Jill Berger, the former VP of Benefits for Marriott International, has been managing health benefits for nearly 30 years at Fortune 500 companies including General Motors (GM) and Sears, Roebuck. She served on the boards of numerous national employer campaigns for health care quality and payment reform, including a stint as board chair of The Leapfrog Group, which she recently joined as senior advisor. Leapfrog is a national nonprofit started nearly 20 years ago by a group of large employers aiming to drive a movement for giant “leaps” forward in the quality and safety of American health care. Employers across the country ask hospitals to voluntary submit important data to Leapfrog Hospital Survey, and then use that data to drive value.
Jill sat down with Tom Scott, Ph. D., director of the inaugural Health Plan Design and Health Informatics master’s degree program at the University of Lynchburg recently to discuss the challenges employers face today and how her new role at Leapfrog can help. Dr. Scott has a doctorate degree in quantitative analysis, is co-founder of Sonospine, LLC and spent the last six years in the health care industry. His online, one-year master’s program, which Al Lewis has deemed “unparalleled in higher education” involves a practical curriculum in which current and upcoming benefits advisors and HR directors put value-based health plan designs into practice. He believes this program will fill a void that exists in graduate education regarding value-based healthcare purchasing.
Scott: How can employers engage employees and encourage them to select safer hospitals?
Berger: Coming from a large employer, I think about employee engagement all the time. And the key to this is to make it as simple as possible. Hospitals can vary dramatically on quality and safety, even when they are in the same city. Employees need to know that they often have a choice when it comes to where to go for care.
In markets where they do not have a choice, they still need to be aware of the dangers that exist in hospitals. Even though risks exist in all hospitals, it is critically important to choose a hospital with a good track record. In addition to the publicly reported Leapfrog Hospital Survey data, employees can access Leapfrog Hospital Safety Grades. Both programs are free to consumers. The Hospital Safety Grade assigns a letter grade of A, B, C, D, or F to general acute care hospitals based on how well they protect patients from harm. Consumers can visit www.hospitalsafetygrade.org to see which hospitals near them are the safest. Leapfrog also has tools available for employers that are free to use. The Leapfrog Lives & Dollars Lost Calculator helps employers estimate the number of avoidable deaths among their covered lives as well as their annual spend due to medical errors in the hospital.
Scott: How was The Leapfrog Group founded?
Berger: Leapfrog was started in response to a 1999 Institute of Medicine Report titled To Err is Human, which showed almost 100,000 people were dying annually of preventable medical errors in hospitals. Large employers including Marriott, Boeing, FedEx, GM– where I was at the time–and others wanted to find a way to ensure their employees were receiving the safest care in hospitals. Since To Err is Human was released, further studies have shown that the number of deaths due to errors is upwards of 200,000 annually. For a large employer, that could translate into one employee per month dying unnecessarily. These founding employers–or “Founding Frogs” as they proudly called themselves–recognized that addressing patient safety was an essential business need. I’m excited to be a part of The Leapfrog Group again to help employers address this ongoing challenge.
Scott: People often associate cost with quality in health care, but there is no connection between the two. How would you provide guidance to an employee or employer regarding defining value?
Berger: When I think of value, it means cost plus quality and safety. One of the programs we have at Leapfrog to help address the need for greater value in health care is the Leapfrog Value-Based Purchasing (VBP) Program which helps employers, health plans and other large purchasers find the highest value hospitals. When mistakes happen in the hospital, employers pay the price in both lives and in dollars, but it’s not always obvious when you look at your claims.
The Leapfrog VBP Program uses data collected through the annual Leapfrog Hospital Survey which measures hospitals on safety, quality and efficiency. That data identifies hospitals that have attained top performance or made significant improvements from one year to the next. This program also provides a transparent and effective payment methodology to drive further improvement in hospitals, enabling employers to achieve the best care possible for employees.
Scott: How can employers use the Leapfrog VBP Program?
Berger: Employers can use the Leapfrog VBP Program to identify the highest value hospitals in their network, including those that have attained top performance or made significant improvement from one year to the next. Basically, it’s an expert-designed composite that allows employers to benchmark how hospitals are doing compared to their peers. The composite is called a “Value Score” and it allows purchasers to rank hospitals and set benchmarks for financial awards or incentives, such as allocating the highest rewards to hospitals scoring in the top decile. If you are in a rural area with limited choice of hospitals, you might want to create contracting incentives for the local hospital, tying increases to the hospital’s decile ranking on the value score. The point is this makes it easier for employers to customize a program that really drives quality, without having to sift through enormous reams of data.
Scott: Do you feel confident that the data is collected accurately?
Berger: Yes, data accuracy is of upmost importance to Leapfrog and there are many ways we verify the data. First and foremost, the hospital’s CEO or their designee must complete an Affirmation of Accuracy for each section of the Survey. The Survey platform itself scans for potential data entry errors and alerts hospitals to inconsistencies prior to Survey submission. Throughout the Survey cycle, there is also a monthly data review, and Leapfrog randomly selects hospitals to submit documentation. There’s also onsite verification for a random selection of hospitals.
Scott: As bundled pricing, centers of excellence and travel medicine continue to grow, does Leapfrog envision itself getting data from outpatient and ambulatory facilities?
Berger: Yes. As a matter of fact, on April 1 we launched the inaugural Leapfrog Ambulatory Surgery Center (ASC) Survey and expect to see a good level of participation even in our first year. We’re also starting to collect data from hospital outpatient departments. As you see more and more procedures performed in the outpatient setting, it is essential to gather this data which is not currently publicly available elsewhere. When we start reporting this data in 2020, we’re going to make it easy for consumers to compare ASCs and hospital outpatient departments side by side so that they can make an educated decision on where to receive their care.
Employers face a lot of challenges and rarely get credit for some of their truly remarkable achievements over the years. One of those achievements is creation of The Leapfrog Group. So, I’m excited to help build on that achievement and support purchaser leadership.
To learn more about the Leapfrog and the Leapfrog Value-Based Purchasing Program, as well as other tools available from Leapfrog, visit www.leapfroggroup.org. To contact Jill Berger and Dr. Scott, reach out at [email protected] and [email protected].
