The end of a year is often a time of reflection and, as the news stream continually reports on the overflowing hospitals and dedicated but overworked staff, I find myself reflecting on the strength, perseverance, and commitment of our member health systems. Each health care team member, whether on the front lines or in the many roles that provide support behind the scenes, has been working tirelessly for what is closing in on three years. Words of gratitude seem insufficient at this moment, but simply stated, I want to say thank you.
Thank you to the health care workers and systems that are focused on not just the patients suffering from any variant of COVID-19, but to all patients that continue to need care. We know that behind the urgency of the overflowing ICU’s is a slow moving onslaught of patients in need of important and often delayed care. WCHQ aims to do its part by providing information and strategies that shine a light on areas in need of the most attention as resources are stretched thin. In 2022, our focus will be on using our robust data, submitted by health systems to drive improvement in quality even during a pandemic, to provide support and information where it is needed most. We will be providing more information on delayed treatment, subpopulations that are experiencing disparities, and opportunities to continually improve for all patients.
Thank you to the WCHQ staff that, behind the scenes, work daily to support our members. And thank you to each WCHQ member for your continued commitment to providing high quality health care.
The December 3 WCHQ Executive Summit on Health Disparities brought together health care leaders representing more than 23 systems in Wisconsin. The goal of the Summit was for WCHQ members to select a few measures in the portfolio that showed significant disparities that all health systems would work on for the next 18-24 months to reduce identified gaps in care statewide.
The measures, which were selected based on the disparities identified in WCHQ data, stratified by rural and urban geography, are:
In remarks delivered at the Summit, co-chairs Cathy Jacobson, president and CEO of Froedtert Health and Sue Turney, MD, president and CEO of Marshfield Clinic Health System, emphasized that it is critical to close existing gaps that are “leaving some people behind,” according to Jacobson. She recognized WCHQ for bringing the health systems together to initiate action to end disparities.
“We had our ‘a-ha’ moment when we talked about the stark reality of how disparities pervade everything that we do,” Jacobson said. “It really showed up in COVID, especially during the first wave. We need to do more with greater impact.”
Dr. Turney pointed out that in rural areas there is an overall lack of access to care, and the fact that rural has been in crisis for a long time.
Keynote speaker Wade Norwood, president and CEO of Common Ground Health in Rochester, New York, said in that region of the country, people were astounded to learn that poverty is not “just relegated to urban areas, it’s rural, too.”
Norwood said Covid didn’t create disparities, but it “piled on to existing inequities and shined a bright light on how unacceptable it is.” He noted that to fix it will require health systems to work together and provide support that extends beyond the four walls of the hospitals into the community with a focus on prevention.
Addressing disparities requires a backbone organization, such as WCHQ, according to Norwood. Organizations, such as WCHQ, can provide the data and convene multistakeholder groups that may need a “shared language” to get started, but that can do the different types of work that are necessary to end disparities.
“You understand care in the community is care that understands socioeconomic realities,” Norwood said, “We need a delivery system that is rooted in equity, in understanding how we impact others. If we change care we must make sure we support longevity of all our patients and create a system of care that works for everyone.”
Tim Prince, senior advisor of strategic project alignment at Findorff, graciously volunteered to facilitate the Summit. He noted that a magnifying glass on inequity and racism has come up over the past two years, and we must admit at times that we do not know the answers.
“We can, however, go to the communities where disparities are occurring and watch, learn and ask the people who do know and live it every day,” according to Prince.
WCHQ President and CEO Gabrielle Rude, PhD, acknowledged the outstanding participation of all health system members in selecting the measures that will be the focus of improvement at WCHQ.
“This work is fundamentally important to the health of all residents of Wisconsin. By identifying where disparities exist, we can target our resources, work with community stakeholders, and address the gaps in care that we all want to close,” Dr. Rude said. “By raising the visibility of this issue, we can develop a statewide plan that we can work on together so we can increase our impact on health.”
While the pandemic disrupted progress on the WCHQ Value Acceleration Initiative, which was launched in 2019, the Board asked staff to resume the work in 2021. WCHQ members are focused on further refining the definition of health care value to allow measurement and tracking of its improvement. Broadly, WCHQ’s definition of value is higher quality, more affordable care. The initial focus of this work is on individuals with diabetes, and the Value Acceleration Steering team was tasked with identifying interventions that increase value with a reasonable implementation threshold, to align with priorities for providers, purchasers and payers. The improvement strategies that group identified included integrating behavioral health and pharmacists into primary care, improving tobacco cessation rates, and reducing stress testing in individuals with stable disease after PCI.
Staff is developing a report that will include results for individual measures selected from a set identified by the Steering Team. Selected measures align with value improvement strategies endorsed by the WCHQ Board of Directors and will provide a baseline for tracking improvement over time. The Measurement Advisory Committee and Value Acceleration Advisory Group, chaired by Imran Andrabi, MD, President and CEO, ThedaCare will review the final iteration of the report prior to its dissemination in early 2022. The initial report will include member specific results and be blinded so members are only able to see their own performance in comparison to the rest of WCHQ.
