Making%20Leaps%20in%20Health%20Care%20Suzanne%20Delbanco,%20Ph.D.,[e-mail]%20www.leapfroggroup.org

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Making Leaps in Health CareSuzanne Delbanco,
Ph.D., CEOThe Leapfrog Groupsdelbanco_at_leapfroggr
oup.orgwww.leapfroggroup.org

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The Purchasers Perspective
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Employer-Based Health Care System in Trouble

• Rapid escalation in cost (9-20/yr)
• Companies unable to absorb growing medical cost
  through product price increases
• Individual companies have limited purchasing
  power to effect change in system

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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
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The Impact of Bad Health Care Purchasing
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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
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The Leapfrog Movement and other Remedies
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The Leapfrog Operating System
Inform Educate Enrollees
Multipliers Health plan products
Member Support Activation
Compare Providers
Improved Value
CMS state purchasers
Rewarding Creating Incentives for Quality
Efficiency
Other distribution channels partners
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Pillars for Improving Quality
Standard Measurements Practices
Incentives Rewards
Transparency
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Sec. Leavitts Four Cornerstones to Promote
Quality and Efficiency

• Interoperable Health IT
• Transparency of quality information based on
  standard measures
• Transparency of price information
• Incentives for high quality care

Expands Presidents Executive Order calling for
federal purchasers (OPM, CMS, DoD) to use
purchasing practices to promote these cornerstones
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Standard Measurements Practices We must speak
the same language when asking hospitals
doctors to report national standards are
essential
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Four Safety Leaps and Beyond

• Four Leaps
• Computer physician order entry (CPOE)
• Staffing ICUs with intensivists
• Evidence-based hospital referral (EHR) for
  patients needing high-risk care to hospitals with
  the best track record and experience
• Safety Score of 27 other National Quality Forum
  (NQF) -endorsed Safe Practices
• Beyond
• Never events policy
• Leapfrog Hospital Insights

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The Dashboard of Information Neededis Still
Largely Blank
Hospitals Physicians Integrated Delivery Systems Treatment Options
Clinical Quality (Safe, Timely, Effective)
Efficiency
Patient Experience
Equity
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Transparency Make reporting quality and cost
measure results routine and use this information
to make health care purchasing decisions
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Leapfrog Hospital Quality and Safety Survey

• 2007 Survey launched on March 5
• New additions include aortic valve and bariatric
  surgeries, never events, and a transparency
  indicator
• 2376 hospitals targeted in 33 regions
• 1,264 hospitals participating to date (7/31/07)

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Leapfrogs Regional Roll-OutsPainting the USA
Green 2001-2007

• Regions drive survey data collection
• Recognize hospitals for participation and good
  performance
• Use various financial incentives and rewards to
  drive further improvements
• Regional Roll-Outs!
• (Regions in Green)

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Survey results posted publicly
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Leapfrog Hospital Insights

• Helps consumers make informed health care
  decisions and purchasers and plans create
  informed benefit designs, provider networks and
  reimbursement strategies
• Measures hospital performance on 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.

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Good Progress, but

• Leapfrog and other reporting efforts are limited
  in either or both scope and participation
• Rate limiting factors include quality of
  measures, burden of reporting, voluntary
  reporting may lead to self-selection, cost and
  quality are rarely connected

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Incentives RewardsEncourage better quality of
care through incentives and rewards
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Growing Efforts to Buy Right

• Public reporting and recognition
• Financial rewards to providers (200 programs)
• Reliance on process rather than outcomes measures
• Payments are small 2 to 6
• Financial incentives for consumers
• CMS and states engaging and can be major force

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Leapfrog Hospital Rewards ProgramTM

• Leapfrog Hospital Rewards ProgramTM (LHRP) is
  based on Leapfrog Hospital Insights measures
• Program Goal is to motivate hospital quality
  improvement through recognition and rewards
• Self-sustaining as rewards are paid out of
  savings from improvements

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There Is Significant Variance in Hospital
Performance
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The Top Performing Hospitals Show What is
Achievable
Top 25 in Quality and Efficiency
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Savings Analysis - Results
AMI AMI AMI AMI
of hospitals Average Payment of Average
Perf. Group 1 8.2 13,631 65
Perf. Group 2 50.9 18,699 90
Perf. Group 3 12.7 23,372 112
Perf. Group 4 28.2 25,700 123
Average 100 20,852 100
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National Opportunity
Lives saved total includes 7,810 lives saved from
ICU staffing
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Whats Next?
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Gainsharing Module

• Reward sharing between a hospital and its
  physicians under a scenario that also benefits
  purchasers and payers
• Based on quality, not cost as in other programs
• Possibly layered on top of Leapfrog Hospital
  Rewards Program

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Physicians Referrals

• Rate physicians on whether the hospitals to which
  they most often refer patients meet the relevant
  Leapfrog standards
• Goal of shifting market share to hospitals
  meeting standards to drive performance
  improvement among others
• Requires attention to benefit design and
  administration

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PROMETHEUS is a new payment model that, if
successful, will

• Remove the current barriers to the realization of
  high levels of professionalism in medicine,
  restoring autonomy with full public
  accountability
• Significantly improve the coordination of care in
  a fragmented delivery system, and the quality of
  care for patients
• Reduce unwarranted variation and moderate medical
  cost inflation
• Create true pricing information for all, and a
  way to measure output
• More information www.prometheuspayment.org

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It has a few important ingredients

• Pay right, right from the start It starts with
  Evidence-informed Case Rates (ECRs) that are
  adjusted to reflect patient severity. High
  performers can make more than 100 of the Case
  Rate doing well while doing right. Low
  performers will make less.
• Promote clinical integration and accountability
  across the board, and reward better quality 10
  to 20 of the payment is deposited in a
  performance contingency fund and tied to provider
  performance on process and outcomes of care,
  patient experience of care, and cost-efficiency.
  Providers are encouraged to be clinically
  integrated, even virtually, with 30 of their
  score dependent on the performance of downstream
  providers.
• Promote transparency ECRs provide real and
  complete price transparency for consumers and
  providers, and the scorecard provides full
  transparency on quality.

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Will Incentives and Rewards Work?

• Our current fixes are superficial
• They highlight the need to rebuild the payment
  system and how we organize care
• Costs are rising aging population, new drugs
  and technology may outstrip efficiencies we can
  create
• The need to shave the trend in health care costs
  is desperate

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Leaping Over the Gridlock

• Growing standardization in measurement,
  transparency and aligned incentives
• Health care system evolves so slowly, we can see
  the future now and might as well prepare