Models for Success

8/21/2019 Models for Success

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Value Analysis:Models for Success

Cindy Christofanelli, RN, MSN, CMRP


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Objectives

• Identify which value analysis models arebeing utilized on a national level.

• Explore the various components ofseveral value analysis models.

• Identify what value analysis models are

the most successful.


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Value Analysis

What is it….


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AHVAP: Healthcare Value Analysis

“ A systematic process to review clinicalproducts, equipment and technologies to

evaluate their clinical efficacy, safety andimpact on organizational resources”.

Source: Association Heathcare Value Analysis Professionals


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Healthcare Value Analysis A collaboration between Clinical,

Finance and Supply Chain

FINANCE(Cost-benefitknowledge)

PRODUCTUSERS(Product

knowledge &

evaluation)

Supply Chain(Vendor management &

contracting knowledge)

VATVAT’’ss(Review &

Evaluation)



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VHA’s Clinical Quality Value AnalysisTM

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Definition

• A consistent decision-making process

• Interdisciplinary involvement

• Support by executives

• Involved physicians


An organized approach to decisions about products andservices in the context of cost effective, safe and qualitypatient care that includes:

Applied consistently across the organization

Decision-making platform

C l i n i c a l &

p h y s i c i a n p r e f e r e n c e

S u p p l i e s a

n d S e r v i c e s


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7

Premier’s Definition of Value Analysis

Va l ue A na l y s i s ( n. ) – a s y s t e m a t i c ,

o b j e c t i v e p r o c e s s f o r

e va l ua t i ng a nd red uc i ng

e x pe nses b y co ns ide r i ng

a l te r na te p rod uc ts a nd p r

ac t ices w h ic h m e e t , b u t d

o n o t

e x c e e d, t he need w h i le m

a i n t a i n i n g o r i m p r o v i n g

q u a l i t y

pa t ie n t ca re.

Value Analysis is customer

focused, process oriented,and data driven.

Source: Premier


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Consistent Attributes


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Value Analysis

Why do it?


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Benefits of


10

• Takes product and service evaluation from subjectiveto objective

• Provides a formal, customized, collaborative approachto reduce and manage expenses

• Involves interdisciplinary teams

• Includes all supplies and services

• Ensures optimal benefits because of staff buy-in

• Integrates the Medical Staff into the ongoing process

• Supported by clinical documentation which maintainsand/or improves quality and customer satisfaction


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Value Analysis:

Hospitals Rising to the Challenges…

Lack of Data

Duplication

of Efforts

Drive for

Standardization

MinimalTransparency

Advances in

Technology

Bias in

Decision-Making

Financial Pressures

Source: Premier


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MedAssets: Factors DrivingChange in How We Control Costs

Payment reform Enhanced collaboration between clinicians and

finance Tough economic times Technology critical to efficiency and transparency

Traditional strategies for controlling costs are nolonger enough

12Source: MedAssets


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Value Analysis

How do you do it?


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Comparison of a few

National Models


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AHVAP Value Analysis Methodology

Product Opportunity

Gather DataStructure Opportunity

Preliminary Negotiations

Clinical Trial or Approval

Final Negotiation

Implementation

Audit Process

8 Step Process8 Step Process



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Product Opportunities

• New Technology

• Change in Vendor or Market Place

• Standardization Opportunity

• Change in Practice or Regulatory Issues• Contract Price Change



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Gather Data/StructureOpportunity

• Identify Key Issues with Current

• Define the Clinical Need

• Literature Review

• Data Analysis

• Know the Vendors

• Request for Information (RFI)

• Request for Proposal (RFP)



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Preliminary Negotiations

• Review Data• Engage Contract Agent

• Maintain Good Business Relationship with Vendors

• Identify GPO Affiliation• Identify Distribution Relationship



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Clinical Trial or Approval

• Clinical Decision

makers• Test of Change

• Clinical Champion

• Evaluation Tool• Trial Product

• Trial Areas and Trial

Length

• Plan In-service

• Correlate Evaluation Data

• Present Options

• Substitute Product

Selection



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Final Negotiations

• Contract Agent Completion Contractand/or Pricing Agreement Language

• Include Product Support during and

after Conversion• Shipping and Payment Terms



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Implementation

• Assign Accountabilities

• Communication Plan

• Implementation Plan

• Pre-conversion Meeting

• Training Plan



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Audit Process

Measure Success!

• Periodic Audit

• Report to Stakeholders

• Ongoing Vendor Alliance and Support



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• Current use &process

Identify:

• Project team

• Champions

• Barriers• Best practices

• Opportunities

• Initiative goals

• Project plan(s)

• Identifies &supportsadditionalstakeholders

• Finance

• Bio-Med

• Other Depts

• Developobjective criteria

• Supportprocesses?

