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WCHQ Results in 2018

December 14, 2018

Accomplishments and Vision for the Future

President’s Column

When we look back at 2018, I believe it will be remembered as the year that started an organizational transformation within the Wisconsin Collaborative for Healthcare Quality.

Health care quality in Wisconsin is among the best in the country. While we are proud of our ranking, we still have a long way to go to ensure we are delivering high VALUE care. The variability in both the cost and quality of care is an aspect of our health system that is a concern for all stakeholders, including providers, payers, purchasers and consumers.

In 2018, the WCHQ Board and staff invested considerable time shaping a novel proposal designed to leverage the integrated claims/clinical database we are developing in partnership with the Wisconsin Health Information Organization (WHIO). The most promising “use case” for improving quality and lowering costs is to create the decision-making tools that are required to measure, compare and improve the value of health care.

The move by WCHQ members to accelerate the value of Wisconsin’s health care represents the seamless synthesis and integration of WCHQ’s core competencies — measurement, analytics, convening/facilitation, quality improvement and practice transformation — in support of creating and sustaining a high-value health care system in Wisconsin.

The 2018 Results shared in this report were only possible because leaders at all levels of Wisconsin’s health care organizations are sharing what they learn to improve care across the state and beyond our borders. Your commitment to and participation in our organization is the essential ingredient to our joint success. We look forward to 2019 with a renewed sense of purpose to serve our membership and help you achieve your mission of helping people live better, healthier lives.

2018 Accomplishments

Practice Transformation/Quality Improvement

Each year, the Wisconsin Collaborative for Healthcare Quality staff, with significant member input, sets aggressive but realistic goals, which support and inform the measurement and improvement activities that are occurring in WCHQ member organizations.

One of WCHQ’s core strengths is helping members develop the skills and network to improve health care quality. Several areas showed improvement but one area showing dramatic improvement was depression screening, which increased 46% from June 2017 to June 2018.

Depression is the leading cause of disability and contributes to other health conditions. Many people who are experiencing depression present at clinics with an acute condition that requires care, but without a screening, depression may not be addressed. WCHQ’s Behavioral Health Steering Team, which is one of its largest steering teams, dedicated considerable time in 2018 researching and discussing clinical issues and identifying best practices that integrate behavioral health into the primary care practice.

WCHQ steering teams bring members with a shared interest in an improvement topic together to guide the development, dissemination and monitoring of goals and strategies to improve clinical outcomes. The information shared in these groups is compiled and curated by WCHQ staff and disseminated to members. Team members are encouraged to present their findings at WCHQ learning events.

In 2018, WCHQ staff researched, wrote and published four toolkits that provide detailed guidance for outpatient practices of any size to address a significant population health concern. Toolkits released in 2018 focused on hypertension control, diabetes control, rural chronic disease and colorectal cancer screening. Toolkits are updated on an annual basis and published on www.hipxchange.org in partnership with the University of Wisconsin.

Now in its second year, WCHQ, together with the Compass Practice Transformation Network (PTN), continues to provide hands-on quality improvement support and an opportunity to participate in peer-based learning networks to more than 300 clinicians. WCHQ, with support from the PTN, is helping clinicians develop the skills and provide the tools that are needed to improve care delivery and prepare for successful performance in a value-based health care environment.

“Fifty percent of Medicare beneficiaries in Wisconsin are screened for depression. That is very important. It is great to get these results; harder to sustain them, but that is what you are doing. On colorectal cancer, more than 60,000 additional people were screened over the past five years. The colorectal cancer screening rate in this country has remained abysmally low. I am so glad you are taking that on and getting tremendous results.”- Dr. Kate Goodrich in her keynote address at the 2018 WCHQ Statewide Quality Improvement Event

Measurement / Analytics / Public Reporting

Data collection, analytics and public reporting are WCHQ core strengths; key benefit

After six months of study and review by WCHQ’s Individual and Specialty Reporting Workgroup, and with a recommendation from the Measurement Advisory Committee (MAC), in May the WCHQ Board approved moving forward with public reporting of individual physician performance.

This is an opportunity for WCHQ members to influence how individual provider information is collected, measured and reported. The MAC will now begin work on a development and implementation plan. The measures that will be publicly reported must be carefully selected and vetted, and technical issues related to sample size, risk adjustment/segmentation, timeframes and preparations for the public launch will be finalized. Public reporting is not expected until later in 2020.

WCHQ staff released its biennial clinical performance score cards in 2018 that included all WCHQ’s members across all measures. This report allows WCHQ members to review their own performance and compare it to other health care organizations.

