WCHQ Quality and Value Improvement Event Focuses on Key Priorities

The WCHQ Quality and Value Improvement Event and Diabetes Summit is an opportunity to learn how health systems both in and outside of Wisconsin are improving care for patients with obesity, diabetes and hypertension. The care of patients with diabetes and hypertension are of particular importance because of the link these chronic diseases have with other more serious conditions, such as chronic kidney disease.

The graphs below illustrate the early impact the pandemic had on health indicators related to blood pressure and A1C control. 

‍

In June 2020, WCHQ observed decreases in both the hypertension rate and A1c control measures. While diabetes A1c control is generally cyclical in nature and dips during the June reporting period, the drop is now below historic lows. Hypertension control has consistently topped 82 percent for 5 years, but it also decreased in June 2020.

The decrease in the hypertension and diabetes control rates could be attributed to one or both of the following:

• Early in the pandemic, the patients seen were likely those that required complex care and monitoring for chronic conditions.
• The number of patients who were seen in the clinic during the early months of the pandemic dropped, therefore reflecting fewer patients that required more care and were more likely to have been adversely impacted by avoiding or not being able to schedule clinic visits.
• WCHQ measures require two patient visits to be eligible for the measure, which also lowers the denominator and magnifies the effects of the previous bullets.

“We know the pandemic has had an impact on patient care. With data starting to come in, we are now able to begin to quantify the impacts and use that data to develop interventions that will not only help us regain the ground we lost but also attain better performance than we had in the past,” according to Gabrielle Rude, PhD, WCHQ President and CEO.

Thanks in large part to the direction of WCHQ’s Board of Directors, WCHQ will resume its normal public reporting cadence in July 2022 with data from January 1 – December 31, 2021.

“We are anxious to resume public reporting to its normal cycle starting with calendar year 2021. This will allow us to more completely assess the pandemic impact. We are aware through news stories and conversations with providers that many patients opted to delay care due to Covid. What we don’t know yet, but will soon learn, is the extent to which those factors impacted the state of Wisconsin in general and our members more specifically,” shared Brian Slattery, WCHQ’s Director of Performance Measurement and Analytics. “We will be closely monitoring performance across the membership to determine the specific health conditions, geographies and socio-economic situations that felt the greatest impact and will quickly begin translating those results into action to help shore-up the areas that were most negatively affected.”

Attestations for public reporting are due from each member by 6/30/2022. Results will be posted on WCHQ.org in July. Contact Brian Slattery for more information.

WCHQ is in the process of adding a position to the Measurement Team. The Data Analyst will support organization-wide projects and initiatives related to performance measurement and analytics, quality improvement, research and other shared initiatives that support improved health, better care and value initiatives.  

“WCHQ members trust us to collect data and run performance reports that informs their internal improvement activities. We’ve been able to use this information to help drive evidence-based improvements in quality on a statewide level, too” said Brian Slattery, Director of Performance Measurement and Analytics. “That said, I think we’ve only scratched the surface in terms of the value that we can provide to the membership. By investing in this additional data analyst position, we will have additional capacity that will allow us to more quickly deliver data that will help us be better informed and able to resolve some of the issues that are most pressing to our members and funders.”

Click here for information or to apply for the job.

WCHQ was pleased to welcome Katharine A. R. Price, MD, to present at a webinar May 5 on strategies to increase HPV vaccination rates in Wisconsin. Dr. Price reviewed the indications, benefits, and safety of the vaccine. She summarized the vaccination rates and discussed health disparities related to HPV vaccination rates. Dr. Price went into detail about how to increase HPV vaccination rates while discussing barriers and how to overcome them.  

As an oncology surgeon, Dr. Price noted that 70 percent of the cancers she treats are preventable. The treatment of HPV head and neck cancer includes surgery, radiation therapy and chemotherapy. The short- and long-term toxicity from head and neck cancer treatment is substantial. These cancers cause unnecessary suffering and loss of life for men and women, young and old.  

Dr. Price discussed the ability of the HPV vaccination to prevent cervical, vulvar, anal and vaginal cancers.

“The most critical disparity to address in HPV vaccination is the rural-urban divide,” according to Dr. Price. The WCHQ 2020 Health Disparities Report supported this, finding substantial disparities in HPS vaccination rates in rural advantaged areas of the state.

Dr. Price reviewed the CDC recommendations for HPV vaccinations, which included:

• Recommended age for HPV vaccination is 11-26 years old;
• HPV vaccination is recommended for all preteens (including girls and boys) at age 11–12 years;
• Can start series at age 9;
• Ideal timing is before initiation of sexual activity;
• FDA approval is through age 45; and,
• Individuals ages 27-45 may benefit from HPV vaccination based on risk.

A WCHQ member comment after the webinar sums up the effectiveness of Dr. Price’s presentation: “No question, I would love to take you on tour to promote this message!”

