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CQO in Action: The Impact of Physician-Led Value Analysis on Improved Outcomes

Christopher J. O’Connor, CMRP, FACHEPresidentGNYHA Services & Nexera

Mary Beth Lang, RPh, MPM, DScExecutive Vice President, Cognitive Analytics and HC PharmacyUPMC

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Elevating the healthcare supply chain from transitional to strategic

Elements for sustainable success Physician engagement tactics CQO-based data & analytics How the CQO framework is impacting outcomes

Agenda

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CQO: A framework for advanced decision-making

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COST: all costs associated with delivering patient care and supporting the care environment

QUALITY: patient‐centered care aimed at achieving the best possible clinical outcomes

OUTCOMES: financial reimbursement driven by outstanding clinician care at the appropriate cost

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Supply chain has followed and continues to follow reimbursement!

Evolution of Supply Chain

COST HEALTH REFORMHEALTH REFORM

OLD WORLD NEW WORLD

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The Building Blocks of CQO

INTEGRATED MODEL

TRANSFORM CULTURE/GOVERNANCE

ENGAGE NETWORK

TRANSACTIONAL

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Focus on price improvement Perform fundamental supply chain practices

‣ Inventory‣ Contracting‣ Procurement‣ Basic data sets‣ Supply chain automation‣ Product Committee

Transactional

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TRANSACTIONAL

ENGAGE NETWORK

TRANSFORM CULTURE

INTEGRATED MODEL

CQO

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Engage end users, administration & suppliers‣ Historic provider-supplier relationship = price over

value‣ New provider-supplier relationship = healthcare

issues over supply chain issues

Understand the needs of others and incorporate their feedback into the sourcing process‣ Clinicians‣ Physicians‣ Business‣ C-suite

Beginning stages of value analysis

Engage Network

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TRANSACTIONAL

ENGAGE NETWORK

TRANSFORM CULTURE

INTEGRATED MODEL

CQO

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Focus on culture change Examine, learn, and familiarize department

with alternative data sets Begin to integrate clinical data to gain

enhanced insights Implement education and training initiatives

for supply chain staff Need a structure to facilitate change

Transform Culture/Governance

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TRANSACTIONAL

ENGAGE NETWORK

CULTURE/GOVERNANCE

INTEGRATED MODEL

CQO

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Purchasing goals are aligned across the organization

New measures and data sets are used to make evidence-based purchasing decisions

Focus on ‣ how products are used‣ what is the total cost‣ difference in quality‣ comparative effectiveness

Integrated Model

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TRANSACTIONAL

ENGAGE NETWORK

TRANSFORM CULTURE

INTEGRATED MODEL

CQO

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Focus on securing results that‣ decrease total costs and maintain quality‣ BEST: decrease costs and improve quality

& outcomes

Implement and sustain a system-wide, physician-led value analysis program that enables CQO-based initiatives

Operating at the Intersection of CQO

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TRANSACTIONAL

ENGAGE NETWORK

TRANSFORM CULTURE

INTEGRATED MODEL

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PEOPLE Understand current

healthcare environment Comprehend the

importance of their role to larger organizational objectives

PROCESS Careful data

management Optimize technology to

eliminate inefficiencies Utilize data to generate

enhanced insights Move to best practice

CULTURE/GOVERNANCE Support multi-

disciplinary collaboration Breakdown internal

siloes Training & education Focus on continuing

process improvement to achieve organizational goals

Integral Elements to Sustainable Success

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“Culture eats strategy for breakfast.”

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Key piece to sustainable success and one of the biggest challenges leaders face

Tips from our physician advisors:

Physician Engagement

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Show that you value their time; meet them where they are

Involve them prudently; time is a physician’s most precious commodity

Communicate candidly

Speak a common language; focus on clinical outcomes

Recognize the challenges they face

Make them aware of the cost impact of their decisions

Identify a physician champion

Invite them to financial meetings

Create a culture devoted to quality & safety Reward collaboration and inspire teamwork

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There is tremendous potential in comprehensive data‣ Supply chain‣ EMR

• Outcomes• Variability

‣ Financial reimbursement

Data must be analyzed in order to be actionable

No matter how much sophisticated technology a hospital employs, its people and processes are critical to making data usable and leveraging it to its fullest potential

Data is King

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COGNITIVE ANALYTICSConnecting data for better CQO

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The world’s most valuable resource is no longer oil, but dataThe data economy demands a new approach

Source: https://www.economist.com/news/leaders/21721656‐data‐economy‐demands‐new‐approach‐antitrust‐rules‐worlds‐most‐valuable‐resource

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CASE STUDIESThe Impact of Physician-Led Value Analysis on Outcomes

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CMS Comprehensive Care For Joint Replacement (CJR) Program

Final rule November 16, 2015 – mandatory program for hospitals in 67 MSAs

Program begins April 1, 2016 through 2020 One bundled payment and quality measurement for

entire episode of care for hip and knee replacements‣ Hospitals, physicians, post-acute providers‣ Pre-surgery to post recovery

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UPMC MS-DRG 470 Total Joints

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700

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$20,000.00

$40,000.00

$60,000.00

$80,000.00

$100,000.00

$120,000.00

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Discharges

Charge Per Discharge

Linear (Charge Per Discharge)61% discharges

Number of Discharges vs. Charge per Discharge(by surgeon)

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MS-DRG 470 Blood Use

Variance of blood use for surgical procedure was 15.7% across all blood products

Waste related to blood added cost not associated to procedure (e.g., $85K)

Physicians who performed the fewest procedures had the highest cost and longer length of stays

CostCost

QualityQuality

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Blood Waste = Cost

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Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

PLT

RBC

FFP

One UPMC Hospital - Blood Product Waste FY '12

6.1% of Total

0.9% of Total

1.3% of Total

Red Blood Cells

Platelets

Plasma

$21,476

$47,956

$14,251

One UPMC Hospital -Blood Product Waste FY '12

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Medication - Vigilance of Appropriate Use

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February 2014Mallinckrodt Plc. agrees to buy Cadence Pharmaceuticals, Inc.

