✯
✯
2003 National Health Policy ✯Conference
January 22-23, 2003
J.W. Marriott
Washington, D.C.
January 23, 2003
Dr. Adam Smith’s Prescription
for Efficient, Quality-Reliable
Employee Health Benefits
Arnold Milstein MD, MPH
Pacific Business Group on Health
Mercer Human Resource Consulting
The Leapfrog Group
Estimating Our Opportunity
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50 point gain in quality
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40 point gain in direct cost
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30 point gain in frequent user satisfaction
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20 point gain in indirect cost
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10 point gain in avoidable patient suffering
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Options For Inducing Better Care
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Exhortation of professionals
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Government as purchaser or regulator
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Strengthen performance competition between plans
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Boost performance sensitivity within plans
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Divine intervention
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Boost Performance Sensitivity Within Plans
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Measure efficiency and quality of providers
and treatment options
Engage consumerism:
Gear consumer decision support and incentives to
encourage selection of better-performing providers
and treatments (including “backstage providers”)
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Expand performance-based provider payment (P4P)
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Jumpstart clinical re-engineering
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What Ingredients are Scarce or MIA?
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Standardized, public performance measurement x 6 IOM
aims for non-HMO plans, providers and treatment options
Electronic clinical info systems and connectivity rules
Cost-effectiveness research on consumer incentives to
select better providers and treatments
Unambiguous assignment of
accountability for longitudinal care
Anti-trust vigilance
Critical mass of
accountable leadership x3
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Creating Accountable Purchaser Leadership:
Leapfrog’s Developmental Cycle
Babyfrogs 2001–2003
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3 transformational hospital safety Leaps
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7 regions
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Vague market sensitivities to performance
Childfrogs 2003–2006
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6 hospital & MD Leaps with a few 4-D performance measures
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19+ regions
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Some specific market sensitivities to performance
Big Frogs 2006–
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6–D performance measurement sets for hospitals, MDs and Txs
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50 states
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Routine specific market sensitivities to performance
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Traversing the Chasm With Help From
124 Multiplying Frogs:
IOM Care Redesign Imperatives
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Redesigned care processes (PAN)
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Effective use of information technologies (CPOE)
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Knowledge and skills management (EHR)
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Development of effective teams (IPS)
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Coordination of care across patient conditions, services,
and settings over time (PODS)
Use of performance and outcome
measurement for continuous
quality improvement and
accountability (POCE)
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Closing Thoughts on Dr. Smith’s Prescription
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Better procurement creates performance-sensitive markets
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Performance-sensitive markets induce better performance
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Health care’s nuances require tailored solutions
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Aging and biomedical advances will force our hand
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Economic downturns will catalyze bolder strokes
Rx for U.S.providers
Performance sensitive markets
I.V.ST AT
Adam Smith MD
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