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Wisconsin Health Information Organization Julie Bartels. Executive Director, WHIO


Academic year: 2021

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Wisconsin Health Information


Julie Bartels


Background re:


• Wisconsin Health Information

Organization (WHIO)

– Voluntary

– 501(c)3 Non Profit

– Conceptualized and funded by of

group of visionary – but very diverse

--Founding Organizations

– Shared commitment to improving

quality, safety, efficiency and


Background re:

State Involvement

• WI Stat Chapter 153

– Calls for collection and dissemination of

health care and related information for public consumption

• Inpatient and Outpatient Hospital Data

– WI Hospital Association

• POVD – Patient Office Visit Data

– Initiated in 2001, funded by annual provider assessment

– Terminated in 2006 based on expense and inability to meet data requirements

– Law amended to allow service contract with third party data provider


WHIO Mission

To create and maintain a

centralized health care data

repository that can be used to

improve quality, affordability,

safety and efficiency of health

care delivered in WI


Wisconsin Department of Health ServicesThe Wisconsin Collaborative for Healthcare QualityWisconsin Department of Employee Trust FundsWisconsin Hospital AssociationGroup Health Cooperative South Central WisconsinHealth Tradition Health Plan

Dean Health Plan



Greater Milwaukee Business Foundation on HealthHumanaThe AllianceUnited Healthcare of WIAnthem BC/BS of WI

WEA Insurance Trust

WPS Health InsuranceWisconsin Medical SocietyGundersen Lutheran Health Plan MercyCare Insurance

Security Health Plan

The Wisconsin Collaborative for Healthcare Quality



Value in


Quality / Cost = Value

– Conclusions drawn on incomplete

information may be erroneous

• Quality at any cost is unaffordable and


• Cost regardless of quality can lead to

inappropriate and unproductive health care decisions

– Value adds a sense of ‘worth’ from a

patients perspective to the health care decision making process.


WI Healthcare


• Wisconsin Collaborative on

Healthcare Quality

– Clinical quality measures

• Wisconsin Hospital Association

CheckPoint and PricePoint

– Inpatient and Outpatient cost and quality reporting


– Quality process measures

– Health care services utilization/cost measures


The Data

• 28% of Wisconsin’s population

– 1.6 million Members:

– 72,281 provider entities (both

people and facilities)

– 72.7 million Claim Records:

– 7.3 million care episodes


The Source

• Current:

– Anthem Blue Cross Blue Shield – Humana

– United Healthcare of WI – WEA Trust Insurance – WPS

• 2010 :

– Medicaid

– Dean Health Plan

– Gundersen Lutheran – Security Health Plan

– Group Health Cooperative – South







2006 WHIO Number of Members Frequency Map Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond Du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk St Croix Sauk Sawyer Shawano Sheboygan Taylor Trempealeau Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood 0-5000 5001-10,000 10,001-25,000 25,001-50,000 50,000 + Members Frequency




Population View

-Captures variation in care among

population components and highlights

where opportunities for broad based

care improvement exists:

– Gaps in quality – Access to care

– Elderly or Adolescent care – Disease Prevalence




Provider View

-Measures variation in practice that

lead to less than optimal care

– Compliance with national quality of care standards for specific conditions or

preventive care

– Relative over use (or under use) of health care services

– Identification of peer group average – Identification of best practice


Ex. Population Analytics


Diseases of: Total Standard Cost Total Inpatnt Admits Standard Cost per Admission 30 Day Re-admit rate 30 Day Re-admit count Circulatory System $459,768,184 24,398 $18,845 0.09 2,212 Musculoske letal System and Connective Tissue $335,984,835 20,204 $17,620 0.08 1,619 Digestive System $191,815,255 15,818 $12,126 0.09 1,451 Respiratory System $151,991,283 12,171 $12,488 0.10 1,194 Pregnancy $148,241,587 19,982 $7,417 0.03 571


Ex. Population Analytics

Quality Measures by Condition

Condition Category National Standard for Care # pts meeting selection criteria for testing # of pts receiving test(s) # pts not receiving test(s) Frequency national std of care for pts is met Diabetes (Endocrine) Adults with LDL cholesterol in last 12 mo 155,449 96,904 58,595 0.62 Preventive Breast Cancer Screening 321,126 218,942 102,184 0.68 Cardiology Pts with lipid profile during yr 71,929 28,591 43,338 0.40


Ex. Provider Quality Process Analytics

Measure Practice Group Performance Peer Practice Group Performance

Best Practice Provider Group Performance / compliance target Diabetes: Pts with LDL Cholesterol Test in last 12 mo. .97 .80 .97/1.00 Preventative: Pts with Mammogram screening in last 12 mo. .71 .81 .95/1.00 Cardiology: Pts with lipid test in measurement year .87 .77 .93/1.00


Ex. Provider Utilization Analytics

Type Of Service Provider Performance -Frequency

-Cost per episode

Peer Group Performance -Frequency

-Cost per episode

Provider Performance Index Laboratory 696 $40.89 968 $52.83 .72 .77 Radiology 129 $46.09 228 $59.15 .57 .78 Pharmacy 2868 $197.38 4626 $298.45 .62 .66


The Opportunity

• Refocus the health care debate with

an emphasis on VALUE

– Increase value to the patient by raising quality and/or decreasing cost

– A sense of worth or value is determined by applying what the patient knows/understands about care

options to their personal circumstance.

• Educating patients/caretakers is an essential part of the solution

• Waste Reduction is only way to

reduce health care cost

– Waste is anything not value added to the patient

– Experts suggest that as much as 30% to 50% of the cost of health care is waste


The Opportunity

• Set expectations that health care

decisions be based on facts.

– Use Population Analytics to identify opportunities for improvement

– Use Provider Analytics to identify best practices

– Design reimbursement programs and benefit plans that encourage and reward the right behaviors in patients and providers


To Continue the Conversation

Julie Bartels






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