months ahead. More strategically, we plan to systematically pursue opportunities to bring our dental and health system members together in pursuit of WHCQ’s vision of a population-focused, value-based model of oral and systemic health.
It is incredibly gratifying to see WCHQ and its members once again leading the way toward a bold, inspiring, and patient-centric vision. And this is just the beginning.
- Chris Queram
The development of WCHQ’s data platform, Data Voyager, continues to advance as members upload their data. As of October 26, approximately 80 percent of WCHQ’s members have uploaded their data for fall 2020 reporting. We expect the preview period to begin in December for members whose data is ready, with results added for the remaining members throughout the preview period. As a reminder, the Fall 2020 publication period has been moved to mid-January 2021.
Several members were granted access to the User Acceptance Testing (UAT) environment to evaluate early copies of their measures. Their feedback helped staff understand how members use their data and resulted in development fixes to many of the measures and improved accuracy. The UAT environment will be available to all members in November.
Coming soon! Members will be able to submit questions, issues and support requests for Data Voyager in an online helpdesk. Currently, WCHQ staff are inputting member tickets on their behalf and will be the first tier of Data Voyager support. Our vendor will assist us if the issue requires an engineer’s expertise.
If you have questions concerning the data transition or public reporting, contact Mary Gordon.
Cara Winsand will be stepping into the role of Director of Practice Transformation when Gabrielle Rude, PhD, officially becomes President/CEO later this year.
Winsand joined WCHQ in 2018 as the Quality Improvement Specialist and was promoted to Practice Transformation Program Manager in November 2019. She has worked with the Adolescent and Child Health, Chronic Disease and Value Acceleration teams.
“We are excited that Cara will be taking on these new responsibilities. Cara’s knowledge and experience will be a natural fit and asset for the Director of Practice Transformation,” said Dr. Rude.
Prior to joining WCHQ, Winsand was with UW Health in the Health Services Department where she analyzed performance on quality measures and developed quality improvement initiatives for health plan members and providers. Prior to working at UW Health, Winsand held two different positions at the UW School of Medicine and Public Health, Center for Tobacco Research and Intervention where she focused on tobacco cessation research and providing tobacco cessation training and technical assistance for providers in Southwest Wisconsin.
In her new position, Winsand will work with the Practice Transformation Team and assist WCHQ members on achieving improvement goals related to WCHQ members’ top priorities.
Winsand holds a Bachelor of Science degree in school and community health education from Winona State University in Minnesota.
Matt Gigot, director, performance measurement and analysis, will represent WCHQ on the Core Quality Measure Collaborative (CQMC) Steering Committee. The Core Quality Measure Collaborative (CQMC) is a broad-based coalition of health care organizations convened by America’s Health Insurance Plans (AHIP), whose mission is to promote better patient outcomes, align measures across different health care sectors and reduce measurement burden.
The U.S. health care system is moving from one that pays for the volume of services to one that pays for the value of services. Value-based payment requires quality, patient experience and efficiency metrics to assess the success of alternative payment models (APMs) and their participants at delivering value. The increased reliance on performance measures as part of these models led to a proliferation in the number of measures and a commensurate increase in burden on providers collecting the data, confusion among consumers and purchasers seeing conflicting measure results, and operational difficulties among payers. The CQMC aims to:
- Identify high-value, high-impact, evidence-based measures that promote better patient outcomes, and provide useful information for improvement, decision-making and payment.
- Align measures across public and private payers to achieve congruence in the measures being used for quality improvement, transparency, and payment purposes.
- Reduce the burden of measurement by eliminating low-value metrics, redundancies, and inconsistencies in measure specifications and quality measure reporting requirements across payers.
To date, the CQMC has developed eight core measures sets that focus on primary care, cardiology, gastroenterology, HIV/hepatitis, medical oncology, OB/GYN, orthopedics, and pediatrics. The WCHQ Measurement Advisory Committee frequently references the CQMC core measure sets when selecting measures for WCHQ’s reporting work.
“WCHQ’s representation on the CQMC Steering Committee provides the voice of a regional collaborative in the work of the CQMC as it seeks to encourage greater measure harmonization across the country,” according to Gigot. “In turn, I will be able to bring the ideas and best practices from across the nation back to our work here.”
