The WCHQ May board meeting included discussion of our upcoming value report. The report will identify costs avoided due to quality interventions, as well as more granulated evaluations on clinical interventions and their impact on quality outcomes. This valuable reporting is possible using the data submitted to WCHQ from our member health systems. The board discussion was robust and energetic - WCHQ members are eager to evaluate the long-term impact of their exceptional quality while also continuing to drive improvement.  

Shortly after the board meeting, I saw a commercial for a website that promotes helping patients select a physician. The commercial emphasized how individual and personal the physician-patient relationship is, reminding me of a frequent question we receive around our value work: when will we provide it at the physician level? WCHQ does not publicly report any data at the clinician level, however we do share this data extensively with our members.

Patients select a clinician following several other layers of evaluation, such as insurance coverage, appointment availability, reputation of the health system, etc. The absence of clinical quality on a patient’s list of criteria does not mean it isn’t important to a patient. Rather, when you ask a patient how they pick a doctor, they are thinking about differentiating factors amongst doctors they have already found acceptable. 

The commercial I saw promoted available information on physicians including languages spoken and average patient review and even physician age. I visited the company’s website and before patients can look at these factors the page narrows the physicians by specialty, location and insurance coverage. Patients rely on the system that surrounds their physician relationship to narrow acceptable providers - the insurance network, the reputation of the health system, etc.  

WCHQ’s quality data is not designed to be used by the public to select a physician. It is designed for health systems to identify trends and drive improvement. Health systems look at WCHQ quality results through a myriad of lenses -- by clinic, geography, social determinants of health, etc. to elucidate trends and best practices that can be spread. Our goal with our upcoming value report is to identify system practices that can be spread to others to support the work of their clinicians. This data improves healthcare value from the inside of the health system, providing a solid foundation to layer upon with information that is important to patients when they chose their provider.

Last week, WCHQ released updated public reporting results for quality performance spanning January – December 2022. WCHQ completed a high-level review of the aggregated results from across our publicly reported measures. Below are measures which saw a statistically significant shift:

“It’s always exciting to see how Wisconsin’s health is trending, both positively and negatively,” shared Director of Performance Measurement and Analytics, Brian Slattery. “On the positive side, continued adoption of screenings for clinical depression led to an uptick in performance on this measure and comes at the same time as mental health remain a significant concern.”

Both Diabetes A1C Good Control and the All-or-None Outcome measures also saw statistically significant improvements. Slattery added: “It’s really encouraging to see that the Diabetes All-or-None Outcomes measure was one of the largest positive shifts we saw this reporting period. Members only get credit for this measure if their patients with diabetes meet all five goals within the measure. The fact that this measure improved so significantly is a strong indication that our members are improving upon their already excellent work at managing the diabetic population.”

At the other end of the spectrum, three measures with the largest declines from the last period included: Diabetes eGFR Testing, Cervical Cancer Screening and Childhood Immunizations.

“It’s interesting that two of our diabetes measures would have positive improvement while another would trend downward,” said Slattery. “This could be an item we take back to that improvement team for discussion. Additionally, we have seen childhood immunizations decline for some time. So while this is a concerning trend, it’s not new information. Lastly, Cervical Cancer Screening performance is already a strong focus of WCHQ’s improvement teams, with multiple strategies to address this decline.

WCHQ has multiple workgroups working to address these measures. If you’re interested in joining, please reach out to Abbey Harburn.

Another Member Benefit

On January 1, 2023, the Joint Commission implemented new and revised requirements to reduce health care disparities nationally. Participating in WCHQ’s health disparities work will help member health systems to meet some of the requirements in this Joint Commission standard. Many of WCHQ’s health system members will be required to comply with these standards in 2023.

What’s the new standard?

• It includes a Leadership chapter with six elements of performance.
• These elements address health care disparities as a quality and safety priority.
• The standard also updates the Record of Care, Treatment, and Services requirement to include collecting patient race and ethnicity information.

The Leadership chapter requirements are:

1. The [organization] designates an individual(s) to lead activities to reduce health care disparities for the [organization’s] [patients].
2. The [organization] assesses the [patient’s] health-related social needs and provides information about community resources and support services.
3. The [organization] identifies health care disparities in its [patient] population by stratifying quality and safety data using the sociodemographic characteristics of the [organization’s] [patients].
4. The [organization] develops a written action plan that describes how it will address at least one of the health care disparities identified in its [patient] population.
5. The [organization] acts when it does not achieve or sustain the goal(s) in its action plan to reduce health care disparities.
6. At least annually, the [organization] informs key stakeholders, including leaders, licensed practitioners, and staff, about its progress to reduce identified health care disparities.

How does being a member of WCHQ help us meet this new standard?