This year, the WCHQ Improvement Advisory Committee (IAC) and the improvement teams integrated disparities into all aspects of their work. Throughout the year, members shared what they are working on in their own organizations to implement change that closes care gaps. These conversations will continue into 2022 with a more focused approach as WCHQ launched a Disparities Improvement Team in early December
The statewide 2021 WCHQ improvement priorities included behavioral health, colorectal cancer screening, chronic disease management and adolescent and child health, including immunizations. COVID-19, competing priorities and workforce shortages have made it challenging to observe improvement in these areas. At the December IAC meeting, the group reviewed preliminary data for calendar year 2020, and noted a significant drop in most measures, with an exception for Screening for Clinical Depression and Adolescent Immunizations, which remained steady.
The IAC and improvement teams will continue to address challenges and focus on improvement work in 2022. Regular reports on the newly identified improvement areas will be brought to the IAC for discussion as WCHQ assists members in priority areas.
The Improvement Advisory Committee is open to all WCHQ members. To join, contact Cara Winsand.
The strength of WCHQ as an organization is a direct result of the professionals who share their expertise by volunteering to serve on the Board and Committees. WCHQ recognizes two individuals who have made countless contributions at both the Board and Committee levels who will be leaving the Board at the end of this year
Dr. Tim Bartholow was both a member of the Board and chair of the Measure Advisory Committee for more than five years. Dr. Bartholow’s naturally inquisitive nature supported by his clinical knowledge was an asset to WCHQ throughout his tenure of service.
Dr. William Cannon, who is retiring at the end of 2021, represented Fort Healthcare. As an engaged and valued Board member, Dr. Cannon applied his knowledge of clinical care with his passion for community health to keep WCHQ focused on the patient.
“WCHQ’s success through the years is a direct result of the excellent leaders who have served on our Board,” said Gabrielle Rude, PhD, WCHQ president and CEO. “We appreciate the time Tim and Bill have given to us and the insights they have shared that have helped us progress and grow. Our team wishes them the best in the future.”
The University of Wisconsin Neighborhood Health Partnerships Program partnered with the Wisconsin Collaborative for Healthcare Quality to build an outreach prioritization tool using EHR and influenza vaccination uptake data to support community-level understanding of COVID-19 mortality risk and vaccination barriers. The tool used electronic health record and influenza vaccination data to estimate COVID-19 relative mortality risk and potential barriers to vaccination in Wisconsin ZIP Code Tabulation Areas. Data visualization revealed four groupings to use in planning and prioritizing vaccine outreach and communication based on ZIP Code Tabulation Area characteristics. The program provided data, visualization, and guidance to health systems and health departments in Wisconsin.
Authors included Matt Gigot, COO, WCHQ and staff from the Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin School of Medicine and Public Health.
Asthma affects more than 400,000 adults and over 100,000 children in Wisconsin. Because it is the most common chronic disease in children, it is a public health priority to ensure people with asthma can learn to properly manage and control their disease at an early age and into adulthood.
In March 2021, Dr. Nicholas Antos, a pediatric pulmonologist at Children’s Wisconsin, the director of the Cystic Fibrosis Center at Children’s Wisconsin and the Medical College of Wisconsin and the medical director of the Southeastern Wisconsin School-based Asthma Management Program (SAMPRO), presented on multiple asthma control tests, including usage, differences, and clinical relevance.
Since that time, WCHQ has been working with members on the development of an Asthma Annual Assessment Measure using the Asthma Control Test (ACT). The ACT is a self-assessment survey that provides a score to help providers determine if a patient’s asthma treatment plan is working. It is an efficient, reliable, low-cost, and valid way to measure asthma control. This screening tool can be used in primary care practices to improve management of patients with asthma and to set asthma management goals. ACT is also a great conversation starter with patients who are reluctant to talk about their challenges, whether it is managing their asthma triggers or taking medications regularly.
If you are interested in learning more about the measure, contact Jen Koberstein.
WCHQ Seeks Representatives for Disparities Team
The WCHQ Disparities Improvement Team held their kick-off meeting on December 13. ThisTeam is responsible for operationalizing plans to improve health disparities associated with the three priority measures selected by the participants of the December 3 Executive Summit on Health Disparities. The priority measures selected are: Diabetes A1c Control, Hypertension Control, and Colorectal Cancer Screening. The Improvement Team will identify and share best practices to decrease disparities gaps, set goals and monitor data related to these priorities, and enable partnerships to reduce disparities.