WCHQ Members Commit to Transparency, Quality Improvement, Collaboration
Five regional WCHQ members became the first dental practices in the country to publicly report oral health quality measures to the WCHQ reporting website, WCHQ.org.
The five organizations are founding members of the WCHQ Oral Health Collaborative and include: ForwardDental; Marshfield Clinic Health System; Dental Associates; HealthPartners (MN); and Children’s Wisconsin. The practices serve a diverse demographic and geographic range of pediatric and adult patients in rural and urban communities throughout Wisconsin and Minnesota.
The first publicly reported measures are: caries risk assessment in children; ongoing care in adults with periodontitis; and, topical fluoride application in high risk children. The three oral health measures are commonly found in family practice settings that care for children and adults.
The WCHQ acquires and analyzes the quality measures from de-identified data submitted by the dental organizations. Measure specifications along with the individual organization reports are available to the public on the WCHQ website.
“WCHQ has proven that ‘what gets measured and reported publicly, improves faster,’” according to Chris Queram, President/CEO, WCHQ. “It has been exciting to see dentists work with our organization and join physicians and health systems to work toward setting a new standard of overall, holistic care. Our goal is to see a closer alignment between oral and medical providers in our region because a number of serious health issues must be managed in both settings.”
ForwardDental was the first dental organization to join WCHQ. Jesley Ruff, DDS, MPH, found the wealth of experience among the members of the collaborative valuable to his organization.
“This endeavor gave us the opportunity to collaborate with peers to improve oral health by publicly reporting information that is meaningful to clinical teams with a mission of better informing and benefiting the overall health of people living in communities we are privileged to serve,” according to Dr. Ruff.
For Children’s Wisconsin, children’s oral health is essential to ensuring good overall health.
“Children deserve great dental care and good heath starts with a healthy mouth,” according to Lori Barbeau, DDS with Children’s Wisconsin. “The ability to collaborate with four dental organizations focused on improving dental care through measurement, public reporting and sharing best practices will help ensure that children receive the best care possible everywhere in the state.”
The integration of oral and medical health delivery is a goal at the Marshfield Clinic Health System, which has dental and medical clinics in central and northern Wisconsin. As Executive Director of the Marshfield Research Institute, Amit Acharya, BDS, MS, PhD, has developed dashboards that help dentists and physicians jointly monitor conditions that have an impact on overall health.
“Our goal is to improve the health of people in our communities. It is extremely helpful working with the members of the oral health collaborative to develop measures where we can compare our results to one another, network to share common practice issues, and improve our performance through collaboration,” according to Dr. Acharya.
David Gesko, DDS, is dental director and senior vice president with HealthPartners, a health system based in Bloomington, Minnesota. WalletHub recently ranked Wisconsin first and Minnesota third best in the country based on dental health scores across several indicators.
“Minnesota and Wisconsin are both known for delivering high quality health and dental care. As an integrated health system with dental offices in multiple states, we were excited to join the WCHQ Oral Health Collaborative to help develop and now publicly report our results on a starter set of dental quality indicators,” Gesko said. “It is a step in the right direction at a time when our patients need us to provide more information to them about the quality of care they receive and the value they derive from our services.”
Thomas Manos, DDS, MS, is owner and CEO of Dental Associates. Collecting data and using it to improve quality is not new to Dental Associates. A data-driven and patient-centric practice, Dr. Manos said they are looking forward to working with WCHQ as a partner to continue to develop quality metrics related to oral health.
“There is a critical link between oral health and general health and well-being. We know poor dental hygiene is linked to an increase in chronic and acute diseases,” according to Dr. Manos. “We are looking forward to working with our colleagues in both the medical and oral health communities to improve the overall health of the people we all serve.”
The WCHQ Oral Health Collaborative is working on its next set of metrics with a goal to help practitioners better manage patients with chronic medical conditions using the results of measures that incorporate medical and dental data.
One of the clearest determinants of health disparities is related to where people live. In its second report, WCHQ identifies where disparities in health outcomes and care exist in rural and urban areas, by ZIP code, to inform and accelerate programs that are working to eliminate health care disparities.
