September 2020

President's Column

Pandemic Takes a Toll on WCHQ Members

Chris Queram

“No industry has been harder hit by COVID-19 than health care.”

Those were the words of Mark McClellan, former CMS Administrator and FDA commissioner, speaking at the WCHQ Board Retreat September 22.

Unfortunately, the pandemic’s toll on our industry will not end anytime soon. With what looks like a second, and even bigger, wave hitting Wisconsin now, health systems, physician clinics, payers and dental providers continue to struggle with unprecedented economic pressure. Patient volumes will likely ebb and flow over the next year or so as we experience the convergence of seasonal flu and COVID-19.

If early results to the WCHQ member survey are any indication, economically recovering from the pandemic is the number one priority for our members in 2021. While Wisconsin providers may have been in an overall better position at the beginning of the pandemic than those in other states, the duration of it is taking its toll on our members’ internal operations and workforce.

The team at WCHQ moved quickly in response to the pandemic. By the end of March, we sent clinic-specific reports to members that identified patients at high risk for serious COVID-19 symptoms. The quality improvement teams shifted their focus to COVID-19 as members used these groups to discuss clinical issues related to care continuity and coordination during the pandemic, telehealth, PPE shortages and shared plans for reopening clinics. On the bright side, Wisconsin providers are finding innovative and effective ways to deliver care while reducing the chance of spreading the virus. And, in partnership with WCHQ, they are sharing best practices with other health care organizations to ensure that information is widely disseminated.

Looking ahead, we are concerned about the impact that delaying care due to the virus will have on measures related to preventive care – such as immunizations, well child checkups, and screenings – as well as those which monitor patients with chronic conditions. We saw a shift from providers delivering care in the clinic to employing technologies such as telehealth, remote monitoring and health apps. While these virtual tools are very helpful in facilitating patient engagement, they have their limitations for those services which can only be delivered in person. As an example, we anticipate the impact of the pandemic will cause a drop in the statewide immunization rates for both children and adults. It is also likely to trigger a decrease in preventive screenings, such as colorectal, breast and cervical cancer.

Wisconsin has a well-earned reputation for delivering high quality, safe care driven by a deep commitment to improvement within a culture of collaboration. By tapping these well stones we will no doubt quickly attain and surpass our past levels of performance. Our entire team is honored to work with and serve the health systems and medical clinics that are singularly focused on caring for the people in our state.

- Chris Queram

WCHQ Board Retreat Focuses on Future Vision

The WCHQ Board of Directors met on September 22 for a robust and engaging retreat which served as the kickoff for  WCHQ’s strategic planning for the next five years. The meeting was led by WCHQ Board Chair, David Rushlow, MD, Mayo Healthcare and facilitated by incoming President and CEO, Gabrielle Rude, PhD.

Dr. Rude began the day by sharing a high-level vision for the future of WCHQ and asked that Board members share their frank and actionable advice for WCHQ’s strategic plan. Mark McClellan, PhD of the Duke-Margolis Center for Health Policy at Duke University provided the keynote address. Dr. McClellen highlighted how value-based care has promoted resilience in the COVID-19 era by providing increased financial security and infrastructure to provide care virtually. Dr. McClellen ended his remarks by emphasizing that organizations such as WCHQ are critical to the continued success of health care by identifying key areas of opportunities and providing solutions powered by a shared measurement framework.

The Board discussed key components of WCHQ’s future strategy including the operational definition of health care value and the role of the payer community in WCHQ’s ongoing work. Throughout the day the term “action” was heard repeatedly as Board members expressed their support for WCHQ to continue its value acceleration work. The Board recognized that there is not currently a perfect measure of health care value; however, WCHQ has robust measures which can drive results and should take action to deploy their use with a focus on long-term value improvements.

Watch this Webinar to Answer the Question: Why Get Vaccinated

When patients ask you why they should get vaccinated for the seasonal flu, you’ll be glad you watched this webinar.

