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

WCHQ partnered with the Medical College of Wisconsin on a project funded by Advancing a Healthier Wisconsin to increase access to behavioral health services for patients with Medicaid. As part of this project, patients tell the stories of their experience receiving services. WCHQ will feature these stories in upcoming newsletter.

These contemporary portraits of people living with mental illness provide brief glimpses into the experience of navigating the US health system as Medicaid recipients. They 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 on health, and the resilience it takes to access care and get better.   
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Peggy – “The Power of Diagnosis” 
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Peggy illustrates how diagnosis can collect in one’s medical record. She conveys the difficulty of not only removing diagnoses when they are no longer relevant, but also the challenge of which one to work with in any given moment. Which one is valid? How does one understand themselves when they have multiple diagnoses over a lifetime of inpatient and outpatient care? 

Possible topics for discussion: Overdiagnosis, illness identity, self-advocacy, the danger of labels.

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Asthma 

Asthma Guidelines for Health Care Professionals Coming August 2023!

The American Lung Association will be releasing a new asthma resource. The Asthma Guidelines for Health Care Professionals training will be a free one-hour course providing the latest information on asthma diagnosis, treatment, and management including SMART therapy and severe asthma. Those who complete the course will earn one CME. Information will be provided at lung.org.

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Behavioral Health 

Behavioral Health Training Opportunity

In collaboration with Mental Health American, the Behavioral Health Training Partnership at the University of Wisconsin – Green Bay is offering training on suicide risk assessment best practices. There are several training opportunities available, offered both in person and virtually.  

Suicide Care Trainings - Trainings - Behavioral Health Training Partnership - UW-Green Bay

Chronic Disease

Chronic Disease Learning Collaborative Member Success Story:
Marshfield Clinic

The Chronic Disease Learning Collaborative met on January 30, to share their improvement goals and outcomes in a poster presentation format. Aspirus Health Care, Associated Physicians, Gundersen Health System, Marshfield Clinic Health System (3), Prevea Health and Primary Care Associates of Appleton shared their improvement goals and the work they are doing in their health systems. One year ago, each team member set a chronic disease improvement goal unique to their health system.

With a goal to improve outcomes and reduce hospitalizations for patients with diabetes, Marshfield Clinic shared data on their project; which was a pharmacist-led comprehensive medication management review for patients with diabetes in rural health care settings. This project works with the patient populations of five providers. 

The comprehensive medication review focuses on assessment and problem-solving around:

• Medication adherence and challenges to medication adherence
• Side effects of medications
• Cost and other barriers to obtaining medications

Pharmacists identified patients with an HbA1c greater than eight. They then provided outreach explaining the program and how the program can support the patient’s diabetes management. Once a patient enrolls, the pharmacist provides the assessment and interventions over the phone, along with recommendations to providers to help to optimize the treatment plan. These recommendations are sometimes also based on decreasing barriers to obtaining and taking medications (i.e.: changing a medication due to patient cost). 

Since 2019, there have been 233 patients enrolled in the program. From May 2022 through October 2022, 49 patients were evaluated, 80% of patients had a measured improvement in HbA1c with a median decrease of 1.3%. Given these significant improvements for patients, Marshfield Clinic will continue to work toward this project’s sustainability and expansion.  

If you are interested in this work, please reach out to Renee Sutkay.

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Chronic Kidney Disease

‍Education in the Early Detection and Treatment of Chronic Kidney Disease      

Member health systems met twice in June to put the final touches on a full-day education event aimed at early detection and treatment of chronic kidney disease (CKD). The event will be held at the Heidel House Resort in Green Lake on September 26 and is open to all members. There is no fee. More information can be found on the WCHQ website.

A sub-group of the committee met to begin development of a CKD toolkit. The toolkit is aimed at giving primary care providers easy to access information on screening and treatment for CKD. We expect the toolkit to be launched on the WCHQ website in the fall.  

For more information on CKD, contact Jen Koberstein.

Colorectal Cancer Screening

Wisconsin Cancer Collaborative Reviews Wisconsin County Cancer Profiles

The Colorectal Cancer (CRC) Screening Advisory Group met in June to continue its work toward the goal of 80% of eligible patients screened for CRC in every community. The advisory group meets monthly on the second Friday of the month at 1 pm.

The group met in June with a presentation from the Wisconsin Cancer Collaborative reviewing the updated 2023 Wisconsin Cancer County Profiles and gave a sneak peek at the interactive dashboard that will be released soon. These profiles show cancer incidence and mortality rates, along with a host of social determinants of health information, including rates of alcohol use, obesity, poverty, food insecurity, location to parks, and unemployment. Take a look at the county-by-county information and the interactive data dashboard on the Collaborative’s website.

The advisory group is exploring health systems’ biggest challenges and barriers to increasing screening for rural populations. These challenges include: nuances of insurance coverage, transportation, and cultural barriers. The group will review disparities data during the August meeting. Participating health systems will then identify interventions and set goals for increasing screening rates.

If you are interested in joining the advisory team, please reach out to Renee Sutkay.

