A. Inform and educate employees
B. Use comparative rating
C. Use substantial incentives
D. Focus on discrete forward leaps in quality and safety
E. Hold health plans accountable for Leapfrog implementation
F. Encourage the support of consultants and brokers
Purchasers will educate employees about the importance of comparing the performance of healthcare providers and assist them in understanding how to use such measures to make informed health care choices.
Rationale: Without a modification to the current contextual framework within which consumers currently process information about their healthcare providers, they are unlikely to use comparative performance data. Employees/consumers are central in making important improvements in the healthcare system. Their behavior can send powerful signals to the marketplace about the value patients place on better care.
Purchasers will aggregate available validated performance information on their major providers of health care into comparative value ratings for all of their employees, retirees and family members. Wherever available, the performance measurement will come from nationally recognized sources such as NCQA, JCAHO, states and medical societies, in addition to the data collected by and made available through The Leapfrog Group, to assure validity in performance comparisons.
Rationale: Without relevant information disseminated effectively to consumers, patients cannot make informed decisions about the facilities that may be better suited to treat them. Lack of transparency in the health care system occults the variations in quality that are inherent to it and fail to serve the needs of its primary customer: the patient.
Purchasers will use two or more of the following methods to reward delivery systems with higher value ratings and will annually increase their intensity until they prove sufficient to motivate widespread and substantial annual performance improvement among their major providers.
Rationale: To motivate delivery systems to stretch for major breakthroughs in customer value, purchasers must build significantly more robust market rewards.
In implementing comparative rating and substantial incentives, purchasers will highlight a common set of discrete delivery system improvements likely to yield the largest safety gains ("safety leaps"). These will be earmarked for special visibility in purchasers' interaction with providers, insurers/ administrators, and consumers.
For example, purchasers will use common RFP questions to rate the implementation status of the safety leaps for their plans and providers and explicitly integrate such status information into every method used to reward superior value (patient volume, price and/or public recognition). With expert input, we identified three initial safety leaps, which have been transformed into the safety standards.
Rationale: Of all types of quality improvement, focus on patient safety is likely to produce dramatic improvements in patient outcomes and garner the widest support from the public, the media, regulators, accreditors, other purchasers, and the health industry.
In advancing these principles, purchasers who utilize health plans as their intermediaries may delegate responsibility to plans for applying the principles to their network providers. If so, purchasers would hold their health plans accountable via nationally standardized Leapfrog questions in health plan RFPs, heavily weighted scoring criteria, robust health plan performance incentives, and other methods of assuring health plan application of Leapfrog principles. Purchasers would intensify these incentives annually until their largest health plans fully meet their delegated responsibility for applying Principles A, B, C and D outlined above.
Rationale: Many purchasers utilize health plans as their intermediaries to healthcare delivery systems. The application of Leapfrog principles by health plans to their relationships with providers, for their whole book of business, will further leverage purchaser efforts.
In selecting benefits consultants and brokers, purchasers will create strong incentives for them to incorporate Leapfrog principles (1) in their advice to other purchaser clients and (2) in their standard tools for assessing health plans and delivery systems.
Rationale: The purchasing principles advocated and utilized by these advisors profoundly shape the market experience of insurers and delivery systems. As major customers of these advisors, purchasers can motivate them to advocate these principles on behalf of all of their clients.
† Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A; "Selective referral to high-volume hospitals: estimating potentially avoidable deaths"; JAMA; 2000, 283: 1159-66.
‡ Phibbs CS, Bronstein JM, Buxton E, Phibbs RH; "The effects of patient volume and level of care at the hospital of birth on neonatal mortality"; JAMA; 1996, 276: 1054-9 and unpublished analysis, 2000.