Trust in transparency and public reporting

In January 2019, the ABIM Foundation launched its Trust Practice Challenge, an initiative to address the “trust gap” in health care by identifying practices that foster trust and trustworthiness in various aspects of the health care system. The Foundation would later launch Building Trust to build on this open call.

The Wisconsin Collaborative for Healthcare Quality (WCHQ) is a voluntary consortium formed in 2003 by nine health system leaders, in partnership with the business community, who believed data collection, transparency, and collaboration had the power to transform practice and improve the quality of patient care. WCHQ members, which now number nearly 40 provider and dental organizations, agree to not compete on quality, owing to a shared belief that every patient should receive the same high-quality, safe care, regardless of where they may reside in the state. Members share and use data to fulfill accountability to consumers (the public) and to catalyze performance improvement. Today, WCHQ’s membership represents more than 65 percent of the primary care physicians practicing in Wisconsin, along with thousands of nurses, quality improvement specialists and others in administrative and support roles. They deliver care to more than 94 percent of the state’s Medicare beneficiaries.

WCHQ was an industry pioneer in producing valid and reliable comparative measures of physician performance for an entire population of patients, irrespective of payment source. Achieving this goal required direct access to data residing within the billing and clinical systems of the provider organizations. Through an iterative series of trust-building conversations, WCHQ members agreed to voluntarily submit patient-level billing and clinical data to create the first true population-based measure of diabetes process and control in 2004.

The WCHQ has steadily built on this foundation of trust by creating a robust data warehouse that stores granular information on more than 500 million patient encounters. The WCHQ measure portfolio currently consists of more than 40 ambulatory quality measures at both the health system and practice-site levels. WCHQ members also use the data for internal improvement and can evaluate performance down to the level of the individual clinician. WCHQ serves as a convener and facilitator of collaborative learning sessions that focus on sharing best practices. The combination of transparent public reporting and sharing best practices epitomizes an environment of reciprocal trust. Members trust that WCHQ will be a faithful and diligent steward of their data and that, in return, WCHQ will generate valid and reliable measure results that are used in the spirit of public accountability, collaboration and improvement.

Skills/Competencies:

Inclusive governance
Relational management
Consensus building on core values

Proof of Concept:

Wisconsin was one of the first states in the country to publicly report clinical data related to quality when WCHQ released a diabetes process and control (hemoglobin A1C and cholesterol) measure for six physician organizations in October 2004. WCHQ has grown to an organization that now has 35 members and a diverse measurement portfolio with over 40 measures.

Publicly reporting quality results requires trust, especially given that there is always a top and a bottom performer, even in a state with exceptional quality. WCHQ members recognize that improvement will result from the sharing of best practices once top-performing organizations can be identified through public reporting and benchmarking. WCHQ’s model brings health care leaders together to create a forum for discussions centered on public reporting, quality improvement and per capita cost, and appropriateness of care.

Replicability/Scalability:

The WCHQ governance model and value streams can be replicated in any practice setting and geographic region that combines vision, foresight and will to pursue a multi-stakeholder, collaborative approach to systems change. As one concrete example, WCHQ has expanded its measurement and improvement work to dentistry, welcoming four dental practices to its membership in 2018. Their vision is to advocate for an integrated model of oral and systemic health, while leading dental providers down the now familiar path of initiating data collection, generating measures for benchmarking, facilitating improvement, and reporting publicly. The WCHQ model has spread outside Wisconsin “organically” by virtue of mergers involving health care systems based in other states as well as members that serve patients across the borders with Illinois, Iowa, Michigan and Minnesota. WCHQ is seeking to expand beyond adjoining states by pursuing franchise partnerships. WCHQ’s data repository can accept data from anywhere in the country and its intellectual property could be licensed to and adopted by a willing partner in another state.

Evidence suggests that WCHQ has contributed to Wisconsin’s serial ranking as one of the top performing states in the country on meta-measures of health care quality. Some of the evidence is observational, as a review of the longitudinal data on the WCHQ web site shows steady and sustained improvement across the measure portfolio. WCHQ’s experiences have been contributed to the evidence base through several qualitative and quantitative studies published over the last decade.^1-3

References:

1. Greer, AL. Embracing Accountability: Physician Leadership, Public Reporting, and Teamwork in the Wisconsin Collaborative for Healthcare Quality. The Commonwealth Fund, 2008.

2. Smith MA, Wright A, Queram C, and Lamb GC. Public reporting helped drive quality improvement in outpatient diabetes care among Wisconsin physician groups. Health Affairs (Milwood). 2012; 31(3): 570-773. Lamb GC, Smith MA, Weeks WB, and Queram C. Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve. Health Affairs (Milwood). 2013; 32(3): 536-543.

3. Lamb GC, Smith MA, Weeks WB, and Queram C. Publicly reported quality-of-care measures influenced Wisconsin physician groups to improve. Health Affairs (Milwood). 2013; 32(3): 536-543.