Our planet, our country, and our state face a crisis of unprecedented scale and proportion. Here in Wisconsin, the Coronavirus has exposed both the strengths of our state’s public health and health care professionals as well as the limitations of our collective preparedness. While there will be many compelling suggestions for improvement, I am confident there will be universal agreement on the need to target the investment of additional human and financial capital to ensure that we maintain and strengthen our capacity to identify and respond to such events in the future.
In that spirit, foundational to a public health crisis of any scale is data, as it allows decision makers to better understand the breadth and scope of the crisis. This includes identifying the rate and mechanisms by which a disease spreads between and within communities, the populations that are vulnerable to the disease and its outcomes, and how the outbreak impacts public health and the health care infrastructure.
The WCHQ Board recently met with Secretary-designee Andrea Palm and affirmed its commitment to assist the State of Wisconsin and its communities in responding to and recovering from the pandemic with data and information. Our work in this area continues to evolve as our health systems, state and county government, and employers take steps to reopen our communities with the health and safety of our citizens and health care workers guiding their decisions.
Meanwhile, as we await the day when we are able to resume some semblance of normality, WCHQ is focused on leveraging our core competences – generating and reporting valid and reliable data and serving as a convener/facilitator of practice transformation – in support of you, our members and key partners. The WCHQ team is currently facilitating member-driven dialogues on COVID-19 topics related to behavioral health, chronic illness, child and adolescent health and dental. Read more in this newsletter.
Finally, allow me to conclude with a quick note about our education programs, as COVID-19 and the restrictions on in person gatherings has necessitated a change in delivery for the foreseeable future. WCHQ is working with our partner, BadgerBay, to create an online education resource center accessible through our online community. As webinars, podcasts and presentations are developed, WCHQ will employ all these mediums to ensure content is regularly being created and added as member resources.
The WCHQ team is honored and privileged to be working in support of our health care and dental members. Thank you for your commitment and service.
Wisconsin Department of Health Services Secretary-designee Andrea Palm asked WCHQ Board members to do what they can to ensure that a sustainable COVID-19 testing framework is in place in Wisconsin health care facilities. Palm said until a vaccine is available, testing will continue to be a critical piece of controlling outbreaks.
The National Guard has been operating testing centers around the state, but those efforts are winding down. Some heath care systems also opened community testing centers as needed.
“We need to work with our partners in health care, including health systems and clinics, to figure out what is the sustainable model that must be in place to do the necessary testing to fight this virus,” Palm told the Board members. “We have purchased tests, we are purchasing testing supplies, and we have supported partners around the state. We need to actually get more people tested in higher numbers every day of the week.”
Board members shared their local experiences in testing, with questions ranging from how reimbursement will be handled to low turnouts at testing centers. Palm acknowledged there are challenges and barriers to testing on this scale, but she was optimistic that they would be addressed.
“Thank you for all the work that everyone is doing, I know this is not what we thought we would be doing this year to help keep people in Wisconsin health and safe as possible, but we appreciate your partnership…in helping us to better do our work,” Palm concluded.
Spotlight: Telehealth Role in Managing Chronic Care During COVID-19
With: Dirk Steinert, MD, Medical Director, Specialty Care - Quality, Ascension Wisconsin
While healthcare systems had a goal to increase virtual visits over the next few years, the use of telehealth rapidly escalated when COVID-19 halted in-person clinic visits.
“Suddenly, everybody across the country was scrambling to do virtual health care to continue caring for their patients during this unique time of social distancing,” said Dirk Steinert, MD, Medical Director, Specialty Care - Quality, Ascension Wisconsin.
The Centers for Disease Control (CDC) identified the highest risk patients for COVID-19 were those with chronic illnesses that require monitoring and ongoing care to avoid hospitalization. High on this list were patients with one of more of the following conditions: diabetes, hypertension, older than 65, liver disease, or lung disease. For example, only six percent of the patients treated for COVID-19 in one New York area health system had no chronic conditions. Hypertension, obesity and diabetes were common.
“When I looked at the projections for COVID-19 surges in hospitals, my first thought was we need to keep our chronically ill patients, who are at higher risk for the virus, out of the ER and hospital with active case management,” said Dr. Steinert. To begin proactive outreach to patients most at risk, Ascension Wisconsin clinicians coordinated with the IT department to sort medical records to identify people who were at higher risk for hospitalization if they contracted COVID-19. Using the Charlson Comorbidity Index (CCI), which predicts 10-year survival in patients with multiple comorbidities, and certain diagnosis codes the technology team scored patients using the CCI and the clinical team then began to contact them based on their risk score.
