Dr. Michelle Robinson, inaugural Director of the Office of Health Equity (OHE) at the Wisconsin Department of Health Services, will keynote the upcoming WCHQ Value and Disparities event, “The Impact of Disparities on Healthcare Value.” As director, Dr. Robinson serves as the principal program and policy officer for equity and inclusion and workforce planning programs. Dr. Robinson received the 2018 Madison Community Leader Award by Church Women United, the 2018 Collaborator of the Year award by the Progress Center for Black Women, the 2017 Community Justice Award by the Urban League of Greater Madison and was named one of the University of Wisconsin’s Outstanding Women of Color in Education in 2014.

 Other speakers/topics include:

• Asthma-Safe Home visiting program’s work to reduce disparities related to asthma
• Rural Jefferson ½ Mile ATV Club collaborating with Fort HealthCare to raise funds for mammogram financial assistance
• Bellin’s employer health program highlights how onsite clinics can add value to the health system, employer and patients

The event will take place February 8, 2024 at the Doubletree by Hilton Madison East. The event is open to members and non-members, with a fee of $80 for non-members. Registration is available on our website now.  

Interested in learning more? Please contact us at info@wchq.org.

As the year 2023 comes to an end, I find myself reflecting on the incredible accomplishments of WCHQ's members and our staff. At the beginning of this year, we centered ourselves on five long-term strategic priorities for WCHQ. While these priorities will take numerous years to fully accomplish, we made significant progress on each throughout this year.  

Comparative Data: Continuing in our leading role providing comparative data that facilitates improvement via learning between health systems.  

The transparent reporting of health outcomes is even more critical following the pandemic as we aim to get patients back on track with preventative care and provide support for populations that were disproportionately affected by the pandemic. WCHQ’s measures are available publicly twice a year at the health system and clinic level. These validated measure results provide the data used in numerous public and members-only reports produced throughout the year.  

Health Equity: Serve as a statewide convener of thought leaders committed to reducing health disparities, utilizing data to provide focus and collaboration to create strategies to reduce disparities. 

We identified strategies that have closed or reduced disparities gaps in and are now focused on disseminating those effective strategies across the state. Our first event of 2024 will feature this topic.  

Value Acceleration: Connect quality and cost to drive upstream improvements in healthcare value.  

Early in 2023, we previewed a series of reports we are pushing out to help members identify value strategies that work, showing our members have saved over $100 million by their improvement work for patients with diabetes. In December, a members-only report built on this learning by connecting specific quality metrics with avoided complications.  

Engage Wisconsin Employers and Stakeholders: Engage employers directly in our work to drive improvement.  

This year we took several steps to include employers more closely in our work. We established our first Employer Engagement Council, chaired by Sue Anderson, SSM Regional President, which sets the strategic direction for engaging and listening to employers. WCHQ will release a toolkit on obesity care that employers can use in their benefit design and working with providers during the first quarter of 2024. In the new year, we will see more of this work as we aim to listen to employers’ needs and provide tools that employers and providers can use together to improve patient outcomes.

As the year ends, I am grateful for the steady leadership of our board of directors.  

Departing Board Members:

A sincere thank you to departing board members who collectively served on the board for a  total of nearly twenty years.  

• Marilu Bintz, MD, Gundersen Health System
• David Gesko, DDS, HealthPartners
• Paul Pritchard, MD, Prevea Health
• Jim VanderMissen, Primary Care Associates of Appleton

Welcome New Board Members:

• Jill P. McMullen, MD, Gundersen Health System
• Samantha Klebe, DO, Marshfield Clinic
• Todd Thierer, DDS, HealthPartners

Under the direction of WCHQ’s Measure Advisory Committee, comprised of clinicians, measurement and quality experts, the new composite measure summarizes member performance across all measures and benchmarks participants into percentile rankings based on performance.

This year-long effort gives members a tool to discuss their results across all 27 publicly-reported WCHQ measures by providing enhanced benchmarking capabilities.

"In the sphere of ambulatory quality measurement, integrating all of WCHQ's measures into a composite framework elevates the way we can talk about quality performance," shares Chris Elfner, VP of Bellin Health’s Clinically Integrated Network and Measurement Advisory Committee chairman. "It allows us to move the discussion beyond individual measure performance and better understand health system performance. Many members have been doing something like this on their own, so it makes sense to have the Collaborative provide a standard model."

The new composite ranking is currently available to WCHQ members only and was included in WCHQ’s recent release of the latest public reporting results.

Primary Care Associates of Appleton Uses Self-Measured Blood Pressure Monitoring to Increase Blood Pressure Control

Self-measured blood pressure monitoring (SMBP) with clinical support is a proven strategy to lower blood pressure and increase medication adherence (Community Preventive Services Task Force, 2017). Primary Care Associates of Appleton (PCAA) has successfully incorporated SMBP into patient care and the electronic health record (EHR), resulting in significant improvements in blood pressure control.

