I’m at a conference on patient safety…

Suzanne Delbanco is the CEO of the Leapfrog Group. This is the group which is where big employers get together to grouch about health care and ask the providers nicely to try to provide better care, cheaper, and suggest that they adopt some innovations like using computers–which of course get rebuffed. She thinks that "in this country we have a funny employer-based health insurance system".  So employers are moving to cost shifting, etc, etc, but they know that wont work.

So Leapfrog was started to try to improve the process, to make "leaps" in patient safety and quality. CPOE was the first not only because it was the gold standard for reducing errors but because it also required hospitals to put in the information systems that will enable process measurements. They’ve focused on inpatient setting, but are looking at outpatient eRx, lab tests, and care management prompts. Now as the base for Bridges to Excellence office link program.

They run their own online survey (voluntary and online) and license the data.

So how have they done? Well progress on CPOE has been slow. They think they’ve gone from 2% to 7%, and another 17% say they’re working on it.They are also creating a CPOE evaluation tool (something that HISTalk might want to get involved in)

She also asks is transparency enough? Well the AHRQ quality report showed improvement in nursing home care (15%) compared to only 3% in hospitals, because Medicare mandated reporting by nursing homes. Now CMS is quasi-mandating reporting by hospitals, so she expects that improvements will start showing up in hospital quality measures.

In addition P4P is getting closer to being standardized and less confusing, although not widespread…they are seeing more and more P4P, such as Bridges to Excellence. She’s also on the CCHIT committee that will be evaluating and later certifying products for the physician setting.

On the other hand I didn’t ask the nasty question which is given that
the employers have let their suppliers stick them with 15% annual
increases add infinitum why do they think that anyone is going to be
convinced by these efforts?

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7 replies »

  1. Donald, I agree with you that for a provider there a number of established QI protocols that can yield savings. However, these savings are preserved by the provider. They are rarely passed along to purchasers.
    A more direct form of my response, did SSM Heathcare of Missouri reduce its charges to patients and payors by $56 million in 2002? Probably not. I am not being sarcastic, just highlighting a common reality in any business. And I am not suggesting that the savings were not used for expansion of patient-focused programs and thereby increasing value.

  2. I too believe as John C. that good QI programs should be initiated by leaders at individual healthcare sites. Good leadership does make things happen. However, I have disagree with the fact that there aren’t monetary returns in the short and midterm. For instance, SSM Heathcare of Missouri achieved remarkable results in pursuing the Baldrige Award in 1999-2001. Let me quote from an article in the April 2003 American Society of Quality’s “Quality Progress”: “…a $56 million improvement in operating margins..”. Much of this was achieved by better communication, better team work, and developing lean principles in the administration.
    My point, then, is that many sites can improve the bottom line while improving patient health.

  3. These efforts for quality improvement make for great presentations at a conference, but in practice they fail to yield quantifiable results employers are looking for.
    I had a large public sector client whose HR folks attended a conference on quality improvement initiatives like the Leapfrog Group. They came back and demanded we implement similar DM and QI programs. Now, here was the catch. Because the presentation they heard sounded made so much sense, they wanted us to quantifiably prove that we were saving them money (which in turn reduced their rate increase).
    The problem is that some of the programs they wanted would not produce results in 1 year’s time (smoking cessation and weight loss programs). Such programs are more about cost aversion (soft dollars) then hard money. While some of the other programs (Asthma and diabetes) faced patient compliance issues, same proplems Dr’s face. But somehow the insurance companies were expected to improve patient treatment compliance where Dr’s have failed. It was nuts. And here I thought the HMO backlash was caused by people pissed about HMO’s acting like physicians.
    What happened is after a period of implementation they realized tangible results (rate reductions) were not readily achieved. There were too many other variables affecting price. They didn’t give up on the programs however. They felt it made for a good HR benefit and was socially responsible. They ended up expanding the efforts (health fairs, HRA, etc) by contracting with outside vendor and forcing us to pay for it (which we simply turned around and included the costs in the rates).
    I am fan of QI and DM programs but only because I believe they are the right thing to do. I do not believe that they yield demonstrable ROI (in the short and mid-term) to a purchaser. I believe they are most effective when supported by providers, employers, and patientss.

  4. Matthew- your reference to Bridges to Excellence ought not be made in passing. BTE is a good approach to quality improvement– one that the US Congress has chosen not to model its own programs after.
    I loathe self promotion, but anyone really interested in hearing more about this approach should listen to my interview early this year with Jeff Hanson- President of BTE (available on ‘past shows’ at ericnovack.com).
    The early BTE data is that for every $1 in bonuses to MDs, $3 are saved in costs. BTE also has taken the correct approach- start with the big costs- heart disease and diabetes.
    BTE also explores the “bonus” concept on the patient side to promote healthy behavior.
    And again- by referring to ‘cost shifting’, you forget that employees already pay for their health insurance through lower wages.

  5. > why do they think that anyone is going
    > to be convinced by these efforts?
    A lone voice crying in the wilderness will be considered kooky by the establishment, but that doesn’t mean he’s not a herald of greater things to come. More and more people are hearing the herald’s cry, and are beginning to pay attention. I do not know whether to expect a savior, but I do know the establishment will not survive a popular movement to remake the society.
    It is interesting to hear the CEO of the Leapfrog Group characterize the employer-based health insurance system as “funny”. It sounds to me like the employers she represents want out. But why then do they spend resources the way they do? Maybe they figure they’re stuck for now with buying medical services, and need to reduce total costs somehow. Hmmmmmm. I wonder what this means…