The Ascension Wisconsin clinical team, led by Dr. Steinert, developed a workflow to contact high risk patients based on the date of their last clinic visit. Those who had not been seen recently were proactively contacted and encouraged to set up a virtual visit with their provider.
Clinicians could connect with patients on Ascension’s secure, confidential platform - Ascension Online Care, in addition to Zoom, Google Hangouts and FaceTime. Because many patients and clinicians were first-time telehealth users, it was critical to offer a variety of secure platforms to ease comfort levels.
Ascension Wisconsin also encouraged patients to use its online portals and OpenNotes to directly communicate with their clinicians. This empowered patients to better manage their healthcare needs.
“While telehealth may seem easy, not all patients and not all physicians are comfortable discussing health matters virtually,” said Dr. Steinert. “There is a learning curve for both patient and provider.”
To assist clinicians, Dr. Steinert and the Ascension Wisconsin team developed tools that would help guide them during a telehealth visit. This was especially important when asking questions related to depression, which is critically important when people are isolated due to in-home sheltering. Depression is also a factor in whether a patient can adhere to their care plan. Asking questions about their sleep habits, lifestyle, ability to exercise and whether they are interacting with others in meaningful ways can help the clinician determine how the patient is doing. Based on their responses, medications can be adjusted or changed. And with that, the physician also can ask if their patient can access medications by having home health or the pharmacy deliver them. In some cases, the physician might determine that a virtual visit with a behavioral health professional would be beneficial.
“If a patient has diabetes, we might ask if we could set up a visit with a diabetes educator,” Dr. Steinert said. “What’s nice about a virtual visit is we can ask to see how our patients live and better understand their social determinants of health. Sometimes our patients show us the inside of their refrigerator which helps understand their diet and whether or not they have access to nutritious foods. That is important, and for some patients, it is reassuring to have an ‘in-home’ experience. They really enjoy that interaction and as a physician, it means a lot to me, too, that they are willing to share details of their lives that can help me help them.”
COVID-19 has made clinicians rethink how they can use telehealth to interact with patients on a personal level to learn how their patients’ lives and identify socio-economic needs. A telehealth visit can also improve safety at home by helping the patient identify expired or unused medications that are in their medicine cabinet that should be disposed of, so they don’t accidentally take the wrong medication.
“Telehealth is not something most physicians do naturally. It requires guidance and practice to do it successfully. And not all patients like it, so we need to take that into account to determine how to do this well in the long term,” Dr. Steinert said. According to the American Hospital Association, telehealth is changing how care is delivered in communities across the country. From emergency department care to remote patient monitoring for chronic care management and access to care from specialists, telehealth is changing the way healthcare is provided – both expanding patient access to routine and specialty care while improving patient satisfaction and outcomes. (American Hospital Association, AHA.org, 4/27/2020)
“This crisis will lead us to improved and expanded care possibilities which will aid our patients and communities into a safer healthcare dynamic,” said Dr. Stienert. “We have learned many lessons during this time and can use our findings to improve healthcare delivery. We want to encourage patients to feel supported and safe when they seek care and to not delay reaching out for help. As healthcare professionals, we are here for them and the community in this time of need, and in the future.”
The COVID-19 pandemic has accelerated and necessitated the use of virtual care in a matter of weeks. Over time, telehealth will make care more accessible and with that, have a measurable positive impact on population health.
WCHQ Announces Infection Prevention and Behavioral Health Webinars in June
COVID-19 has altered how WCHQ will deliver education in 2020 and potentially into 2021. While in-person Assemblies have been the standard for more than a decade, WCHQ is adopting new platforms and creating an Education Hub to ensure our members have access to outstanding resources.
Live webinars will be presented by both nationally recognized speakers and by WCHQ members. The combination of national perspectives on topics of interest followed by in-state best practices related to that topic delivered by WCHQ members has proven popular.
