September 2022
President’s Column
In 2019, WCHQ began actively strategizing to address health care value, taking considerable time to name this new priority the “Value Acceleration Initiative.” The name was chosen to emphasize that work to improve health care value would build upon decades of work to improve quality and to emphasize that we needed to improve at an accelerated pace. As we’ve focused on value, we’ve recognized that there are many partners and perspectives focused on the same broad topic. WCHQ has a specific role in this realm: driving improvement for all while maintaining a focus on the ultimate beneficiary, the patient.
Value Acceleration isn’t an “initiative;” it is a foundational cornerstone of our collective work to improve the health of the people in our region. WCHQ has incorporated measures of value into all our improvement priorities, we’ve engaged partners from new areas that impact overall health care costs (employers, industry supplies, health plans) to help drive innovation, and we’ve pushed out actionable information to shine a light on areas that require more immediate attention.
Improving value also isn’t new; better health care quality is directly related to improved health care value. Perspective is important here as many investments in health care value have upfront costs with benefits that accumulate over time. Traditional quality improvement activities, such as aiming to decrease high blood pressure or lower diabetic A1c, are associated with lower health care costs for the patients it encompasses. Taken a step further, health care systems have made investments, such as embedding a pharmacist or behavioral health specialist in primary care, increasing tobacco cessation activities, or offering obesity counseling. These are real strategies our member health systems have implemented that have significant up-front costs but are proven to increase the value of health care for the patient.
One difference in our work with value compared to traditional health care clinical quality improvement is the need to engage more partners from outside the health care provider system. As anyone trained in quality improvement knows, you cannot solve a problem without ensuring all of the perspectives that influence or are impacted by the problem are actively engaged in the solution. This strategy is noted elsewhere in this newsletter where you’ll see employers joining a conversation on how to provide effective solutions for treating obesity, and pharmaceutical companies engaged in the development of educational tools for diabetes care. That is why at the WCHQ Board level we have voting members who represent organizations that are outside the provider community.
Throughout its tenure, WCHQ has catalyzed collaboration in the health care community that have helped Wisconsin move forward together to set and achieve high standards of patient care. The value initiative is set to follow a similar path as we share a passion with our members and partners to make care more accessible and affordable.
SPOTLIGHT: Dramatic Increases Seen in Childhood Obesity Rates
September is National Childhood Obesity Month: A Call to Action
Childhood and adolescent obesity have reached epidemic levels in the United States, affecting the lives of millions of people. In the past 3 decades, the prevalence of childhood obesity has more than doubled in children and tripled in adolescents, according to the National Center for Health Statistics (2017). Children with obesity are more likely to become adults with obesity, thus increasing their risk for several diseases before they even reach their teen years.
For children and adolescents aged 2-19 years in 2017-2020:
- The prevalence of obesity was 19.7% and affected about 14.7 million children and adolescents.
- Obesity prevalence was 12.7% among 2- to 5-year-olds, 20.7% among 6- to 11-year-olds, and 22.2% among 12- to 19-year-olds. Childhood obesity is also more common among certain populations.
- Obesity prevalence was 26.2% among Hispanic children, 24.8% among non-Hispanic Black children, 16.6% among non-Hispanic White children, and 9.0% among non-Hispanic Asian children.
- Obesity-related conditions include high blood pressure, high cholesterol, type 2 diabetes, breathing problems such as asthma and sleep apnea, and joint problems.
The differences in obesity by race/ethnicity seen among children are also reflected in the adult obesity prevalence rates in WCHQ’s data. Black/African American, Hispanic/Latino and American Indian obesity prevalence rates are higher than those for white and Asian/Pacific Islander, as seen in the chart below:
The dramatic increases in childhood obesity could create serious health consequences for an entire lifetime. And, as people age, it becomes increasingly more difficult to treat successfully. WCHQ will continue to provide data that helps our members identify opportunities to improve care for those who have obesity. To learn more about WCHQ’s work on issues related to obesity, register for the WCHQ Obesity Summit November 10, 2022, at The Hotel Retlaw in Fond du Lac.