The report will be released at the WCHQ Health Disparities Assembly held virtually November 12 from 9 a.m. – noon. The Assembly will feature Leonard Egede, MD, MS, Medical College of Wisconsin, who will present the urban perspectives on health disparities, and Malia Jones, PhD, MPH, who will describe the rural angle.
Dr. Egede is a nationally recognized health disparities researcher who has developed and tested innovative interventions to reduce and/or eliminate health disparities related to race/ethnicity, socioeconomic status and geographic location.
With expertise in social factors related to infectious disease, demography and geospatial research methods, Dr. Jones’s research focuses on social and spatial determinants of health at the population level.
Jen Weiss, MD, MS and Matt Gigot, MS, will describe the findings in the report. Both have contributed to the research and analysis required to document disparities related to geography. Dr. Weiss is a faculty member of the division of gastroenterology and hepatology within the Department of Medicine at UW Madison. Gigot is director, performance measurement and analysis at WCHQ.
A new tool that health systems and medical clinics will find valuable in managing population health will be demonstrated by Jessica Bonham-Weling, MBA, director of the Neighborhood Health Partnerships Program.
Registration is open; direct questions to Mary Kay Fahey, email@example.com.
Comprehensive Medication Management (CMM) is the standard of care that ensures each patient’s medications are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.
At the September WCHQ Chronic Disease Learning Collaborative meeting, Sara Griesbach presented on Marshfield Clinic Health System’s full scale CMM Services, which includes over 10 board-certified clinical pharmacists. In a pilot program, their pharmacy department partnered with an interdisciplinary team at one of their rural health centers to expand diabetes focused management services. They set a 12-month aim to provide sustainable CMM services to 30 rural, regional-center diabetes-care-management patients with HbA1c>8%. Additional goals included decreasing HbA1c to <8% in 40% of patients and achieve an improvement in A1c in 70% of the population. To be included in this pilot, patients with type 2 diabetes needed to have an A1c>8% and have a primary care provider at one of Marshfield’s regional rural centers. The implementation team consisted of a physician champion, diabetes care management, quality improvement, and clinical pharmacy services.
In the Clinical Pharmacy Services workflow, they incorporated a new hardwired follow-up process 3-6 months after the initial visit, which included a pharmacy resident calling the patients to answer questions, assess adherence to their medication regimen, and discuss barriers. At the 10-month mark, 46% of patients reached their A1c goal and 85% of patients had an improvement overall in A1c from baseline. The average change in A1c was -1.14%.
Marshfield plans to expand their CMM services to additional primary care providers. They recently added four primary care providers at three separate locations.
For any questions related to Marshfield’s Comprehensive Medication Management work or their pilot program, contact Sara.
During the October Behavioral Health Steering Team meeting, Jon Glover from MetaStar presented on alcohol screening and implementation in Wisconsin primary care practices. It was not surprising to learn that a 2017 report from America’s Health Rankings identified Wisconsin as having the highest percentage of “excessive drinking” in the nation with 26.2 percent of the population consuming alcohol at this level compared to the United States’ average of 18.5 percent.
The presentation emphasized the connection between unhealthy alcohol use and the potential chronic and acute medical consequences that can occur as a result. A recent 2018 update by the United States Preventive Services Task Force (USPSTF) to its recommendations regarding alcohol screening and brief intervention acknowledged the importance of addressing this issue in health care.
The group discussed key issues related to screening and brief intervention. This included:
- The importance of using a validated screening instrument.
- Providing brief interventions for patients who score positive.
- Educating patients regarding the low-risk guidelines for alcohol consumption and the potential negative consequences their unhealthy alcohol use might be having on their health.
A final focus was on the various populations that have seen the greatest increase in unhealthy alcohol use. While there has been continuing concern about the increases in unhealthy alcohol use for older adults, whose population is quickly expanding, another population that has been increasingly affected over the past 10-15 years has been women. Alcohol use among men has remained relatively stable during this time and has always exceeded women’s alcohol use, but recent trends show that alcohol consumption by women has increased significantly and is now approaching levels similar to those seen in men.
