Wisconsin Quality Collaborative CEO Describes ‘Secret Sauce’ to Group’s Success

Jan. 23, 2025
Gabrielle Rude, Ph.D., CEO of the Wisconsin Collaborative for Healthcare Quality, says a strong data foundation allows members to collaborate on practice transformation

The Wisconsin Collaborative for Healthcare Quality (WCHQ) is a member-led consortium comprised of health systems representing 75 percent of the patients in the state. The members work to improve the quality and cost-effectiveness of healthcare through the public reporting of comparative performance information. Following the organization’s recent 20th anniversary, Gabrielle Rude, Ph.D., president and CEO, spoke with Healthcare Innovation about WCHQ’s progress and new directions. She was also recently named to the Civitas Networks for Health board of directors. 

Healthcare Innovation: Could you start by telling us a little about your career before you became president and CEO at WCHQ?

Rude: I was inspired to get into this career originally starting as a medical translator. I was in college and decided that I was going to work a summer translating at a migrant camp from Spanish to English, and that changed my entire career trajectory. I thought I was going to be a physician, and the experience of translating information and context for providers made me want a career where I was helping healthcare providers deliver better care. 

After that experience, I chose to go get a degree in population health sciences, which is essentially epidemiology or studying the health of groups of people, and is all about giving that context to care providers. A lot of my research was on healthcare delivery, which I didn't fully understand the business of. I then switched and did about 10 years in an integrated health system, working in a variety of roles. One of my jobs was to become a member of WCHQ, and I loved the spirit of collaboration, the data that we were using, and wanted to be a part of it. It allowed me to be a part of an organization that had a statewide impact, driving improvement across the region. So I chose to leave direct patient care and come to WCHQ, which for me personally, is the perfect mix of academia, where I started my professional career, and improvement in healthcare, because we spend so much time touching on both of those items to drive improvement.

HCI: Let’s go back to the beginning of WCHQ.  Was it the health systems themselves coming together to work on quality? Was there one person who was the driving force behind it? Were there already other regional collaboratives in other places? Or was this kind of a pioneering model?

Rude: We were definitely a pioneer in this space. Since our formation, there have been a lot of organizations coming along that have followed in our footsteps.We celebrated our 20th anniversary of officially being incorporated in 2024. We were formed by a small number of health systems. There certainly was some individual leadership. You know, at our 20th anniversary, we had John Toussaint, who was then president of ThedaCare health system in northern Wisconsin, but who also is somewhat of a legend in the lean healthcare improvement world. It was his idea, but there were other real leaders from other health systems. 

Their idea was that if they came together to measure healthcare quality, by doing it themselves they believed that they would have better measures of things that mattered than some of the alternatives, which were claims-based. If they did it themselves, they could have better measures that would be embraced by the physicians at their organizations, so that they could actually use them for improvement. They had this pioneering idea of  not only sharing with each other, but making the measures public. We were the first organization in the nation to publicly report quality measures at the health system level, where you could go online and actually see how my organization compares.

HCI: Did they have to fight against any resistance within their own organizations about that aspect?

Rude: I think 20 years ago we had this handful of leaders who believed this really strongly and had been talking about it for a long time. Yes, they did have to really champion and get support for this vision, but they were the senior executives at their own organizations, so they were leading and they very quickly developed this club that other people wanted to join. They started with just a handful of organizations that were really brave, and then it grew from there.

HCI: Did they start with particular conditions that they wanted to demonstrate the ability to measure and report on such as diabetes? 

Rude: Well, you nailed it. The first measure that they publicly reported on was diabetes care, and actually, it's still a significant priority for us in Wisconsin, given the prevalence of the condition, as well as the cost. They chose it because it was so prevalent and so high cost in our state that it was a significant opportunity to show who's doing well on caring for these patients, as well as the improvement and the cost savings that we could achieve together..

Our work has stayed primarily in the outpatient space because we want to be as upstream as possible. We're looking for screenings and prevention and things that have a downstream impact on cost and patient outcomes, but we want to measure it before the patient is hospitalized or has those outcomes. That's where they started. But today, we're still publicly reporting diabetes measures. We've added a lot of other measures to that suite. It started with A1C, but now there are some composite measures and other things that we're publicly reporting that help us have a more holistic view of the patient care, but it's still a significant part of our portfolio.

HCI: Have the EHRs themselves evolved to make this easier for the health systems to do the work of gathering the data and reporting it?

Rude: Yes, in some cases. It still remains highly variable. In Wisconsin, where we are the home of Epic, we still have a lot of health systems on other solutions, and also variability in whether they can pull data out of them. So certainly, there has been a growth of organizations on EMRs. When we started, not everyone was even on an EMR. 

Initially we started with organizations just giving us the results of a measure that they measured themselves. We told them what population we wanted, the ages, the criteria, and they would go and query that data. We even allowed them to manually look through a sample of charts at that time. Fast forward to today, and every one of our members is sending us raw patient-level data on all of their patients for every visit that that patient has been seen. That wasn't possible 20 years ago, when not everyone was on the same EMR, or even on an EMR at that time. So it's definitely improved. We have dozens of different EMRs in our state, so we have to be flexible in how they get the data out and how we support them to do that.