PCAA plans to increase the number of patients using SMBP and overall blood pressure control. PCAA shares their best practices:

• Ensure sufficient primary care teams are supporting patients using SMBP so that every patient interested in doing SMBP has a team to support them. Since launching the SMBP program in 2021, PCAA increased the number of provider teams utilizing SMPB from 4 teams to 24 teams.
• Coordinate with health plans that offer SMBP benefits to make SMBP easy for patients. PCAA worked closely with Network Health through a pilot, to offer free home blood pressure monitors and training for their enrollees that completed the PCA training. Network Health identified eligible patients and ensured they took advantage of this benefit.
• Make the SMBP service affordable and accessible. PCAA currently uses a no-copay code to ensure patients are not charged. The two codes used for SMBP are 99473 and 99474.
• Utilize an automated SMBP registry. PCAA received support from the Wisconsin Community Health Empowerment Fund (WCHEF) in 2023 to change from a manual process to an automated registry through the electronic health record. Health care registries improve the quality and safety of services and provide a mechanism for recording the SMBP in the EHR.

Program statistics include:

• 433 patients trained prior to 2023. Eighty-nine percent of those returned “first home results” to their provider as indicator of compliance. Patients that go through training, but do not send in their first round of results, or “first home results,” despite outreach reminders, are counted as not completed with the program.
• 313 patients added since the beginning of 2023.
• 23/31 teams are utilizing SMBP which is a participation rate of 74%.
• 2 staff are offering one day a month for SMBP training and device accuracy tests that any team can schedule with. 

“Not only is this an evidence-based program that has proven to bring patients to BP control, in a more timely and efficient way than prior methods, it’s a big win for the patients, too! Once trained, patients no longer need to come into the clinic for nurse visit BP checks. We are very proud of the continued growth of this program. This is both a patient and staff satisfier,” reports Ann Taake, PCAA Quality Improvement Specialist.

At this year’s educational events, knowledgeable presenters inspired and challenged our WCHQ member representatives with actionable strategies in a variety of healthcare specialties. For example:

• At the Statewide Quality Improvement Event and Diabetes Summit in June, Mallory Baerenwald and Maria Boeck of Bellin Health shared their Diabetes Prevention Program. Mallory and Maria reported overall improvement in HgA1c over a five-year period with plans to expand the program.
• Joan Nuener, MD, MPH, represented the quality health collaborative Healthy Metric, of which WCHQ is a partner, at our Healthcare Disparities event in July. She shared findings from their recently published report, Disparities in Mental Health Care and Outcomes: A HealthyMetric 2023 Report for Wisconsin. The report showed visits for depression and anxiety increased by age and insurance type from 2019 to 2021. Overall percentage of visits for depression and anxiety in 2019 were 8%, 2020 8.4% and 2022 8.9% respectively, showing that more Wisconsinites are being seen for mental health treatment. “It doesn’t help if we just talk about it,” Dr. Neuner had said, noting these reports are essential for driving health system work in quality improvement interventions.
• A panel of five physicians shared case studies with the audience at WCHQ’s Obesity Summit in September. Each of the case studies highlighted treatment that a primary care physician could also implement in their clinic to help someone with obesity. The panel included Samantha Pabich, MD, MPH, UW Health; Chris Weber, MD, Ascension; Sachin Jogal, MD, SSM Health; Melanie Smith, DO, Advocate Health and Compton Kurtz, MD, UW Health. Conference attendees asked numerous questions and were really engaged with “real-life” examples of patients living with obesity.
• At our first event highlighting chronic kidney disease (CKD), also in September, we were joined by Dr. George Bakris from the University of Chicago. He reminded the group of employing the following best practices to diagnosis CKD as early as possible, such as screening high risk patients due to diabetes or hypertension and referring patients for additional services, such a dietitian.

Feedback from our events has been informative as we plan for 2024. When we hear comments like, “Tons of ideas to implement in primary care,” and “I will be sharing this information with other primary care providers at my organization,” we know we are on the right educational path for our members.

In addition to the four in-person events, WCHQ hosted nine webinars, with varying topics from CKD and heart failure disparities, increasing immunization rates, antibiotic stewardship and more.  

Our 2024 events are on our website now, mark your calendar and plan to join us. You won’t want to miss out on the chance to hear from both fellow WCHQ members and industry experts on information and strategies that will make a difference to your patients.

In 2023, three WCHQ member systems participated in a project to improve HPV vaccination rates, including almost 300 clinical staff across Wisconsin and the Upper Peninsula of Michigan. We are now enrolling WCHQ member systems for 2024! Will your health system join?

HPV vaccine improvement project by the numbers in 2023:

WCHQ invites member systems to receive a 1-hour CME/CNE evidence-based communication workshop. Workshops will be held in the spring and early summer of 2024. The workshop, called The Announcement Approach Training, has been shown to increase HPV vaccination rates by five percentage points. It also helps reduce conflicts with patients by giving staff the tools to communicate with them differently and supports sustainable improvements by training internal staff to become trainers.

The Announcement Approach Training workshop is for all clinical staff who have a role in adolescent vaccination. Additional training for one or more vaccine champions in your health system is provided. Champions deliver the workshop to half of your system’s participating clinics, facilitating project sustainability. Experts from the project team deliver workshops to the remaining clinics. WCHQ data will be used to track improvements. 

To learn how your health system and clinics can get involved, contact Jen Koberstein at Jkoberstein@wchq.org or the UW-UNC project team at prokids@pediatrics.wisc.edu or 608-263-1202.

The project is led by Elizabeth Cox, MD, PhD, a pediatrician and health services researcher and Meghan Brennan MD, MS, an infectious disease physician and health services researcher, from the University of Wisconsin, and Melissa Gilkey, PhD, a behavioral scientist specializing in adolescent health at the University of North Carolina. The project is funded by the University of Wisconsin-Madison.