A recording of the presentation is HERE. Use Passcode: w?jr8ND2 (meeting starts at 08:00)

Precision medicine is rapidly evolving the treatment landscape creating opportunities to improve care and mortality rates for patients diagnosed with cancer. On May 19, WCHQ presented an online seminar, “Revolutionizing Health Improvement and Disease Treatment,” that explained how biomarkers are used in the field of oncology to ensure a proper diagnosis and to guide treatment.

Dorothy 'Dot' Guccione, RN, senior biomarker testing executive with Genentech, identified some of the gaps in cancer diagnosis as:

• Lack of clarity around test selection and results interpretation;
• Lack of clear processes for collecting sufficient amounts of tissue and ordering tests;
• Lack of clear processes for choosing labs and ordering tests;
• Uncertainty around diagnosis access, reimbursement and inefficient prior authorization process.

Better diagnostics play a role in delivering better outcomes and a better patient experience. This point was illustrated by Alecia Mandal, a colon cancer patient who found she qualified for immunotherapy after biomarker testing.

“When your patients come into the primary care clinic, please hook them up with biomarker testing,” said Ms. Mandel. “I am here, I am alive because of immunotherapy and biomarker testing.”

“As her GI medical oncologist, before we knew about biomarker testing, I will say it would not have been possible for Alecia to be in the health state where she currently is,” according to Sheetal Kircher, MD Associate professor at Robert H. Lurie Comprehensive Cancer Center, Northwestern University.

Dr. Kircher said first line cancer therapy can be time sensitive and it depends on knowing the results of the biomarker testing. She said some health systems are starting initiatives to order biomarker testing in the primary care office so the results are available at the first visit the patient has with the oncology specialist.

Clinical trials have evolved as well, according to Dr. Kircher, no longer being the “last resort” but rather the first line of therapy using biomarkers to guide treatment.

“It takes a village to put this together. There are so many people the cancer patient depends on that they may not meet, but it comes down to working together and not having unnecessary delays in accessing treatment,” Guccione concluded.

Listen to the webinar HERE using this access code: 6+UjC*C0

Obesity

WCHQ Unveils Results of Obesity Prevalence Measure  

WCHQ Obesity Advisory Group members agreed to begin measuring the prevalence of obesity in health systems. The measure specification includes patients who have either:

• a BMI < 30 or
• a BMI < 27 for patients of Asian descent or those with certain co-morbidities.

The obesity prevalence rate across the WCHQ health systems reporting this measure through December of 2020 is 58 percent. This rate is higher than what is typically reported from other sources, such as the Wisconsin Department of Health, because it requires two primary care visits to qualify. Our assumption is that the two-visit requirement coupled with the impact of Covid on our measurement period drove up the reported obesity prevalence rate as patients who qualified for the denominator were likely those who had co-morbidities that required a visit. The high percentage of those with the disease of obesity reinforces the work WCHQ is doing on obesity to drive improvement. WCHQ members requested additional data including how many of these patients are on medications that increase weight, the number of patients on anti-obesity medications, and geography, payer, race, and ethnicity. The Advisory Group will meet in July to begin to develop quality improvement activities.

The Obesity Advisory Group is participating in an upcoming training on obesity for employers. The Alliance, along with WCHQ, M3 and Health Payment Systems, are sponsoring an educational event that includes obesity providers, psychologists and employers. This learning event is focused on the impact that obesity has on people in their work environment. Register for this free event here.

To learn more about the Obesity Advisory Group, contact Jen Koberstein.

Disparities

Health Systems Share Goals for Reducing Disparities

Health systems shared their individual goals for improving disparities at the May Improvement Team meeting. Each health system participating in the Disparities Improvement Team will select a measure, priority population and goal to improve health equity. These goals vary based on the populations served, location, resources and systems. One health system has identified data collection as a goal, citing the need to ensure that data on race, ethnicity, and social determinants of health are consistently and accurately captured. Another health system has set a goal to close the disparities gap in colorectal cancer and breast cancer screenings between people of color and white populations. See recent article on this topic HERE.

In addition to discussing improvement goals, the team also reviewed updated disparities data from 2019 and 2020. The team reviewed statewide, stratified data on diabetes testing and control, hypertension control, and colorectal cancer screening by geography and race/ethnicity. These data, which describe the impact of the first year of the COVID-19 pandemic on health disparities, will be published in a series of brief reports at the end of June.

To participate in the Disparities Improvement Team, contact Abbey Harburn.

Chronic Disease

Chronic Kidney Disease Advisory Group Continues to Define Scope, Recruit Health Systems

A subcommittee of the Chronic Kidney Disease (CKD) Advisory Group met in May to further discuss the opportunity to look beyond patients with diabetes and to consider including additional populations at risk of developing chronic kidney disease. There was robust discussion and by the end of the meeting, the group was confident with their recommendations and next steps. Their recommendations encouraged an evidence-based approach that could be supported through measure development and educational opportunities.

