Data by hospital available at: www.leapfroggroup.org/tooearlydeliveries

January 25, 2011, Washington, D.C. –The employer-driven hospital quality watchdog, The Leapfrog Group, announced today that 2011 results from the annual Leapfrog Hospital Survey indicate that hospitals are making progress in eliminating early elective newborn deliveries. The Leapfrog Group announced that 39% of reporting hospitals kept their early elective delivery rate to 5% or less, compared to 30% of reporting hospitals last year.

In 2010 Leapfrog was the first, and remains the only, national organization to make hospital-specific information about this practice publicly available. Since Leapfrog highlighted data on this unsafe practice last year, early elective deliveries has emerged as a priority issue for dozens of national and local health organizations, the National Priorities Partnership, and policymakers through the Department of Health and Human Service’s Partnership for Patients campaign.

According to Leapfrog, there is still wide variation among hospitals. Rates of early elective deliveries ranged from less than 5%, which is Leapfrog’s target for all hospitals, to over 40%. Leapfrog’s 2011 data is the first indication that hospitals are improving. 

 “Of the hospitals that reported an elective delivery rate in 2010 and 2011, 65% improved their performance. This is extremely promising news. We are making a difference in the lives of women and newborns,” said Leapfrog CEO Leah Binder. “But there is still work to be done. We are seeing far too many newborns delivered early and without a medical reason, and there are still a number of hospitals who refuse to make this information public.” Currently, only hospitals that participate in Leapfrog’s annual hospital survey make this information public.

Experts, including those from the American College of Obstetricians and Gynecologists (ACOG), Childbirth Connection, the Institute for Healthcare Improvement (IHI), and the March of Dimes, caution that a baby needs at least 39 completed weeks to fully develop. There are medical reasons to schedule a delivery before the 39^th completed week, such as if a woman has high blood pressure at the end of pregnancy or broken membranes before labor begins, but these are rare.

Dr. Billie Lou Short, Chief of Neonatology at Children’s National Medical Center, said that last year, 19% of admissions at Children’s National Medical Center were newborns who fell into the category of “early term” or 37 to 38 weeks gestational age.  “These infants came to the Children’s NICU because of morbidity related to being delivered early,” noted Dr. Short. She went on to explain that short-term morbidities of an early term infant include respiratory distress (breathing problems), temperature instability, increased bilirubin resulting in in-hospital treatment, infection, longer-hospital stays, and a higher mortality rate.

 In 2011, 757 hospitals voluntarily reported their rate of early elective deliveries through the Leapfrog Hospital Survey. The average rate across all reporting hospitals fell from 17% in 2010 to 14% in 2011. Several states have an average rate at or below the national average, including California, Colorado, and Massachusetts. Ohio reported the lowest average rate at 7.6%. Other states reported average rates well above the national average. For example, the average rate of hospitals reporting from Alabama was 22.5%.   South Carolina was not far behind with an average rate of 19.4% in 2011, which was still an improvement from the 2010 average of 27.8%.    Pam Sawicki, Operations Manager for the South Carolina Business Coalition on Health commented, “There is a lot of room for improvement with wide variation among hospitals across the state and only 50% of SC hospitals publicly reporting this information to Leapfrog.”  The South Carolina Business Coalition on Health (SCBCH) is the regional roll-out leader in South Carolina for the Leapfrog Hospital Survey.  SCBCH members work collaboratively in creating sustainable initiatives to improve healthcare quality and efficiency in South Carolina.  Each year, the Coalition invites all South Carolina hospitals to report their quality and outcomes so that consumers and purchasing organizations can make informed health care choices.

 National Partnerships to Eliminate Early Elective Deliveries

 Today, Leapfrog also announced a series of initiatives to eliminate early elective deliveries. Leapfrog will be joined by the IHI, Childbirth Connection, Catalyst for Payment Reform (CPR), and employer and regional business coalition members to make available tools that encourage healthcare consumers, employers, health plans, hospitals, and policymakers to take action.

“Leapfrog’s work in measurement and public reporting has caught the attention of hospital leaders and facilitated a shared goal of eliminating this harmful practice,” noted Maureen Bisognano, President and CEO, of the Institute for Healthcare Improvement. “We are now seeing these leaders focus on implementing innovations developed at IHI, saving mothers and babies from needless harm. We are grateful to Leapfrog for creating a collaborative space where measurement and education lead to improvements in safety and quality of care.”

