THE MANY FACES OF VALUE

PEER ROUNDTABLE/FORUM

PANEL & TABLE LEADS

ANN KAHR, CATHOLIC HEALTH INITIATIVE

CHRIS MATALA, ISLAND HEALTHCARE

BILL KNIGHT, VIRGINIA MASON MEDICAL CENTER

FACILITATOR

KATHI PRESSLEY, OLYMPIC MEDICAL CENTER

HEALTHCARE VALUE ANALYSIS

• ASSOCIATION OF HEALTHCARE VALUE ANALYSIS PROFESSIONALS –

• IDN SUMMIT MODELS FOR SUCCESS PRESENTED AT IDN SUMMIT

• CINDY CHRISTOFANELLI, RN, MSN, CMRP

“A SYSTEMATIC PROCESS TO REVIEW CLINICAL PRODUCTS,

EQUIPMENT AND TECHNOLOGIES TO

EVALUATE THEIR CLINICAL EFFICACY, SAFETY AND IMPACT ON

ORGANIZATIONAL RESOURCES”.

A COLLABORATION BETWEEN CLINICAL,

FINANCE AND SUPPLY CHAIN

VALUE

ANALYSIS

PRODUCT OPPORTUNITIES

• NEW TECHNOLOGY• CHANGE IN VENDOR OR MARKET PLACE• STANDARDIZATION OPPORTUNITY• CHANGE IN PRACTICE OR REGULATORY ISSUES• CONTRACT PRICE CHANGE

BENEFITS OF

VHA’S CLINICAL QUALITY VALUE ANALYSIS

• TAKES PRODUCT AND SERVICE EVALUATION FROM SUBJECTIVE TO OBJECTIVE

• PROVIDES A FORMAL, CUSTOMIZED, COLLABORATIVE APPROACH

TO REDUCE AND MANAGE EXPENSES

• INVOLVES INTERDISCIPLINARY TEAMS

• INCLUDES SUPPLIES AND SERVICES

• ENSURES OPTIMAL BENEFITS BECAUSE OF STAFF BUY-IN

• INTEGRATES THE MEDICAL STAFF INTO THE ONGOING PROCESS

• SUPPORTED BY CLINICAL DOCUMENTATION WHICH MAINTAINS

AND/OR IMPROVES QUALITY AND CUSTOMER SATISFACTION

WHAT IS VALUE-BASED PURCHASING?

VALUE-BASED PURCHASING IS A DEMAND SIDE STRATEGY TO MEASURE, REPORT, AND REWARD EXCELLENCE IN HEALTH CARE DELIVERY.

VALUE-BASED PURCHASING INVOLVES THE ACTIONS OF COALITIONS, EMPLOYER PURCHASERS, PUBLIC SECTOR PURCHASERS, HEALTH PLANS, AND INDIVIDUAL CONSUMERS IN MAKING DECISIONS THAT TAKE INTO CONSIDERATION ACCESS, PRICE, QUALITY, EFFICIENCY, AND ALIGNMENT OF INCENTIVES.

EFFECTIVE HEALTH CARE SERVICES AND HIGH PERFORMING HEALTH CARE PROVIDERS ARE REWARDED WITH IMPROVED REPUTATIONS THROUGH PUBLIC REPORTING, ENHANCED PAYMENTS THROUGH DIFFERENTIAL REIMBURSEMENTS, AND INCREASED MARKET SHARE THROUGH PURCHASER, PAYER, AND/OR CONSUMER SELECTION

NATIONAL BUSINESS COALITION ON HEALTH’S VALUE-BASED PURCHASING COUNCIL

WHY IS THIS IMPORTANT TO SUPPLY CHAIN?

