July 2021

President's Column

Gabrielle Rude, PhD
WCHQ President and CEO

The WCHQ Board of Directors met in July with a primary focus on discussing our collective commitment to improving health care value. I began the meeting by reminding the Board that WCHQ, since its inception, has utilized a multi-stakeholder governance model. Effective problem solving involves the inclusion of diverse perspectives to truly identify and address the root cause. Our work to improve health care value certainly requires such a strategy.

The WCHQ Board engaged in a robust discussion regarding how to measure and improve health care value. There was uniform support for WCHQ to continue this work. Members reflected on the success Wisconsin has had in improving quality and suggested that we follow a similar path on value. It was noted that WCHQ’s focus is on improving the care delivered by health systems and we have had success by utilizing the collective wisdom of those who provide that care in both our measures and improvement strategies.

Several board members mentioned that value is more than cost divided by quality and should also include measures such as patient experience and affordability. Our September Board retreat will continue this discussion and ask our members to help us identify new strategies and data sources to measure value. I look forward to a robust dialogue that will guide our organization as we work with our members, payers, and stakeholders to improve the value of health care in our region.

Consistent with our multi-stakeholder approach, I’m pleased to welcome our newest corporate member, Myriad/Genesight. MyriadGenetics is a leader in genetic testing and precision medicine, focused on advancing women’s health and answering questions related to oncology treatment decisions.

WCHQ Receives AHW, WPP Funding for Disparities

The Medical College of Wisconsin (MCW) and the UW School of Medicine and Public Health are partnering on an initiative to improve health equity in Wisconsin. MCW’s Advancing a Healthier Wisconsin Endowment (AHW) and the UW's Wisconsin Partnership Program (WPP), statewide health funders based at Wisconsin’s two medical schools, have announced a joint three-year, $3 million grant to launch an expansive new statewide partnership that will study, measure, and recommend solutions for health inequities across the state of Wisconsin.

The long-term goal of the project is to reduce health disparities and improve health in Wisconsin by partnering academic institutions with health systems, payers, and communities to build sustainable systems that measure, monitor, and reduce disparities through best practices and evidence-based innovations.

“WCHQ’s role in this new partnership is to provide data, assist in conducting analyses and writing reports, and to facilitate a statewide improvement team focused on identifying strategies to improve health equity and reduce gaps in care,” according to WCHQ President and CEO Gabrielle Rude, Ph.D. “The WCHQ Improvement Team will serve an important role in identifying best practices to reduce health disparities and monitoring related data.”

With rising health inequities, it is critical to understand where health disparities exist so targeted interventions can be developed to eliminate them. This project will allow collaborators to leverage existing statewide data on a wide range of clinical and health care topics from participating health systems and health insurers as well as geographic data to develop reports and action tools aimed at improving health outcomes statewide. The information will help researchers identify and understand where gaps in care exist. Examples could include identifying areas and populations that can benefit by focusing on maintaining healthy blood pressure, colorectal cancer screening, or depression screenings during pregnancy. The data will inform interventions and recommendations for improvement.

“This new collaboration brings tremendous synergy and capacity to extend the reach of both WPP and AHW across our state. We anticipate benefits to people in both rural and urban areas because we know that disparities exist in multiple settings in Wisconsin and have deepened even more because of the pandemic,” said Richard Moss, PhD, Senior Associate Dean at the UW School of Medicine and Public Health and chair of WPP’s Partnership Education and Research Committee.

The grant will support researchers at the two medical schools in partnering with the Marshfield Clinic Research Institute, the Wisconsin Collaborative for Healthcare Quality, a membership organization comprised of 35 health systems, over 300 medical clinics and more than 200 dentists, and the Wisconsin Health Information Organization, a consortium of 20 health insurers.

“By supporting a collaboration of this magnitude — between academic centers, health systems, and payers — we aim to bring forward new solutions that will reduce inequities in health and positively impact those who have been underserved and marginalized,” said Jesse M. Ehrenfeld, MD, MPH, director of the Advancing a Healthier Wisconsin Endowment and senior associate dean at the Medical College of Wisconsin.

Under this new partnership, a team led by Maureen Smith, MD, PhD, MPH, Professor of Population Health Sciences and Family Medicine and Community Health at the UW School of Medicine and Public Health and Joan M. Neuner, MD, MPH, Professor of Medicine at the Medical College of Wisconsin, and will bring diverse areas of expertise in health equity, health services, health system data, epidemiology, and rural and urban health to rapidly translate data and findings into solutions aiming to transform how people experience healthcare and, ultimately improve health outcomes in Wisconsin.

For more information on the project or to join the WCHQ Disparities Improvement Team, contact Abbey Harburn.

AHW Funds WCHQ Integrated Behavioral Health Initiative

WCHQ members will soon start to work on a project aimed at increasing integrated behavioral health (IBH) in primary care clinics throughout Wisconsin, thanks to a grant funded by Advancing a Healthier Wisconsin (AHW). The AHW Endowment was established by the Medical College of Wisconsin in 2004 to receive a portion of the charitable funds from the conversion of Blue Cross & Blue Shield United of Wisconsin from a nonprofit organization to a for-profit corporation. 

WCHQ has initially recruited Bellin Health, Marshfield Clinic Health System, Primary Care Associates of Appleton, UnityPoint Health-Meriter, Fort HealthCare, ProHealthCare, Ascension, and Beloit Health System to participate in this work. These health systems will work together over the next two years to add and increase integrated behavioral health services in their health systems. WCHQ will work with the health systems to share the successes of the project with other Wisconsin health systems.  