WCHQ regularly provides quality measure results stratified by sociodemographic characteristics, including race/ethnicity, geography, and payer type, to all WCHQ members. This complies with item three of the Leadership chapter.

Additionally, participants in WCHQ’s Disparities Improvement Team are actively creating plans to address specific health care disparities identified in their patient populations, complying with item 4 of the Leadership chapter.  

For more information about how WCHQ can help your organization to meet this new Joint Commission standard, please reach out to Abbey Harburn.

Tool kit offers resources for primary care providers treating patients with obesity

During a webinar on May 24, WCHQ unveiled a newly created toolkit to help primary care providers with their treatment of patients with obesity.  

The webinar was presented by Dr. Sam Pabich, Assistant Professor in the Division of Endocrinology, Diabetes and Metabolism at the University of Wisconsin, who was instrumental in developing WCHQ’s Obesity Toolkit. She recognizes that historically, obesity has been treated as a "cosmetic" issue, yet sees the tremendous impact it has on her patients' health and well-being. She is passionate about changing the perception of obesity, enhancing treatment and advocating for prevention efforts within the medical field and the country overall.

Dr. Pabich spoke about the importance of empowering providers to treat obesity due to the magnitude of the disease. There has been more than a doubling of prevalence since 2007. In addition, Dr. Pabich highlighted:

• the lack of evidence-based treatments because obesity was not seen as a disease until recently.  
• the many myths that have contributed to misinformation about the disease of obesity. This has caused people to internalize these messages and contributed to the spread of the disease. This has also contributed to bias within the medical community.  
• how the WCHQ Obesity Toolkit can be used in to talk to patients about the disease, screen for co-morbidities, recommend lifestyle changes, and utilize medications and other interventions to help patients control and treat obesity.  

The toolkit is located on the WCHQ website here.

If you would like to learn more about obesity, please join us for the WCHQ Obesity Summit on September 13 at the Sheraton Hotel in Madison. Registration and other program details can be found here.

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

Statewide partnership focused on health equity finds gaps in mental health diagnosis and treatment

Healthy Metric, of which WCHQ is a member, is a statewide partnership dedicated to advancing health equity in Wisconsin. The group has released a report titled, "Disparities in Mental Health Care and Outcomes: A Healthy Metric 2023 Report for Wisconsin,” which highlights mental health disparities in the state.

The data used in the report were sourced from health system data submitted to the Wisconsin Collaborative for Healthcare Quality (WCHQ) in 2021. Claims data from the Wisconsin Health Information Organization (WHIO), spanning 2019 to 2021, was also used.

The report concluded:

• There was a substantial increase of over 63,000 people seeking treatment for mild to moderate depression and/or anxiety between 2019 and 2021. Notably, the highest percentage of visits during this period was recorded among individuals residing in urban advantaged and urban (defined as neither advantaged nor underserved) areas, while those in rural underserved and urban underserved areas had the lowest rates.
• Depression screening rates reveal a potential underestimation of actual depression prevalence, particularly among rural and urban underserved populations, as not all patients receiving primary care services were screened for depression.
• There was a 40% increase in telehealth visits from 2019 to 2021, primarily driven by urban advantaged areas. However, despite the rise in telehealth utilization, it is evident that it has not effectively bridged the gaps as anticipated, especially among rural populations.

Gabrielle Rude, PhD, president/CEO of WCHQ, expressed the organization's commitment to addressing healthcare disparities in Wisconsin, stating, "WCHQ is honored to be part of Healthy Metric as we work collaboratively to bring attention to healthcare disparities in Wisconsin. This report highlights two important factors—the significant increase in Wisconsinites seeking mental health care, underscoring the magnitude of the need for this care in the face of clinician shortages, and the persistent underservice of rural areas, as observed in previous reports comparing healthcare in urban and rural regions. Our challenge remains finding ways to bridge these gaps."

With health inequities on the rise, it is imperative to identify the areas where disparities exist in order to develop targeted interventions to eliminate them. Healthy Metric, with its diverse coalition of medical schools, healthcare organizations, and research institutes, is at the forefront of this effort, striving to create a healthier and more equitable future for all Wisconsinites.

To access the full report, please visit: www.healthymetric.org/reports.

Healthy Metric's work is made possible through a three-year, $3 million grant awarded jointly in 2021 by Medical College of Wisconsin’s Advancing a Healthier Wisconsin Endowment (AHW) and The University of Wisconsin School of Medicine and Public Health’s Wisconsin Partnership Program (WPP). This collaboration brings together the two medical schools, the Wisconsin Collaborative for Healthcare Quality (WCHQ), the Wisconsin Health Information Organization (WHIO), and the Marshfield Clinic Research Institute (MCRI), the largest private medical research institute in Wisconsin.

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 newsletters.

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.  