• Detail review ofbook of business

• Developimplementationplan

• Metrics

•Update itemmaster

•Delivertraining

•Provide

support•Evaluate &test processes

•Evaluateoutcomes

•Modify asrequired

• Reinforceoutcomes

• Roll out to otherfacilities ifapplicable

• Set new targets

PROJECT MANAGEMENT AND COMMUNICATION

Methodology


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Value Analysis Success Factors


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Premier: Clinically Integrated Supply Chain

P e r s

p e c t i v e

Best Patient

outcomes &

experience

Product performance

requirements &

practice protocols

Service line

optimization

Sourcing, contracting,

logistics decisions

Stakeholder Involvement

P r o c e s s e s &

M e t r i c s

Evidence-BasedMedicineResource

Utilization

Comparative

Effectiveness

Waste Reduction Opportunities

Harm Avoidance

Reimbursement

Implications

Physician & Clinician

Engagement

Market Intelligence

GPOPortfolio

Contract Optimization

Clinical Performance

I n f r a s t r u c t u r e

Clinical Data Spend DataCharge Master/

Item Master Linkage

Value Analysis Process & Clinical Resource Teams

Source: Premier


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Premier: ValueAdvisor

Automating Value Analysis

REQUESTREQUEST

TRIAGETRIAGE

ANALYZE ANALYZE

DECIDEDECIDEMONITORMONITOR

• How will th is affect patients?

• What savings are available?

• What is impact on contracts?

• How would we convert?

• Who else is using this item?

• What’s their experience?

What did the

Value Analysis

Committee decide?

Did we achieve

our goals?

What was the

actual impact

Value Advisor TM►Manages Value Analysis Process

►Facili tates Collaboration

►Promotes Informed Decision Making

►Tracks / Measures Resul ts

►Promotes Accountability

►Drives Standardization

AlertsDecision

Routing

Savings

Opportunity

New items

Source: Premier


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Source: Premier


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MedAssets: A Holistic Approach

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Physician Preference

Items

Clinical Preference

Items

Commodities

Aspen

Healthcare

Metrics

Clinical

Value Analysis

Standardization

Di f f i c ul t y

Difficult

Easier

Source: MedAssets


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A 1

MedAssets: Value Analysis Change ManagementProven, data driven, and evidence-based

• Extract data• Analyze data• Prepare analyti cs inrational format

• Present to stakeholders• Discuss criteria for NOT

implementing opportunity

• Decisions based uponevidence and data

• Executive leadershipaware of criteria and

decision processes

• Stakeholders action

plan communicated• Vendor impact review• Staff impact review

• Develop and finalizeimplementation plan

• Implement opportunity• Implement p rocesschanges

• Report progress to

stakeholder committeeand executive leadership

Source: MedAssets


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Physician/surgeon approachesNew Product

Elevate request for analysis and research

Approved

Decision Decline

Declined

Successfultrial

Trial

Physician feedbackobtained

Decision

communicated toimpacted physicians

/item stocked on shelf

Inform Requester of Decision

Stockon shelf

Determination made if a trial is needed

Training Coordinated

Refer to Form Entitled,

“technologyTrial/Investigation

Request”*Note that we include twodifferent style forms

Refer to Form “Request forNew or Product

Tentative Yes

Yes

No

Presentation of research to Committee

Yes

YesNo

No

Team/Committee Review

Decision forward toteam/committee

MedAssets:

Processes Depend on Data Connectivity

INFO

INFO

INFO

INFO

INFO

INFO

INFO

INFO

Physician/surgeon approachesNew Product

Team/Committee Review

INFO

Source: MedAssets


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MedAssets Pharmacy Analytics-

Targeting Utilization

Source: MedAssets


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MedAssets: Linking the ItemMaster to the Charge Master

• Assuring all theprocesses andefforts are

measured• Ensuring

defensibility,transparency andrevenue integrity

Optimal Supply

Expense Management

Optimal Supply

Expense Management

Source: MedAssets

M dA t S l Ch i d


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MedAssets: Supply Chain and

Revenue Cycle Relationship Problem

Cost to Charge Transparencyand Accuracy

PPI uncharged or pricing iswrong

Solution Linked Supply chain item file and

Closed Receipts (purchasecosts) to CDM using CrossWalk®

Benefit Client example: $300,000 net

increase on strategic markups

34Source: MedAssets


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Successful Value Analysis

How do you know whenyou are doing it right?