Registration is open for two webinars in June (there will be time for Q & A, and the webinars will be recorded):
Infection Control and Prevention Featuring: Nasia Safdar, MD, PhD June 8, 2020, 1 PM – 2 PM
Join Dr. Safdar to learn more about preventing and controlling COVID-19 in health care settings. Throughout the pandemic, Dr. Safdar has been a sought-after expert because of her knowledge of health care-associated infections. WCHQ is pleased she is available to share her expertise with our members.
Dr. Safdar is an internationally recognized leader in health care-associated infection prevention research. She has been the Medical Director of Infection Control at UW Hospital and Clinics since 2009.
Integrated Behavioral Health Care Amidst the COVID-19 Pandemic Featuring: Neftali Serrano, PsyD, CEO, Collaborative Family Healthcare Association June 22, 2020, 12 PM – 1 PM
As the CEO of the Collaborative Family Healthcare Association, Neftali Serrano, PsyD has been on the front lines of addressing behavioral health amidst the COVID-19 pandemic. With national and clinic level perspectives, he’ll address how integrated behavioral health improves health system responses to increased mental health needs, how to adapt to telehealth and remote work for team efficiency and provider satisfaction and looking into the future on how integrated behavioral health should be the standard of care.
If you are from a member organization, these webinars at at no cost; however, you MUST first have an account in WCHQ’s Online Community. If you do not have an account go to JOIN. Unsure if your organization is a member? Click here for provider members; here for corporate/annual partners. For information about education events, contact: Mary Kay Fahey.
WCHQ Releases New Depression Screening/Treatment Toolkit Amid COVID Crisis
WCHQ’s Behavioral Health Steering Team developed a Depression Screening and Treatment Toolkit intended for providers and the administrative staff in a primary care setting serving adult populations. The toolkit is a practical, usable tool for quick referencing and adoption. Two workflows are contained in the toolkit; one for clinical providers with step-by-step instructions on depression screening and treatment options and one for administrative staff related to special operational considerations for the implementation, documentation and tracking of depression screening. There is also a robust addendum with tools that supplement the workflows; including medication augmentation strategies, behavioral health billing codes, a suicide ideation policy, and patient health screeners.
To help with quick referencing, the Table of Contents includes a ‘Print’ button next to each tool for easy viewing, downloading and printing. To access the toolkit for free, follow this link.
“We’re excited about this new toolkit,” says Sarah Wright who staffs the Behavioral Health Steering Team. “There’s a current treatment gap in Wisconsin where people who need behavioral health services can’t access them. This toolkit will help address that gap. We’re hoping the toolkit provides support to ambulatory care settings where they are better equipped to manage patients with depression internally and reduce unnecessary referrals to specialists.”
Jan Simonson, MSN,RN, PPE Branch Director-Supply Chain at the Institute for Quality, Innovation and Patient Safety at Marshfield Clinic Health System, chairs the WCHQ Behavioral Health Steering Team commented: “Now more than ever it’s important to help care teams close the care gaps for patients with depression. My hope is that clinical, as well as operational team members will find the toolkit valuable.
About 1.45 million individuals in Wisconsin, or 18.75%, have some mental or behavioral health issues, and the percentage of major depressive episodes for adults aged 18 and over is 6.56%. The economic impact of poor mental health in Wisconsin adds up to $9 billion annually, with depression alone costing Wisconsin $800 million annually.
Wisconsin might be seeing these numbers worsen as the COVID-19 pandemic continues. Outbreaks, such as COVID-19, can increase stress among people and cause fear and anxiety. Henry J. Kaiser Family Foundation released a poll stating that people are worried about finances such as losing their income, jobs, or investments and about health such as being exposed to the virus at work or having themselves or family members get sick. A total of 72% of Americans state their lives have been disrupted “a lot” or “some” due to COVID-19. This disruption, fear and anxiety can result in the worsening of mental health conditions such as depression.
In addition to an increased need for mental health services, there is a treatment gap in Wisconsin of 49%, where roughly 441,378 individuals annually do not receive the care they need. Increasing primary-care based depression services has demonstrated to increase health care capacity to care for patients with depression and to improve health outcomes. WCHQ members are working hard to address the care gap and to care for depression in primary care. The depression screening rates among WCHQ members has drastically increased over the last two years. From 2017 to 2019, the overall population performance went up from 46.7% to 75.3%. (References available, contact Sarah Wright)
WCHQ Steering Team Reports
Behavioral Health Steering Team
The Behavioral Health Steering Team has been meeting about every two weeks to focus on COVID-19; offering support and encouragement, sharing best practices, and analyzing the ever-changing health care landscape. The May 18 meeting focused on clinic reopening strategies, reimbursement for telemedicine, new competition in the virtual health care arena, and new behavioral health resources. A COVID-19-specific behavioral health forum was created in WCHQ’s Online Community. New resources shared have been compiled and uploaded to the forum. The steering team’s next meeting will be June 8 at 10 AM.
