Interview with Suzanne Delbanco, Executive Director of The Leapfrog Group
Barry Jacobs: There is a lot of talk about the empowered consumer. What's
different about the new consumer, and what changes lie ahead?
Suzanne
Delbanco: Consumers are increasingly aware that there is variation in quality.
If you look at the Kaiser Family Foundation Survey that came out in early 2003
in the New England Journal of Medicine, it details these views.
We're seeing a growing awareness of the importance of putting particular practices in place that can make a difference in terms of quality. There's also an increasing use of the Internet and other sources for information.
What we're also seeing, according to a Harris poll, is that very few consumers feel like the information they have is useful enough to have an affect on their decision-making. Even in the Leapfrog data that we put out, there are only three data points about hospitals, and obviously consumers have a lot of other issues and concerns they want to have information on.
Consumers have pent-up demand for the ability to be more informed decision-makers, but there is not quite enough supply yet to meet that demand.
In addition to demands for increased amounts of information, there's also increasing pressure now on the health care system to become more transparent. By transparent, I mean more and complete disclosure about health care performance on a variety of measures, whether it's at the hospital, health plan, physician, or treatment level.
The future also holds greater financial involvement for consumers in health care. By that, I mean that employers and others are looking for ways to share the costs of health care and are also looking for ways to have consumers be more sensitive to the costs of health care, so that they make more careful decisions about how they are expending limited resources.
BJ: What kind of impact will heightened levels of consumer access to information have on the provider?
SD: It's yet to be determined. The idea, of course, is that when you have more information out there, it will shift market share, meaning patients will choose to go to providers with better performance. We're a long way from knowing for sure if that's true. Public reporting has been shown many times to be associated with improved performance, largely due to the desire to impress competitors and because of the inherent threat that consumers might make a different decision based on that information. But we have yet to see what the potential impact could be.
BJ: What kind of work is Leapfrog involved in that will increase patient empowerment?
SD: We're involved in making information about hospitals available. One example is, reporting whether hospitals have certain practices in place that prevent errors and improve quality. We are also involved in helping our member-employers learn how to activate their employees to gain some basic awareness that their health care choices matter.
We're doing education work, both on the national level and through our employer members, which together represent 33 million Americans. We have quite a channel of communication to a large number of insured Americans.
Beyond that, some of the incentive and reward work that we're doing is going to provide tools for employers to use in creating financial incentives for employees to make certain health care choices. The financial piece of it will come into play over the next year.
BJ: How heavily do you weigh the importance of technology in improving the health care system?
SD: It's incredibly important, for two reasons. First, technology is an important tool that, if used well, can reduce errors, increase adherence to practice guidelines, and increase clinical decision-support for our caregivers.
The second reason it's important is that without an information technology system, it's very difficult to measure quality of care and to measure progress, in terms of whether performance is improving or deteriorating. Without those clinical information systems set up and an IT infrastructure, it's very laborious and expensive to gather information on the quality of care provided. Without the ability to measure quality of care, it's very hard to improve it.
BJ: People have been talking about how technology can improve health care for a long time — in fact, since HIPAA came to the fore as a key issue. There's been a lot of resistance and slow adoption. Is there something that's happened, fundamentally, that has made clinical transformation especially important right now?
SD: There are several different reasons clinical transformation is important now. One is that health care costs have been increasing with no end in sight. People recognize that there's no quick fix to reducing costs; cost reduction has to do with putting the processes and systems in place to make sure that care is delivered as efficiently as possible, meaning in the right way with as few resources as possible.
Also, we're living in a computer age, and people see that health care is the industry that's lagging behind the most in terms of adapting to the new world that we're living in. Those are probably the two major reasons.
BJ: Is Leapfrog involved with the Internet, media advertising, and report cards? Are you doing some analysis?
SD: One way in which we're involved is we are publicly reporting information about hospitals that we gather from an online voluntary survey. We are not going out and rating other report cards, but our data are appearing on various report cards that employers are using in different com-munities. In terms of the Internet, we don't have a specific Internet bent other than the fact that we have a public Web site with data that people can search.
BJ: Executives, board members, and consumers are trying to find information that helps them make serious decisions about how to improve the quality of health care. Besides your own site, where would you point people to help them make these important decisions?
SD: The National Quality Forum is an increasingly important organization. It's the clearinghouse for creating nationally standardized performance measures. If I were running a hospital and I wanted to know where to focus, I would look to see which standards have been endorsed by the Quality Forum and make sure that those are things that I'm able to measure and improve. Because if the National Quality Forum determines that there are ways of measuring these things, then it probably means they're pretty important.
