Updates from the Lily Pad Why Isn t

Updates from the Lily Pad

Why Isn’t Quality Better? Health Plans Providers Not Letting Provider Value Show Through 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

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

Leapfrog’s 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

Pillars for Improving Quality Standard Measurements & Practices Transparency Reimbursement: Incentives & Rewards

Standard Measurements & Practices To achieve transparency and improved quality, we must ‘talk the same language’ when asking hospitals & doctors to report

Initial Quality and Safety ‘Leaps’ 1. An Rx for Rx – Computer Physician Order Entry (CPOE) 2. Sick People Need Special Care – ICU Staffing with CCM Trained M. D. live or via tele-monitoring, or risk-adjusted outcomes comparison 3. The Best of the Best – Evidence-based Hospital Referral (EHR) or risk-adjusted outcomes comparison 4. Leapfrog Quality Index – Rolled-up score of the remaining 27 of the 30 NQF- endorsed Safe Practices

Transparency Make reporting results routine and use results to make health care purchasing decisions

Information for Consumers & Purchasers on Hospital Patient Safety Practices

Incentives & Rewards Encourage better quality of care through incentives and rewards

Growing Efforts to Buy Right Leapfrog Group Compendium of Incentive and Reward Programs: http: //www. leapfroggroup. org/ircompendium. htm • 90 programs nationwide – 1 in 4 include Leapfrog’s 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

Leapfrog’s 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

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 Medstat’s Market. Scan, the 5 represent 33% of admissions and 20% of a commercial payer’s I/P spend

Hospitals Arrayed in Four Performance Groups Using Expert-reviewed Statistical Methodology Cardiac Bypass Surgery 1. 8 Good quality, But inefficient 1. 6 Efficiency 1. 4 1. 2 Top Cohort 2 Cohort 3 Cohort 4 Efficient, But poor quality 1 0. 8 0. 6 0. 4 0. 85 0. 95 Effectiveness 1 1. 05 1. 1

The Leap over the Gridlock Has Begun • Rapid growth in purchasers signing on to Leapfrog’s 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