Getting to know the Leapfrog Hospital Rewards Program

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Getting to know the Leapfrog Hospital Rewards
Program
April 4 6, 2006
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Leapfrogs Mission Statement

• Trigger Giant Leaps Forward in the Safety,
  Quality
• and Affordability of Healthcare By
• Supporting Informed Health Care Decisions by
  Those Who Use and Pay for Health Care
• Promoting High-Value Health Care Through
  Incentives and Rewards

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Pillars for Improving Quality
Standard Measurements Practices
Reimbursement Incentives Rewards
Transparency
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Leapfrog Hospital Rewards Program Improving
patient care advancing incentives rewards

• Expands on Leapfrog Hospital Quality and Patient
  Safety Survey to address quality and efficiency
  of care for five clinical areas important to the
  commercially insured population
• Data feedback to hospitals allows for performance
  comparisons improvements
• Has an incentive reward (IR) structure
  designed around measured hospital performance
  performance improvements
• The IR structure can be customized to fit local
  market needs and goals

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What does the Program do?

• Measures hospital performance on the two areas
  that matter to quality improvement clinical
  quality and efficiency
• Five clinical areas
• Coronary artery bypass graft (CABG)
• Percutaneous coronary intervention (PCI)
• Acute myocardial infarction (AMI)
• Community acquired pneumonia and,
• Deliveries/newborn care.
• Hospitals can participate in any of the clinical
  areas that are important to them

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What does the Program do? Measures

• Uses nationally standardized measures
• JCAHO, Leapfrog Survey, National Quality Forum
• Efficiency first nationally collected/calculated
  efficiency measure
• Leverage existing relationships quality
  activities
• Data reported through JCAHO core measure vendors
• Overlapping measurement with JCAHO CMS
  Hospital Quality Alliance
• Data gathered through the program provide basis
  for rewarding high performers, educating
  consumers and providing benchmark data to
  hospital participants

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Measures

• Quality measures
• Leapfrog Survey JCAHO core measures
• Resource-based measure of efficiency
• Average actual LOS / case, broken down by routine
  care days and specialty care days
• Severity adjusted based on risk factors
• Re-admission rate to same hospital, by clinical
  condition, within 14 days
• Program Licensees will marry this resource-based
  measure of efficiency with payment data from
  their own experience
• Overall Performance
• Nexus of Quality Efficiency

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How is the Program Used?

• Publicly Available Data for purchasers and
  consumers
• Overall Performance Group score displayed on The
  Leapfrog Group Web site, by condition.
• The quality and efficiency results will be made
  available to health plans for pay-for-performance
  initiatives, tiering, etc
• The data will also be made available to employers
  and data vendors to augment consumer education
  decision support strategies

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Locally customizable incentive reward program

• Leapfrog Hospital Rewards Program
• Savings Calculation
• National Rewards Principles
• Customizable by implementers based on market
  dynamics and goals for the Program
• Partner with The Leapfrog Group to implement
• Use LHRP quality and efficiency data as basis for
  rewarding hospitals
• Work with Leapfrog to determine savings
  calculation and rewards payment methodologies, in
  line with national Program guidelines
• Collaborate with Leapfrog to engage stakeholders,
  hospitals, etc.
• Use the Leapfrog name and brand

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Implementation Status

• Early Implementers Users
• Memphis Business Group on Health (Memphis, TN)
• CIGNA (Memphis, TN)
• Major regional health plan (statewide)
• CIGNA (Hospital Value Profile, nationwide)
• Others on the horizon
• Feasibility studies for future markets underway
• Building the hospital database
• Next data submission deadline May 15th, 2006

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Data Reporting Process Flow
1
Leapfrog PatientSafety Survey
ProgramLicensees
Leapfrog
Survey Results

• Clinical Area-specificScores
• Quality
• Resource-Based Efficiency

JCAHO CoreMeasures Data
AggregationandScoring
2
Hospital
Leapfrog
3
LFG Efficiency Measures
Core MeasureVendor
New
DataLicensees
Hospital Feedbackvia Vendors
All reported data must be hospital-specific to
be reward-eligible
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Leapfrog Hospital Rewards Program Data
Requirements
1

• Leapfrog Hospital Quality and Safety Survey
• Required for LHRP participation in ANY clinical
  area
• Current survey, including affirmations
• Latest survey as of Nov 30 for Jan 1 results
• Latest survey as of March survey cycle-ending for
  July 1 results
• Partial completion no points earned for that
  componentExample process compliance not measured

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Leapfrog Hospital Rewards Program Data
Requirements
2

• JCAHO Core Measures
• Objective no additional reporting burden
• Core Measures must be reported for clinical
  area(s)
• Copy of JCAHO data submission to LFG
• add LFG hospital identifier
• split HCO into component hospitals (
• extraneous data ignored on submission, e.g.,
  heart failure, unused measures
• Timing
• quarterly
• 15-30 day lag after JCAHO deadlines

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Leapfrog Hospital Rewards Program Data
Requirements

• Leapfrog Resource-Based Efficiency Measures
• By clinical area for which hospital participates
  in LHRP
• Actual length of stay (LOS), routine and special
• Severity-adjusted expected LOS, routine and
  special
• cases with readmit following discharge, within
  14 days, same hospital, any condition at readmit

3
Total length of stay for Deliveries
See details about risk adjustment models at
http//leapfrog.medstat.com/hrp
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Hospitals Arrayed in Four GroupsExample
Pneumonia
Cohort 1
Cohort 2
Average
Cohort 3
Cohort 4
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Hospital Data Feedback

• Hospitals receive their score and weight earned
  for each individual quality measure within each
  clinical area in which they participate.

• Hospitals receive their scores on each
  individual element within the efficiency measure
  for each clinical area in which they participate.

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Next Steps

• Timeline
• Next data submission deadline May 15, 2006
• Initial release of results July 2006
• How do I participate?
• Ask your JCAHO core measure vendor to submit data
  to Leapfrog on your behalf
• Participate in the Leapfrog Hospital Quality and
  Safety Survey
• For more information
• https//leapfrog.medstat.com/hrp/

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Appendix
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LHRP Hospital Pricing Structure
1 Hospital elects to be eligible for rewards and
is identified in results. 2 Hospital participates
anonymously to receive benchmark results but
elects not to authorize its identification in
results, though its results are included in the
national ranking
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Weighting Scoring AMI
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Weighting Scoring AMI (contd)
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Weighting Scoring CABG
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Weighting Scoring CABG (contd)
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Weighting Scoring PCI
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Weighting Scoring PCI (contd)
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Weighting Scoring Pneumonia
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Weighting Scoring Pneumonia (contd)
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Weighting Scoring Deliveries
For a hospital indicating in its Leapfrog
survey responses that it electively admits
high-risk deliveries (mothers expected to deliver
complicated newborns), NICU census and Antenatal
steroids measures do not apply. The weights
associated with these measures are allocated to
the remaining measures and the second set of
weights applies.