January 2024

Mark Your Calendar!

Chronic Kidney Disease Toolkit Published

Launch Webinar Scheduled for Feb. 27, 2024

“How to help patients with CKD in your primary care office”  

The WCHQ Chronic Kidney Disease (CKD) Improvement Team launched a toolkit to help primary care providers screen for and treat kidney disease. The toolkit helps primary care practices to adhere to standards of care in screening for CKD, understand diagnosis of CKD, manage and treat CKD in their practice, and refer to nephrology when necessary.

Brett Pasiuk, MD, a Nephrologist at SSM Health, will present a webinar on how to use the toolkit in primary care practices. The webinar will be held on February 27, 2024 from noon – 1 PM. You can find the link here to register for the event.

There are limited nephrology resources within some health systems and treating people in primary care settings can increase the health care capacity, slow disease progression, and improve outcomes. The toolkit is a practical, usable tool for quick referencing and following standards of care.

Providers can find information about:

  • causes, prevalence, and costs of CKD
  • the connection between diabetes and kidney disease
  • connections between hypertension and kidney disease
  • guidance on screening and treatment illustrated on the KDIGO Heat Map

The new toolkit is available here.

If you are interested in joining the work members are doing on chronic kidney disease, contact Jen Koberstein.


Todd Thierer, DDS, MPH, Associate Dental Director, HealthPartners

In last month’s edition of our newsletter, WCHQ introduced new members of our Board of Directors. Unfortunately, a photo published introducing Todd Thierer, DDS, MPH, as one our new board members, was incorrect. We regret the error and offer this correction. Apologies to Dr. Thierer, and again, welcome to the WCHQ Board of Directors.

SPOTLIGHT: 20 Years Of Measuring and Improvement: A1c Control

As WCHQ celebrates its 20th anniversary, we review the results achieved over that time. This month we examine Diabetes A1c Control.

Diabetes A1c Control was among the very first publicly reported measures at wchq.org, selected because of the massive prevalence and cost of the disease. Studies have shown that controlling A1c to below 8.0% prevents longer term complications and leads to future cost savings.

WCHQ recently released a members-only report with evidence that quality interventions are reducing long-term complications. WCHQ President & CEO Gabrielle Rude, PhD said, “We know our members have had a significant impact on patient quality of life and health costs in our state of the last twenty years.” Members interested in obtaining this report should contact info@wchq.org.

Since 2004, the Diabetes A1c Control measure has gone through several iterations to ensure that it provides the most meaningful and actionable data for WCHQ members. The latest iteration of the measure occurred in 2013. Since then, the number of WCHQ members publicly reporting their A1c control numbers increased by 17.6% (from 17 to 20), while the number of patients qualifying for the measure increased by 57.1% (from 136,277 to 214,028 patients). Despite this large increase, members were impressively still able to maintain their A1c control rates, increasing the number of patients in good control by 58.3% (from 99,128 to 156,902 patients).

There were several factors over the past 20 years that have had an impact on healthcare and A1c control rates, but none greater than the COVID-19 pandemic. During the July 2019 – June 2020 reporting period, WCHQ saw A1c control drop below 70% for the first time since 2013. Members proved they could handle COVID-19 without sacrificing care for other diseases and chronic conditions. By the January 2022 – December 2022 reporting period, members achieved a 74.1% control rate, the highest rate observed by WCHQ.

In celebration of American Heart Month, in February be sure to check out our analysis of another long-standing WCHQ measure: high blood pressure.

Member Profile

In recognition of the WCHQ 20th anniversary in 2024, we are planning a member profile each month. This month, we are pleased to profile Gundersen Health System.

Member Name: Gundersen Health System

Member Background: Gundersen is a founding member of WCHQ. While legally a part of the Bellin and Gundersen Health System formed in December 2022, Gundersen is a separate entity within WCHQ’s membership, having unique representatives in our work and separate data measurement.  

Number of Providers: More than 900 providers in the Gundersen Region

Member of WCHQ Since: 2004

Jill McMullen, MD, Medical Director, Quality & Patient Safety, Gundersen Health System

Current Quality Goals: “We follow the WCHQ measure definitions for our ambulatory quality priority measures: Colorectal Cancer Screening, Depression Screening, and Diabetes Optimal Control, Breast Cancer Screening, Controlling High Blood Pressure,” said Dawn Thorsten, RN, BBA, MSOCL, Director, Quality & Patient Safety. “We benchmark against top performers to identify areas for improvement and to help set challenging, yet realistic targets. Benchmarking quality measure results allows us to learn about our performance compared to other organizations and to encourage our clinicians and staff to improve the quality of healthcare.”