1. PATIENT PERCEPTION OF VALUE & QUALITY -

SATISFACTION

2. COMMODITY SELECTION, I.E. INFECTION CONTROL

(CAUTI)

3. CHANGES IN PATIENT ACUITY

VALUE BASED PAYMENT BY THE NUMBERS:

2014 2015 2017

1. PROCESS OF CARE 45% 20% 5%

2. SATISFACTION (HCAHPS) 30% 30% 25%

3. OUTCOMES (MORT, READMIT) 25% 30% 25%

4. SAFETY (HAC) 0% 0% 20%

5. EFFICIENCY/COST REDUCTION 0% 20% 25%

BASED ON RESULTS 2012 2013 2015

QUALITY PATIENT CARE EXPERIENCE BRINGS VALUE TO THE

INDIVIDUAL AND THE HEALTHCARE PROVIDER

THREE FACES OF VALUE ANALYSIS

1. CATHOLIC HEALTH INITIATIVES – ANN KAHR

2. ISLAND HEALTHCARE – CHRIS MATALA

3. VIRGINIA MASON - BILL KNIGHT

Catholic Health Initiatives /

THE BASICS : THE WHAT AND HOW OF CLINICAL VALUE ANALYSIS

CLINICAL VALUE ANALYSIS IS A PROCESS DESIGNED TO DETERMINE THE LOWEST COST APPROACH TO MAINTAINING OR

IMPROVING THE BEST POSSIBLE PATIENT EXPERIENCE.

• CHI IS COMMITTED TO USE HEALTHTRUST CONTRACTED PRODUCTS WHEREVER POSSIBLE.

• STANDARD CHI NEW PRODUCT REQUEST FORMS REQUIRED FOR ALL NEW PRODUCT REQUESTS.

• REQUESTS FOR CONTRACT EXCEPTIONS MUST FOLLOW CONTRACT EXCEPTION REVIEW PROCESS AND BE APPROVED.

• ALL PHYSICIAN PRODUCT REQUESTS ARE REVIEWED IN REGIONAL MD PRODUCT COMMITTEES WITH PHYSICIAN

LEADERSHIP AND MEMBERS.

• NON- PHYSICIAN PRODUCT REQUESTS ARE REVIEWED IN APPROPRIATE REGIONAL CLINICAL VA TEAMS.

• CHI HAS CLINICAL REPRESENTATION ON HEALTHTRUST COMMITTEES AND SHARES CHI STAFF FEEDBACK ON PRODUCT

PREFERENCES AND HISTORY.

• CHI CLINICIANS WILL SUBMIT HEALTHTRUST PRODUCT QUALITY AND VENDOR SERVICE FEEDBACK FORMS, LOCATED ON

“INSIDE CHI” TO PROVIDE FEEDBACK TO HEALTHTRUST.

Catholic Health Initiatives /

VALUE ANALYSIS GOALS: THE ROLES OF REGIONAL CLINICAL VALUE ANALYSIS MANAGERS

• CVAMS IN CHI REGIONS:

• COORDINATE THE NEW PRODUCT REQUEST PROCESS.

• PROVIDE CLINICAL SAFETY AND PERFORMANCE EVIDENCE AND COST IMPACT PROFILES TO REVIEW COMMITTEES.

• REDUCE DUPLICATE PRODUCTS AND HELP CLINICIANS SELECT PRODUCTS WITH THE LOWEST COST AND BEST

OUTCOMES.

• WORK WITH CLINICIANS TO REDUCE WASTE.

• SHARE INFORMATION ON “BEST PRACTICES” AS THEY RELATE TO PRODUCTS.

• HELP REPORT PRODUCT FAILURES OR VENDOR SERVICE PROBLEMS TO HEALTHTRUST

• HELP MAINTAIN CHI CONTRACT COMPLIANCE BY:

• EDUCATING CLINICIANS ON CURRENT HT CONTRACTS.

• SUGGESTING CONTRACTED PRODUCTS TO PHYSICIANS.

• RESTRICTING UNNECESSARY SALES REP VISITS.

