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Update from the Lily Pad Greg Belden, MBA Director, Regional Implementation

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Title: Update from the Lily Pad Greg Belden, MBA Director, Regional Implementation


1
Update from the Lily Pad Greg Belden, MBA
Director, Regional Implementation

2
Failures in the Quality and Safety of Care
  • Patients receive recommended health care only 55
    of the time1
  • 30 of all direct health care costs are due to
    poor care
  • Misuse, under-use, overuse, and waste2
  • Poor quality care costs between 1,900 and 2,250
    per covered employee year2
  • Poor quality means lives lost and mistakes made
  • Up to 98,000 deaths/year due to medical mistakes3

1McGlynn et al. 2003 2Midwest Business Group on
Health/Juran Institute 2003 3Institute of
Medicine 1999
3
Gridlock in the Health Care System
Health Plans Not Letting Provider Value Show
Through
Providers Not Seeing Case for Reengineering
Purchasers Not Buying Right, Toxic Payment System
Consumers Not In the Quality Game
Everyone Responsible, No One Accountable New
Thinking is Needed to Leapfrog the Gridlock
4
The Leapfrog Movement
5
Leapfrogs Mission
  • Trigger giant leaps forward in the safety,
    quality
  • and affordability of health care by
  • Supporting informed health care decisions by
    those who use and pay for health care
  • Promoting high-value health care through
    incentives and rewards

6
The Leapfrog Operating System
Inform Educate Consumers
Multipliers Health plan products
Member Support Activation
Compare Providers
Improved Value
CMS state purchasers
Rewarding Creating Incentives for Quality
Efficiency
Other distribution channels partners
7
Pillars for Improving Value
Standard Measures Practices
Incentives Rewards
Transparency
8
Standard Measurements Practices We must speak
the same language when asking hospitals
doctors to report national standards are
essential
9
Four Quality Safety Leaps and Beyond
  • Four Leaps
  • CPOE- Computer Physician Order Entry
  • IPS- Staffing ICUs with intensivists
  • EHR- Evidence-based hospital referral for
    patients needing high-risk care to hospitals with
    the best track record and experience
  • NQF- Safe Practices Score- safety score of 27
    other National Quality Forum (NQF) -endorsed safe
    practices
  • And Beyond.
  • Additional measures- Leapfrog Hospital Insights,
    leap refinements and measure harmonization
    coming in 2007!

10
Leap Applicability to Urban/Rural Hospitals
  • 2001-2003- Leaps Apply to Only Urban Hospitals
  • Areas where consumers have a choice of hospitals
  • Do not want to raise public expectation that
    rural hospitals should prioritize the leaps
  • 2004 and Beyond- Leaps Apply to Urban and Rural
  • 2 leaps (NQF Safe Practices and EHR) apply to
    rural hospitals

11
Transparency Make reporting results routine and
use results to make health care purchasing
decisions
12
Public Reporting of Quality Measurements Improves
Quality
(p lt .001, N34) Reference Hibbard et al.
Health Affairs 200322(4)84
13
Building a Dashboard of Information
14
Leapfrog Hospital Quality and Safety Survey
  • Largest national volunteer public reporting
    effort
  • Hospital participation continues to grow
  • Significant progress with ICU staffing (from 10
    of ICUs to 27 today)
  • Slow progress with CPOE
  • Sizable effort to improve wide range of other
    patient safety practices
  • High correlation between hospitals who perform
    well on our survey and patient satisfaction
    (PressGaney)

15
Leapfrog Unique in the Reporting Milieu
  • Represent employers/purchasers/consumers
    interests- the end users!
  • Measures are all NQF-endorsed
  • Seeks public accountability
  • Performance measures that are not the low
    hanging fruit (e.g., CPOE, IPS)
  • Full range of measuresstructural, process and
    outcome
  • Regional and national in scope
  • Recognizes high performance and improvement
  • Concerted effort to harmonize

16
Leapfrog Survey Results are Public
17
Leapfrogs Regional Roll-Outs Providing a
National Backdrop for Regional Change
  • Regions drive data collection
  • Invite hospitals to complete national survey
  • Recognize hospitals for participation and
    performance
  • Use various incentives and rewards for
    performance
  • 31 Regional Roll-Outs
  • (Regions in Green)

18
Who Are Our Current RRO Leaders?
19
Tracking Our Progress Leapfrogs Longitudinal
Reporting Tool
20
Some National Survey Stats
  • Over 55 of consumers in U.S. live w/in 25 miles
    of 3 hospitals reporting to Leapfrog!
  • 48.7 w/in 25 miles of IPS-compliant hospital
  • 47.7 w/in 25 miles of NICU-compliant hospital
  • 54.3 w/in 25 miles of NQF-compliant hospital
  • But..
  • 70 million people still w/out access to a
    Leapfrog reporting hospital w/in 25 miles
  • What about IA?

21
The Midseason Leapfrog Standings Opportunity for
Improvement
22
Leapfrog in Iowa Kudos to Genesis Medical Center!
23
Incentives RewardsEncourage better quality of
care through incentives and rewards
24
Incentive and Reward Tactics
  • Public Reporting
  • Benefit Design- Steerage
  • P4P- Direct Rewards
  • If you arent directly involved in the above
    value-based purchasing tactics, make sure your
    health plans are!
  • How? NBCHs eValue8, Leapfrogs Health Plan User
    Groups,etc.

