Getting to know the Leapfrog Hospital Rewards Program™
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Transcript of Getting to know the Leapfrog Hospital Rewards Program™
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Getting to know the Leapfrog Hospital Rewards
Program™
April 4 & 6, 2006
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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
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Pillars for Improving Quality
Transparency
Standard Measurements
& Practices
Reimbursement:
Incentives & Rewards
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Leapfrog Hospital Rewards Program:
Improving patient care & advancing incentives & rewards
• Expands on Leapfrog Hospital Quality and Patient Safety Survey to address quality and efficiency of care for five clinical areas important to the commercially insured population
• Data feedback to hospitals allows for performance comparisons & improvements
• Has an incentive & reward (I&R) structure designed around measured hospital performance & performance improvements
• The I&R structure can be customized to fit local market needs and goals
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What does the Program do?• Measures hospital performance on the two areas
that matter to quality improvement: 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.
• Hospitals can participate in any of the clinical areas that are important to them
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What does the Program do?: Measures
• Uses nationally standardized measures:– JCAHO, Leapfrog Survey, National Quality Forum
– Efficiency: first nationally collected/calculated efficiency measure
• Leverage existing relationships & quality activities:– Data reported through JCAHO core measure vendors
– Overlapping measurement with JCAHO & CMS’ Hospital Quality Alliance
• Data gathered through the program provide basis for rewarding high performers, educating consumers and providing benchmark data to hospital participants
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Measures• Quality measures:– Leapfrog Survey + JCAHO core measures
• Resource-based measure of efficiency:– Average actual LOS / case, broken down by routine care days and
specialty care days– Severity adjusted based on risk factors– Re-admission rate to same hospital, by clinical condition, within 14 days– Program Licensees will marry this resource-based measure of efficiency
with payment data from their own experience
• Overall Performance:– Nexus of Quality & Efficiency
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How is the Program Used?
• Publicly Available Data for purchasers and consumers– Overall Performance Group score displayed on The
Leapfrog Group Web site, by condition.
• The quality and efficiency results will be made available to health plans for pay-for-performance initiatives, tiering, etc
• The data will also be made available to employers and data vendors to augment consumer education & decision support strategies
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Locally customizable incentive & reward program
• Leapfrog Hospital Rewards Program™– Savings Calculation– National Rewards Principles
• Customizable by implementers based on market dynamics and goals for the Program– Partner with The Leapfrog Group to implement – Use LHRP quality and efficiency data as basis for rewarding
hospitals– Work with Leapfrog to determine savings calculation and rewards
payment methodologies, in line with national Program guidelines– Collaborate with Leapfrog to engage stakeholders, hospitals, etc.– Use the Leapfrog name and brand
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Implementation Status
• Early Implementers & Users– Memphis Business Group on Health (Memphis, TN)– CIGNA (Memphis, TN) – Major regional health plan (statewide)– CIGNA (Hospital Value Profile, nationwide)– Others on the horizon …
• Feasibility studies for future markets underway• Building the hospital database
– Next data submission deadline: May 15th, 2006
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Data Reporting: Process Flow
Hospital*
Leapfrog
Leapfrog PatientSafety Survey
*All reported data must be hospital-specific to be reward-eligible
Core MeasureVendor
JCAHO CoreMeasures Data
LFG Efficiency Measures
Leapfrog
Survey Results
Clinical Area-specificScores:• Quality• Resource-Based Efficiency
DataLicensees
ProgramLicensees
New
Aggregationand
Scoring
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Hospital Feedbackvia Vendors
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Leapfrog Hospital Rewards Program
Data Requirements• Leapfrog Hospital Quality and Safety Survey
– Required for LHRP participation in ANY clinical area
– Current survey, including affirmations• Latest survey as of Nov 30 for Jan 1 results• Latest survey as of March survey cycle-ending
for July 1 results– Partial completion: no points earned for that
componentExample: process compliance not measured
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Leapfrog Hospital Rewards Program