IAC Discusses Strategies to Reach Improvement Goals
Improvement Advisory Committee Reviews Progress on Quality Priority Improvement Goals
The Improvement Advisory Committee (IAC) reviewed progress on the 2022 improvement goals for WCHQ’s quality priorities at their regular meeting in August. The Committee examined the publicly reported data, published in July, and evaluated both the impact of the pandemic and the progress made by health systems to achieve improvement targets.
The 2022 WCHQ Improvement Goals are:
- Childhood Immunizations: 83.6%
- Adolescent Immunizations: 90%
- Diabetes A1c Control: 73%
- Controlling High Blood Pressure: 82%
- Cervical Cancer Screening: 78.5%
- Colorectal Cancer Screening: 80%
Performance on nearly all priority measures has dipped since 2020. This led to a robust discussion on strategies and interventions for reaching the improvement goals established by the IAC in May 2022. Participants shared strategies for improving childhood immunization rates. Some health systems have implemented workflows for proactively scheduling additional appointments for pediatric patients either at their well-child visit or in the week following the visit. Additionally, by vaccinating children early in the age window, health systems have a buffer to get kids current on their immunizations.
The IAC reviewed the brief reports published by the Healthy Metric project and discussed strategies for improving health equity in the disparities priority measures: colorectal cancer screening, diabetes A1c control, and hypertension control. Committee members shared strategies for stratifying internal measures by race/ethnicity and insurance status to identify gaps. Given current staffing challenges at clinics across the state, health systems need to be creative in identifying new strategies to engage patients experiencing health disparities that do not require increased staffing levels, such as automated text campaigns. Other health systems have established partnerships with Federally Qualified Health Clinics (FQHCs) to identify needs and support interventions to reduce health disparities. The IAC will continue to discuss strategies to reach improvement goals and close disparities in upcoming meetings.
WCHQ Offers Robust Education Opportunities
WCHQ Education Highlights
With a blend of virtual and in-person education opportunities, WCHQ is offering several education topics in the upcoming months that build on its commitment to collaborate and educate on clinical topics of high interest to our members.
Here are a few highlights of our upcoming events:
WCHQ Obesity Summit
October 13
Dr. Tony Hampton has a national reputation for his work with patients on nutrition and weight management. Dr. Hampton will keynote the WCHQ Obesity Summit October 13 at the Hotel Retlaw in Fond du Lac. He will share several interventions aimed at removing barriers and increasing access to fresh, healthy food in partnership with food pantries. Follow Dr. Hampton on Instagram.
Lisa Cadmus-Bertram, PhD will share her findings on the connections she has found between lifestyle and chronic disease. Her research centers on physical activity, sedentary behavior and obesity and their relationship with cancer and other chronic diseases.
WCHQ Disparities Summit
November 10
The first of its kind for WCHQ, the Disparities Summit will focus on sharing interventions that have worked to ensure all people in our community have access to the care they need to lead their healthiest life. Registration is now open; the agenda will be finalized soon.
The complete schedule of education events follows. Contact Mary Kay Fahey for more information on any event.
Education Schedule: September – November 2022
Adolescent and Child Health Assembly
September 20
9 AM – 11:30 AM virtual
“Catching Kids Up: Improving Pediatric Quality in the Wake of the Pandemic”
Bringing children and adolescents up to date on their vaccinations and well child visits is a priority across the state. This webinar will address vaccine hesitancy with an emphasis on how to build trust and have effective conversations with parents. Fort Healthcare will share how they are using WCHQ pediatric data to enhance provider engagement and drive improvement.
Understanding the Treatment Options for Patients with Heart Failure
September 28
11:30 AM – 1 PM virtual
Heart failure remains a leading cause of morbidity and mortality globally. This online seminar will provide value to increase awareness of current medical management for the spectrum of HF based on the 2022 heart failure guidelines. The intent is to improve quality of care and align with patients’ interests and improve patient outcomes to decrease hospitalization for heart and CV mortality.
