August 2022

WCHQ Reports: Disparities Worsen as Pandemic Halted Clinic Visits

A series of reports released by WCHQ and Healthy Metric provide an initial look at the impact the pandemic has had on health care disparities. The reports cover three chronic conditions, diabetes, colorectal cancer screening and high blood pressure from the onset of the pandemic through 2020.

The pandemic created several barriers to patients accessing care, perhaps none more hindering than the closure of some clinics across Wisconsin in early 2020. While health systems rapidly pivoted to telehealth, not all patients could access this service. That, along with other factors including personal concerns for safety outside of the home, reduced the number of patients that were seen in primary care clinics. Health disparities existed before the pandemic; however, they were made worse by challenges to access care during the pandemic.

The total number of diabetic patients who saw a primary care physician fell, with the largest declines of 7 percent for American Indians and 3 percent for Black Wisconsinites. While the percentages seem small, the number of people not seen for important screening services was significant. Typically, the number of patients seen in primary care remains stable from year to year.

“WCHQ’s member health systems are committed to addressing health disparities, as demonstrated by their continued public reporting of this essential information during a global pandemic. WCHQ’s role is to use this data to shine a spotlight on populations in need and to facilitate solution generation across the region,” according to WCHQ President and CEO Gabrielle Rude, PhD. “Our multi-disciplinary team of health system leaders representing the Midwest are using WCHQ data to identify and eliminate disparities.”

All racial and ethnic groups had lower rates of diabetes control during the pandemic, but white Wisconsinites had the most significant change at 6 percent more patients who were uncontrolled in 2020 when compared with 2019, or more than 6,000 individuals. People with uncontrolled diabetes are at greater risk of serious complications, such as heart disease, stroke, amputation, kidney disease, blindness and death.

High blood pressure, a sentinel chronic disease that is often linked to other serious health conditions, was significantly impacted by lower rates of primary care visits in the pandemic. More than 30,000 people in Wisconsin with high blood pressure did not receive care in 2020 compared to 2019. Primary care visits related to high blood pressure in rural underserved areas dropped the most at 10 percent while urban underserved and rural service areas fell nearly as much.

Disparities in colorectal cancer screening persisted and, at the end of 2020, had not changed, with Asian/Pacific Islanders having the lowest screening rates. Screening intervals for different colorectal cancer tests vary, so only a subset of patients is eligible for screening each year. This may be why the change in this measure from 2019 to 2020 is not as large as expected, even though primary care visits and preventive care decreased during the COVID-19 pandemic.

“The pandemic led to substantial decreases in primary care visits, which has concerning implications for the health of Wisconsin residents such as cancer being diagnosed at later stages and chronic diseases, like diabetes, not being well-managed,” according to Maureen Smith, MD, MPH, PhD, UW Madison School of medicine and Public Health, Professor of Population Health Sciences and Family Medicine. “With these findings, we want to encourage people to return to their health care provider to care for their health and stay up to date on screenings and care for chronic conditions. Focusing on health maintenance and addressing health issues as soon as possible helps prevent more serious health complications in the future.”

Joan Neuner, MD and internal medicine specialist with Froedtert and the Medical College of Wisconsin, believes investments must be made to ensure health care is accessible to everyone.

“Treatment of chronic conditions like diabetes and high blood pressure, can prevent strokes, heart attacks, amputations, and kidney failure and everyone 45 and over should get colon cancer screening. People should see their doctors, and make sure their loved ones do, too” according to Dr. Neuner. “For some people, this can be easier than before as most doctors now do televisits using computers or smartphones, or even telephone calls.  For others, our state needs to reinvest and innovate in public health solutions like better transportation. Working together, we can make those investments that advance the health of our state.”

WCHQ recently sent health system-specific measure result reports for 2019 and 2020, stratified by race/ethnicity, payer, and geographic groupings. This data allows health system to review their performance on the WCHQ measures in different patient populations and to compare that performance to other WCHQ members. This information can help inform and drive internal improvement goals.