25
EXAMPLE Public ReportingHC 21s Annual Consumer
Guide
26
EXAMPLE Benefit DesignState of MEs Hospital
Tiering Program
  • Criteria for Preferred Hospitals
  • Leapfrog Safe Practices Survey
  • The hospital completed the National Quality Forum
    (NQF) endorsed safe practices that universally
    can be used in all clinical settings
  • Maine Health Management Coalition (MHMC)
    Medication Spotlight Systems Review
  • Centers for Medicare Medicaid (CMS) Clinical
    Measures
  • Immediate impact in market since announcement of
    steerage program in July
  • MEs Leapfrog hospital participation rate jumped
    from 50 to over 90!

27
Leapfrog Hospital Rewards Program Value-Based
Purchasing for the Private Sector
  • Easy-to-manage national hospital Incentive
    Reward program for the private sector
  • But health care is local!
  • Flexible enough for employers and health plans to
    implement regionally as their hospital VBP
    strategy
  • Inspired by the CMS-Premier Hospital Quality
    Incentive Demonstration
  • Designed through multi-stakeholder collaboration
    and vetted through leading experts
  • Designed and implemented in partnership with
    Medstat

28
LHRP Program Goals
  • Activate consumers provide actionable hospital
    performance information to beneficiaries
  • Reduce trend potential for purchaser/payer
    savings as hospital performance improves
  • Improve patient care incentives rewards
    motivate hospital performance improvement
  • Encourage regional partnerships through
    implementation
  • Design an incentive reward framework that is
  • Win-win financial bonuses based on shared
    savings
  • Advancing consumers ability to make informed
    health care decisions
  • Customizable based on market-level partnerships

29
National Program Measures 5 Clinical Areas
  • 33 of commercial inpatient admissions
  • 20 of commercial inpatient spend
  • Opportunity for quality improvement
  • Actuaries show potential dollar savings as
    quality improves
  • NQF endorsed measures available already being
    collected

30
Quality Efficiency Measures
  • Helps to determine hospital value by measuring
    hospital performance in two dimensions quality
    and efficiency
  • Uses nationally accepted and standardized
    measures
  • JCAHO, Leapfrog Survey, National Quality Forum
  • Efficiency first nationally collected/calculated
    efficiency measure
  • Foundation of Leapfrogs expanded set of hospital
    performance measurement

31
Opportunity to Improve Care
Performance Group 1
Performance Group 2
Average
Performance Group 3
Performance Group 4
Example Pneumonia
32
Incentives and Rewards 1) Public Recognition 2)
Steerage 3) P4P- e.g. LHRP,
BTE
High
Transparency 1) Initiate LF RRO 2) Encourage
Hospital Participation in Leapfrogs
public reporting initiatives
Higher Quality Lower Cost
Clinical Re-engineering by MDs, Hospitals
Suppliers
Value of Health Expenditures
? Market Sensitivity to Hospital/MD Quality Cost
Performance Comparisons for Hospitals, MDs Tx
Low
Key Evolutionary Steps
2000
2010
33
The Leapfrog Group Some History
2000 Public launch at press conference 60
member companies 2001 Initial survey results
public 6 Regional Roll-Outs Launch initial
pay-for-performance programs 2003 National
Quality Forum endorses three leaps 2004 Leapfrog
survey incorporates NQF Safety Practices Over
600 hospitals attend town hall calls on Leapfrog
survey Leapfrogs Health Plan User Groups
launched 2005 Over 1200 hospitals respond to
survey Leapfrog Hospital Rewards Program
launched 2006 Roll-Outs now total 31. .
.targeting more than 50 hospital beds in
U.S. 2007 Leapfrog rolls out new survey, _?_
New Regional Roll-Outs
34
The Leapfrog Group Some Accomplishments
Before Leapfrog
After Leapfrog
Little publicly available information about
provider quality No modern pay-for-performance
programs Employer voice quiet or focused on
frustration Public and private sector purchasers
not aligned
Public release of provider information considered
mainstream Over 150 P4P programs
nationally Employers recognized as leaders in
driving value agenda CMS, private sector, and
state government purchasers agree on principles
35
How Are Employers Doing?
As major purchasers of health care services,
employers have the clout to insist on change.
Unfortunately, they have also been part of the
problem. In buying health care services,
companies have forgotten some basic lessons about
how competition works and how to buy
intelligently.
36
Whats Next?
37
Federal Action
  • Deficit Reduction Act of 2005 puts principles
    behind Leapfrog into law for Medicare and
    Medicaid
  • President Bushs Executive Order of August 22,
    2006 requires federal health care purchasers to
    use principles behind Leapfrog in purchasing
    practices
  • HHS Secretary Leavitt has challenged top 100
    employers to do the same

38
Recommendations
  • Competitively Bid Health Plans And Choose the
    Best
  • Use Contracts to Insist that Health Insurers
  • Publicly Release Quality/Cost Data on
    Doctors/Hospitals
  • Pay-for-Performance
  • Incentives For Employees Health and Health Care
    Choices
  • Focus Your Government Affairs Teams on Health
    Care
  • Join Leapfrog and Other Market-Focused Efforts
    like BTE

Why Employers Need to Rethink How They Buy Health
Care Robert S. Galvin, MD Suzanne Delbanco, PhD
Health Affairs November/December 2005
Leapfrogs . . . most important impact has been
as a powerful market catalyst.
39
Leapfrogs Annual Call for New RROs is Now!
Application Deadline is Nov. 30
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