WCHQ’s health care performance measures distinguish themselves from those created by other organizations because they assess the care received by every provider’s patients regardless of who pays for the services. By upholding the principle, “All Patients; All Payers; Always,” WCHQ builds provider confidence in performance measurement and supports quality improvement efforts. View updated performance results for WCHQ measures of chronic and preventive care at wchq.org.

Measure alignment and reporting fatigue are issues that WCHQ has been tackling over the past year. WCHQ staff met with representatives of Minnesota Community Measurement and with purchasers and insurers throughout the year to discuss aligning measures to reduce the time and expense associated with collection and validation. This work will continue in 2019.

At the national level, the Centers for Medicare and Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP), have partnered with the National Quality Forum (NQF) to be the Core Quality Measures Collaborative’s (CQMC) operational home and further improve health care quality for every American.

The CQMC is a coalition of health care leaders, including CMS, health insurance providers, primary care and specialty societies, and consumer and employer groups. WCHQ President/CEO Chris Queram is serving on the CQMC Steering Group and Matt Gigot, WCHQ director, performance measurement and analysis, serves on its ACO Measurement Workgroup. CQMC recommended measure sets will be a key input to WCHQ’s measure alignment discussions.

The Centers for Medicare and Medicaid Services (CMS) included a WCHQ measure in the final policies for Year 3 (2019) of the Quality Payment Program via the Medicare Physician Fee Schedule (PFS) Final Rule. The measure, Ischemic Vascular Disease (IVD) care, is referenced in two sections of the rule; family practice and internal medicine. It is an “all or none” outcome measures related to optimal care.

This is an additional affirmation that WCHQ measures are valid, reliable and useful for standardizing care and measuring quality and that WCHQ continues to move in the right direction to align measures members are now using to those that are being used on the national level for payment reform.

In May, the WCHQ Board approved moving forward with public reporting of individual physician performance.

WCHQ Creates First Regional Dental Collaborative

Earlier this year, WCHQ announced it had formed one of the country’s first dental collaboratives. WCHQ is leveraging its experience, expertise, and infrastructure to benefit the dental community in the same way that it has advanced measurement, improvement and reporting in the medical sector.

The long-term vision for this initiative is informed by research showing the clear and compelling connection between good oral health and the management of diabetes and hypertension as well as maternal health outcomes. Viewed from this perspective, an integrated model of oral/physical health represents an important strategy for improving population health.

Joining ForwardDental, which was the first organization to become a WCHQ dental member, are: Health Partners, Minnesota; Marshfield Clinic Health System; and, Children’s Hospital of Wisconsin.

A starter set of measures (fluoride treatment, sealants, and caries risk assessment), has been developed; however, new measures are expected to be added in 2019, including scheduled check-ups related to periodontal disease. WCHQ will host a regional by-invitation-only dental summit in 2019 with presentations expected from the University of Iowa School of Dentistry, the Dental Quality Alliance and representatives from education, policymaking bodies and state agencies.

View updated performance results for WCHQ measures of chronic and preventive care: https://www.wchq.org/reporting/

A Vision for the Future

WCHQ submitted a successful response earlier this year to the CMS “Network of Quality Improvement and Innovation Contractors” (NQIIC) RFP. Final negotiations on WCHQ’s award are in process. If selected by CMS as a qualified contractor, WCHQ could bid on various task orders that will involve a broad range of health care quality improvement services involving data-driven initiatives to optimize health outcomes for persons and families while supporting clinicians, providers, and communities in improving health care and the health of the population they serve.

The WCHQ Board approved the 2019 operating and capital budget. These resources support two Board-approved inter-related strategic priorities: implementing an initiative to accelerate the move toward high value health care and the integration of claims and clinical data in partnership with WHIO. This initiative lays the groundwork to align WCHQ’s performance measurement/reporting and its quality improvement/practice transformation value streams to more rapidly increase health care value in Wisconsin.

Education

Education and networking are core values upon which WCHQ was built.

The WCHQ 2018 Assemblies and the Statewide Value Improvement Event drew record-breaking attendance where participants heard from nationally-recognized speakers and WCHQ members on key clinical topics. More than 90 percent of the attendees rated each event as excellent. Member input and participation drive content and ensure WCHQ’s education offerings are relevant to cost effective clinical practice. Topics covered in 2018 included health care value, chronic disease, behavioral health, and maternal and child health.

New Members

WCHQ welcomed four new members this year: Children’s Hospital of Wisconsin; ForwardDental; HealthPartners, Minnesota (joined WCHQ’s dental initiative); OakLeaf Clinics; and Vibrant Family Health Center, River Falls.

2019 WCHQ Assembly Learning Events:

February 12

April 16

September 19

November 23

WCHQ Statewide Quality Improvement Event:

June 5

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