May 2014IV acetaminophen price increased 75% ($1.8M)Company stated product was “undervalued”

Drug Utilization Standardization Practice Variation No Buy

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Value Analysis Considers Total Cost of Ownership Cost of Procedure Cost of Population Bundle Readmission Considerations Minimizing Practice Variation Physician Service Levels and Support Documented Clinical Evidence of Outcomes

Evidence-Based Product Selection

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BACKGROUND: The medical center’s current IV catheter routinely leaked blood from the

catheter hub immediately upon insertion, exposing caregivers to potential blood-borne hazards. The issue was brought to the medical/surgical value analysis team, with the goal of improving clinician safety related to potential exposure to blood-borne pathogens at the IV insertion site. Finding an alternative product that didn’t pose the same degree of risk was a priority.

Simultaneously, blood-borne contamination of the IV insertion site was leading to increased supply and personnel costs, creating a financial imperative for change.

Peripheral IV Catheter 500+ bed medical center in NJ

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So, what does this look like?

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METHODOLOGY: The value analysis team evaluated

alternative products, finding one that offered the most benefits:‣ Increased clinician safety, due to blood control

technology; reduced blood exposure‣ Proprietary vialon catheter material extending

the dwell time of the IV catheter, reducing catheter complications and associated costs

‣ Reduced blood cleanup, helping to reduce supply costs and improve nursing efficiency from reduced cleanup time

‣ Technology designed to improve first stick proficiency and minimize painful missed insertions

RESULTS: 5% annual cost savings. Additionally,

supply and personnel costs associated with blood-borne contamination of the IV insertion site will be significantly reduced/eliminated through use of this product

Quality will be significantly improved based on elimination of blood leakage at IV insertion site

Improved financial and clinical outcomes through patient and employee satisfaction

Peripheral IV Catheter 500+ bed medical center in NJ

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BACKGROUND: The nurse manager for EP, cath lab, and IR noticed that contrast media use was way over budget. He reached out to the interventional value analysis team for help. The data team found that the Iodixanol(Visipaque) use was rising at a rapid rate, and the Iohexal (Omnipaque) was declining to almost nothing (Visipaque and Omnipaque are dyes).

Contrast Media Utilization Hospital IDN in western NY

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So, what does this look like?

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Injector Port Examples: Procedure Example: Spine Injection using Fluoroscopy

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METHODOLOGY: Through interventional value analysis team discussions, it was identified that

nursing staff were using Visipaque for most all cases, as they did not want to change the power injector to use the Omnipaque. Visipaque was three times as expensive as Omnipaque. Following research, it was agreed by the physicians (including radiologist and interventional cardiologist champions) that Omnipaquecould and should be used for most cases, with few exceptions. The value analysis team—in collaboration with radiologists and physicians—created a policy and procedure for contrast media use, educated the nursing and physician staff, and are holding them accountable.

RESULTS: Savings on use alone was $279,515, improving financial outcomes An RFP for price reduction secured an additional $132,917 in savings

Contrast Media Utilization Hospital IDN in Western NY

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BACKGROUND: Hospital seeing high rates of central line acquired blood stream infections (CLABSI), resulting in

untoward patient events, extended patient stays, and increased cost of care/reduced reimbursement‣ Report of 24 CLABSIs in 12-month period at average cost of $45,000 per infection

Product state: multiple vendors and products for venous access devices (all used non-impregnated/regular catheters)‣ Increased supply chain costs, low-quality processes, poor financial outcomes

METHODOLOGY: Physician-led value analysis team recommended a change to a high-quality product with

chlorhexidine impregnated catheters (catheters saturated in antimicrobial substance) to reduce patient risk of acquiring CLABSI

Hospital standardized purchasing to a single manufacturer (cost), a high-value product with anti-microbial catheters (quality), and developed a calculation methodology to monitor results (outcomes)

Mutual agreement between the hospital and the selected vendor to assess current practice, educate clinicians on best practice, and re-evaluate quarterly to measure the impact

Venous Access Devices 300+ bed urban community hospital

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Calculation methodology: Quarterly CLABSI rate comparison status post implementation

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RESULTS: Value analysis team worked with the hospital’s infection prevention department to

track occurrences of CLABSI Simultaneously, the value analysis team facilitated vendor-provided education on

best practice catheter placement and care Provides a quarterly look back to continually monitor results The hospital experienced a 50% improvement in CLABSI infection rates Reduction in hospital-acquired condition (HAC) penalties Total infection prevention savings (device cost + CLABSI reduction) = $550,351

Venous Access Devices 300+ bed urban community hospital

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QUESTIONS?Thank You

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