At the initial meeting, the Team had a robust discussion about the structure, participation and representation of the Disparities Improvement Team. Highlighted in the discussion was the importance of incorporating the perspectives and stories of those who experience disparities, as well as including other stakeholders and subject matter experts as relevant to meeting agendas. Over the next two months, the Improvement Team will establish a Charter and begin crafting organization-specific goals to track and measure as they undertake quality improvement projects.
The Disparities Improvement Team is actively recruiting participants from WCHQ’s membership. For more information or to participate in the Improvement Team, contact Abbey Harburn.
Efforts Continue to Combat Obesity in Wisconsin
The obesity project at WCHQ continues with regular meetings between providers and payers discussing how to communicate the importance to employers and other insurers of covering obesity treatment. More than 32 percent of Wisconsin adults are reportedly obese, and data shows that of the 71 percent of those with obesity who seek doctor’s help, only 55 percent receive a formal diagnosis of obesity. The payers and providers agree that it is important to build a model that will provide information on costs and benefits of providing obesity treatment. Further, the group stressed the importance of providing early treatment to this population.
The Advisory Group is continuing work on obesity measures that will be released in early 2022. Planning is underway for a virtual education event in February that will be open to all WCHQ members. The group is also working on the details for a full-day in-person obesity Summit which will be held October 13 at the Hotel Retlaw in Fond du Lac from 9 AM – 3 PM.
If you are interested in learning more about the obesity project, contact Jen Koberstein.
Over the past year, the WCHQ Adolescent and Child Health Improvement Team has balanced education and quality improvement with supporting its members as the COVID-19 pandemic continued to disrupt the health care delivery system. The team was able to transition both meeting formats and content to provide support, feedback and best practices as members managed rollouts of COVID-19 vaccines to children and facilitated testing and treatment for their patients. Meetings shifted to include regular COVID-19 huddles, during which members were encouraged to share the issues and successes they saw in their own clinics in addressing the pandemic in the pediatric patient population and their families. Lessons learned regarding vaccine clinics, partnerships with schools and community organizations, and strategies for addressing staff burnout and fatigue were regularly discussed by Improvement Team members from across the state.
As WCHQ prepares for 2022, the Adolescent and Child Health Improvement Team will continue to prioritize education and quality improvement strategies driven by member priorities. The Improvement Team has designed a calendar of meeting topics for 2022 that will allow members to learn from one another and from outside experts. Focus areas for the next year include immunizations, developmental screening, childhood obesity, health equity, and value. The upcoming year will also drive forward measurement priorities in adolescent and child health, with plans for analyzing new metrics related to well-child visits and immunizations. In addition to reviewing potential new metrics, the team will also review stratified data to identify disparities in care in the pediatric population.
To participate in the Adolescent and Child Health Improvement Team, contact Abbey Harburn.
Behavioral Health Shifts to Meet Increased Need During the Pandemic
Shanda Wells, PhD, behavioral health manager for primary care at UW Health, is an expert on general and brief evidence-based interventions for therapy, integrated care, and collaboration within systems. At the December meeting of the Behavioral Health Improvement Team, Dr. Wells presented on the impact of telehealth on warm handoffs and its relationship to integrated care. The group also discussed virtual care as a strategy to improve access and meet the demand for behavioral health services during the pandemic.
If you are interested in joining the Behavioral Health Improvement Team contact Jen Koberstein.
Throughout the second half of 2021, 14 health systems engaged in Chronic Disease workgroup discussions and presentations. Several of the participating systems committed to improvement goals showcasing efforts related to diabetes and hypertension management. The members of the workgroup established SMART goals and they will be checking in on these during future meetings.
High level themes for diabetes management include timely and consistent labs prior to appointments, completion of labs, a feasibility study and referrals to Diabetes Self-Management Education and Support (DSMES).
Themes for blood pressure management include establishing a self-management blood pressure program, recording self-managed blood pressures in the EHR, accurate diagnosis and management, blood pressure re-checks and implementing team-based care. In addition, the groups will integrate priority populations into their work.
Eleven health systems provided feedback for the creation of a combined Chronic Disease Toolkit. This toolkit will combine and update the current Diabetes & Hypertension Toolkits. Additional feedback will be sought when the first draft is complete early in 2022.
To find out more about the Chronic Disease Learning Collaborative Workgroups, contact Sheryl Pierce.
Work on Oral Health Measures Continues
The WCHQ oral health members continue their work on multiple projects. The members are submitting data to WCHQ on four measures for services provided through June 2021:
· Oral Health Evaluation for Patients with Diabetes
· Caries Risk Assessment in Children
· Ongoing Care of Adults with Periodontitis
· Topical Fluoride Application in High-Risk Children
The members began discussions this month on implementing measures to advance value-based care. The discussions stemmed from a convening of oral health leaders reviewing a paper on the topic.
Members are working with WCHQ measurement staff to determine next steps on this project.
If you are interested in more information, please contact Jen Koberstein.