HCI: And that all flows into a data warehouse that WCHQ has and your team does the data extraction for the reports?

Rude: Yes. We are unique. I'm not aware of any organization in the nation that does things exactly like we do. A lot of my counterparts in the improvement world are using other data sources from other partners, repositories, registries, to do their work. Wisconsin is unique in that our members wanted quick access to the data so that we can drive improvement, and that meant we built our own repository that we've had for nearly 20 years of patient-level data.

HCI: Has eliminating health disparities become a goal? I read about something called Healthy Metric. Can you describe that?

Rude: Reducing health disparities is one of our top two priorities. Improving healthcare value is our other shining star that we focus on. It came about as a priority primarily because Wisconsin has exceptional quality. When you look across the state, we are consistently one of the top five states for healthcare quality. We see dramatic improvement in quality when organizations join us and they do work to compare with others and learn from them. 

When you look at our measures, there are some populations that don't have those same outcomes or the same access to care. So as a state and as a collaborative, when we see a measure that we are exceeding the nation on, I'm very proud that our members have said: who within that population isn't achieving that outcome? In Wisconsin, we have traditional disparities based on race and ethnicity, socioeconomic status, but there are also some significant disparities and differences between rural and urban communities. 

WCHQ is uniquely positioned to figure out who those people are. Because WCHQ has patient-level data, we know where people live, their full address. We know a lot about their socio-economic status, their demographics. We can use our reports to get down to the census-level track of the disparities they're experiencing. We have found that there are really advantaged rural areas and really disadvantaged rural areas, and there are differences in what their concerns are. There are also disparities in traditionally high-socioeconomic-status areas. But without having the data to really think about what health condition they are more prone to because of where they live and who they are, it's hard to know what solution to put in place. 

So because of that data, we've been the perfect partner for our members to use to drive improvement. Healthy Metric, which you asked about, is a collaboration between our organization, being this data hub, and several research institutes in our state. We have two medical schools in our state, the University of Wisconsin, which is in Madison, and the Medical College of Wisconsin, which is in Milwaukee, as well as Marshfield Research Institute, which is a really important partner in rural Wisconsin. And then finally, there is the state's all-payer claims database, Wisconsin Health Improvement Organization. They're also part of it as a data contributor. The idea behind the collaboration is to put all the researchers together, all of the data together, so that we can figure out where the opportunities for improvement are. And we've put out a series of reports showing where the opportunities are. One of our more recent reports showed that the improvement practices WCHQ has supported have actually started to close some of the health disparities we're focused on.

HCI: Is part of the collaborative’s role educational — bringing people together to look at that data, with an organization that is a high achiever on a certain measure presenting about what how they're doing that?

Rude: That is exactly the secret sauce of our organization. I think of our data as the foundation for our work. It allows us to know where to focus and who's doing well and who's not doing well. But built upon that, we have an entire team dedicated to practice transformation. So they do a wide variety of services, from educational events, putting together toolkits of best practices based on their observations and study of who's doing well, facilitating learning between health systems.

 Everything we do, we try to collate and publish and make available to our members so that we can learn. It is a requirement of our membership that you submit all of your data, that you’re all in. We call our “all-in” reporting method our philosophy, because we want organizations all in on transparency. You don't get to come in and share just what you do well on; you share everything. 

The other part is that we don't compete on quality. We have some really clear rules with our members about that. They can't take our results and shame their competitor, but they can take our results and use that to talk to that competitor about, how do you do it? That's why I wanted to join WCHQ when I was working on quality within a health system. When I came to an event or a learning collaborative event at WCHQ, the amount of collaboration, transparency, and sharing I saw was not something I ever experienced in my health system, and now being at WCHQ, I don't see it anywhere else in the nation.

HCI: Is there anything else that your team is working on in 2025 that you want to mention?

Rude: One of our biggest focus areas is our work to establish ourselves as an extension of our members’ quality departments. When WCHQ started, we were a data shop pushing out results that our members could use. When I was hired, prior to becoming CEO, I worked for a few years to build out a practice transformation department for WCHQ because our members said they needed more hands-on support, so we have built up a staff that can provide that support. 

We built tools such as a self-service portal. Our members can log in and run measures beyond our public measures. We have several dozen measures available behind the scenes. We've increased the data technology that we have and the amount of data that's available to our members, so our priority going forward is to push services out more proactively. We're hearing from health systems that are under a lot of financial pressure, that are merging with larger health systems, sometimes outside of our state, that we need to transition from an organization that's available to support them to being this proactive part of their organization that knows what they need and puts it in place. 

It is a big transformation from being a resource that you can go and access to actually being a part of our member organizations. I'm looking forward to it, because I think it's going to be a real solution for our members that are struggling to keep all of the resources in place they need. The most important thing is that even during a pandemic, even during financially hard times, we need to have quality still be a priority so that we can do the other things that remain our top priorities, which are to reduce health disparities and improve healthcare value. That's how we're planning on doing it.

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