‍Richard – “Please trust us”

We ask for help in different ways

In this video portrait Richard talks about his experience being traumatized as a young child and how that transformed him into a man depending on violence to protect himself and his subsequent journey being caught in the justice system. His message is clear, people cry out for help in different ways. Richard talks about being a young black man how this impacted his experience seeking mental health. 

Possible topics for discussion: adverse childhood experiences and health outcomes, racism, mental health access, stigma, black masculinity.

Antibiotics Stewardship

Using CHARM to Gain Usable Antimicrobial Data

The Antibiotic Stewardship Improvement Team met May 9 and welcomed representatives from Ferris State University showcasing their antimicrobial work Collaboration to Harmonize Antimicrobial Registry Measures (CHARM).  

CHARM is funded by the Michigan Department of Health and Human Services.  

CHARM works with organizations to extract data from their electronic health record and uses methodology that has been created specifically for this project to better understand prescribing patterns. The project developed a dashboard that can be drilled down to site and prescriber level data.  

If a health system is interested in partnering with the CHARM project, a data use agreement needs to be established. The CHARM team will then work with the IT department to work on how the data will be extracted and transferred. Organization champions, staff passionate about this work, stay involved and continue to provide input throughout the process. The CHARM team will input data into dashboard, validate the data and work with the health systems on needed adjustments.   

Froedtert’s Ambulatory Antimicrobial Stewardship Pharmacist, Micky Hart, shared his experience implementing CHARM at their organization. Hart explained the roll out took about six months and utilized a pharmacy staff informatics business analyst and the Froedtert IT department. “Just being able to see, within minutes, how prescribing has changed over the past couple years, has been a game changer for us,” Hart said. At this point, his organization is using it mainly at the clinic leadership level in areas where interventions are taking place. They hope to drill down to individual prescriber level in the future. 

Please contact Lori Bue, Quality Improvement Specialist, if you would like to learn more about this project or join the improvement team.

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Asthma 

Enhancing Asthma Control  

The WCHQ Asthma Improvement Team had the pleasure of having Mimi Guiracocha, DNP, RN and Manager of Health Promotions for the American Lung Association (ALA), speak to the group regarding The Enhancing Asthma Control Program. The American Lung Association is working with Wisconsin Department of Health and Human Services and actively recruiting primary care clinics in Wisconsin to participate in this program.

As part of the ALA program, the Asthma Control Team holds virtual monthly meetings with the health system participating. Data is collected prior to implementation and again at 12- and 18-months post implementation and shared with the team. 

The ALA is recruiting health systems for this project. The American Lung Association and Wisconsin Department of Health Services invite Wisconsin primary care clinics and healthcare providers to join the “Enhancing Asthma Care” program to help improve their patients’ health.   

The program is proven to improve the quality of asthma care, asthma health outcomes, quality indicators/metrics, and captures legal and appropriate reimbursement. Continuing education credits are available and clinics that successfully complete the program will receive a $5,000 stipend.   

The American Lung Association encourages clinics who serve both pediatric and adult patients to take advantage of this free program. Learn more at Lung.org/EnhancingAsthmaCare. For more information contact Jill.Heins@Lung.org.

The WCHQ Asthma Improvement Team is also looking for health systems to participate. If interested, please reach out to Lori Bue, Quality Improvement Specialist at lbue@wchq.org.

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Behavioral Health Improvement Team 

Utilizing Genetic Testing in Psychiatry

Dr. Alison Jones, Child and Adolescent Psychiatrist at Marshfield Clinic Health System, met with the Behavioral Health Improvement Team at their last meeting and gave an overview about how she utilizes genetic testing for medications in her practice:

• Dr. Jones uses genetic testing when the family asks, there is a history of challenges with medications/finding the correct medication and/or when the person requests the test.
• This is also a helpful tool when patients are resistant to medications, feeling like there is no “right” medication for them.
• The test results can help the patient understand what medications may work well for them because of the results.

Framing the expectations of the results with the patient is very important. For example, helping the patient to understand what the test results will mean or how you will use this in your course of the patient’s treatment.

If you are interested in joining the Behavioral Health Improvement Team contact Renee Sutkay.

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Colorectal Cancer

Health Systems Begin Work on Colorectal Cancer Screening Disparities in Rural Communities

The Colorectal Cancer (CRC) Screening Advisory Group had its first meeting May 12, with a variety of member health systems including Bellin Health, Fort HealthCare, Gundersen Health System, Mercy Health, Prevea, Reedsburg Area Medical Center, UW Health, and Watertown Regional Medical Center. Departments represented included population health, quality improvement, ambulatory, nursing, gastroenterology, diversity and inclusion, and care management.  

The advisory group will continue to meet monthly, on the second Friday of the month, at 1 pm. The team will be reviewing WCHQ CRC screening data to understand rural disparities in CRC screening, mortality rates in rural Wisconsin and rural cultural considerations. The team will use this data to understand barriers to CRC screening and develop insights and change projects within their health systems to improve these rates.  