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MedAssets: Expediting Savings with

Clinical AnalyticsPhysician, Case, Outcome and Reimbursement Measurement

Source: MedAssets Service Line Analytics

C


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MedAssets: Categorization is Key to

Advanced AnalyticsVarious Data Categories Decreases the Ambiguity

Source: MedAssets

Market ShareProfilingTier Opportunities

Premier: Specific Supply Utilization Analysis


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Premier: Specific Supply Utilization AnalysisLow Molecular Weight Heparin Utilization and Outcome

Comparison by Drug

Premier

Regional

Medical

Center

Facility

Enoxaparin

Premier

Overall Top

Performer

Peer

Enoxaparin

Facility

Fondaparinux

Premier

Overall Top

Performer

Peer

Fondaparinux

Facility

Dalteparin

Premier

Overall Top

Performer

Peer

Dalteparin

Cases 2637 94,333 124 1903 0 5974

Total

Variable

Cost/Case $4,187 $5,850 $8,073 $10,744 $0 $7,872

Pharmacy Average Variable

Cost/Case $864 $910 $841 $1,511 $0 $616

Lab Average VariableCost/Case $179 $257 $196 $284 $0 $273

Blood

Bank

Utilization

Rate 20.5% 25.6% 49.9% 60.3% 0.0% 23.6%Blood Bank Average Variable

Cost/Case $147 $96 $248 $228 $0 $48

ALOS 5.7 5.9 5.9 6.8 0.0 5.5

Bleeding Complications 91.0 8102.0 14.0 638.0 0.0 0.0

Bleeding Complication Rate 3.5% 8.6% 11.3% 33.5% 0.0% 0.0%

PE/DVT's 19 672 4 30 0 0

PE/DVT

Rate 0.7% 0.7% 3.2% 1.6% 0.0% 0.0%Mortality Rate 1.5% 2.2% 1.6% 2.7% 0.0% 3.0%

%

of

Total

LMWH

Cases 95.5% 92.0% 4.5% 1.9% 0.0% 6.1%

Source: Premier

C S S


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Current State Survey

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Focus Area Definition

Process Capability of existing processes to support continueddevelopment of value analysis

ExecutiveLevel of executive focus, sponsorship, and enforcementof value analysis

Stakeholder Degree of stakeholder buy-in, ownership, andparticipation in value analysis

Assess perception of the maturity of the value analysisprogram across three major focus areas, and in aggregate

Show variation within and across departments and the

organization, if it exists

Provide current state for future state planning purposes

O i ti l C t


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Organizational Current

State Summary

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Percentage rating is a relative measureof maturity with 100% being maximum

Organizational Mean = 75%

Range = 73% - 78%

Variance rating is composite of standarddeviations

Organizational Current State Survey Results

Baptist Health Montgomery, AL 2009

75%

78%

75%

73%


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Premier: Value Analysis AssessmentDelivered with every ValueAdvisor implementation

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Strategy and AlignmentStrategy supports mission and vision

Alignment of goalsExecutive and physician participationKey stakeholder engagement and accountability

Structure and ProcessReview team structure and effectiveness

Assess for breaks and barriers in process:Project planning and prioritizationData collectionDecision-makingImplementation

Follow-up

Outcomes and EffectivenessIdentification of goals; metricsUse of benchmark toolsTimeliness of processTracking / Documentation / Communication

Source: Premier


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Key Components to Successful VA Model

• Executive Engagement and Participation

• Physician Engagement and Participation

• Stakeholder Engagement and Participation• Goal Alignment and Linkage to Strategy/Vision

• Structured process to secure data

• Project Management to define timelines• Use of benchmarking tools and information

• Tool(s) to trend, track and document outcome

• Systematic process to communicate results to alllevels of organization

• Access to staff with deep analytical and clinical skillsets


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WEIGH the EVIDENCE,

Clinical Ou tcome Fin

ancial Impac t

Technology Adoption CycleInnovators Laggards


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TIP the SCALE,

C l in ica l Ou tcome

F inanc ia l Impac t

PhysicianSatisfation andRecruitment

MarketingClinicalPreference

Conflict ofInterest

Group PurchasingCommitment

PerceivedComplexity

Lack of AdminstrativeSupport


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OR….Create Balance

Clinical Outcome Financial Impact


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P a i n

Gain

Pain/Gain

LowPain/Low

Gain

HighPain/High

Gain


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Education

&

Knowledge

Individual Attitude Change

IndividualBehavior Change

Organizational

Culture Change

D i f f i c u l t y

Time

Changing Culture


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Thank You

• Melanie Miller, RN, Past President, AHVAP• Peg Tinker, Sr. Director, VHA Performance

Services

• Gina Thomas MBA,RN, CMRP, FAHRRMRegional Vice President South CentralMedAssets Inc.

• Dale Newman, RRT, MBA, Product Director,Premier, Inc.

Documents

Models for Success