WCHQ Engagement: In 2023, Gundersen had 26 employees participate in an advisory group or improvement team. In addition, Gundersen presented to an advisory group or improvement team 24 times. Gundersen was represented on the WCHQ Board of Directors by Marilu Bintz, MD, MBA, Gundersen’s Medical Vice President for Community Care, who retired in early January. Gundersen will continue to be represented on the WCHQ Board of Directors by Jill McMullen, MD, Medical Director, Gundersen Quality & Patient Safety, who joined the board this year.    

How WCHQ has impacted healthcare at Gundersen: “It is exciting to be a member of an organization that was forward thinking when founded and continues to be unique today,” Dr. McMullen shared.

WCHQ Maternal Health Improvement Team Recognizes Maternal Health Awareness Day January 23

In recognition of Maternal Health Awareness Day, January 23, 2024, it is important to bring awareness to maternal health disparities and challenges, not only at the local and state levels, but nationally. For example:

  • The United States has the highest maternal mortality rate amongst 11 other developed countries. The Commonwealth Fund published a report that determined the undersupply of maternity care providers and no guaranteed access to provider visits contributes to maternal mortality.  
  • The November 2023 Wisconsin Maternal Mortality Review Team report found that 90% of the maternal deaths reviewed could have been prevented. The types of severe maternal morbidities that most often occur include: cardiovascular condition, hemorrhage, substance use disorder and mental health disorders. These morbidities can occur during a delivery or up to one year postpartum.  
  • According to the Wisconsin Department of Health Services, severe maternal morbidity rates in our state were highest for women younger than 20 years old, women 35 years of age and older and non-Hispanic Black women. Racial and socioeconomic disparities contribute to this issue.

WCHQ member health systems and community partners have invested time and resources to reduce maternal health disparities in Wisconsin as part of the Maternal Health Improvement Team. The team is using data to identify pregnant populations across Wisconsin that are in the most need of improvement, particularly in areas of chronic disease that can increase maternal risks.  

“The team provides a wealth of resources by providing input from other organizations providing prenatal care and allowing us to learn from each other,” said improvement team member Janet Letter, MSN, RNC-OB, C-EFM, Team Leader at Bellin Kress Birthing Center.  

The Maternal Health Improvement Team is currently developing a maternal health toolkit.  The purpose of this maternal health toolkit is to provide resources and guidance to healthcare professionals, empowering them to deliver optimal care and support to all expectant mothers, ultimately enhancing maternal well-being and reducing maternal morbidity and mortality rates. Together, we can strive for equitable maternal health outcomes, ensuring the well-being of mothers and future generations.

If you are interested in learning more about the work WCHQ is doing on maternal morbidity and mortality, contact Lori Bue.

WCHQ Primary Care Toolkit on Obesity Offers Resources to Providers

In the face of a global obesity epidemic, medical education and training are evolving to equip healthcare professionals with the tools to address this complex health issue.  One such initiative is the development of the WCHQ Primary Care Obesity Toolkit.  This toolkit is now available to healthcare providers to enhance the understanding, assessment and treatment of obesity in primary care settings.  The toolkit is located on our website, wchq.org.

Obesity has emerged as a significant public health concern with prevalence rising both nationally and in Wisconsin.  Recognizing the multifaceted nature of obesity on overall health, educators at the Medical College of Wisconsin (MCW) have developed a training for second year medical students and the training will include the use of the WCHQ Primary Care Obesity Toolkit.  

Additionally, national physician organizations such as America’s Physician Groups (APG) has shared the toolkit on their resource page so that physicians nationwide can use this resource to better understand and treat their patients with obesity.

The toolkit features information on:

  • How to talk to patients about obesity using people first language.
  • Lifestyle factors that are important in facilitating weight loss.
  • Patient care plans including medications and surgical options.
  • Clinical operations including billing and coding.
  • Myths about obesity.
  • Resources for patients.

As the prevalence of obesity continues to rise, initiatives like the WCHQ Primary Care Obesity Toolkit play a pivotal role in equipping the next generation of healthcare professionals with the knowledge and skills to address this issue.

If you would like to participate in the improvement team work WCHQ is doing on obesity, contact Jen Koberstein.

Meeting Patients Where They Are Increases Vaccinations

WCHQ recently hosted the webinar, “Navigating Immunizations: Meeting Patients Where They Are.” Participants heard innovative ways organizations across the state have increased health equity and immunization rates for children and adolescents in Wisconsin. In Wisconsin, there are significant disparities in childhood vaccinations by race, with Black and American Indian/Alaska Native children experiencing much lower vaccination rates.

Brian Stamm, BA, MPH, Vice Chair of Dane County Immunization Coalition, shared an example of a back to school vaccination event conducted with community partners. Over 150 vaccines were given to children, with over half of these students from the Black community.  The community rallied to provide vaccines, education, haircuts, school supplies, and even shoe vouchers.  Brian reported, “the success of a community-based health event depends on creating close relationships and partnerships within that community.”

