The Leapfrog Group Initiative Making Inroads

Humana supports the coalition's positive approach to improving consumer experience by increasing transparency in the health care system and is developing related initiatives.

The health care purchaser coalition that seeks to improve patient safety and reduce preventable medical mistakes in U.S. hospitals is making progress and getting the attention of both the health care community and consumers. The Leapfrog Group, established in 2000 by the Business Roundtable, was formed largely in response to a 1999 Institute of Medicine report, "To Err Is Human," that claimed that more than 98,000 preventable medical errors occur each year in hospitals.

The coalition of predominantly Fortune 500 corporations and other large purchasers now counts 121 members and has rolled out its hospital safety performance survey in 19 regions throughout the country. To date, more than 500, almost 20 percent of the nation's nonfederal urban acute-care facilities, have reported on their progress toward meeting the three safety standards — or "leaps" — identified by Leapfrog. Those standards include:

• Implementing computerized physician order entry (CPOE) in hospitals.
• Using full-time intensivists to staff intensive care units.
• Employing evidence-based hospital referral for certain complex surgeries and management of high-risk neonatal conditions, which involves intentional steerage of patients to facilities that perform large volumes of those procedures.

As hospitals complete the survey, The Leapfrog Group reports results on its Web site, www.leapfroggroup.org. Coalition members, in turn, make the data available to their employees and, as a condition of joining, commit to certain purchasing principles, including:

• Educating employees about patient safety and the importance of comparing hospital providers' performance.
• Recognizing and rewarding hospitals that make advances that could reduce preventable medical errors.
• Comparing providers' efforts and holding health plans accountable for implementing the purchasing principles.

In recent months, some Leapfrog coalition members have begun devising their reward systems, which range from steering their employees to providers that are implementing the safety standards to providing financial rewards — in the form of higher reimbursement or payment rates.

Many hospitals are responding to the initiative, and one large hospital chain—HCA in Nashville, representing over 300 hospitals nationwide — became a member of the Leapfrog initiative.

Humana supports the transparency that is at the heart of the Leapfrog initiative, as well as its goal of bringing about positive change through incentives rather than through regulation. The Leapfrog principles are truly in line with much of the work Humana has undertaken in recent years to become more consumer-centric by providing decision support — via accurate and reliable information — without interfering in the care decisions members and their physicians make.

"It's not so much about Leapfrog itself, but rather about our commitment to transparency and to giving members information that helps them make decisions about their care," said Jack Lord, M.D., Humana’s chief innovation officer. "We are also going down this path — to help our members make important health care decisions." The point, Lord said, is to give members both more choices and greater independence in the decisions they make about seeking care or pursuing treatment.

In support of the Leapfrog initiative, Humana is encouraging its participating hospitals to complete the survey — especially since several of the Leapfrog regions overlap with major markets Humana serves. Members are also being encouraged to obtain the Leapfrog data available on providers in their area. To that end, Humana is working with a vendor that will capture the Leapfrog survey data for dissemination to members early in 2003.

"We encourage hospitals in our networks to report and we will help interested members to find the data," said Tom Granatir, senior advisor for clinical health policy. He noted that Humana has also embarked on other improvement initiatives, including a successful program with Baptist Memorial Health Care in Tennessee. As part of the program, Humana is providing fully funded nursing education grants in exchange for Baptist's commitment to meeting certain improvement goals, some of which are aligned with Leapfrog standards.

"This is a model that creates positive relationships between health plans and hospitals," Granatir said, "and we are looking to expand to other pilot sites in the coming year."

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