Short answer: It’s the most important flu shot of the century because it has the potential to stop the “twindemic” of seasonal flu and COVID-19.

At a September 15 webinar, Drs. Jon Temte and James Conway from the UW School of Medicine and Public Health presented information supported by research and illustrated by graphs that shows the undeniable benefit of getting the flu shot now and being vaccinated for COVID-19 when it becomes available.

Here are a few quick takeaways from their presentation:

  • Australia is a bellwether for the severity of seasonal influenza in the northern hemisphere. This year, Australia saw the flu season peak early with far fewer cases than in past years and then fall and stay at zero, largely attributed to social distancing, masking, and hand washing.
  • Influenza and SARS CoV-2 are expected to circulate at the same time. In this context, vaccination against influenza will be more important than ever to decrease the overall impact of respiratory illnesses by reducing influenza-associated hospitalization and deaths and reducing the burden on the health care system.
  • SARS CoV-2 vaccine will initially be available in only limited doses. Dr. Conway shared that each state has been asked to develop a vaccine distribution plan to health systems and public health. A chart shared by Dr. Temte that shows how H1N1 vaccine distribution was prioritized in 2008:

Dr. Conway said in surveys where the public is asked if they will get the SARS Co-V2 vaccine, the negative responses are very similar the reasons given for not getting the seasonal flu shot:

  • Concerns about side effects
  • I will get the coronavirus from the vaccine
  • Vaccines don’t work well
  • Coronavirus outbreak is not as serious as some people say it

In response to a question from the audience, Temte said older patients should not wait to be vaccinated until later in the season because it is important to avoid crowding at vaccination sites.

“We want people to have flu vaccine on board before COVID-19 vaccine is administered because we don’t have a lot of information on co-administration of these vaccines,” according to Dr. Temte. However, Conway said for those in the clinical trials receiving the COViD-19 vaccine did not preclude being immunized for influenza, so there will be some information forthcoming.

The recording of the above presentation can be found in our member site, Online Community, under Education, Assembly Meeting Materials.

WCHQ Education: On Demand and Upcoming Events

Ideas for education are always welcome from our members and partners. Sharing best practices is always important to clinicians, but with COVID 19 and the challenges we face every day, collaboration among health care professionals takes on an added urgency. Contact Mary Kay Fahey to volunteer to present on any topic..WCHQ has maintained a very ambitious online education schedule throughout the pandemic to ensure our members have the information they need to continue the high-quality care that Wisconsin is known to deliver.

Webinar:  September 29, 2020
12:00-1:00 PM
Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) in the Clinical Setting

On September 29 Laura Saunders, MSSW, Great Lakes Addiction Technology and Transfer Center, will discuss how early intervention for those at risk for substance use disorders can avoid more severe consequences later.

During these times of job losses, isolation and uncertainty, residents may be at higher risk for substance use disorders. SBIRT is a comprehensive, integrated public health approach to the delivery of early intervention and treatment services for persons with substance use disorders as well as those who are at risk of developing these disorders. Primary care providers are in a unique position of identifying and intervening substance use disorders:

  • The screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
  • Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
  • Referral to treatment providers those identified as needing more extensive treatment with access to specialty care.

REGISTRATION for this webinar is free to WCHQ members, learn more in the FLYER.  

Contact Tracing Webinar for Clinicians – Available On Demand
With the number of COVID-19 cases dramatically increasing, contact tracing is essential to stop the spread of the virus. This is why the Wisconsin Department of Health Services (DHS) is working with local public health departments to build a network of contact tracers who are tasked with interviewing every person confirmed with COVID-19.

DHS Epidemiologist Christine Muganda, PhD recorded a webinar for WCHQ members that explains the contact tracing process and protocols the Department has in place for this activity. Download this webinar. To view, click the download icon at the top right.