WCHQ Obesity Summit
October 13
The Hotel Retlaw, Fond du Lac
9 AM – 3:30 PM hybrid
WCHQ Disparities Summit
November 10
9 AM – 4 PM
Brookfield Conference Center, Brookfield, WI
Improvement Teams
Adolescent and Child Health
Register Today for the Adolescent and Child Health Assembly, September 20, 2022
Registration is now open for WCHQ’s annual Adolescent and Child Health Learning Assembly. This virtual event will be held September 20 from 9:00 AM – 11:30 AM and is open to all WCHQ members. The pandemic delayed critical preventive care for children and adolescents, with immunization and well-child visit rates dropping substantially. Catching kids up on this care is imperative to maintaining individual and community health. Please join us for a discussion of how to address vaccine hesitancy, raise HPV immunization rates, and use data to drive improvement in pediatric care.
Disparities
Team Establishes Strategies to Maintain Momentum in 2022
The Disparities Improvement Team met this month to review the data presented in the Healthy Metric Brief Reports and to strategize to build and maintain momentum for interventions in the remainder of the year. Moving forward, the Disparities Improvement Team will host focused meetings on a variety of topics including incorporating diversity, equity, and inclusion into all aspects of improvement, workforce issues, and specific clinical topics such as colorectal cancer screening and chronic disease. These meetings will include additional stakeholders with a wide array of expertise in addressing health disparities.
For more information on the Disparities Improvement Team, contact Abbey Harburn.
Chronic Kidney Disease (CKD)
CKD is Expensive and Preventable
According to the Centers for Disease Control and Prevention (CDC), in 2019, the costs associated with treating chronic kidney disease (CKD) were $87.2 billion with an additional $37.3 billion ($86,400 per person) to treat people with End Stage Renal Disease (ESRD). Evidence supports treatment options that have been proven to slow or prevent the progression of CKD while also reducing cardiovascular risks.
As a patient progresses through the stages of CKD they experience a lower quality of life and increased economic burden, which are good reasons to slow the progression. The WCHQ CKD Advisory Group is committed to supporting efforts toward early detection and treatment of CKD in patients with diabetes and hypertension.
At its September meeting the CKD Advisory Group will move one step closer to their goal to early identification and treatment as they evaluate options for a second diabetes CKD measure.
For more information or to join the group, please contact Sheryl Pierce.
Chronic Disease Learning Collaborative (CDLC)
In August, the CDLC Diabetes Workgroup heard from representatives of nine health systems that reviewed and discussed a few of the recent disparities reports, progress toward statewide goals, and individual, member specific workgroup goals. Collectively, there is good news as more patients are being seen again, programs are being developed to support underserved populations, and WCHQ performance metrics for blood sugar (A1c) control and blood pressure control are continuing to show signs of improvement.
The work hasn’t been easy. Improvement goals were in place; however, they were modified as challenges related to staffing variations and/or new electronic medical records for some have made them more difficult to achieve now. But, that may improve over time.
Members of the CDLC continue to work toward improvement goals and will be sharing their improvement work with their peers at an upcoming CDLC meeting in January. For more information or to join the group, contact Sheryl Pierce.
WCHQ Fourth Annual Oral Health Summit
WCHQ will host the Fourth Annual Oral Health Summit in LaCrosse October 7. The event will focus on two topics; value-based oral health care and disparities in oral health. National and Wisconsin-based speakers will share their expertise with Summit attendees. The link to the agenda is HERE. If you are interested in learning more about WCHQ’s work in oral health or you would like to attend the Summit, contact Jen Koberstein.
Behavioral Health
BHIT Reviews 2021 Data and Share Improvement Strategies
With the launch of the 2021 publicly reported data, the Behavioral Health Improvement Team (BHIT) met in September to review progress on the suite of behavioral health measures including Screening for Clinical Depression, PHQ-9 Utilization, and Depression Response and Remission. Most behavioral health measures have continued to improve through 2021, with Screening for Clinical Depression reaching 84%. The members discussed how to act on the available data and how this data can be used in their individual practices. Team members have now received their own health system data to allow for comparisons and identify opportunities for improvement. In future meetings, the BHIT will examine these measures stratified by race and ethnicity, insurance status, and geography to identify disparities in behavioral health services and outcomes.
If you are interested in learning more about the Behavioral Health Improvement Team, contact Jen Koberstein.