Disparities

Health Disparities Team Begins Dissemination of Findings

Over the last 12 months, WCHQ and The Health Innovation Program (HIP) at the University of Wisconsin – Madison have been working with the nine health systems that make up the WCHQ Health Disparities Improvement Team. WCHQ and HIP have collected data about quality improvement and disparity reduction strategies. As a result, thirteen evidence-based strategies have been identified to reduce disparities and 19 quality improvement strategies have also been identified.  

The Health Disparities Improvement Team met in June and began to review the participating health systems’ findings and talk about how their improvement projects to reduce disparities are progressing.

Each health system on the improvement team has done the following:

• Identified a specific population/community they want to support in improved outcomes
• Identified a quality measure affecting the community they chose to support
• Begun documenting quality improvement and disparity reduction interventions that are in place
• Begun documenting quality improvement and disparity reduction interventions they plan to implement

Here is an example:

• Priority: Blood pressure control for African American community and patients with Medicaid insurance
• Example Interventions: Addressing barriers to access, addressing financial barriers, care located and available at convenient location and hours in the community, cultural competency training for staff

During the meeting, health system partners began to discuss their goals and began to give feedback on what is working in their health system and what is not working. 

For the second part of the meeting, Network Health (co-owned by Froedtert Health and the Medical College of Wisconsin and Ascension) staff Nancy Weber, Clinical Integration Program Manager, and Amber Smits, Quality Revenue and Health Equity Program Manager, presented their work on disparities improvement. Network Health has put together a Health Equity Steering Committee working on regulatory requirements related to health equity, CMS star ratings related to health equity and diversity and inclusion and social justice. Weber and Smits discussed the importance of this work within their organization to identify at risk patients, work with clinics, and improve outcomes for members. 

For more information about the work WCHQ is doing on disparities, contact Renee Sutkay.

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Lung Cancer Biomarker‍

Lung Cancer Biomarker Testing Advisory Group Holds Kickoff Meeting

The advisory group for the Lung Cancer Biomarker Testing project had their kickoff meeting on Friday, June 24, 2023.  The goal and objectives of the project were reviewed and the group established a charter that will direct the work of the group.  

The first action item is to develop and disseminate a survey to Wisconsin health systems seeking information about their biomarker testing processes, such as who orders the test, is it a send out or performed in-house, how are the results captured in the system’s EHR, etc.  

The survey will be distributed in the fall of 2023 and results will provide a picture of the current state of biomarker testing for lung cancer across the health systems. This advisory group has monthly meetings and would welcome additional participation.  

If you are interested in learning more about this project, or to participate, please contact Lori Bue.

Maternal Health

Caring for Mom and Baby Doesn’t Stop Once Discharged

Dr. Jasmine Zapata, co-chair of Wisconsin’s Maternal Mortality and Morbidity Review Team (MMRT), spoke at the Maternal Health Improvement Team meeting in July. She shared some alarming statistics from the work done by her team at the Wisconsin Department of Health Services (DHS).  

Dr. Zapata shared that 97% of all pregnancy-related deaths in Wisconsin reviewed by this team could have been prevented and 73% of those deaths occurred postpartum. The MMRT follows deaths that happen during, after and up to one year postpartum in Wisconsin. MMRT does a full medical record review on each case to understand not just what happened, but what contributed to the death. From this review, MMRT comes up with recommendations for how this death could have been prevented.  

In the coming months, the WCHQ Maternal Health Improvement Team will be reviewing measures that focus on the pregnant population in areas such as hypertension, obesity and depression screening. The group will also review health disparities of this population. This work will identify areas of opportunity to help improve the health of pregnant women during and following delivery. 

If you are interested in learning more about this project, or to participate, please contact Lori Bue.

Obesity

Obesity Education and Measurement are Priorities for Members  

The Obesity Advisory Group met on June 21 and continued discussion of the Obesity Prediabetes and Diabetes HbA1c Control measure. The current HbA1c levels in the measure are 6.5 for prediabetes and 8.0 for diabetes. The group decided to change the 8.0 to 7.0 to align with the American Diabetes Association recommendation that the goal for most adults with diabetes is an A1C that is less than 7%. The WCHQ measurement team will adjust this measure, produce new results for the group and discuss with the Measurement Advisory Committee (MAC) to determine if any changes should be made to other measures.   

The group then went on to discuss new obesity measures the Obesity Advisory Group member health systems would like to build this year. The group decided to proceed with the following measures:

• Blood pressure control and obesity
• Obesity Diagnosis

An informal look at the WCHQ data set showed that less than 10% of patients are being diagnosed with obesity. This leaves a lot of room for improvement and education about the importance of diagnosing patients appropriately. The WCHQ Obesity toolkit, which can provide resources to primary care providers, can be found on the WCHQ website. 

WCHQ continues to receive feedback on the obesity toolkit from members and the community. The group will frequently review changes and make updates to the toolkit as appropriate.

The Obesity Summit is scheduled at the Sheraton Hotel in Madison on September 13, 2023. Information about the event and registration can be found on the WCHQ website. 

For information about our Obesity Advisory Group, contact Jen Koberstein.