Catholic Health Initiatives /

EXAMPLE OF EXECUTIVE SUMMARY

• TECHNOLOGY REQUESTED: STABILINK MIS SPINAL FIXATION SYSTEM

• MANUFACTURER: SOUTHERN SPINE

• REQUESTED BY:DR RICHARD WOHNS, ST FRANCIS HOSPITAL FEDERAL WAY, WA/OR

• DESCRIPTION: THE STABILINK MIS SPINAL FIXATION SYSTEM IS A POSTERIOR, NON-PEDICLE SUPPLEMENTAL

FIXATION DEVICE, INTENDED FOR USE AT A SINGLE LEVEL IN THE NON-CERVICAL SPINE (T1-S1). IT IS INTENDED FOR

PLATE FIXATION/ATTACHMENT TO SPINOUS PROCESSES FOR THE PURPOSE OF ACHIEVING SUPPLEMENTAL FUSION

IN THE FOLLOWING CONDITIONS: DEGENERATIVE DISC DISEASE, SPONDYLOLISTHESIS; TRAUMA; AND /OR TUMOR.

• PROPOSED USE OF PRODUCT: DR WOHNS STATEMENT OF USE, “I BELIEVE THAT STABILINK IS BIOMECHANICALLY

SUPERIOR TO THE CURRENT ISP DEVICE ST FRANCIS CURRENTLY OFFERS FOR SPINOUS PROCESS FIXATION. THE

INSTRUMENTATION IS SIMPLER AND WILL RESULT IN LESS OR TIME AND BLOOD LOSS. IN ADDITION, STABILINK HAS

A WIDER CHOICE OF IMPLANTS FOR VARYING PATIENT ANATOMY. THE STABILINK SYSTEM IS SIMPLER AND HAS A

WIDER VARIETY OF IMPLANTS WHICH WILL RESULT IN SAFER PROCEDURES AND BETTER RESULTS FOR MY PATIENTS

• CURRENT PRACTICE: SPINEOLOGY AND NUVASIVE SPINOUS PROCESS CLAMP.

• CHI FRANCISCAN PPI COMMITTEE [SLIDE 1 OF 2]

15

Catholic Health Initiatives /

EXAMPLE OF EXECUTIVE SUMMARY

• FDA CLEARANCE: K123093

• SAFETY: NO MAUDE REPORTS FOUND

• INDICATIONS FOR: SAME AS INDICATED IN DESCRIPTION

• CONTRAINDICATIONS: ALLERGY TO TITANIUM, KNOWN INFECTION, DISORDERS AFFECTING

OSTEOGENESIS, MORBID OBESITY, OPEN WOUNDS, PREGNANCY

• CREDENTIALING CONSIDERATIONS: PHYSICIAN IS CREDENTIAL FOR SPINAL FIXATION/ FUSION.

• CLINICAL OUTCOMES: NO RESEARCH FOR THIS DEVICE IS AVAILABLE

• ADVERSE EFFECTS: EARLY OR LATE IMPLANT BENDING, BREAKAGE, FAILURE, LOOSENING OR

MOVEMENT OR MIGRATION, BONE OR SPINOUS FRACTURE, ALLERGIC REACTION TO IMPLANT

MATERIAL

• FINANCIAL IMPACT: SEE FINANCIAL ANALYSIS SPREADSHEET

• CONTRACTING IMPLICATIONS: NOT ON CONTRACT, EXCEPTION WAS REQUESTED.

• CHI FRANCISCAN PPI COMMITTEE [SLIDES 2 OF 2]

16

Catholic Health Initiatives /

EXAMPLE OF EXECUTIVE SUMMARY• CHI FRANCISCAN PPI COMMITTEE

17

Financial Summary

Spinous Process Fixation System

NuVasive / Spineology VS Stabilink

Vendor DOS MRN Pmts Dir Cost Fixation Cost CM Closed?