 IHI will join Leapfrog in hosting two national webinars for health care professionals. The webinars, featuring Leapfrog’s Senior Science Director Barbara Rudolph, PhD, MSSW and IHI’s Director Sue Gullo, RN, BSN, MS and Peter Cherouny, MD, Chair, Perinatal Improvement Community, will focus on the importance of the reliable determination of gestational age as a component of the IHI Perinatal Bundle Sequence and will be held February 15^th from 2 p.m. to 3:00 p.m. ET and February 28^th from 2:00 p.m. to 3:00 p.m. ET.

Maureen Corry, executive director of Childbirth Connection, a national advocacy organization that works to improve the quality of maternity care, said “We salute Leapfrog for providing women with the information they need to make informed decisions. Next we need all hospitals to make the data available to the public.” Among other resources, Childbirth Connection provides evidence-based resources on benefits, harms, and appropriate use of labor induction, including tips and tools for avoiding an unnecessary induction, at www.childbirthconnection.org/induction.

In addition to making resources available to hospitals and healthcare consumers, Leapfrog is committed to seeing employers and other large healthcare purchasers play a role in eliminating early elective deliveries through health benefit design, education and payment reform. Suzanne Delbanco, executive director of Catalyst for Payment Reform, noted that “We need to stop providing the perverse financial incentives to intervene in birth when it’s not medically necessary.  CPR is working alongside Leapfrog to support employers and other health care purchasers, as well as health plans, to encourage adherence to clinical guidelines through payment reform.”  Available to the public domain, CPR has created health plan RFI (request for information) questions and model health plan contract language to help purchasers signal expectations to health plans about how they should improve payment practices for maternity care. CPR will join Leapfrog in hosting a free webinar for employers and purchasers on February 21^st from 1:00 p.m. to 2:00 p.m. EST.

 The nation’s four largest health plans – Aetna, Cigna, UnitedHealthcare, and WellPoint — will also continue their awareness campaign to expectant mothers across the country. The campaign includes three key messages: (1) the last weeks of pregnancy are important, (2) there are risks for mothers and babies if births are scheduled before 39 weeks for nonmedical reasons, and (3) expectant mothers should investigate the rates of early elective deliveries for hospitals in their community. Last year the campaign reached thousands of women. Leapfrog’s membership of employers and regional business coalitions continue to help raise awareness in their local communities by sharing Leapfrog data and resources from Childbirth Connection and March of Dimes.

 These new data on early elective deliveries come from Leapfrog’s 2011 annual hospital survey, where hospitals are asked to report the percentage of non-medically indicated births between 37 and 39 completed weeks gestation delivered electively by induction or by cesarean section before the mother has gone into active labor or has experienced spontaneous rupture of membranes. Hospital rates of elective deliveries are now available for viewing on a special website: www.leapfroggroup.org/tooearlydeliveries.

 The Joint Commission also monitors hospital performance on this quality measure, and most recently the Department of Health and Human Services announced this measure will be included in the first set of quality measures for the Medicaid program, though reporting is not scheduled to begin until December 2013.

 The Leapfrog Group is a coalition of public and private purchasers of employee health benefits founded a decade ago to work for improvements in healthcare safety, quality, and affordability.  Maternal/child care represents a major component of health benefits programs for these healthcare purchasers, and Leapfrog’s purchaser members share concerns about the quality of obstetrics and neonatal intensive care. Early elective deliveries represent a significant cost in the U.S.  healthcare system, with one study estimating that nearly $1 billion dollars could be saved annually in the U.S. if the rate of early elective deliveries were reduced to 1.7%. Information about all the webinars listed above can be found at www.leapfroggroup.org.

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Elliott Fisher, MD, MPH, of Dartmouth, announced the release of a new report “Better to Best, Value-Driving Elements of the Patient Centered Medical Home and Accountable Care Organizations” at the March 30, 2011 PCPCC meeting in Washington. The report outlines the importance of access and care coordination as functions and use of health information technology and payment reform as tools needed in both patient centered medical home and new accountable care models.