Sarang Baman, MD, Advocate Aurora, will bring the subcommittee’s recommendations to the Advisory group at the June 2, 2022, CKD Advisory Group meeting. This information will segue into finalizing the CKD Advisory Group Charter.

WCHQ is actively recruiting members to create a diverse level of expertise to support this work. To learn more about this work or to join the CKD Advisory Group, contact Sheryl Pierce.

Chronic Disease Learning Collaborative (CDLC) Hypertension Workgroup

Korina Hendricks, MPH from University Wisconsin Madison Health Innovation Program, Neighborhood Health Partnership (NHP) Program, presented at the May meeting of the Chronic Disease Learning Collaborative. In addition to the measurement data reporting tools that utilize WCHQ measures, the NHP recently added sociodemographic profile reporting capabilities that utilize US Census Bureau data. Both tools provide powerful data that can be turned into actionable improvement efforts. For additional information, visit the Neighborhood Health Partnership Program.

The group discussed current hypertension initiatives and a number of members reported progress related to their hypertension SMART goals. Overall, the group seemed optimistic about current progress while noting a few new obstacles along the way as sometimes resources needed to be reallocated. Whether seeking new resources or retaining current resources, demonstrating a return on investment appears to be an important part of the equation to support improvement efforts worked on by care management staff. This topic will be explored further at upcoming meetings.

The CDLC Hypertension workgroup will continue to meet this year to share best practices and work toward goals with a final presentation in January 2023. The final presentations will summarize SMART goal accomplishments and lessons learned from the members of the CDLC Hypertension, Diabetes, and Team-Based Care workgroups.  

To join or to learn more about the CDLC Hypertension workgroup, contact Sheryl Pierce.

Behavioral Health

Emphasis on Behavioral Health Continues

The pandemic has significantly increased the demand for behavioral health services. WCHQ members continue to review data from the depression screening, PHQ-9, and depression remission and response measures. While health systems have dramatically improved their rates for depression screening, more progress could be made. At the next few improvement team meetings, the group will hear from high performers on each measure in the coming months to hear what they have implemented to increase their scores.  

In May, the behavioral health team met with WCHQ staff to learn more about the disparities work being led by WCHQ. Members want to more thoroughly understand where disparities are occurring related to depression screening, remission and response.  WCHQ will provide members disparities-related data on over the next several months. The group discussed the need to ensure that patients have access to services and are not encountering barriers, such as long wait times for an appointment. The group members will work with WCHQ to determine what metrics could be useful in assessing progress on that issue.  

To join this improvement team or learn more about behavioral health initiatives at WCHQ, contact Jen Koberstein.

Adolescent and Child Health

Depression in Adolescents: A Growing Concern

Adolescents face incredible pressures during normal times and the addition of the pandemic added to the burden teens were already facing at home and in school. In 2021, the US Attorney General issued an advisory calling on the American people to pay attention to the urgent public health issue related to children’s mental health and released recommendations. The recommendations include health systems surrounding young people with resources to address mental health issues. It also suggests the need to focus on underserved populations.  

WCHQ members continue to monitor the rates of depression screening within the health systems and learn from those who are screening high numbers of adolescents.  Additionally, those diagnosed with dysthymia or depression received PHQ-9 screening and these rates are monitored and action is taken to improve follow-up. WCHQ members were pleased to see that PHQ-9 screening rates for adolescents went up during the pandemic from forty-eight to forty-nine percent. This was largely due to the systems’ ability to pivot to virtual services when the pandemic hit.  

The Adolescent and Child Health and Behavioral Health Improvement Teams will continue to spotlight the importance of adolescent and child behavioral health screening, services, and access. For more information, contact Abbey Harburn.

Oral Health

June is National Oral Health Month        

Many of the WCHQ oral health providers recite the phrase, “the mouth is part of the body.” The WCHQ Oral Health Collaborative and its partners are committed to ensuring the integration of medical and oral health. Oral health is often not part of the initial discussion about health, which causes issues downstream for the patient and their providers.

June is National Oral Health Month and here are a few reminders of the importance that oral health has on overall health:  

Diabetes significantly raises the risk of developing gum disease and regular appointments with the dentist can help address this issue quickly. Patients with diabetes are three times as likely to develop periodontitis which negatively impacts HbA1c control.

Periodontal disease among pregnant women is known to contribute to adverse birth outcomes, including low birthweight and preterm birth. WCHQ oral health members contributed earlier this year to a perinatal resource tool to ensure that oral health is included in considerations.

Most recently, the Journal of Clinical Periodontology published an article drawing conclusions about the connection between COVID-19 and gum disease. This is emerging work that the oral health members will continue to monitor.

The WCHQ Oral Health Collaborative members understand the importance of medical and dental integration and have aligned the oral health work with the WCHQ medical side to prioritize patients who have diabetes. A cross-cutting dental-medical diabetes measure will be publicly reported in the fall of 2022.

For information about the WCHQ Oral Health Collaborative, contact Jen Koberstein.‍