NuVasive

9/9/14 599294 $27,466 $25,735 $13,000 $1,731 Y

8/26/14 1000574327 No Payment yet $17,688 $6,500 ($17,688) N

6/3/14 1135484 No Payment yet $11,471 $6,400 ($11,471) N

Spineology 5/20/14 1319890 $8,333 $4,784 $4,000 $3,549 Y

Note: One Level Case -Stabilink

SS-219 $250CBL-16 $1,650CBT-16 $2,500

Total $4,400

ISLAND HOSPITAL – GATEWAY TO THE SAN JUANS

• ISLAND HOSPITAL – 46 BED, ACUTE CARE COMMUNITY HOSPITAL SERVICING

SKAGIT, ISLAND AND SAN JUAN COUNTIES. WITH 7 CLINICS LOCATED IN

ANACORTES.

• ADDITIONALLY WE HAVE A RESTORIX/WOUND CARE CENTER,

ONCOLOGY/INFUSION, LEVEL 2 ER, HOME HEALTH, CARDIAC REHAB AND A

VARIETY OF OTHER SERVICES

• 4 OR’S, IR ROOM AND ENDOSCOPY LAB

• 750 EMPLOYEE’S - CITIES LARGEST EMPLOYER

OPPORTUNITY AND VALUE ANALYSIS AT ISLAND

• APPROACH – I CHAIR A MULTIDISCIPLINARY TEAM THAT INCLUDES – ADMIN,

OB, ACUTE CARE, OR, DI, ED, PHARMACY, RESPIRATORY, ENGINEERING, EVS,

HOME HEALTH, INFUSION, CLINICS, QUALITY, NURSING EDUCATION,

INFECTION CONTROL, LAB

• MEET MONTHLY – 3RD WEDNESDAY OF THE MONTH

• STRUCTURED AGENDA

• STRUCTURED PROCESS FOR SUBMISSIONS

• CLINICAL PRODUCTS, CAPITAL, SERVICE CONTRACTS, LIGHT IT/IS

TRIALS AND TRIBULATIONS = SUCCESS

• “IT IS NOT THE STRONGEST OF THE SPECIES THAT SURVIVES, NOR THE MOST

INTELLIGENT THAT SURVIVES. IT IS THE ONE THAT IS MOST ADAPTABLE TO

CHANGE” DARWIN

• EVERYONE PARTICIPATES – THIS IS INCLUDES BUSINESS PARTNERS

• KEY POINTS – EFFECTIVE COMMUNICATION, FOLLOW THROUGH, EDUCATE,

COMMUNICATE, FOLLOW THROUGH

• KEY STAKEHOLDERS – STAFF, PHYSICIANS, PATIENTS = COMMUNITY

VIRGINIA MASON VALUE ANALYSIS TEAM

VAT TEAMS AND AGENDA

VATs

ORLAB

GI/EndoIR/

RadiologyNursing

Satellite Clinics

VMMC Inpatient Clinics

VAT TEAMS AND AGENDA

GENERAL AGENDA:

1. PRODUCT ISSUES – PRODUCT SAFETY ISSUES, RECALLS, BACKORDERS

2. REVIEW PRODUCTS CURRENTLY IN TRIAL

3. REVIEW PRODUCTS BROUGHT TO VAT BY CLINICIANS – PPI OR COMMODITIES

4. REVIEW PRODUCTS INTRODUCED TO VAT BY SUPPLY CHAIN

5. QUESTIONS AND CONCERNS – DISCUSSION

MEETING FREQUENCY

• QUARTERLY (OR LESS) – LAB, GI/ENDO, IR/RADIOLOGY, REGIONAL MEDICAL CENTERS

• MONTHLY – OR, NURSING

VAT PROJECT INFORMATION - VNET

THE VIRGINIA MASON VALUE ANALYSIS TEAM IS A TOOL TO HELP CLINICIANS

AND MANAGERS MAKE INFORMED DECISIONS CONCERNING MEDICAL

SUPPLIES. THE VALUE ANALYSIS TEAM HELPS GATHER DATA THAT CONSIDERS

PATIENT AND STAFF SAFETY, CLINICAL OUTCOMES, STANDARD WORK, STAFF

EDUCATION REQUIREMENTS AND FINANCIAL IMPACT OF PRODUCTS NEW TO

THE INSTITUTION AS WELL AS THOSE ALREADY A PART OF THE VM SUPPLY

FORMULARY.