Data Requirements• JCAHO Core Measures
– Objective: no additional reporting burden– Core Measures must be reported for clinical area(s)– Copy of JCAHO data submission to LFG
• add LFG hospital identifier• split HCO into component hospitals (<1%)• extraneous data ignored on submission, e.g., heart
failure, unused measures– Timing
• quarterly• 15-30 day lag after JCAHO deadlines
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Leapfrog Hospital Rewards Program
Data Requirements• Leapfrog Resource-Based Efficiency Measures
– By clinical area for which hospital participates in LHRP
– Actual length of stay (LOS), routine and special*– Severity-adjusted expected LOS, routine and
special**– # cases with readmit following discharge, within 14
days, same hospital, any condition at readmit
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* Total length of stay for Deliveries
** See details about risk adjustment models at http://leapfrog.medstat.com/hrp
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(2.5)
(2.0)
(1.5)
(1.0)
(0.5)
0.0
0.5
1.0
1.5
2.0
2.5
20% 30% 40% 50% 60% 70% 80% 90%
(2.5)
(2.0)
(1.5)
(1.0)
(0.5)
0.0
0.5
1.0
1.5
2.0
2.5
20% 30% 40% 50% 60% 70% 80% 90%
(2.5)
(2.0)
(1.5)
(1.0)
(0.5)
0.0
0.5
1.0
1.5
2.0
2.5
20% 30% 40% 50% 60% 70% 80% 90%
Hospitals Arrayed in Four GroupsExample: Pneumonia
(2.5)
(2.0)
(1.5)
(1.0)
(0.5)
0.0
0.5
1.0
1.5
2.0
2.5
20% 30% 40% 50% 60% 70% 80% 90%
Quality
Res
ou
rce-
Bas
ed E
ffic
ien
cy
Cohort 4
Average
Cohort 3
Cohort 2
Cohort 1
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Hospital Data Feedback
TotalPCI Weight PCI Weight Weight 80%+ Weight
Hosp ID Hospital Mortality Earned Volume Earned Earned Adhere Earned
00-0032 Hosp A1, City, State Better 34.00% 2,739 12.00% 46.00% No 0.00%
Mortality-RelatedLFG Outcomes LFG Volume
Major Morbidity-RelatedLFG: PCI Process
• Hospitals receive their score and weight earned for each individual quality measure within each clinical area in which they participate.
# AverageExpected AverageExpectedReadmitsSeverity Std Readm
Hosp ID Hospital Cases ALOS r ALOS r ALOS s ALOS s <= 14 Index ALOS Rate
00-0032 Hosp A1, City, State 499 1.983 2.121 1.364 1.400 33 1.112 3.011 6.6%
Resource-Based EfficiencyAverage Length of Stay
• Hospitals receive their scores on each individual element within the efficiency measure for each clinical area in which they participate.
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Next Steps
• Timeline– Next data submission deadline: May 15, 2006– Initial release of results: July 2006
• How do I participate?– Ask your JCAHO core measure vendor to submit
data to Leapfrog on your behalf– Participate in the Leapfrog Hospital Quality and
Safety Survey
• For more information– https://leapfrog.medstat.com/hrp/
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Appendix
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LHRP: Hospital Pricing Structure
Number ofConditions Reported
Per Hospital Annual Fee
RewardEligible1
Masked Identity2
1 1,000 2,000
2 1,350 2,700
3 1,700 3,400
4 2,050 4,100
5 2,400 4,800
1 Hospital elects to be eligible for rewards and is identified in results.2 Hospital participates “anonymously” to receive benchmark results but elects not to authorize its identification in results, though its results are included in the national ranking
© 2006 The Leapfrog Group and Thomson Medstat
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Weighting & Scoring – AMIMeasure Source Weight Scoring
Inpatient mortality JCAHO
(AMI=9)
15.33% • Percent rank (0% = worst, 100% = best) times
• 15.33% weight
Aspirin at arrival JCAHO
(AMI-1)
16.06% % compliance times weight
Beta blocker at arrival JCAHO
(AMI-5)
14.61% % compliance times weight
Aspirin prescribed at discharge JCAHO
(AMI-2)
4.83% % compliance times weight
Beta blocker prescribed at discharge JCAHO
(AMI-6)
4.83% % compliance times weight
ACEI for LVSD JCAHO
(AMI-3)
4.83% % compliance times weight
Thrombolytic agent received within 30 minutes of arrival
JCAHO
(AMI-7a)
4.83% % compliance times weight
PCI with door-to-balloon time within 90 minutes of arrival
LFG 4.83% % compliance times weight
Adult smoking cessation advice/ counseling
JCAHO
(AMI-4)
4.83% % compliance times weight
© 2006 The Leapfrog Group and Thomson Medstat
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Weighting & Scoring – AMI (cont’d)
Measure Source Weight Scoring
Computerized physician order entry (CPOE)
LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
Intensivist ICU staffing (IPS) LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
Leapfrog Quality Index (NQF Safe Practices)
LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
© 2006 The Leapfrog Group and Thomson Medstat
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Weighting & Scoring – CABGMeasure Source Weight Scoring
Mortality LFG 34.00% Full credit if• Public risk-adjusted mortality rate better than state median
OR• STS risk-adjusted mortality rate better than national
average
… else no credit
Volume LFG 12.00% Full credit if• Volume ≥ 450
