December 2022
President’s Column
Working Toward Health Equity — Together
WCHQ President and CEO
While the pandemic revealed the health inequities in our communities, it did not create them. Identifying where inequities exist is the first step we all must take if we are to eliminate health disparities. Health care data is foundational to the work ahead of all of us as it can be used to not only identify where the gaps in health care exist, but also to monitor and assess progress. This is novel work and we must use data to identify and spread successes.
Nearly every speaker that presented at the WCHQ Health Disparity Summit November 10 shared how they are turning data into information to create appropriate and proactive responses to ensure all people receive and experience care in a culturally-appropriate way.
Marshfield Clinic and Froedtert and the Medical College of Wisconsin each presented how they are taking wholistic approaches to address disparities. From changes in internal policies that guide human resources decisions to external programs to increasing diversity in their workforce; their goal is to better understand how to reach out to people they serve.
Tammy Simon from Marshfield Clinic particularly caught my attention as she described their efforts to offer education to area college students on how to more wholistically address disparities. This took me back to my college days in the late ‘90s (or last century, as my children point out) when I spent the winter in a dorm in Marshfield learning what it meant to be a medical provider.
That experience was transformational for me personally. It helped me decide that I did not want to pursue medical school but did have an interest in the medical field in another capacity. This led to an experience working as a medical translator, which allowed me to experience healthcare with those for whom English was a second language. It is then that I found my passion for turning data into information that could be used to better understand underserved populations and work to create better access for them and their families.
We all have stories like this. Places we find inspiration. Aspirations to make a difference. Health systems and medical clinics join WCHQ because they want to improve access and equity for everyone. To accomplish this, we must work together and adopt the principles that were shared at the Disparities Summit:
- Equity must be part of our mission;
- We need to use a wholistic view to drive change;
- We should identify what is within our control and then recognize what else we need to know to have a collective impact; and,
- If we do this we can “change the world!” according to Renita Robinson from Prevea.
We heard very real and practical examples of what is being done in the region to drive change. Joan Nuener from Froedtert and the Medical College credited our health systems for their eagerness to do this difficult work. Bellin and Froedtert shared how they broadened their view on barriers to care and then designed improvement interventions.
With all of this excellent work we also heard an overall theme about the importance of caring for our healthcare colleagues. Mental health is a crisis for our patients who cannot access care and for the care teams that are still surviving a pandemic. Each of us is a flawed, mostly well-intentioned human. Take care of your heart and well-being and remember, great minds do not think alike.
SPOTLIGHT: WCHQ Members Commitment to Continuous Care Reflected in 2022 Measure Results
At the start of each year, the WCHQ Improvement Advisory Committee recommends and the WCHQ Board approves key improvement priorities for the coming year. The priorities selected in 2022 for improvement were chronic disease, cervical and colorectal cancer screening, and immunizations. Behavioral health, health disparities, and value were areas of overarching focus that were considered throughout all priorities.
The 2022 WCHQ measure results from the time period of July 1, 2021 through June 30, 2022, reveal that despite the pandemic and workforce challenges, WCHQ members achieved or came very close to meeting the goals set in early 2022. The WCHQ member measure results are posted HERE.
“The fact that Wisconsin health systems’ valued high quality care reflects the commitment that individual practitioners in our state have to ensuring their patients receive the care they need,” said WCHQ President and CEO Gabrielle Rude. “In spite of the pandemic and the barriers it brought with it, our health systems met those challenges by reaching out to their communities in innovative ways to ensure that patients who needed ongoing care received it.”
The graphs below illustrate the measure results related to WCHQ’s top improvement priorities through June 2022.
Adolescent Immunizations
While many states are struggling to attain pre-pandemic immunization status, WCHQ members are within 1 percent of goal of 90 percent. To meet the goal, approximately 236 more adolescents would need to complete their immunizations on time.
Childhood Immunizations
Confounded by the pandemic and issues associated with vaccine hesitancy, the childhood immunization performance dropped in both 2021 and 2022, with a 2.2 percent decrease in 2022. However, despite the challenges, WCHQ members are only 3.7 percent short of the statewide goal of 83.6 percent. Wisconsin health providers would need to vaccinate approximately 1,073 more children to complete their immunizations on time to reach the goal.
Blood Pressure Control
WCHQ is seeing excellent upward momentum in rates of blood pressure control with a major increase of nearly 5 percent between December 2021 and June 2022. About 2,237 more adults with hypertension would need to be in control to meet the statewide goal of 82 percent.
A1c Control
Similar to blood pressure control rates, WCHQ saw a significant increase of nearly 5 percent in A1c control. About 2,429 patients would need to be in good control in 2022 to meet the statewide goal of 73 percent.
The A1c and blood pressure control graphs show that chronic disease management rates are in beginning to recover from the lower rates of control that were seen in the first two years of the COVID-19 pandemic.
Cervical Cancer Screening
Clinic closures and concerns about in person visits due to Covid 19 contributed greatly to drops in cancer screening rates, which continue today. Cervical cancer screening performance decreased by 1.3 percent in 2022. Approximately 1,105 patients would need to be screened for cervical cancer to achieve the goal of 78.5 percent.
Colorectal Cancer Screening
There has been very little change in the colorectal cancer screening rates from December 2021 to June 2022 as WCHQ data continues to trend downward. To achieve a statewide screening rate of 80 percent among eligible adults, 28,744 more patients would need to be screened in 2022.