The overall goal is to see an improvement of screening rates from participating health systems, while understanding that interventions may need to be tailored for specific populations and communities. The National Colorectal Cancer Roundtable has a goal of 80% of eligible adults in every community are screened, and that is the goal we strive for in this group. 

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

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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.  

Marshfield Clinic has developed a team representing primary care providers, nursing staff and pharmacy staff to improve blood pressure control. This team has created a protocol for nursing staff to adjust specific hypertension medications.  

The registered nurse, under the protocol authorized by the physician, works directly with the patient to adjust their anti-hypertensive medications. The patients meet with the nurse monthly to review and adjust medication, review labs, and blood pressure readings. The nurse and primary care physician are in close communication regarding the medication changes while giving the nurse the autonomy to adjust medications. For one provider working with their patients under this protocol, blood pressure control increased from 80% to 87.5%.  

“We’re empowering nurses to not only meet with patients, take their blood pressure and review medications, but also understand if it is appropriate to titrate the medications,” says David Ellenberger, RN, Clinical Quality Nurse Specialist at Marshfield Clinic.  

By increasing communication and collaboration between the nurses and providers, nursing staff can build relationships with patients and patient care is more efficient. This program is currently a pilot project; providers can choose to enroll patients into the program. Overall, providers are satisfied with the improved blood pressure control.  

Ellenberger said, “We are trying to expand this system wide and understand how it fits into the workflows for providers.”

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Disparities

Disparities Summit Details

The Health Disparities Improvement Team has a full agenda for the annual summit on July 27 in Madison. The day will showcase presentations from member health systems and community organizations working to decrease health disparities:

• The Wisconsin Hospital Association will present their community needs assessment tool that shows social determinants of health by zip code. This tool can be helpful to understand the needs of patients in their neighborhoods.  
• Fort HealthCare will discuss the impact they have on community health literacy, vaccinations, improving healthcare relationships, and other community benefits through their innovative school nursing program.
• Unite Us will talk about how they interface with Wisconsin health systems and impact patient lives by streamlining referral processes for community services.
• Dr. Travelle Ellis will discuss disparities in colorectal cancer screening throughout Wisconsin and how providers can impact colorectal cancer outcomes by increasing early detection.
• We will learn from the Great Rivers HUB Community Health Worker program and how their work increases collaboration among community providers and health systems.

Please visit wchq.org for registration and more information.

The Health Disparities Improvement team continues to meet monthly, the second Tuesday of each month, at 1pm. As the team continues to work on decreasing health disparities, we understand the need to involve community organizations in our work. We are recruiting community organizations that have goals to develop health literacy, impact social determinants of health, and improve patient follow-up. Adding these organizations to our disparities work will help us understand barriers and challenges that patients experience when obtaining healthcare. If you are interested in joining this work, please reach out to Renee Sutkay for more information.

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Immunizations 

Exploring Shifts in Vaccine Hesitancy for Children

The Childhood and Adolescent Immunization Improvement Team meets monthly and has several objectives to accomplish during the 18-month project. This project aims to better understand how and why parents shift their beliefs from not immunizing their child to seeking vaccines to protect their children against disease. These parents’ beliefs and experiences will provide the knowledge health systems need to improve vaccination rates and overall health. This information will be used in education for clinical staff and providers to help increase immunization rates and reduce hesitancy toward vaccines.

Parents will be asked to share their experience around vaccine hesitancy, and changing their minds about vaccines, through one interview that will last about 45-60 minutes. This can be done online or in person. Participants will be paid $50 for their time with a check being mailed post interview. The interviews will be recorded and reviewed for important information to be shared with the health systems. Only the study team will have access to the recordings and will keep this information confidential. 

Participation is completely voluntary and can be stopped at any time. We may invite select participants to take part in an additional phase of this project which also will be voluntary. 

If you have patients that you feel would be appropriate for this project and have a story to tell, please reach out to Lori Bue, Quality Improvement Specialist.

Lung Cancer Biomarker

Seeking Participants:  Advanced Lung Cancer Biomarker Testing Project

Do you provide care in your system’s Oncology department?

Do you provide ancillary support services?

Do you have an interest in understanding, and improving, the biomarker testing process for patients with advanced stage non-small cell lung cancer?

WCHQ is looking for individuals to join us on the Biomarker Testing Advisory Group. Other potential advisory group members include quality improvement staff, operational leaders and health system leaders.

The goals of this project are:

• to understand the landscape of biomarker testing for lung cancer in Wisconsin
• identify best practices
• increase rates for biomarker testing
• improve outcomes for patients with lung cancer

If you are interested in participating in this group, please reach out to Lori Bue, Quality Improvement Specialist.