The Coronavirus Disease 2019 (COVID-19) pandemic has also led to a significant increase in alcohol use across the United States. The Journal of the American Medical Association pointed out in a September 29, 2020 article that "Nielsen reported a 54 percent increase in national sales of alcohol for the week ending March 21, 2020, compared with 1 year before; online sales increased 262 percent from 2019."
The study also found that the frequency of alcohol consumption increased:
- 14 percent over the 2019 baseline overall.
- 17 percent over the 2019 baseline for women.
- 19 percent over the 2019 baseline for adults age 30 to 59 years.
Of particular concern, however, was the increase in alcohol consumption by women. The study reports that for women, days of heavy drinking increased 41 percent over the 2019 baseline and resulted in a 39 percent increase in alcohol related problems for nearly 1-10 women in the study, independent of consumption level.
We have included some resources below for you if you’re interested in looking into this topic further.
- Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions – USPSTF Final Recommendation Statement, November 2018
- Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Girls and Women – Alcohol Research Current Reviews, August 2020
- Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US – Journal of the American Medical Association, September 2020
MetaStar is participating with Northwestern University in the Association for Healthcare Research and Quality (AHRQ) research study called Intervention in Small primary care Practices to Implement Reduction in unhealthy alcohol use, or INSPIRE, which is focused on facilitating alcohol screening and intervention in primary care. Of particular interest in this study is the added component of medication interventions for primary care providers.
If you are interested in additional information regarding how to get involved in addressing this important issue for Wisconsin by participating in this study, please contact:
Jon Glover LCSW / Practice Facilitator
MetaStar, Inc., Madison, WI 53713
Phone: (800) 362-2320
The Adolescent and Child Health Steering Team reviewed upcoming changes to NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) pediatric quality measures, including the addition of telehealth for well-child visits and the monitoring of flu vaccination rates. In the future, the team is interested in expanding the available pediatric measures for WCHQ’s membership to allow us to monitor a more complete picture of healthcare quality for our youngest patients.
The Team also discussed the impact of COVID-19 on Wisconsin’s pediatric practices at the October 19 meeting. To better understand the severity of the COVID-19 on pediatric practices, the group reviewed the results of a statewide survey conducted by the National Improvement Partnership Network (NIPN). The survey also identified the individual stressors experienced by practices and the primary sources for COVID-19 information. The discussion centered on the impact of personnel shortages and the increased volume in patient calls and strategies to address these problems.
A primary aim of the Adolescent and Child Health Steering Team is to share best practices and strategies for addressing the unique needs of pediatric care in Wisconsin. To that end, the team is currently recruiting new members from health systems throughout the state. The group is comprised of a wide variety of roles, including quality improvement staff, nurses, pediatricians, gynecologists, and researchers. For more information or to join the team, please reach out to Abbey Harburn.
The Chronic Disease Prevention Program has developed several prediabetes webpages and promotional resources on the Wisconsin Department of Health Services website to coincide with National Diabetes Month.
The prediabetes webpages can be reached through: www.PreventDiabetesWI.org. The webpages include:
- A landing page with definitions of prediabetes and risk, testimonials, and a link to Wisconsin’s risk test URL;
- Myths and Misconceptions;
- Take Control of Your Health (National DPP);
- Resources for Providers (identification and referral information); and
- Promotional Resources.
The Promotional Resources page features turn-key resources to promote both www.PreventDiabetesWI.org and Wisconsin’s prediabetes risk test. The website allows access to deidentified data that will help visualize geographical areas of elevated interest and commonalities in risk factors. Soon the Promotional Resources page will also feature turn-key resources for promoting National Diabetes Prevention Program (DPP) cohorts. A variety of materials can be downloaded; such as posters, flyers, palm cards, print ads, Facebook carousel ads, and other social media posts.
Here are some ways to use these resources:
- INTEGRATE www.PreventDiabetesWI.org and www.diabetes.org/widhsrisktest into your organization’s website and social media.
- SHARE www.PreventDiabetesWI.org and www.diabetes.org/widhsrisktest with your organization’s partners/networks, encouraging them to include this information on their websites/social media and share with their partners/networks.
- USE the available resources to promote www.PreventDiabetesWI.org and www.diabetes.org/widhsrisktest. (November’s National Diabetes Month is a perfect time to start!)
For information on WCHQ’s activities related to diabetes, contact Cara Winsand.