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Dolores Mitchell Executive Director, Massachusetts Group Insurance Commission, Boston, MA

What Is the Business Case for Patient Safety? Costs and Potential Costs Savings A Leap Frog Case Study. Dolores Mitchell Executive Director, Massachusetts Group Insurance Commission, Boston, MA. The Leapfrog Group. IOM Report: up to 98,000 people die in US hospitals yearly from medical errors

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Dolores Mitchell Executive Director, Massachusetts Group Insurance Commission, Boston, MA

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  1. What Is the Business Case for Patient Safety?Costs and Potential Costs SavingsA Leap Frog Case Study Dolores Mitchell Executive Director, Massachusetts Group Insurance Commission, Boston, MA

  2. The Leapfrog Group • IOM Report: up to 98,000 people die in US hospitals yearly from medical errors • Business leaders decide to join forces as health care purchasers to deal with this issue

  3. The Leapfrog Group • To mobilize employer purchasing power to save lives and reduce preventable medical mistakes • Inform and educate employees • Use incentives for breakthrough improvements in safety • Hold health plans accountable for Leapfrog implementation • Three initial methods to improve patient safety: • Computer physician order entry • Evidence-based hospital referral • ICU physician staffing.

  4. Group Insurance Commission Joins Leapfrog in 2001 • Public Commendation • Implementation is hardest part • Limitations of Best Practices and Protocols

  5. Challenges to Implementation Structural Barriers • Purchasers contract with health plans, not hospitals • Must use plans as the vehicle to get data • Put data collection in HMO contracts • Included financial penalties for failure • Included financial rewards for moving admissions to complying hospitals • More than $1 million on the table

  6. Challenges to Implementation Economic Barriers • Timing in life is everything. • 2001 not the best of times. • Health plans under attack. • Hospitals in financial stress. Institutional Barriers • Hospital Associations not supportive. • Critical of the three leaps • Some resentment at outsiders interfering in their business.

  7. Log Jam Begins to Lift • Benefit Consultant acts as a go-between • Dana Faber reports • Acting as mediator sets up meeting with selected hospital leaders GIC and national Leapfrog leaders to thrash out issues • Sets up negotiating sessions with major hospital system • Compromise reached - reporting deadlines delayed in exchange for commitment to report

  8. Lessons Learned • Patience combined with [quiet] persistence works best • There is strength in numbers • Keep the message simple – and focused. • Don’t demonize the other side • Compromise on the small points • “Speak softly and carry a big stick”.

  9. Patient Safety • Low profile on the public agenda • Purchasers concerned about quality not safety • Hard to get consumer interest • Patients assume both quality and safety

  10. The Early Bird Sometimes Finds it Hard to Hold on to the Worm • Good press, both national and local • GIC, State of Maine, Mass Medicaid still not able to get hospitals to report • Even hospitals who had CPOE would not report • Partial data collected by more aggressive HMOs

  11. There is Strength in Numbers • GIC, Medicaid joined by Verizon, GE, Fidelity, and the Mass Healthcare Purchaser Group, agree to form a joint committee to make Massachusetts a roll-out state • 19 areas throughout America are now rolling out the program • Leapfrog now covers 30 million consumers • Hospital after hospital begin to report (28 hospitals, or 40.3% as of September 1, 2002)

  12. Next Steps • Cooperate with Leapfrog committee to publicize the hospitals that report and comply • Encourage financial incentives for complying program • Publicize complying hospitals in our annual enrollment materials

  13. Education • Used our news letter to discuss importance of measures • Used our website - including links to other websites • Review plans by our HMOs to do their own education and outreach • Made ourselves available to the press, as speakers at professional meetings to discuss safety issues

  14. Purchasing Principles • Educate and inform enrollees • Compare at the provider level • Reward superior provider online: • volume • pay for performance • public recognition

  15. “Leaps” and Cost Savings • Computerized physician order entry (CPOE) • Prevent 8 of 10 serious drug errors • Brigham and Woman’s reported a per event cost of $4,500 or $2.8 million per year • ICU daytime staffing with an intensive care specialist • 10% morbidity reduction

  16. “Leaps” and Cost Savings • Evidence based referrals for 7 high risk procedures • 20% morbidity reduction • COST is $1.4 million plus $500,000 per year maintenance or $5 million in savings if you add avoidance of ADE and greater efficiency of drug use (6.5% of admits have adverse events; 28% avoidance)

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