Following is information on the “Leapfrog Group” health care initiative involving improvements in and reporting of health care safety and quality.

SUMMARY

The Leapfrog Group is a voluntary organization aimed at mobilizing employer purchasing power to alert the nation's health care industry that big leaps in health care safety, quality, and customer service will be recognized and rewarded. Among its various initiatives, Leapfrog works with its employer members to encourage transparency and easy access to health care information as well as reward hospitals that have a proven record of high quality care.

THE LEAPFROG GROUP INITIATIVE

Background

The Leapfrog Group is an initiative promoted by organizations that buy health care. It seeks to initiate breakthrough improvements in the safety, quality, and affordability of health care. It is aimed at mobilizing employer purchasing power to alert America's health industry that big leaps in health care safety, quality, and customer value will be recognized and rewarded. It was founded in 2000 by a small group of large employers and initially supported by the Business Roundtable (BRT). It continues to receive support from the BRT, as well as from the Robert Wood Johnson Foundation, Leapfrog members, and others. The Leapfrog Group has a growing membership list of Fortune 500 companies and other large private and public healthcare purchasers that provide health benefits to over 37 millions Americans in all 50 states.

The Institute of Medicine's (IOM) 1999 report on medical errors gave the Leapfrog founders an initial focus—reducing preventable errors. One of IOM's recommendations was that large employers provide more market reinforcement for the quality and safety of health care. The Leapfrog Group realized that it could take “leaps” forward with their employees, retirees, and families by rewarding hospitals that implement significant improvements in safety and quality.

Leapfrog members have agreed to base their health care purchasing on principles that encourage provider quality improvement and consumer involvement.

Mission

The Leapfrog Group's mission is to trigger giant leaps forward in the safety, quality, and affordability of health care by (1) supporting informed health care decisions by those who use and pay for health care and (2) promoting high-value health care through incentives and rewards.

This effort is based on four principles:

1. American health care remains far below obtainable levels of basic safety, quality, and overall customer value.

2. The health industry would improve more rapidly if purchasers better recognized and rewarded superior safety and overall value.

3. Voluntary adherence to purchasing principles by a critical mass of America's largest employers would provide a large jump-start and encourage other purchasers to join.

4. These principles should not only champion superior overall value but should initially focus on a handful of specific innovations offering “great leaps” to maximize media and consumer support and adoption by other purchasers.

Hospital Quality and Safety

The Leapfrog Group has identified four hospital quality and safety practices that are the focus of its health care provider performance comparisons and hospital recognition and reward. Based on independent scientific evidence, these are computer physician order entry (CPOE); evidence-based hospital referral (EHR); intensive care unit (ICU) staffing by physicians experienced in critical care medicine; and the Leapfrog Safe Practices Score, based on the National Quality Forum (NQF)-endorsed Safe Practices. The Leapfrog Group explains them and their potential to reduce the risk of error and harm as follows:

• CPOE: With CPOE systems, hospital staff enter medication orders via computer linked to prescribing error prevention software. CPOE has been shown to reduce serious prescribing errors in hospitals by more than 50%.

• EHR: Consumers and health care purchasers should choose hospitals with extensive experience and the best results with certain high-risk surgeries and conditions. By referring patients needing certain complex medical procedures to hospitals offering the best survival odds based on scientifically valid criteria (such as the number of times a hospital performs these procedures each year or other process or outcomes data) research indicates that a patient's risk of dying could be reduced by 40%.

• ICU Physician Staffing: Staffing ICU with physicians specially trained in critical care medicine, called “intensivists,” has been shown to reduce the risk of patients dying in the ICU by 40%.

• The Leapfrog Safe Practices Score: NQF-endorsed Safe Practices cover a range of 30 practices that, if utilized, would reduce the risk of harm in certain processes, systems of environments of care.

Leapfrog explains that this list is based on four primary criteria:

1. There is overwhelming evidence that these quality and safety leaps will significantly reduce preventable medical mistakes.

2. Their implementation by the health industry is feasible in the near term.

3. Consumers can readily appreciate their value.

4. Health plans, purchasers, and consumers can easily ascertain their presence or absence in selecting among providers.

These steps, Leapfrog believes, are a practical first step in using purchasing power to improve hospital safety and quality.

Buying Right

Leapfrog' member companies agree to following four purchasing principles in buying health care for their enrollees:

1. Educating and informing enrollees about the safety, quality, and affordability of health care and the importance of comparing the care providers give.

2. Recognizing and rewarding providers for major advances in the safety, quality, and affordability of their care.

3. Holding health plans accountable for implementing the Leapfrog purchasing principles.

4. Building the support of benefits consultants and brokers to use and advocate for the Leapfrog purchasing principals with all of their clients.

Leapfrog Hospital Rewards Program

In 2005, the Leapfrog Group began its first rewards program for hospitals. The program measures hospital performance on five conditions for effectiveness and affordability. Hospitals that demonstrate excellence or show improvement along both dimensions will be rewarded.

These five conditions are coronary artery bypass graft, percutaneous coronary intervention, acute myocardial infarction, community acquired pneumonia, and deliveries and neonatal care. An efficiency measure has been developed that applies a regional price adjuster to the average payment a hospital receives for each condition. The program has minimal reporting requirements according to Leapfrog. All the measures, apart from the efficiency measures, are currently collected through the Leapfrog Hospital Quality and Safety Survey or through JCAHO vendors.

Hospital rewards may be bonus payments to hospitals, higher reimbursement rates from health plan payers, public recognition, and increased patient market share.

For more information see www. leapfroggroup. org.

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