Updates from the Lily Pad

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Updates from the Lily Pad
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Why Isnt Quality Better?
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
Gridlock in the Health Care System Everyone
Responsible, No One Accountable New Thinking is
Needed to Leapfrog the Gridlock
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Who we are-Populating the Pond

• Leapfrog represents..
• More than 170 large health care purchasers
• More than 36 million Americans
• More than 67 billion in health care expenditures

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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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Standard Measurements Practices To achieve
transparency and improved quality, we must talk
the same language when asking hospitals
doctors to report
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Initial Quality and Safety Leaps

• An Rx for Rx
• Computer Physician Order Entry (CPOE)
• Sick People Need Special Care
• ICU Staffing with CCM Trained M.D. live or via
  tele-monitoring, or risk-adjusted outcomes
  comparison
• The Best of the Best
• Evidence-based Hospital Referral (EHR) or
  risk-adjusted outcomes comparison
• Leapfrog Quality Index
• Rolled-up score of the remaining 27 of the 30
  NQF- endorsed Safe Practices

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Transparency Make reporting results routine and
use results to make health care purchasing
decisions
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Information for Consumers Purchasers on
Hospital Patient Safety Practices
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Incentives RewardsEncourage better quality of
care through incentives and rewards
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Growing Efforts to Buy Right

• Leapfrog Group Compendium of Incentive and
  Reward Programs http//www.leapfroggroup.org/irc
  ompendium.htm
• 90 programs nationwide 1 in 4 include
  Leapfrogs critieria
• 9 target consumers
• 18 target health plans
• 32 target hospitals
• 50 target physicians
• 51 are financial
• 87 are local
• Good and Bad news lots of programs but no clear
  signal for health care providers

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Leapfrogs Hospital Rewards Program (LHRP)

• Easy way for payers to bring incentives rewards
  for hospital performance into specific markets-
  LHRP can be implemented by health plans,
  purchasers and coalitions
• Adapts CMS-Premier demonstration program for the
  commercial sector
• Focuses on performance improvement in both
  effectiveness and efficiency in 5 important
  clinical areas (see next slide)
• Hospitals can participate with minimal additional
  reporting
• Builds on reinforces participation in the
  Leapfrog survey performance on our survey is key
  to the program
• Builds on reinforces hospital participation in
  another national initiative JCAHO
• Rewards both top performers and improvers

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Focused Clinical Areas Were Chosen to Maximize
Commercial Employer Impact

• Each clinical area has NQF-endorsed measures
  collected through the ORYX initiative or through
  Leapfrog
• Benchmarked against Medstats MarketScan, the 5
  represent 33 of admissions and 20 of a
  commercial payers I/P spend

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Hospitals Arrayed in Four Performance Groups
Using Expert-reviewed Statistical Methodology
Cardiac Bypass Surgery
1.8
Good quality, But inefficient
1.6
1.4
1.2
Top Cohort
Cohort 2
Efficiency
Efficient, But poor quality
Cohort 3
Cohort 4
1
0.8
0.6
0.4
0.8
0.85
0.9
0.95
1
1.05
1.1
Effectiveness
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The Leap over the Gridlock Has Begun

• Rapid growth in purchasers signing on to
  Leapfrogs approach
• Rapid growth in hospitals and physicians
  disclosing status to their communities
• Active health plan support
• Massive education of consumers through purchasers
• Market reinforcement beginning through different
  channels