WCHQ is facilitating a team comprised of representatives from Wisconsin health systems that is tasked with gathering and implementing evidence-based interventions to eliminate health care disparities. This work is funded by the Medical College of Wisconsin’s Advancing a Healthier Wisconsin and the University of Wisconsin School of Public Health’s Wisconsin Partnership Program.  To learn more about WCHQ’s disparities efforts or reports that are available, contact Abbey Harburn.

Partnership to Advance Health Equity Launches “Healthy Metric”

WCHQ and its partners announced the launch of Healthy Metric July 27 and released several new brief reports focused on health disparities in Wisconsin. The first five reports from Healthy Metric, three from WCHQ, provide an initial look at the impact the COVID-19 pandemic has had on health and health disparities. The reports cover a wide range of issues impacting health outcomes and health care in Wisconsin including:

  • Disparities in Colorectal Cancer Screening
  • Disparities in Blood Pressure Control
  • Disparities in Diabetes Control and Outcomes
  • Disparities in Use of Benzodiazepines and Opioids
  • Disparities in Initial Opioid Prescribing  

Healthy Metric is partnering with health systems across the state to identify best practices and take collaborative action to reduce disparities identified in reports.

Supported by the Medical College of Wisconsin (MCW) and the UW School of Medicine and Public Health, Healthy Metric was created to eliminate health disparities through collaboration, measurement, and action. With rising health inequities, it is critical to understand where health disparities exist so that targeted interventions can be developed to eliminate them. Healthy Metric brings together the two medical schools and the Wisconsin Collaborative for Healthcare Quality, the Wisconsin Health Information Organization; and the Marshfield Clinic Research Institute (MCRI), the largest private medical research institute in Wisconsin.

SPOTLIGHT: WCHQ Sees Fluctuations in Measure Results

WCHQ continues to assess the impact the pandemic has had on WCHQ measures. This month, we focus on results seen across key prevention measures publicly reported by WCHQ members.

By mid-2020, WCHQ metrics were beginning to reflect the closure and overall slowdown in patient traffic to the clinics. The denominator, which includes patients seen in a clinic at least twice over a two-year period, decreased an average of 34 percent across WCHQ’s improvement priority areas. Increases and declines in 2021 reporting compared to the pre-pandemic reporting period of June 2020.

“The decrease in the number of patients able and willing to come into the clinic for care is reflected in our measure results,” according to Gabrielle Rude, PhD, WCHQ President and CEO. “We are currently working within the improvement teams to share best practices and innovative ideas for reaching patients we have seen and reaching out to people in the community that may not be connected to a clinic, to ensure these families are receiving preventive care.”  

WCHQ Member Encounters by Month

The decrease in denominator reflects the general decrease in encounters WCHQ members saw across the board, especially in April 2020, as illustrated below.

The WCHQ performance measure results were recently updated to include member data reported through December 2021. Visit WCHQ.org,  to view the most current reports. For information, contact Brian Slattery.

Udy Joins WCHQ Board

Ladd Udy

Ladd Udy, vice president of value-based care and population health at Mercyhealth, joined the WCHQ Board of Directors at the July Board meeting.

Udy began his career with Mercyhealth in 2013 as an administrative fellow. He holds a master’s degree in health care administration from the University of Minnesota; a master’s degree in organizational leadership from Gonzaga University in Spokane, Washington; and a bachelor’s degree in family finance from Utah State University in Logan, Utah.

“Ladd brings a wealth to experience in health care administration to the Board,” according to WCHQ President and CEO Gabrielle Rude, PhD. “He is very familiar with WCHQ’s data capabilities and Mercyhealth uses it to guide their improvement activities. We are looking forward to having Ladd on the Board.”

Udy will serve a three-year term.