… else no credit
Prophylactic antibiotic received within one hour prior to surgical incision
JCAHO
(SIP-1b)
3.50% % compliance times weight
Prophylactic antibiotic selection for surgical patients
JCAHO
(SIP-2b)
3.50% % compliance times weight
Prophylactic antibiotics discontinued within 24 hours after surgery end time
JCAHO
(SIP-3b)
3.50% % compliance times weight
Process measures:• CABG using internal mammary artery• Aspirin at discharge• Beta blocker within 24 hours after
surgery• Beta blockers prescribed at discharge• Lipid-lowering therapy prescribed at
discharge• Extubation within 24 hours after
surgery
LFG 9.25%
+
9.25%
% compliance times weight for two highest compliance rates of up to six measures reported
… else no credit if not measured
© 2006 The Leapfrog Group and Thomson Medstat
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Weighting & Scoring – CABG (cont’d)
Measure Source Weight Scoring
Computerized physician order entry (CPOE)
LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
Intensivist ICU staffing (IPS) LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
Leapfrog Quality Index (NQF Safe Practices)
LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
© 2006 The Leapfrog Group and Thomson Medstat
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Weighting & Scoring – PCIMeasure Source Weight Scoring
Mortality LFG 34.00% Full credit if• Public risk-adjusted mortality rate better than state median
OR• ACC risk-adjusted mortality rate better than national
average
… else no credit
Volume LFG 12.00% Full credit if• Volume ≥ 400
… else no credit
Process measures:• Aspirin at arrival• 1st balloon inflation within 90 minutes
LFG
14.50%14.50%
% compliance times weight for each measure
… else no credit if not measured
Computerized physician order entry (CPOE)
LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
© 2006 The Leapfrog Group and Thomson Medstat
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Weighting & Scoring – PCI (cont’d)
Measure Source Weight Scoring
Intensivist ICU staffing (IPS) LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
Leapfrog Quality Index (NQF Safe Practices)
LFG 8.33% • Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
© 2006 The Leapfrog Group and Thomson Medstat
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Weighting & Scoring – PneumoniaMeasure Source Weight Scoring
Initial antibiotic received within 4 hours of hospital arrival
JCAHO
(PN-5b)
5.50% • Percent rank (0% = worst, 100% = best) times
• 5.50% weight
Influenza vaccination JCAHO
(PN-7)
7.50% % compliance times weight
Pneumococcal vaccination JCAHO
(PN-2)
12.00% % compliance times weight
Adult smoking cessation advice/ counseling
JCAHO
(PN-4)
7.50% % compliance times weight
Intensivist ICU staffing (IPS) LFG 13.50% • Fully implemented: Full credit (13.50%)• Good progress: 2/3 credit (9.00%)• Good early stage effort: 1/3 credit (4.50%)
… else no credit
Oxygenation assessment JCAHO
(PN-1)
14.50% % compliance times weight
Blood cultures (collected prior to antibiotic administration)
JCAHO
(PN-5b)
14.50% % compliance times weight
© 2006 The Leapfrog Group and Thomson Medstat
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Weighting & Scoring – Pneumonia (cont’d)
Measure Source Weight Scoring
Computerized physician order entry (CPOE)
LFG 12.50% • Fully implemented: Full credit (12.50%)• Good progress: 2/3 credit (8.33%)• Good early stage effort: 1/3 credit (4.17%)
… else no credit
Leapfrog Quality Index (NQF Safe Practices)
LFG 12.50% • Fully implemented: Full credit (12.50%)• Good progress: 2/3 credit (8.33%)• Good early stage effort: 1/3 credit (4.17%)
… else no credit
© 2006 The Leapfrog Group and Thomson Medstat
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Weighting & Scoring – DeliveriesMeasure Source Weight* Scoring
Inpatient neonatal mortality JCAHO
(PR-2)
23.00%or
60.50%
• Percent rank (0% = worst, 100% = best) times
• 23.00% or 60.50% weight
NICU census * LFG 23.00%or
0.00%
Full credit if• NICU census ≥ 15
… else no credit
Antenatal steroids for certain high-risk deliveries *
LFG 29.00%or
0.00%
% compliance times weight (if measure is applicable)
Third- or fourth-degree lacerations JCAHO
(PR-3)
8.33%or
13.17%
• Percent rank (0% = worst, 100% = best) times
• 8.33% or 13.17% weight
Computerized physician order entry (CPOE)
LFG 8.33%or
13.17%
• Fully implemented: Full credit (8.33% or 13.17% )• Good progress: 2/3 credit (5.55% or 13.17% )• Good early stage effort: 1/3 credit (2.78% or 13.17% )
… else no credit
Leapfrog Quality Index (NQF Safe Practices)
LFG 8.33%or
13.17%
• Fully implemented: Full credit (8.33%)• Good progress: 2/3 credit (5.55%)• Good early stage effort: 1/3 credit (2.78%)
… else no credit
* For a hospital indicating in its Leapfrog survey responses that it electively admits high-risk deliveries (mothers expected to deliver complicated newborns), NICU census and Antenatal steroids measures do not apply. The weights associated with these measures are allocated to the remaining measures and the second set of weights applies.