“We all know the importance of regular cancer screenings. The statewide decreases in colorectal and cervical cancer screening rates are representative of what we are hearing from both patients and providers—there is a backlog for cancer screenings as a result of workforce issues and delays in care due to the pandemic,” according to Dr. Rude. “As a collaborative, WCHQ is committed to helping our members share best practices and innovative solutions to address the increased demand for care so we not only meet, but exceed, our goals for everyone in Wisconsin to receive preventive care to ensure our communities are as healthy as possible.”
For information on WCHQ measures results, contact Abbey Harburn.
WCHQ Disparities Summit Confirms Health Systems’ Commitment to Health Equity
With representation from nearly every health system in Wisconsin in attendance, the WCHQ Disparities Summit on November 10 was successful in bringing health systems and stakeholders together who have a common mission to decrease health disparities in Wisconsin.
Two health systems shared how they are adopting new internal policies related to hiring practices with a goal of being more inclusive to and reflective of the people who live in their communities. Tammy Simon, RN, Vice President for the institute for Quality, Innovation & Patient Safety at Marshfield Clinic said people living in rural areas have fewer resources and are less able to access care. Increasing the availability of preventive care, tailoring the outreach to the population and helping people who need transportation are important.
“We must work with the fabric and foundation of the communities we serve,” according to Simon. “2020 was a clear call to roll up our sleeves and address our systemic inequities, and intolerance.”
Mark Lodes, MD and Andres Gonzalez from Froedtert and the Medical College of Wisconsin shared how their health system has made policy changes “from top to bottom” in its hiring criteria and even in their vendor mix to ensure it is creating equity and fairness as a business partner in the region.
“We need to ask ourselves what we are doing organizationally, individually and as teams to elevate and improve the quality of life across the region as it pertains to all the determinants of health,” Dr. Lodes said.
Gonzalez emphasized the importance of having executive support for the change that is necessary to eradicate racism. Reducing disparities, he said, is a long-term strategy for which there are no quick fixes.
Data is critically important in anticipating and planning for emergency responses, according to Ben Weston, MD, with the Department of Emergency Medicine at the Medical College of Wisconsin. As the Director of Medical Services in the Milwaukee County Office of Emergency Management, Dr. Weston understands the importance of sharing data publicly. Milwaukee was one of the first areas of the country to publicly report COVID-19 data. And the findings, that it was disproportionately impacting people of color, was a call to action.
“If we hide behind it (data), nothing will change,” according to Weston. “However, if we put it out there, we can use data to improve disparities in the community.”
Once the data was available, resources were shifted in Milwaukee County to the most vulnerable. Aziz Abdullah, co-found of INPOWER, played a key role in gaining the trust of disenfranchised neighborhoods in Milwaukee to help them understand the importance of getting a COVID vaccination.
“We chose to lead with empathy. Our model was based on helping people make informed choices,” according to Abdullah.
Abdullah explained that one of the silver linings of the pandemic was finding and using data in was that decreased inequities and promoted health. Some people who had not been vaccinated for more than two decades agreed to be immunized against flu and COVID-19.”
Debra Nevels, MSHCM, program manager of community outreach and engagement at the Medical College of Wisconsin Cancer Center shared the importance of being able to link communities to resources, such as food banks, as work is being done to create a more sustainable system.
Lyn Ranta, MD and Greg Stadter with the Milwaukee Health Care Partnership, said the approach in Milwaukee was to increase all immunizations, including COVID 19. What the groups working on increasing immunizations learned was most families were very interested in having their children vaccinated and many did not realize their children were not up to date.
“We knew we could not do this alone. A large part of our efforts was to build bridges with our community because that was the best way to amplify our impact,” according to Dr. Ranta.
Immunize Milwaukee originated within the Milwaukee health department and incorporated wide-ranging representation from clinical and community organizations. It is focused on vulnerable populations, including the uninsured and racial and ethnic groups with lower rates.
Joan Neuner, MD, MPH from the Medical College of Wisconsin, described the WCHQ statewide disparities project, which is funded through the Advancing a Healthier Wisconsin Endowment and the Wisconsin Partnership Program foundations through Wisconsin’s two medical schools. She credited the health systems for giving it their full support and said the project represents a first-of-its kind in the country effort to catalyze a statewide effort to reduce health disparities in collaboration with health systems.
WCHQ Analytics Manager Abbey Harburn introduced the last presenters who presented best practices related to decreasing disparities within their communities and internal to their health systems.
Renita Robinson, EdD, VP Diversity and Inclusion at Prevea Health, said the first realization they had when they started working on equity issues was, they did not have the data they needed to do the work.
“We needed to increase awareness across the system about health disparities so we collaborated with others and we started with educating our internal network first,” she said.
At Bellin Health, Maggie Koch, RN suggested leveraging artificial intelligence and digital to connect with people in new ways.
“We must do things differently than we have before,” Koch concluded.
Klein Joins WCHQ Analytics Department
Benjamin Klein has joined the WCHQ staff as a Clinical Information Specialist. Klein brings frontline experience to the position as a registered nurse in the pediatric care department at American Family Children's Hospital in their pre/post-anesthesia care unit. In addition to his clinical background, Klein also completed master’s degrees in both finance and business administration with an emphasis on data and analytics from the University of Wisconsin-Whitewater.
"We're really excited to have Ben joining the team. His blend of direct patient care experience combined with his interest and expertise in data and analytics offer a unique skill set within WCHQ's business needs" said WCHQ’s Director of Measurement and Analytics Brian Slattery. "Not only has he experienced first-hand the importance of providing high-quality care, but he has the ability to help others understand the impact it has through the use of WCHQ's data."
Klein is responsible for providing reports, data, and analytic support to WCHQ and its member health systems.