Accountable Care Organizations, or ACOs, are one of the “big bets” in health care reform, as a possible care delivery model to improve quality and help control costs. However, what an ACO actually is, and how it operates remains to be defined. As consumers, providers and purchasers wait anxiously for CMS to release the rules that will help share these organizations, PBGH has released an issue brief that outlines what purchasers should expect — and what policymakers should require — from ACOs to help guarantee they deliver what they promise. A copy of the Issue Brief, Raising the Bar, is available at: http://www.pbgh.org/news-and-publications/pbgh-articles-a-publications

New Report: Accountable Care Organizations Have Potential to Curb Costs and  Improve Care
If implemented successfully, accountable care organizations (ACOs) will have the ability to achieve better care, better population health, and lower costs, according to a new report released last week by the Commonwealth Fund Commission on a High Performance Health System.

Meeting Materials:

Healthcare Reform: The Good, The Bad, and The Ugly – Jerry Burgess, CEO of HealthCare 21 Business Coalition

Summary of the Delivery and Payment Reform Elements of the Patient Protection and Affordable Care Act of 2010 - Consumer-Purchaser Disclosure Project

A National Strategy to Put Accountable Care Into Practice - Health Affairs May 2010

HealthPass New York:  New York’s Commercial Health Insurance Exchange – Vince Ashton, Executive Director of HealthPass NY

Health Reform: Now What? – Jim Winkler, Managing Principal Health Management Consulting, AON Hewitt

Survey of Large Employers 2011 Health Plan Design Changes - National Business Group on Health June 2010

Cover Page 

Abstract 

 Student Release 

• Individuals found terms such as “medical evidence,” “quality guidelines,” and “quality standards” unfamiliar and confusing.
• Only 34% of participants ever recalled having a physician discuss what scientific research had shown about the best way to manage their care.  Many often assume that their health care providers always based decisions on medical evidence.
• Participants found it hard to believe that providers could deliver truly substandard care-and certainly not their own providers.
• Focus-Group participants perceived medical guidelines as rigid rules that interfere with providers’ ability to draw upon their medical training and experience to tailor their care to the characteristics of individual patients.
• They were more inclined to trust their own and their physicians’ judgments of quality, instead of relying on guidelines that might “discriminate against doctors who give you better care” and “cripple medical advantage.”
• One interviewee had made the comment, “I don’t see how extra care can be harmful to your health.  Care would only benefit you.”  Participants also believed that any new treatment is improved treatment.
• Only 47% of respondents agreed that it is reasonable to pay less out of pocket for the most effective treatments and drugs.
• 33% of survey respondents agreed/strongly agreed with the statement that “medical treatments that work the best usually cost more than treatments that don’t work as well.”
• Many focus-group participants found it inappropriate to discuss with their physician the costs of different treatments, believing that decisions about medical treatments should be based on individual needs along.
• 55% of the respondents had never taken notes during a medical appointment;
• 41% of the respondents had not asked questions or told their doctor about medical problems, because the doctor seemed rushed or they were unsure about how to talk to him/her.
• Only 41% agreed that it is appropriate for employees to pay less for their health insurance or medical care if they use doctors who score high on quality ratings.

Despite consumers’ current perceptions on evidence-based health care, research has demonstrated that decision aids, which provide information about options and outcomes, can help increase consumers confidence with decision making and improve their understanding and knowledge of treatment options.  “Policy makers, employers, health plans, providers, and researchers will thus need to translate evidence-based health care into accessible concepts and concrete activities that support and motivate consumers.

The American Institutes for Research have developed a “communication toolkit”, based on this research.  It is designed to enable employers and unions to communicate with consumers about evidence based health care and help them become active participants in their care through customizable materials that translate these concepts into clear, simple, relevant language. 

Click here to access this free communication tool.

Since different employers have considered different procedures as ‘preventive’, you should check with your TPA/carrier to be sure your health plan provides 100% coverage—with no co-pay or co-insurance charge to your employees, for these procedures.  You may access this list at:  www.healthcare.gov. 

If you have a new health insurance plan or insurance policy beginning on or after September 23, 2010, the following preventive services must be covered without your having to pay a copayment or coinsurance or meet your deductible, when these services are delivered by a network provider. 