Raj Naik, MD, FAAP, CMIO, with Gundersen Health System and Co-chair of Immunize Wisconsin’s Advisory Council shared strategies to identify and overcome barriers for those hesitant to receive vaccines. He highlighted the need to distinguish types of bad information, described the three C’s (confidence, complacency, and convenience) of vaccine hesitancy, identified the three categories (safety, necessity of the vaccine and freedom of choice) of concerns that lead to vaccine refusal and demonstrated communication techniques to help overcome vaccine hesitancy.  Dr. Naik informed the audience, “How we communicate is as important as what we communicate.”  

Mariana Savela, BA, Program Manager and Sheng Khang, BS, Community Health Worker from the Hmong & Hispanic Communication Network Project (H2N) shared several models of how they meet the patients where they are. The organization hosts community events, provides trainings and goes to workplaces such as farms and industries to bring services and education to the patients.  H2N’s communication model relies heavily on the community health workers, who are “trusted messengers and community experts” within the communities they are serving.  H2N initiated pop-up, mobile vaccine clinics in December of 2020 and provided over free influenza and COVID-19 vaccines.

Bayfield County Public Health presented to attendees about their Wellness Wheels.  The department implemented a mobile clinic that has been taken to community centers, polling locations, churches, community events, farmers markets and festivals for the purpose of reconnecting the communities with the department’s programs.  

This webinar provided examples of the efforts happening around Wisconsin with the focus of meeting patients where they are and taking education and services to them. If you are interested in learning more about how WCHQ is partnering with its members and community partners to increase immunization rates across Wisconsin, please contact Lori Bue.

Don’t Miss the Opportunity to Increase HPV Vaccination in Your System!

WCHQ invites member systems to improve HPV vaccine communication and increase vaccination rates in adolescent patients. Three systems participated in the project in 2023. Several other systems are signing up now! Don’t miss your chance to join for 2024.

January is Cervical Cancer Awareness Month. In 2023, approximately 13,960 people were diagnosed with cervical cancer and 4,310 people died from the disease (source: National Cancer Institute.)

Increasing the rates of cancer-preventing vaccines is a goal of the 2020-2030 Wisconsin Cancer Plan. HPV vaccine is an important cancer prevention tool because it can prevent six different cancers, including cervical cancer. The vaccine is recommended for 11–12-year-olds and can start as young as age 9. Yet, among 11–12-year-olds in Wisconsin the rate of HPV vaccine initiation has decreased slightly in each of the last four years, from 41.5% in 2019 to 39.6% in 2022.

Source: Wisconsin Cancer Collaborative; September 26, 2023

Participating primary care clinics will receive a 1-hour CME/CNE evidence-based communication workshop called The Announcement Approach Training. Benefits of the training include:

  • The training has been shown to increase HPV vaccination by five percentage points.
  • In a randomized controlled trial, participating providers reported that the time it took them to recommend the HPV vaccine was reduced by about 20% after the training.
  • Providers also reported greater confidence in addressing parents’ concerns when discussing HPV vaccine, that the communication strategy taught in the training was easy to use, and that the strategy helped them promote HPV vaccination as a part of routine adolescent care.

The Announcement Approach Training workshop is for all clinical staff who have a role in adolescent vaccination. Workshops will be held in the spring and early summer 2024. 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 National Cancer Institute.

Recovery Stories

Navigating health disparities, racism, and stigma to get mental health access

WCHQ has partnered with the Medical College of Wisconsin to increase access to behavioral health services for patients with Medicaid. Together, the partners have produced portraits of people living with mental illness to provide brief glimpses into the experience of navigating the US health system as Medicaid recipients. Patients share their stories of seeking care, engagement with clinicians, therapeutic treatment, peer support, and recovery. The 3-minute personal vignettes point to the impact of social-cultural and institutional determinants of health and the resilience it takes to access care and get better. The portraits are being used in healthcare systems, allied health and medical education training to better understand the patient’s perspective in accessing and receiving care.

Peggy – “Words Matter”
Are we perpetuating or challenging stigma?

Peggy talks about how the language around mental health has changed over the decades. She critically challenges whether the well-intentioned attempts at destigmatizing mental illness through patient centered terms are really beneficial. Peggy deconstructs “recovery” and “mental health consumer” in thought-provoking ways.

Possible topics for discussion: stigma, language, and generational differences

Thank to Our WCHQ Partners for Their Support of Our Work


Novo Nordisk







AboutHealth • The Alliance • Alliance of Health Insurers (AHI)

Bayer • Business Health Care Group • Epic • Exact Sciences

GSK • Health Payment Systems • MetaStar • Moderna

Otsuka • Pfizer • Rogers Behavioral Health

Sanofi • WellStack • Wipfli • Wisconsin Hospital Association