Emplify Health by Gundersen, 2026 Quality
Your Roadmap to Closing Equity Gaps and Increasing Well-Child Visits in the First 15 Months of Life
This project focused on improving well-child visit completion while also addressing equity gaps across populations. The goal was to increase the percentage of children completing six well-child visits by 15 months of age to 80.28% by the end of FY2025.
To support this work, the team implemented a series of targeted, workflow-based interventions designed to improve reliability across the care continuum. A “Well-Child Visit Roadmap” was developed to outline key touchpoints from birth through 15 months, helping teams visualize where gaps were occurring and where interventions could be applied.
Several key strategies were implemented. A standardized NICU discharge process was created to ensure follow-up visits were scheduled appropriately and counted as well-child visits. Scheduling practices were strengthened by encouraging in-room scheduling before families left appointments, with a focus on proactively scheduling future visits. A standardized no-show workflow was also developed to improve follow-up for missed appointments. In addition, Epic reporting tools were used to identify patients not meeting milestones and support targeted outreach.
These efforts led to sustained performance above the FY2025 target, with well-child visit completion rates remaining above 80% throughout the fiscal year. Improvements were also seen in equity measures, with the gap between Medicaid and privately insured populations narrowing over time. Process reliability improved, particularly in early visit milestones, which are critical for keeping patients on track.
Additional targeted improvements were seen in specific areas. NICU discharge visit completion improved from 89% to 94% following implementation of standardized guidance. At the Tomah clinic, well-child visit adherence increased from 69.95% to 75.13%, while the number of patients aging into the measure as noncompliant decreased significantly. Collaboration with social work also helped address barriers such as transportation, improving access for families facing challenges outside of the clinical setting.
This work highlights the impact of standardizing workflows and improving visibility into patient-level data. Rather than relying on large-scale changes, small, consistent improvements across scheduling, follow-up, and outreach processes contributed to meaningful gains in both performance and equity.
Next steps include expanding successful workflows across additional clinics, further developing pediatric no-show processes, and incorporating prenatal education and scheduling guidance to support early visit completion. Ongoing collaboration with community partners and continued use of Epic process metrics will help sustain improvements and monitor progress over time.
Overall, this project demonstrates how focused, clinic-level improvement efforts can strengthen preventive care delivery, reduce disparities, and better support children and families during a critical stage of development.
To support this work, the team implemented a series of targeted, workflow-based interventions designed to improve reliability across the care continuum. A “Well-Child Visit Roadmap” was developed to outline key touchpoints from birth through 15 months, helping teams visualize where gaps were occurring and where interventions could be applied.
Several key strategies were implemented. A standardized NICU discharge process was created to ensure follow-up visits were scheduled appropriately and counted as well-child visits. Scheduling practices were strengthened by encouraging in-room scheduling before families left appointments, with a focus on proactively scheduling future visits. A standardized no-show workflow was also developed to improve follow-up for missed appointments. In addition, Epic reporting tools were used to identify patients not meeting milestones and support targeted outreach.
These efforts led to sustained performance above the FY2025 target, with well-child visit completion rates remaining above 80% throughout the fiscal year. Improvements were also seen in equity measures, with the gap between Medicaid and privately insured populations narrowing over time. Process reliability improved, particularly in early visit milestones, which are critical for keeping patients on track.
Additional targeted improvements were seen in specific areas. NICU discharge visit completion improved from 89% to 94% following implementation of standardized guidance. At the Tomah clinic, well-child visit adherence increased from 69.95% to 75.13%, while the number of patients aging into the measure as noncompliant decreased significantly. Collaboration with social work also helped address barriers such as transportation, improving access for families facing challenges outside of the clinical setting.
This work highlights the impact of standardizing workflows and improving visibility into patient-level data. Rather than relying on large-scale changes, small, consistent improvements across scheduling, follow-up, and outreach processes contributed to meaningful gains in both performance and equity.
Next steps include expanding successful workflows across additional clinics, further developing pediatric no-show processes, and incorporating prenatal education and scheduling guidance to support early visit completion. Ongoing collaboration with community partners and continued use of Epic process metrics will help sustain improvements and monitor progress over time.
Overall, this project demonstrates how focused, clinic-level improvement efforts can strengthen preventive care delivery, reduce disparities, and better support children and families during a critical stage of development.