WCHQ appreciates Dr. Muganda sharing her expertise in explaining the contact tracing process. For more information on contact tracing, check out this page on the DHS website.

Webinar: November 12, 2020
9:00 AM – 12:00 PM
WCHQ Health Disparities Conference: Focus on Rural and Urban Geography

WCHQ is excited to announce Leonard Egede, MD, MS will keynote the 2020 Health Disparities Assembly. Dr Egede is a general

internist, tenured Professor of Medicine, and Chief of the Division of General Internal Medicine at the Medical College of Wisconsin (MCW). He is also the Director of the MCW Center for Advancing Population Science (CAPS), and the Associate Director of Cancer Disparities at the MCW Cancer Center.

As a nationally recognized health disparities researcher, Dr. Egede's research has focused on developing and testing innovative interventions to reduce and/or eliminate health disparities related to race/ethnicity, socioeconomic status, and geographic location for chronic medical and mental health conditions. His career started with diabetes as a template disease, but he has since worked with other physical and mental illnesses. Dr. Egede has published over 240 manuscripts documenting the existence of disparities and showing that factors at the personal, provider, and system level have an influence on health outcomes. His work has led to recognition that disparities exist and moved the field towards focusing on what can be done to address inequities.

WCHQ and the Wisconsin Health Innovation Program will release its second disparities report at this Assembly, which focuses on health disparities as experienced in rural and urban locations. Matt Gigot, WCHQ director of (title goes here) will co-present the report with researchers from the Wisconsin Health Innovation Program.

REGISTRATION is open, more details will be available soon.

Direct questions on WCHQ's educational programs to Mary Kay Fahey.

Steering Team Updates

Behavioral Health: Members Share Suicide Prevention Strategies

In a recent issue, Wisconsin Health News reported that Milwaukee County has seen an 80% increase in suicide attempt encounters compared to last year. From 2000-2017 the suicide rate rose 40%, which might now already be rising further due to the current pandemic.

September is Suicide Prevention Month and the Wisconsin Department of Health Services released a report in partnership with Prevent Suicide Wisconsin to address the concerning increase of suicides among Wisconsinites. The suicide prevention report highlighted four key strategies to help address this public health crisis:

  1. Increase and Enhance Protective Factors
  2. Increase Access to Care for At-Risk Populations
  3. Implement Best Practices for Prevention in Health Care Systems
  4. Improve Surveillance of Suicide and Evaluation of Prevention Programs

WCHQ members have been discussing their methods in addressing suicide ideation and the increased demand for mental health services among their communities, patients and staff. Examples of these methods include staff check-ins, such as weekly meetings and systemwide surveys and assessments on their mental health needs and childcare needs. To increase behavioral health service capacity, members are thinking creatively, such as decreasing appointment lengths slightly to allow for more patient visit timeslots. Primary care providers are encouraged to obtain waivers to prescribe Suboxone in an effort to expand on already-burdened Medication Assisted Treatment programs. Finally, using online mental health platforms, such as myStrength or SilverCloud, are good options to reinforce treatment provided to patients and to offer a broader net of behavioral health tools and resources accessible 24/7.

Many health systems and organizations are collating community-accessible resources on mental health.
These are useful not only for outreach purposes but also to strengthen any established mental health support offered within your health system.

Adolescent and Child Health Assembly

On September 19, WCHQ hosted its second Adolescent and Child Health Learning Assembly, focused on the importance of routine vaccinations during the COVID-19 pandemic. L.J. Tan. MS, PhD, Chief Strategy Officer at Immunization Action Coalition (IAC), delivered the keynote address. In his presentation, “The Critical Importance of Improved Immunization Rates During COVID-19,” Dr. Tan shared a wide array of data demonstrating the importance of vaccines for adults and children and the national and statewide drops in rates for vaccinations at all stages of life. Dr. Tan also discussed the potential for a “twindemic” of COVID-19 and influenza during this year’s flu season if we do not improve vaccination rates.

