Privileged and Confidential CQO in Action: The Impact of Physician-Led Value Analysis on Improved Outcomes Christopher J. O’Connor, CMRP, FACHE President GNYHA Services & Nexera Mary Beth Lang, RPh, MPM, DSc Executive Vice President, Cognitive Analytics and HC Pharmacy UPMC
37
Embed
CQO in Action - South Carolina Hospital Association · The medical center’s current IV catheter routinely leaked blood from the catheter hub immediately upon insertion, exposing
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Privileged and Confidential
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
Privileged and Confidential
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
1
Privileged and Confidential
CQO: A framework for advanced decision-making
2
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
Privileged and Confidential
Supply chain has followed and continues to follow reimbursement!
Evolution of Supply Chain
COST HEALTH REFORMHEALTH REFORM
OLD WORLD NEW WORLD
Privileged and Confidential
The Building Blocks of CQO
INTEGRATED MODEL
TRANSFORM CULTURE/GOVERNANCE
ENGAGE NETWORK
TRANSACTIONAL
Privileged and Confidential
Focus on price improvement Perform fundamental supply chain practices
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
6
TRANSACTIONAL
ENGAGE NETWORK
TRANSFORM CULTURE
INTEGRATED MODEL
CQO
Privileged and Confidential
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
7
TRANSACTIONAL
ENGAGE NETWORK
CULTURE/GOVERNANCE
INTEGRATED MODEL
CQO
Privileged and Confidential
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
8
TRANSACTIONAL
ENGAGE NETWORK
TRANSFORM CULTURE
INTEGRATED MODEL
CQO
Privileged and Confidential
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
9
TRANSACTIONAL
ENGAGE NETWORK
TRANSFORM CULTURE
INTEGRATED MODEL
Privileged and Confidential
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
10
“Culture eats strategy for breakfast.”
Privileged and Confidential
Key piece to sustainable success and one of the biggest challenges leaders face
Tips from our physician advisors:
Physician Engagement
11
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
Privileged and Confidential
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
12
COGNITIVE ANALYTICSConnecting data for better CQO
Privileged and Confidential
The world’s most valuable resource is no longer oil, but dataThe data economy demands a new approach
Number of Discharges vs. Charge per Discharge(by surgeon)
Privileged and Confidential
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
Privileged and Confidential
Blood Waste = Cost
0
20
40
60
80
100
120
140
160
180
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
Privileged and Confidential
Medication - Vigilance of Appropriate Use
25
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
Privileged and Confidential26
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
Privileged and Confidential
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
27
Privileged and Confidential
So, what does this look like?
28
Privileged and Confidential
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
29
Privileged and Confidential
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
30
Privileged and Confidential
So, what does this look like?
31
Injector Port Examples: Procedure Example: Spine Injection using Fluoroscopy
Privileged and Confidential
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
32
Privileged and Confidential
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
33
Privileged and Confidential34
Calculation methodology: Quarterly CLABSI rate comparison status post implementation
Privileged and Confidential
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