Covered Preventive Services for Adults

• Abdominal Aortic Aneurysm one-time screening for men of specified ages who have ever smoked
• Alcohol Misuse screening and counseling
• Aspirin use for men and women of certain ages
• Blood Pressure screening for all adults
• Cholesterol screening for adults of certain ages or at higher risk
• Colorectal Cancer screening for adults over 50
• Depression screening for adults
• Type 2 Diabetes screening for adults with high blood pressure
• Diet counseling for adults at higher risk for chronic disease
• HIV screening for all adults at higher risk
• Immunization vaccines for adults–doses, recommended ages, and   recommended populations vary:
• Hepatitis A
• Hepatitis B
• Herpes Zoster
• Human Papillomavirus
• Influenza
• Measles, Mumps, Rubella
• Meningococcal
• Pneumococcal
• Tetanus, Diphtheria, Pertussis
• Varicella
• Obesity screening and counseling for all adults
• Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk
• Tobacco Use screening for all adults and cessation interventions for tobacco users
• Syphilis screening for all adults at higher risk

 Covered Preventive Services for Women, Including Pregnant Women

• Anemia screening on a routine basis for pregnant women
• Bacteriuria urinary tract or other infection screening for pregnant women
• BRCA counseling about genetic testing for women at higher risk
• Breast Cancer Mammography screenings every 1 to 2 years for women over  40
• Breast Cancer Chemoprevention counseling for women at higher risk
• Breast Feeding interventions to support and promote breast feeding
• Cervical Cancer screening for sexually active women
• Chlamydia Infection screening for younger women and other women at higher risk
• Folic Acid supplements for women who may become pregnant
• Gonorrhea screening for all women at higher risk
• Hepatitis B screening for pregnant women at their first prenatal visit
• Osteoporosis screening for women over age 60 depending on risk factors
• Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk
• Tobacco Use screening and interventions for all women, and expanded  counseling for pregnant tobacco users
• Syphilis screening for all pregnant women or other women at increased risk

 Covered Preventive Services for Children

• Alcohol and Drug Use assessments for adolescents
• Autism screening for children at 18 and 24 months
• Behavioral assessments for children of all ages
• Cervical Dysplasia screening for sexually active females
• Congenital Hypothyroidism screening for newborns
• Developmental screening for children under age 3, and surveillance  throughout childhood
• Dyslipidemia screening for children at higher risk of lipid disorders
• Fluoride Chemoprevention supplements for children without fluoride in their water source
• Gonorrhea preventive medication for the eyes of all newborns
• Hearing screening for all newborns
• Height, Weight and Body Mass Index measurements for children
• Hematocrit or Hemoglobin screening for children
• Hemoglobinopathies or sickle cell screening for newborns
• HIV screening for adolescents at higher risk
• Immunization vaccines for children from birth to age 18 —doses, recommended ages, and recommended populations vary:Diphtheria, Tetanus, Pertussis
• Haemophilus influenzae type b
• Hepatitis A
• Hepatitis B
• Human Papillomavirus
• Inactivated Poliovirus
• Influenza
• Measles, Mumps, Rubella
• Meningococcal
• Pneumococcal
• Rotavirus
• Varicella
• Iron supplements for children ages 6 to 12 months at risk for anemia
• Lead screening for children at risk of exposure
• Medical History for all children throughout development
• Obesity screening and counseling
• Oral Health risk assessment for young children
• Phenylketonuria (PKU) screening for this genetic disorder in newborns
• Sexually Transmitted Infection (STI) prevention counseling for adolescents at higher risk
• Tuberculin testing for children at higher risk of tuberculosis
• Vision screening for all children

 Source:  www.healthcare.gov

•  
  • Medical plan costs
  • Consumer-directed health care
  • Healthy lifestyles and incentives
  • Pharmacy benefits
  • Retiree medical coverage

The following Key Findings were discovered:

• More than half (53%) of large U.S. employers plan to revise their 2011 health care benefit programs in the wake of health care reform legislation and anticipated large benefit cost increases next year.
• Also considering the provisions of the Patient Protection and Affordable Care Act, 19% of respondents are scaling back changes they planned to make while an equal number are making no changes.
• Among employers who will be making specific changes to their health benefit plans to comply with the new law, 70% said they will remove lifetime dollar limits on overall benefits while 37% said they will
• Employers estimate their health care benefit costs will jump to an average of 8.9% next year, compared with an average increase of 7% this year. To help curb those increases employers plan to use a wider variety of cost-sharing strategies.
• According to the survey, 63% of employers plan to increase the percentage employees contribute to the premium, up from 57% who did so this year, while 46% plan to raise out-of-pocket maximums next year compared with 36% this year.
• In order to further mitigate costs, employers are shifting to consumer-directed health plans. In fact, 61% of plan sponsors will offer a CDHP in 2011.
• While the most common type of plan employers will offer is a high-deductible plan combined with a health savings account (64%), the survey found a large spike in employers moving to a full replacement plan.
• Among employers offering a CDHP, the number moving to a full replacement plan doubled from 10% this year to 20% in 2011.
• As the health reform law makes Medicare Part D benefits richer as the “doughnut hole” closes between now and 2020, 5% of employers plan to drop retiree health coverage in 2011 while 60% are considering doing so in the future.
• In attempt to cut costs with wellness initiatives, 41% of employers offered premium discounts for completing health assessments while 22% offered premium discounts for participating in tobacco cessation programs.
• In addition, one in four (25%) of plan sponsors plan to raise the co-pay or co-insurance for retail pharmacy prescription drug benefits while 21% plan to do the same for mail-order pharmacy benefits.

Click here to access a copy of the survey report.

Over the past few weeks some of you have expressed an interest in the Healthy Workforce Act (HWA) (S. 803, H.R. 1897) developed by Senator Tom Harkin (D-Iowa).  Here is the latest update on the bill:

• The bill was introduced by Senators Harkin and Cornyn, and Representatives Blumenauer and Bono-Mack on April 2, 2009.
• Provides a tax credit to cover 50% of the cost of a comprehensive workplace health promotion programs offered by for-profit employers providing a direct tax benefit to employers. 
• Expected to stimulate many more employers to implement effective health promotion programs and; therefore, improve the health of the workforce, and ultimately reduce medical costs. 
• Under review in the Senate Finance Committee and the House Ways and Means Committee as part of the larger health care reform legislation, and found within the workplace health promotion provisions.
• Finance Committee to release a “chairman’s mark” of the larger bill on or around June 17, and be voted on by the Committee sometime between June 22 and 26.  The House of Representatives has a similar schedule. 
• The next step will be a vote in the full Senate and House in July, and a final health care reform bill on the President’s desk for signature in October.

Access the text of the legislation by clicking on the following link: http://thomas.loc.gov/cgi-bin/query/z?c111:S.803:
 
In Congress, there is concern with the cost of the bill, which was scored at $1 billion over three years by the Congressional Budget Office (CBO). Though, there is speculation whether the bill was accurately scored. So, there is a chance that the HWA provisions could be taken out of the comprehensive health care reform bill to keep the cost of the legislation down.  We will let you know when the Finance Committee has voted on health care reform legislation and let you know the status of Healthy Workforce Act within that bill.  At that point, it will make sense for NBCH coalition members and their employers to communicate with their two Senators and Representative about the importance of keeping HWA in the final bill.

The following are some interesting facts related to workplace health promotion and HWA:
 
Improves health in a cost effective manner
­-     Poor nutrition, inactivity and tobacco use are the primary cause of chronic disease, including 80% of heart disease, diabetes and stroke, and 40% of cancer.
-     Workplaces are the most cost-effective place to enhance lifestyle habits because more than 120,000,000 Americans are employed and spend almost half of their waking hours at work. Support from co-workers and encouragement from workplace leaders motivates people to try to change, and helps them maintain positive new habits.  Offering group programs allows economies of scale and facilitates quality controls.  Finally, employers will pay much of the program cost.
-     Comprehensive health promotion programs have been successful in helping people quit smoking, improve eating habits, increase physical activity, get regular health screenings, manage stress, and even prevent diabetes, and reverse heart disease.
 
