Wisconsin Collaborative for Healthcare Quality In Pursuit of Value The Wisconsin Story Chris Queram President / CEO WCHQ March 20, 2017 Wisconsin Collaborative for Healthcare Quality

Defining the Scope of the Problem Per Capita Healthcare Costs — International Comparison, Oct. 17, 2016 http://www.pgpf.org/chart-archive/0006_health-care-oecd Wisconsin Collaborative for Healthcare Quality

Defining the Scope of the Problem Health care cost rise in the U.S. relative to other countries, as measured by total expendi-ture on health as percent of GDP “Exhibit 1” - http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective Wisconsin Collaborative for Healthcare Quality

Defining the Scope of the Problem http://www.commonwealthfund.org/publications/press-releases/2014/jun/us-health-system-ranks-last

Defining the Scope of the Problem Institute of Medicine To Err is Human 1999 44,000 – 98,000 deaths per year due to medical errors $17 - $29 billion in cost

Defining the Scope of the Problem New England Journal of Medicine “The Quality of Health Care Delivered to Adults in the United States” 2003 On average, U.S. adults receive recommended treatments only 55% of the time.

And, Lest We Forget About Health Tobacco use HEALTH BEHAVIORS (30%) Diet & exercise Alcohol use Sexual activity CLINICAL CARE (20%) Access to care Quality of care SOCIAL & ECONOMIC FACTORS (40%) Education Employment Income Family & social support Community safety PHYSICAL ENVIRONMENT (10%) Environmental quality Built environment HEALTH OUTCOMES MORTALITY (LENGTH OF LIFE): 50% MORBIDITY (QUALITY OF LIFE): 50% HEALTH FACTORS POLICIES & PROGRAMS County Health Rankings model © 2012 UWPHI

Improved Health Better Care Lower Costs National Quality Strategy

The WCHQ Mission Wisconsin Collaborative for Healthcare Quality We publicly report and bring meaning to performance measurement information that improves the quality and affordability of healthcare in Wisconsin, in turn improving the health of individuals and communities. Wisconsin Collaborative for Healthcare Quality

Who Participates in WCHQ Board of Directors Providers Purchasers Consumers Members Stakeholders Wisconsin Healthcare Provider Organizations Health Systems Medical Groups Hospitals Local, Regional & National Collaborators Purchasers Consumers Advocacy Organizations Government Agencies Research Institutions Foundations View our member and Board of Directors rosters on the WCHQ website. Wisconsin Collaborative for Healthcare Quality

WCHQ Member Organizations Wisconsin health systems, physician groups, and hospitals Representing approximately 60% of Wisconsin primary care physicians and 60% of all Wisconsin physicians Access Community Health Centers Agnesian HealthCare Ascension Wisconsin Aspirus Associated Physicians Aurora Health Care Bellin Health Beloit Health System Dean Clinic / SSM Divine Savior Healthcare Fort HealthCare Froedtert Health Group Health Cooperative of South Central WI Gundersen Health System Holy Family Memorial Marshfield Clinic Mayo Clinic Health System Medical College of Wisconsin Mercy Health System Meriter Health Services Monroe Clinic Prairie Clinic Prevea Health Primary Care Associates of Appleton ProHealth Care Richland Medical Center Sacred Heart Hospital Sauk Prairie Memorial Hospital & Clinics Sixteenth Street Community Health Centers ThedaCare UW Health Wildwood Family Clinic Wisconsin Collaborative for Healthcare Quality

WCHQ Stakeholders These healthcare purchasers and organizations collaborate with WCHQ: AARP Wisconsin American Cancer Society Business Health Care Group Colony Brands Greater Milwaukee Business Foundation on Health MetaStar Robert Wood Johnson Foundation Rural Wisconsin Health Cooperative Seats Incorprated The Alliance ThedaCare Center for Healthcare Value UW Health Innovation Program UW Population Health Institute WEA Trust Wisconsin Department of Health Services Wisconsin Health Information Organization Wisconsin Hospital Association Wisconsin Medical Society Wisconsin Primary Health Care Association Wisconsin Statewide Health Information Exchnage WPS Health Insurance Wisconsin Collaborative for Healthcare Quality

Values and Guiding Principles WCHQ members build consensus and drive improvement via: Trust – Avoid using performance data for market advantage. Participation – Engage in dialogue, capacity-building, and sharing of best practices. Inclusiveness – Deliberate and make decisions in ways that represent all affected parties. Shared Responsibility – Commit to enhancing capacity for individual growth and organizational improvement. Openness – Transcend competitive / intellectual boundaries that diminish learning. Adaptive Self-Governance – Encourage adaptability, diversity, flexibility, and innovation. Intellectual Output – Use measurement data to benefit all. Acknowledgement – Recognize intellectual contributions from inside and outside of WCHQ. Transparency – Openly share data and processes among WCHQ members and the public. Wisconsin Collaborative for Healthcare Quality

WCHQ Core Competencies WCHQ publicly reports and brings meaning to healthcare performance information. Performance Measures Priorities: We help to facilitate consensus on priority measures for assessing the quality and cost of healthcare in Wisconsin. Collect and Validate Measurement Data: We guide the collection, validation and analysis of both administrative and clinical data. Publicly Report Measurement Results: We publicly report comparative performance results for healthcare providers, purchasers and consumers. Share Best Practices: We share the best practices of healthcare organizations that demonstrate high quality, enabling all providers to adopt successful methods. Wisconsin Collaborative for Healthcare Quality

Performance & Progress Report www.wchq.org Wisconsin Collaborative for Healthcare Quality

WCHQ Public Reporting of Performance at the Clinic Level www.wchq.org Wisconsin Collaborative for Healthcare Quality

Wisconsin Collaborative for Healthcare Quality March 2013 Edition of Health Affairs “…Large Group Practices Will Engage In Quality Improvement Efforts In Response To Public Reporting, Especially When Comparative Performance Is Displayed…” Geoffrey Lamb Maureen Smith William Weeks Christopher Queram Wisconsin Collaborative for Healthcare Quality

Performance Improvement “Layered” Quality Improvement Model WCHQ member scorecard to identify top performers Wisconsin Collaborative for Healthcare Quality

Performance Improvement “Layered” Quality Improvement Model Shared Learning: WCHQ Assembly meetings Webinars Affinity groups Site visits Wisconsin Collaborative for Healthcare Quality

The Business Case for Quality “Public Reporting Helped Drive Quality Improvement in Outpatient Diabetes Care Among Wisconsin Physician Groups” Maureen Smith Alexandra Wright Christopher Queram Geoffrey Lamb Wisconsin Collaborative for Healthcare Quality

V = Q + C Approriateness Health Care Value Wisconsin Collaborative for Healthcare Quality

Efficiency Measure Prototype

Lessons Learned Public reporting is an important driver of improvement priorities Valid/reliable measures create trust and buy-in Granular data are required for performance improvement Social capital is critical to sustainability Wisconsin Collaborative for Healthcare Quality

Wisconsin Collaborative for Healthcare Quality 608-826-6837 Chris Queram President/CEO Wisconsin Collaborative for Healthcare Quality 608-826-6837 cqueram@wchq.org Wisconsin Collaborative for Healthcare Quality