Yolanda Wolff, MD, a pediatric specialist with Children’s Wisconsin, delivered a presentation titled “Maintaining Well-Child Visits through Telehealth and Immunization Clinics.” During her presentation, Dr. Wolff shared actions taken and lessons learned by Children’s Wisconsin as they transitioned to a virtual care delivery system for well-child visits at the outset of the pandemic. Their unique strategy of combining nurse-only visits for vaccinations and measurements with virtual visits to complete all other portions of the well-child visit allowed Children’s to reduce the backlog in appointments due to cancellations and rescheduling while maintaining vaccination rates to avoid a resurgence in other communicable diseases.

The final presentation was delivered by Alexandria Cull Weatherer, MPH, of the Wisconsin Cancer Collaborative. Her presentation, titled “The Importance of HPV Vaccination During COVID-19,” emphasized the need to continue vaccinating adolescents against HPV despite the increased use of telemedicine during the pandemic. Ms. Cull Weatherer shared information on the benefits of HPV vaccination for all children, the effectiveness of the vaccine, and existing guidance and strategies for HPV vaccination during the pandemic.

The recording of the above presentations can be found in our member site, Online Community, under Education, Assembly Meeting Materials.

Oral Health Collaborative

On September 21, WCHQ shared information on the Wisconsin Medical-Dental Integration Program with members of the Oral Health Collaborative and the Adolescent and Child Health Steering Team. Dana Fischer, MPH, CHES and Jenna Linden, RDH, CDHC, of the Children’s Health Alliance of Wisconsin explained how the pilot program is designed to embed a registered dental hygienist in primary care pediatric clinics. The goals of the project are to increase access to preventive dental care and reduce dental disease burden for young children and pregnant women.

The recommended age for a child’s first dental visit is one year, and yet children with Medicaid are not typically visiting a dentist until they reach the age of three or four. This poses a problem as children can develop caries at an early age. According to Wisconsin Head Start, by the age of three, 30% of children will have caries and by the age of five, that percentage increases to an alarming 50%. The Children’s Health Alliance of Wisconsin aims to improve the health outcomes of children by exposing them to dental care at earlier ages and in the primary health care setting which children frequent often. The American Academy of Pediatrics states that children visit a medical provider ten times between the ages of six months and five years.

The Wisconsin Medical-Dental Integration Program is based on research conducted by Dr. Patty Braun who is a pediatrician champion of these efforts for more than a decade. Between 2008-2011, Dr. Braun conducted a study to determine the feasibility of integrating a dental hygienist into the medical care team. Her conclusions were auspicious, demonstrating a 16% reduction in early childhood caries and a 28% reduction in untreated childhood caries.

The team at the Children’s Health Alliance of Wisconsin is actively recruiting health systems and clinics to participate in the Wisconsin Medical-Dental Integration Program. Preferred candidates have a medium to high Medicaid patient volume, at least three medical providers in one clinic, and have an oral health provider champion. If your health system or clinic is interested in learning more about this program, please contact Dana Fischer.

Sources available upon request, contact Jen Koberstein.

WCHQ New Data Platform Project Status

As communicated in past newsletters, WCHQ is transitioning to a new data platform, that we have named, “Data Voyager.” While development and member data uploads are behind the original schedule, they are advancing at a pace that will allow the preview period to begin as planned for members whose data is ready, with results being added for the remaining members throughout the preview period.

The pandemic has caused delays in receiving refreshed data from all WCHQ members, so WCHQ is delaying the next updated reporting period to January 2021. WCHQ staff will be reviewing the measure results at that time and communicate the results in advance to data-reporting members.

Several early-adopting members were granted access to the Data Voyager User Acceptance Testing (UAT) environment where they explore and evaluate early copies of their measures. The feedback is very useful and has resulted in development fixes such as better qualification of patients by birthdate.

If you have questions related to data submission, contact Matt Gigot.