WCHQ Seeks to Expand Improvement Strategies to Improve Value

It might be the next frontier, or a natural extension of WCHQ’s success in improving health care value. Either way, WCHQ is focusing their attention on supporting members in their mission to improve the value of health care in their communities.

Released earlier this year, the first WCHQ value reports to members were developed based on Board-endorsed improvement strategies, which included:

  • Integrating behavioral health into primary care:
  • Integrating pharmacists into primary care; and,
  • Tobacco cessation.

The first reports used data from multiple sources to establish a baseline for value measurement. The reports contained information not previously available on several different indicators of value associated with delivering care to individuals with diabetes. This included information on clinical quality, hospitalization and resource utilization. The data in the reports was blinded and not publicly available, but WCHQ members are able to identify their own results.

The second group of value reports will focus on resource utilization, and will aim to provide the WCHQ members with more specific details about value utilization than were available in the first report. The data collected will help the members further determine two things:

  • What is driving resource utilization within the patient population with diabetes; and,
  • What interventions can be deployed to begin to lower resource utilization.

WCHQ’s Gabrielle Rude, PhD, said there are opportunities to expand current improvement team work to incorporate value.  

“WCHQ is taking a holistic approach to improvement, understanding that many factors must be considered to truly see positive change,” according to Dr. Rude. “WCHQ’s improvement teams work on issues that directly influence patient care. The issues that those teams address touch on clinical decisions that influence both the quality of care that is delivered, as well as the affordability of that care for patients across the region.”

For more information on WCHQ’s value reports, contact Gabrielle Rude.

Nishida Promoted to Data, Information Manager

Jared Nishida

Jared Nishida was recently promoted to WCHQ Manager, Data and Information. WCHQ members have worked with Jared on data-related questions, a role that will be expanded as our organization continues to grow its data capabilities to meet the changing health care landscape.

In his new position, Jared will also manage WCHQ’s internal IT needs and develop and maintain proper protections for all data.

“Not only is Jared very talented at managing member relations, but his calm demeanor and forward-thinking approach help to ensure WCHQ remains innovative and well-positioned for the future to meet our member’s technology and data requirements to support quality and value improvement,” according to Brian Slattery, Director, Performance Measurement and Analysis.

Jared received a Bachelor of Science degree in computer science from the University of Wisconsin - Green Bay. He joined WCHQ in 2015.

WCHQ Releases Chronic Disease Toolkit

WCHQ released a new toolkit that provides resources related to hypertension and diabetes control. The toolkit was created by the WCHQ Improvement team, which identified improvement strategies and shared best practices that have been successfully implemented within WCHQ member organizations. Find it HERE.

The result of their work is a comprehensive package of tools, resources and supportive literature to guide organizations interested in learning more about hypertension and diabetes with a goal of improving patient care and better outcomes.

The toolkit is designed for administrators, clinicians and staff within health care provider organizations who are seeking strategies and tools to improve hypertension and diabetes control among their patients. The toolkit may also be of interest to health plans and payers who have an interest in quality improvement.

Funding for the toolkit was provided by the CDC and the Department of Health and Human Services through the Wisconsin Department of Health Services, Division of Public Health. For more information contact Sheryl Pierce.

Improvement Teams

Obesity Advisory Group

Members Begin Looking at Obesity Measures Using Disparities Data

Members of the WCHQ Obesity Advisory Group met to discuss disparities related to the two new obesity measures:

  • Obesity Prevalence in the Population
  • Obesity Diabetes A1C Control

Each measure was stratified by payer, location and race/ethnicity. The members discussed the most apparent disparities and discussed approaches that would begin to impact these issues. There was a discussion about the difference in A1c control between white patients and all other race/ethnicities in Wisconsin. There was a 12.39% difference between American Indian/Alaska Native and White patients and a 9.79% difference between Hispanic/Latino and White patients. The group asked WCHQ to provide health system-specific data to members so they can further analyze the information as they begin to develop interventions. The health systems talked about challenges their patients face obtaining healthy food, accessing services and receiving information about services available to them. This resulted in several ideas that will continue to be discussed as the health systems begin to implement interventions. WCHQ will look at high performers in each of these areas and invite them to talk about the work they are doing to impact the health of these populations.  

