getting to know the leapfrog hospital rewards program™

1

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

3

Pillars for Improving Quality

Transparency

Standard Measurements

& Practices

Reimbursement:

Incentives & Rewards

4

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

5

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

9

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

1

2

3

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

1

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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

2

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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

3

* 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)


Aspirin prescribed at discharge JCAHO

(AMI-2)


Beta blocker prescribed at discharge JCAHO

(AMI-6)


ACEI for LVSD JCAHO

(AMI-3)


Thrombolytic agent received within 30 minutes of arrival

JCAHO

(AMI-7a)


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)



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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)


… else no credit


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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)


Prophylactic antibiotic selection for surgical patients

JCAHO

(SIP-2b)


Prophylactic antibiotics discontinued within 24 hours after surgery end time

JCAHO

(SIP-3b)


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


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Weighting & Scoring – CABG (cont’d)




… else no credit


… else no credit



… else no credit


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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



… else no credit


25

Weighting & Scoring – PCI (cont’d)



… else no credit



… else no credit


26

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)


Pneumococcal vaccination JCAHO

(PN-2)


Adult smoking cessation advice/ counseling

JCAHO

(PN-4)



… else no credit

Oxygenation assessment JCAHO

(PN-1)


Blood cultures (collected prior to antibiotic administration)

JCAHO

(PN-5b)



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Weighting & Scoring – Pneumonia (cont’d)




… else no credit



… else no credit


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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


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


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.

getting to know the leapfrog hospital rewards program™

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