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FROM THE FIELD
Despite its national visibility, the Leapfrog Group has found progress difficult to achieve.
ABSTRACT: A number of large employers and public purchasers founded the Leapfrog Group in 2000 in an attempt to consolidate the purchaser voice and engage consumers and clinicians in improving health care quality. Drawing on evidence-based medicine, Leapfrog publicly releases information about the extent to which hospitals are adopting three safety "leaps" with the theoretical capacity to prevent thousands of deaths. Although the group has grown rapidly and achieved national recognition, employer-based initiatives historically have struggled to create changes in health care. This paper examines the impact of the Leapfrog Group and its efforts to address the challenges of employer initiatives.
LARGE EMPLOYERS can play a unique role in the U.S. health care system, using private-sector purchasing approaches to procure health benefits for their employees. Most employers believe that the appropriate use of market forces, such as public disclosure of physician and hospital performance measures, incentives to create price- and quality-sensitive consumers, and rewards for better care, is the optimal way to control costs and improve quality.1 In their view, managed care in the 1990s failed because it engaged neither consumers nor clinicians constructively. Providers were alienated because of uniformly lowered fees, and very low copayments created consumers who were insensitive to price. Performance information was developed at the health plan level, even though consumers prefer information about providers, and it is at the provider level that quality improvement occurs.
In 2000 a small group of large employers formed the Leapfrog Group to address these shortcomings in the market. They developed purchasing principles to deliver a new message to health plans and providers about the imperative of swift action to "leapfrog" over the current state of poor value. They called for a market based on the free flow of information about providers, consisting of consumers engaged in choices about quality and a payment system that rewarded physicians and hospitals for superior quality and efficiency based on evidence-based measures.2
Employer initiatives historically have struggled to make a meaningful impact on the health care system, no matter how auspiciously they begin.3 This paper reviews Leapfrog's experience, assesses its impact on the health care market, and discusses the challenges employers...