Chronic Disease

CKD Advisory Group Sets the Stage for Early Detection

Early stages of kidney disease often go unrecognized as many people do not present with symptoms. With nearly 40 percent of patients with diabetes showing evidence of kidney disease and 90 percent of these patients not even aware of their kidney disease, it’s time to create awareness to stop or slow down the progression of CKD.

The CKD Advisory Group, comprised of nephrologists, primary care physicians and clinicians and educators, is actively engaged in outlining their upcoming work. The group is moving forward with the development of a CKD evaluation measure for people with diabetes focused on early detection. WCHQ staff is securing data and measurement specifications to build this measure.

Initially, an aggregated performance summary of the measure will be provided to the group and individual health system performance will be shared with members. Once the measure is successfully implemented, the Advisory Group will have the opportunity to make recommendations to transition it to a publicly reported measure.

The CKD Advisory Group is open to member health systems interested in improving the early detection of and slowing the progression of chronic kidney disease. To learn more about the metrics that are in development, contact Sheryl Pierce.

Chronic Disease Learning Collaborative

Speaking to WCHQ Chronic Disease Learning Collaborative (CDLC), Drea Maier, PharmD, BCPS, ambulatory pharmacy manager at SSM Health, described how her organization is utilizing the skills of a pharmacist in their team-based approach to primary care. She explained SSM’s innovative TBC approach to embedding pharmacists into primary care to optimize therapeutic outcomes, reduce and/or prevent adverse events and to improve population health.

Maier noted that their pharmacists are an integral part of the primary care team, providing direct patient care management and serving as a key resource for providers and the care team. Over the past seven years, this program has continued to expand with a majority of the referral base focused on patients with diabetes and/or hypertension. SSM’s TBC approach has a track record of improving A1C control, medication adherence, and showing signs of lowering adverse events like ER utilization and readmissions.

Members of the CDLC continue to explore and share best practices related to managing patients with diabetes and/or hypertension. To learn more, contact Sheryl Pierce.

Behavioral Health

WCHQ Members Discuss Depression Screening and Suicide Prevention

Depression screening and PHQ-9 utilization measure updates were the topics discussed at the July meeting of the WCHQ Behavioral Health Improvement team. Current results on these measures will be available when the group meets in August.  

The state suicide prevention plan is being revised by Mental Health America (MHA) of Wisconsin to include the health systems. Jen Koberstein who has extensive experience in community mental health is a liaison between the WCHQ health systems and the MHA committee. WCHQ members are committed to contributing to the plan and had a robust discussion at the WCHQ improvement team meeting in July. The discussion focused on best practices for identifying patients who have contact with the health system and die by suicide. WCHQ staff will meet with the MHA project staff to discuss best practices for follow-up.  

To learn more about the Behavioral Health Improvement Team contact Jen Koberstein.

Oral Health Collaborative

CMS Proposes New Rule to Include Medically Necessary Dental Treatment

In early July, CMS announced a proposed physician rule that would include medically necessary dental treatment for certain conditions.  The new rule outlines payment under Medicare Part B for dental treatment that is an integral part of a medical treatment for organ transplant.  Additionally, CMS is seeking comment on the inclusion of other medical conditions such as cancer treatment and joint replacement surgeries.  

The members of the WCHQ Oral Health Collaborative discussed this benefit at their July meeting.  Members expressed support for the new rule as long as the benefit is adequately funded and implemented.  According to the advocates who have worked with CMS on this new rule, the question of payment will not be resolved until after the public comment period.  

The link to the announcement can be found here.

If you would like more information about the Oral Health Collaborative contact Jen Koberstein.

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