VAT PROJECT INFORMATION - VNET

Visual Review Patient Specific CompleteAdd To Existing

Product Line

*One Sample

*No Charge

*Non-Sterile

*Not to be used on Patient

*Product needed to

specifically treat an

individual patient.

* Non-Add to Inventory

*No Procedure Limit

*Evaluation / Direct add to

Inventory

*Add a item to an existing

Product Line

Forms Required

* Visual Review Request Form

Forms Required

* Product Request Form (Page

1)

* Vendor Data Sheet

Forms Required

* Product Request Form

* Vendor Data Sheet

Addition to Existing Product Line

Request Form

Standard Work Standard Work Standard Work Standard Work

VAT STATUS BOARDTracking # Requester Location Description Status

Expense

Opportunity

Status

Update Link to Detail

0315-090 Ross/Chastain GI Endo Covidien: Barrx 360 Express RFA Approved for Trial ($5,964.00) 3/30/2015

Covidien Barrx Epress RFA.xls

0315-89 Sorenson/Brigden OR

Biocomposites: Stimulan Rapid Cure

Beads Financial Analysis $162,720.00 3/30/2015

Biocomposites Stimulan.xls

0315-088 Ross/Chastain GI Endo Cook Medical: Cystotome Approved for Trial $13,790.00 3/30/2015 Cook Cystotme.xls

0315-087 Dr. Pierce Wound Care

Hollister Hydraferra Blue

Antibacterial Dressing Approved for Trial $625.00 3/30/2015

0315-087 Hollister Hydraferra

Antibacterial Dressing.xls

0315-086 Wetteland Cath Lab Boston Sci Safari Wire Evaluation underway $13,202.40 3/11/2015

0315-086 Boston Sci Safari Wire

Workbook.xls

0215-085 Pierce/Satalich Fed Way Osiris Therapeutics Skin Graft completed $43,680.00 3/11/2015

0215-085 Osiris Therapeutics

Workbook - Full.xls

0215-084 Ross/ Chastain GI Endo Boston Scientific: Spyglass Financial Analysis $59,520.00 3/30/2015

0215-084 Boston Scientific

Spyglass.xls

0215-083 Brigden OR Xodus Pink Pad

on hold - vendor

presentation 4/20 @

VAT team meeting $61,423.20 2/26/2015

0215-083 Xodus Medical Pink Pad

Workbook- Full.xls

0215-082 Brigden OR

Smith & Nephew Speedlock Hip

Suture Anchors Pending Decision $197,400.00 3/2/2015

0215-082 Smith & Nephew Speedlock

Hip Suture Anchor.xls

IT’S YOUR TURN – PUTTING IT ALTOGETHER

VALUE ANALYSIS, VALUE BASED PURCHASING EFFECTS & THE VALUE OF QUALITY PATIENT CARE

WHAT’S HAPPENING AT YOUR FACILITY/HEALTHCARE SYSTEM?

IT’S YOUR TURN – WHAT’S HAPPENING AT YOUR FACILITY/HEALTHCARE SYSTEM?

1. DISCUSS YOUR FACILITIES APPROACH TO VALUE ANALYSIS (5 MIN)

1.1 GREATEST CHALLENGES

1.2 SWEETEST SUCCESSES

2. HOW HAVE YOU FELT THE IMPACTS OF VALUE BASED PURCHASING AND

THE ACCOUNTABLE CARE ACT - CHANGES IN PRODUCTS, CHANGES IN

PATIENT ACUITY? HAS THE ACA CHANGED THE WAY YOUR VALUE

ANALYSIS [TEAM OR GROUP] FUNCTIONS?

THANK YOU……….. FOR BEING OPEN AND

SHARING!