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The Leapfrog Groups Impact on Patient Safety and Future Information Technology

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The Leapfrog Group's Impact on Patient Safety and Future Information ... ORYX. NCQA. Physicians. Health plans (HEDIS) Leading Edge Efforts. The Leapfrog Group ... – PowerPoint PPT presentation

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Title: The Leapfrog Groups Impact on Patient Safety and Future Information Technology


1
The Leapfrog Groups Impact on Patient Safety and
Future Information Technology
Founded By The Business Roundtable With Support
From RWJF
Steve Wetzell April 11, 2003
2
Patient Safety and the Impact on CPOE
  • Why should we care?
  • Leading-edge efforts
  • Whats next?

3
National Standards Essential
  • Comparability across markets
  • Credibility
  • Reporting burden
  • Economies of scale and leverage

4
The Good News Lots Going on The Bad News
Lots Going on
5
Leading Edge Efforts
  • IOM
  • To Err is Human
  • Crossing the Quality Chasm
  • Leadership by Example
  • Next National health improvement priorities
  • National Quality Forum
  • Safe Practices
  • Initial Hospital Measurement Set

6
Leading Edge Efforts
  • CMS
  • Hospitals
  • Nursing Homes
  • Doctor Office Quality
  • QuIC

7
Leading Edge Efforts
  • JCAHO
  • ORYX
  • NCQA
  • Physicians
  • Health plans (HEDIS)

8
Leading Edge Efforts
  • The Leapfrog Group
  • 3 hospital safety standards
  • 125 large public and private purchasers
  • 17 local regional rollouts

9
Who we are
  • More than 137 large health care purchasers
  • Approximately 33 million Americans
  • More than 56 billion in health care expenditures

10
Elements of Gridlock
  • Purchasers Not Buying Right
  • Plans Not Letting Provider Value Show Through
  • Providers Not Seeing Business Case for
    Reengineering
  • Consumers/Patients Not In the Quality Game
  • New thinking needed to leapfrog
  • gridlock in the health care marketplace

11
The Silent Calamity
  • Needless mortality and morbidity
  • 44,000-98,000 plus deaths each year from medical
    errors during hospitalizations (IOM, 1999)
  • 7,000 deaths from medication errors alone
  • 17-29 million in added costs
  • Number of avoidable deaths in ambulatory care
    unknown

12
The Leapfrog Groups Mission
  • Trigger a giant leap forward in quality,
    customer service, and affordability of healthcare
    of all types by
  • Making the American public aware of a small
    number of compelling and easily understood
    advances in patient safety
  • Specifying a simple set of purchasing principles
    designed to promote these safety advances, as
    well as overall customer value

13
Leapfrog Purchaser Strategy
  • Organized effort to buy right
  • Purchasing principles that strongly reward
    higher provider value
  • Purchaser accountability
  • Push via plans or directly
  • Create a Business Case for Providers
  • Emphasize tangible safety leaps
  • Mobilize Consumers and Patients

14
Purchasing Principles
  • Educate and inform enrollees
  • Compare at the provider level
  • Reward superior provider value
  • Patient volume (select/deselect/freeze,consumer
    incentives, consumer decision support)
  • Unit price (pay for performance)
  • Public recognition
  • Initially highlight 3 tangible safety Leaps
  • Annually increase provider rewards

15
Criteria for Safety Leaps
  • Whats the Difference? Leap will produce big
    improvement in safety
  • Value Self-Evident Leap can be appreciated by
    consumers
  • Feasible Now Implementation steps are doable
  • Easily Ascertainable Purchaser or health plan
    can see if Leap is in place
  • Keep the List Short Leaps can be remembered

16
Initial Safety Leap Summary
  • An Rx for Rx
  • Computer Physician Order Entry (CPOE)
  • Up to 8 in 10 serious drug errors prevented
  • Sick People Need Special Care
  • ICU Daytime Staffing with CCM Trained M.D. live
    or via tele-monitoring, or risk-adjusted outcomes
    comparison
  • 29 mortality reduction (JAMA, 11/02)
  • Practice Makes Perfect
  • Evidence-based Hospital Referral (EHR) or
    risk-adjusted outcomes comparison
  • gt 30 mortality reduction for 7 complex
    treatments

17
What are the Three Leaps Worth?
  • Annual Gain Projected by Dartmouth
  • ? 522,000 serious med errors
  • ? 58,300 deaths
  • ? 58,300 X disabilities
  • (if fully implemented in U.S. urban hospitals)