Since September 2019, the Behavioral Health Steering Team has been working diligently on the Depression Screening and Treatment Toolkit, which is now published and ready for distribution. WCHQ would like to thank the steering team for its perseverance, great insights and sharing of tools to complete the toolkit. Please read the official announcement within this newsletter for further details. If you are interested in joining the steering team, please reach out to Sarah Wright.
Oral Health Collaborative
The Oral Health Collaborative team have been meeting every two weeks to focus on COVID-19 and other issues. They've shared their experiences with teledentistry, emergency dental care and plans to reopen. On May 12, the members reviewed unblinded, quality-of-care data for the first time and began plans for a quality improvement project based on the data. We plan to begin public reporting new oral health measures later this year. The next meeting is at the end of the month.
Dental members are exploring collaboration with health systems to ensure their staff and patients can be tested for COVID-19 as needed. PPE is an issue dentists continue to face as they plan to reopen their offices. Most of the dental suppliers do not have access to the PPE needed by dentists, and/or not in the quantity needed. The Wisconsin Economic Development Corporation recently announced this service to help all WI businesses in need of PPE:
If you are interested in learning more about the Oral Health Collaborative, contact Jen Koberstein.
Adolescent and Child Health Steering Team
The Adolescent and Child Health Steering Team has been holding huddles every two to three weeks to discuss COVID-19 response in addition to the traditional monthly meetings. COVID-19 discussions have focused on continuing to provide routine care to pediatric patients, including well-child visits and immunizations, managing clinic time, and understanding the impact of COVID-19 on pediatric measurement areas. The team has discussed how to use telehealth with pediatric patients and how to maintain patient confidentiality for adolescents. In addition to the COVID-19 huddles, the team has a COVID-19 forum in WCHQ’s Online Community to allow for continued collaboration. The steering team’s next meeting will be Friday, June 5 at 10:30 AM and will focus on managing patients as clinics begin to reopen to see a larger number of patients. If you are interested in joining the steering team, contact Abbey Harburn.
Chronic Disease Learning Collaborative
The Chronic Disease Learning Collaborative met in April and May to focus on COVID-19 and discuss current clinical practices. Topics discussed include technology tools such as telemedicine, postponement of screenings and procedures, blood pressure self-monitoring and education, diabetes education, and planning for ways to bring patients safely back into the clinics for visits.
A COVID-19-specific chronic disease forum was created in WCHQ’s Online Community. New patient and provider resources have been compiled and uploaded to the forum. The steering team’s next meeting will be June 1 at 1 PM. The focus will remain on COVID-19 and updated publicly reported diabetes and hypertension measures will be discussed. If you are interested in joining the steering team, contact Cara Winsand.
COVID-19 Reports Identify Areas of State at Higher Risk for Severe Illness
These are extraordinary times for public health officials and health systems as COVID-19 sweeps the nation, putting every community at risk for infection, depleting resources and stretching communities to capacity. A critical need for public health is for high-quality data to support decision making.
That is why Jessica Bonham-Werling, Director of Neighborhood Health Partnership Program (NHP) organized a team to quickly design and develop reports to identify ZIP Codes in each county that have a high number and/or prevalence of individuals with known COVID-19 risk factors for severe illness identified by the Centers for Disease Control (CDC).
“We wanted to create a tool that could help inform the decisions and planning for COVID-19 that are taking place in communities across Wisconsin to support their readiness preparations,” according to Bonham-Werling. “Local decision makers in government and health systems are under unbelievable pressure and data is of critical importance to them to help them anticipate where resources will be needed most over the weeks and potentially months ahead.”
These reports are being used by health systems, public health officials and government agencies to identify areas of the state that are at higher risk for complications due to COVID-19 to anticipate and target the need for resources.
The reports include an estimate for the number of individuals with each ZIP code with two or more of the CDC risk factors for severe complications from COVID-19 that could be reliably identified in WCHQ’s data.