Reduces medical costs
-          Half of US employers spend as much on medical care as they earn in profits.  This makes it difficult to compete in a global market place and has forced some companies out of business.
-          Chronic diseases accounts for 73% of all medical spending and 96% of Medicare spending.
-          Comprehensive, well designed health promotion programs save more in medical costs than they cost to operate, sometimes saving 2 to 3 dollars for every dollar invested.  This is addition to comparable savings from reducing absenteeism and enhancing productivity.
-          People, who are physically active, don’t smoke and maintain recommended weight as they age become disabled nine years later than people who smoke, are inactive and overweight.  If we could delay disability for the full population by six years, Medicare would remain solvent.
 
Creates jobs
-          Healthy Workforce Act is projected to create 40,000 new jobs.  Because of the leveraged nature of this bill, the net cost per job to the federal government will be only $5,000.
-          Federal income, Social Security and Medicare taxes from these new jobs will cover 80% of the cost of the bill. (Fact Source: Health Promotion Advocates)

Source: NBCH

Building Organizational Capacity:
A Cornerstone Of Health System Reform
Janet Corrigan and Dwight McNeill

Payment Reform Alone Will Not Transform Health Care Delivery
Charles N. Kahn III

Fostering Accountable Health Care: Moving Forward In Medicare
Elliott S. Fisher, Mark B. McClellan, John Bertko, Steven M. Lieberman,
Julie J. Lee, Julie L. Lewis, and Jonathan S. Skinner

Medicare: The Place To Start Delivery System Reform
Francis J. Crosson

A Consumer Perspective On Physician Payment Reform
John Rother

Using Medicare Payment Policy To Transform The Health System:
A Framework For Improving Performance
Stuart Guterman, Karen Davis, Stephen Schoenbaum,
and Anthony Shih

Measuring Outcomes And Efficiency In Medicare
Value-Based Purchasing
Christopher P. Tompkins, Aparna R. HIggins, and Grant A. Ritter

Payment Reform Options:
Episode Payment Is A Good Place To Start
Robert E. Mechanic and Stuart H. Altman

Consumer-Driven Health Care:
Promise And Performance
James C. Robinson and Paul B. Ginsburg

Costs And Benefits Of Health Information Technology:
New Trends From The Literature
Caroline Lubick Goldzweig, Ali Towfigh, Margaret Maglione,
and Paul G. Shekelle

Measuring, Monitoring, And Managing Quality In Germany’s Hospitals
Reinhard Busse, Ulrike Nimptsch, and Thomas Mansky

[Health Affairs 28, no. 2 (2009): w205-w215 (published online 27 January 2009; 10.1377/hlthaff.28.2.w205)]

• Ineffective, costly and inconsistent care,
• Poor Quality,
• Millions of uninsured, and
• Cost shift instead of cost reduction

Ideas to reduce cost and move toward a patient-centered system include:

• Payments that are NOT based on volume,
• Prevention programs,
• Public policy that fosters better eating, exercise and healthy lifestyle choices,
• Convenience, quality and value,
• No payment for errors and never events, and
• More active consumers

The Washington Post recently reported that $730 billion dollars was wasted in 2007 for “insurance bureaucracies, drug companies, medical device manufacturers and providers”, according to the Congressional Budget Office.   Larry McNeely II, advocate with the Public Interest Research Group (PIRG), stated that in the future, physician “pay should be based on the quality of care they provide rather than the number of tests and procedures they order”.  PIRG released a study in January 2009 that showed “the costs of employer-paid health insurance will jump from $11,381 to $24,291 in the next seven years”.  They site wasteful spending and inefficient care as the catalysts for this increase. 

Health Affairs reports that “reform will happen when consumers are enabled to take a more active role in managing their spending, their health and the health of their families”.

Many companies already strive to help the American worker become the owner of his/her personal good health.  USA Today recently reported that the state of Alabama, Affinia Group, Hospital Corporation of America and General Electric have implemented, or are in the process of implementing, incentive programs that encourage good health behavior.  This trend is taking place all over America, and within Tennessee.   

SOURCE: Health Affairs Web Exclusive, 28, no. 2 (2009) w177-w179, Perspective: Health Care Transformation and CEO Accountability, Craig Barrett and Peter V. Lee, and The Washington Post: Skyrocketing Health-Care Costs Could Double Premiums for Many Americans- January 28, 2009, and USA Today: Firms offer bigger incentives for healthy living- January 19, 2009.