18
Leap Refinement Creating More Sophisticated
Measures
  • CPOE Online evaluation tool developed by First
    Consulting Group
  • ICU Staffing Joint project with JCAHO to
    develop risk-adjustment methodologies and
    reporting program
  • EHR Process indicators being developed by Zynx
    Health, and outcomes reporting programs being
    considered by LF for national relevance

19
Potential Future Leaps
  • NQF safe practices and general hospital measures
  • Recognition for participation and superior
    performance via existing outcomes reporting
    programs
  • Physician office clinical decision support
    (working with CMS and AHRQ)

20
Physician Office Clinical Decision Support
  • Office based physicians electronically guided to
    evidence-based path
  • Histogram-style reporting format encourages
    single baby steps and five-dimensional giant
    leaps
  • Partner with CMS/AHRQ to focus on e-prescribing
    and e-lab result retrieval

21
Regional Roll-Out Strategy
Leapfrog is a national movement using targeted
regions to develop Best Practices, creating early
successes and learning from all Stakeholders
  • Regions must have
  • Effective leadership
  • Competitive HC market
  • Concentration of Leapfrog lives

22
On the Web NOW!
23
Hospitals Are Reporting from All Over the Country
24
Survey Participants
  • As of December 31, 2002
  • 18 Roll-Out Regions reporting
  • 952 urban hospitals invited to submit results
    voluntarily
  • More than half, 543 hospitals (57), submitted
    responses
  • 4 Regions had 100 participation from invited
    hospitals, 12 had greater than 60 participation
  • 53 percent meet at least one of Leapfrogs
    standards for the safety practices

25
Safety Practices Results 18 Regions
  • CPOE
  • 5 of the responding hospitals have fully
    implemented CPOE
  • An additional 24 say they have specific plans to
    implement such systems by 2004
  • IPS
  • 20 of responding hospitals have fully
    implemented IPS
  • Another 16 of responding hospitals indicate
    plans to enlist intensivists by 2004

26
Safety Practices Results (cont.)
  • EHR
  • Among participating hospitals, the following meet
    Leapfrogs volume recommendations
  • 12 meet Leapfrogs recommended volume for
    coronary artery bypass
  • 29 meet coronary angioplasty
  • 21 meet abdominal aortic aneurysm repair
  • 19 meet carotid endarterectomy
  • 11 meet esophageal cancer surgery
  • and 23 have NICUs that meet
  • Leapfrogs specifications.

27
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28
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29
Growing Efforts to Buy Right
  • Common Leapfrog RFI questions
  • Common Leapfrog health plan contract language
  • Focusing on value-based purchasing
  • Empire BCBS-Xerox-IBM-Verizon-Pepsi
  • PBGH
  • GE-PG-Ford-UPS-Humana
  • Blue Shield of CA tiering including Leapfrog
  • Healthcare 21s hospital report card

30
Health Plans Providing Data-based Consumer
Decision Support
  • Aetna, HealthNet, BCBS of RI talking to
    HealthGrades
  • BC of CA, PacifiCare sign deal with Subimo
  • Empire BCBS, UHC engages HealthShare, and CIGNA
    in discussion with them
  • Humana working with DoctorQuality

31
Implications for Information Technology
  • Employers and Plans
  • Data collection
  • Disseminate results
  • Consumer decision support
  • Sophisticated use of the web
  • Feedback systems for providers

32
Implications for Information Technology
  • Hospitals
  • Invest in information systems (NOW)
  • Safety and quality improvement
  • Data reporting
  • Decision support
  • Physicians
  • See hospitals

33
CPOE
  • Not a question of if, a question of when

34
More on the Web
  • Hospital specific information (via HealthGrades)
  • Enrollee communications toolkit (via FACCT) and
    consumer materials clearinghouse
  • Cost and savings information on the 3 leaps
  • CPOE reports
  • Common RFI questions (V-8 2002)
  • Fact Sheets and FAQs about the
  • safety leaps
  • Hospital survey (via MEDSTAT)
  • And more
  • www.leapfroggroup.org

35
How to become a Frog
  • Commitment to implement Leapfrog purchasing
    principles
  • Sign up forms on the Web Site (www.leapfroggroup.o
    rg)
  • click on Purchasers
  • click on Join The Leapfrog Group
  • review cover letter and participation forms
  • sign commitment
  • submit action plan check list within 2 months
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