Adding IBH in health systems will increase access for the most vulnerable populations and provide equitable evidence-based care. Integrating behavioral health into primary care has proven a successful strategy that decreases the burden on health care, government, and community systems that are already overwhelmed by the need for and demand on mental health services.  

To learn more about this opportunity or to participate in the project, contact Jen Koberstein.

Improvement Teams

Obesity Advisory Group

The Ascension Commitment to Care

Dr. Dirk Steinert and JoDeen Hettenbach, Ascension Wisconsin

WCHQ Ascension members Dirk Steinert, MD and JoDeen Hettenbach presented at the WCHQ-Novo Nordisk Diabetes Summit June 29 on the importance of treating obesity. Dr. Steinert and Hettenbach talked about the prevalence of diabetes in Wisconsin: obesity affects more than 32 percent of Wisconsin residents, ranks 41st in the nation in Type 2 diabetes, with the total cost of obesity in Wisconsin at more than $44 billion.  

Patients have challenges accessing care for obesity including bias in health care, limited clinicians statewide, and payers excluding benefits for treatment. Ascension has made changes recently to improve access to care including increased telehealth visits, expanded payer coverage, increased non-surgical patient visits, and expanded pharmaceutical treatment.

The presentation emphasized the importance of increasing access for people with obesity, measurement opportunities, sharing best practices, and engaging employer solutions and community partnerships.  

If you are interested in participating in the WCHQ Obesity Advisory Group, contact Jen Koberstein.

Adolescent and Child Health

AAP Updates School Guidance

WCHQ’s Adolescent and Child Health Improvement Team continues to address best practices and strategies for addressing the mental health crisis facing children and adolescents as the pandemic persists.

The mental health crisis posed by the COVID-19 pandemic has had a serious impact on children and adolescents. Recent national news coverage highlights the effects of isolation due to remote learning and anxiety due to COVID-19 on children as young as eight years old. A CDC report published in November 2020 found that mental health-related emergency department visits for children aged 5-11 and 12-17 years old increased by 24 percent and 31 percent, respectively when compared with 2019 data.

The American Academy of Pediatrics (AAP) published updated guidance on safely reopening schools and is calling for continued use of masks to keep students both safe and physically present in school. The AAP has recommended that school plans should begin with the goal of keeping students safe and in-person due to the impacts of school closures on health disparities and behavioral health. In their most recent statement, the AAP recommended continued masking for all individuals in schools, regardless of vaccination status, due to the large portion of the student population that is not yet eligible for vaccination. However, the AAP also notes that policies must remain practical, feasible, and developmentally appropriate, while balancing teacher and staff safety. More information on the most up-to-date AAP COVID-19 Guidance for Safe Schools is available here.

To participate in or to learn more about these discussions at WCHQ, contact Abbey Harburn.

Chronic Disease

Chronic Disease Learning Collaborative, Diabetes Workgroup

The Chronic Disease Learning Collaborative (CDLC) continues to be a valuable resource for WCHQ members by sharing relevant topics and educational resources. Over the next 12 months, WCHQ will offer two general CDLC webinars and form three virtual workgroups focused on strategic initiatives supporting diabetes, hypertension, and team-based care that meet on alternating months throughout the year.

On July 26, staff from a combination of 12 WCHQ member health systems and partners joined the first Chronic Disease Learning Collaborative diabetes workgroup in support of developing strong relationships and resources to help each other establish impactful diabetic strategies. This group is tasked with establishing one or more goals that support diabetes self-management education and support programs with an additional opportunity to address health disparities.

The diabetes workgroup began with an introduction from Sheryl Pierce as the new WCHQ quality improvement staff member leading chronic disease efforts. Health systems and partners highlighted their current diabetes initiatives and engaged in discussion topics related to diabetes self-monitoring education and support (DSMES) programs and establishing DSMES- related SMART goals.

Over the next few weeks, individuals from this workgroup will be establishing SMART goals to work on over the next twelve months. Members are encouraged to review their DSMES annual reports for goal ideas. Once goals are established, the group will review them at the October meeting.

Important work- still time to join: the next meeting is October 25, 2021.

Contact Sheryl Pierce if you are interested in joining the Chronic Disease Learning Collaborative (CDLC) or workgroups (diabetes, hypertension, team-based care).

WCHQ CDLC/CDLC Workgroup Schedule 2021-2022.

Oral Health Collaborative

Cultivating Your Smile: How to Maintain Wellbeing During the Pandemic

On July 14, WCHQ sponsored a webinar hosted by the Wisconsin Dental Association and the Minnesota Dental Association presented by Dr. Shilagh Mirgain. The pandemic has brought significant changes to oral health and with it, new stressors. Identifying sources of burnout, building resilience, and tips on fostering well-being while at work were shared and that will help dentists identify how to decrease their own stress within their teams.  

Forty percent of Americans are experiencing stress, depression, anxiety, or substance abuse issues since the onset of the pandemic. Additionally, 53 percent of American adults reported their mental health has been negatively affected by worry and stress due to the pandemic. Pre-pandemic, 40 to 60 percent of health care workers identified as personally being burned out. Many healthcare providers found themselves experiencing additional risk related to increased risk of infection to themselves and their family members, the need to shift operational practices, and changes in PPE expectations.  

The webinar provided excellent tools to combat stress, anxiety, and burnout and techniques were shared on how to increase resilience. Dr. David Kopacz’s the“hero’s journey” framework, was described. The framework helps health care providers understand the process of burnout for those who care for others and stresses the importance of catching stress early to prevent burnout.  

If you are interested in learning more about the WCHQ Oral Health Collaborative contact Jen Koberstein.