Understanding Healthcare Value Analysis Tales From The "Darkside

UNDERSTANDINGHEALTHCARE VALUEANALYSISTALES FROM THE “DARKSIDE”PRESENTED BY:Laura L. Polson, BSN, RN-BC, CVAHP

THE VENDOR VIEW OF THEVALUE ANALYSIS COMMITTEEWho are those guys?

NEW VENDOR MEETSSUPPLY CHAIN“When we have a contract with a supplier, wetypically don’t look at breaking that contract toconvert to a new manufacturer, unless:1. There are serious quality concerns with ourcurrent product, or 2. There is significant cost savings to be had(i.e.: 20%) for converting to an appropriatelysimilar product (meaning our “partners”aren’t treating us very well).”

“Its fine for competitive companies (like yours) torequest our usage (volume or quantity of itemspurchased) of a certain product and provide aprice quote for us to do a comparison.When we get to the last year of a contract, wemay begin looking at our options.”By then we’ll ask for this data all over again .

Things to Consider:Our satisfaction level with our current vendor(backorders, recalls, product failures, etc.);A GPO contract is important, but is not essential.The clinical “cost of conversion,” i.e.: Is it worthsaving 10,000 to change products, but 2,000nurses have to learn a new technique?Have you met nurses?

“Clearly, the incumbent company has anadvantage in our system. It behooves them toprovide excellent service to keep our businessand most of them do. “

“We do not issue an RFP for every productcategory at the end of every contract, itwould be unwieldy and often unnecessary.The best I can say is that we’ll keep you inmind as we go forward. I certainly don’t mindyou sending me an e-mail 2 or 3 times a year,asking if we’re still happy with theincumbent.”-James Russell, RN-BC, MBA, CVAHP; Program Director, Value AnalysisSo how do I work with Value Analysis?

WHAT IS VALUE ANALYSIS? It is a PROCESS It is OPERATIONAL It is a CULTURE It is STRATEGIC It is CHANGE MANAGEMENT It is a PATIENT CENTRIC

Advocate for aPatient-Centered Approach Evidence-based health care is theconscientious use of current best evidence inmaking decisions about the care of individualpatients or the delivery of health services.Current best evidence is up-to-date informationfrom relevant, valid research about the effectsof different forms of health care, the potentialfor harm from exposure to particular agents, theaccuracy of diagnostic tests, and the predictivepower of prognostic factors.Evidence-BasedValue Analysis Evidence-based clinical practice is anapproach to decision-making in which theclinician uses the best evidence available, inconsultation with the patient, to decide uponthe option which suits that patient best . Evidence-based medicine is the conscientious,explicit and judicious use of current bestevidence in making decisions about the care ofindividual patients. The practice of evidencebased medicine means integrating individualclinical expertise with the best availableexternal clinical evidence from systematicresearch .From Cochrane: alth-care

I.Healthcare Value Analysis Governance and StructureA. Design an evidence-based healthcare value analysis model1. Advocate for a patient centered approach that includes quality, safety, and patientexperience2. Establish goals, objectives, charters, and education to support the model3. Incorporates support from executive team to create an organizational structurethat utilizes the AHVAP value analysis process4. Assign the roles of participants / stakeholders in the healthcare value analysisprocess5. Define metrics to evaluate robust clinical and financial outcomesB. Project Management in Healthcare Value Analysis1. Initiate or reject a healthcare value analysis project2. Plan a healthcare value analysis project3. Execute a healthcare value analysis project4. Monitor and evaluate a healthcare value analysis project5. Conclude a healthcare value analysis project6. Follow up after a healthcare value analysis project to determine results or checkand adjust as needed

DESIGN OF AN EVIDENCE-BASEDVALUE ANALYSIS MODEL

Communication & CollaborationCommunicate to an organization the value analysis purpose, goals, and metrics1.Facilitate value analysis meetings2.Define timelines3.Tailor communication to diverse audiences4.Establish and implement a barrier escalation process5.Collaborate with physicians, clinicians healthcare providers,manufacturers and consumers to identify and evaluate opportunitiesfor value through:a. standardizationb. clinical quality outcomesc. cost effectivenessd. utilization managemente. safetyf. sustainable practices

Patient SafetyPatient safety should be in every VAprogram charter and can become one ofthe committee’s main focuses. Need to eliminate overriding sole focuson cost. Focus on the function of the productbeing evaluated and how itsimplementation will affect patientsafety.

Aspects to AddressTraining: Have all of the clinicians who use new product beenproperly trained in the use of the item?Documentation provided – sign in sheets, tracked.Standardization: Appropriate standardization will decreaseunnecessary clinical variation in the method and means thatprocedures are performed.If the committee can decrease the amount of different types ofitems that a clinician must know, the potential for error can also bereduced.Usability: Is the item easy to use? (Front-line clinical input is criticalhere.) The committee needs to make sure that any new item is nottoo cumbersome to use. What may seem easy and convenient inthe conference room may not work well in the unit or OR.Tracking: The committee will need to ensure there is that there is anadequate system to track any new items in case of incident orrecalls.

Goals Supporting Value AnalysisMotivate and contribute positive clinical and financialoutcomes. Goals to consider important to VA include: Annual monetary goal for each team and the program Standardization (products and care practices) goals Utilization and Benchmarking Outcomes: Infection Prevention, Value Based Purchasing Standard Policy & Procedure, Protocols and EHRAccomplishments reported monthly to the VA SeniorLeadership Oversight Team Team leader/ VA leader will prepare and report projects,progress and obstacles to reaching their goals Dashboard report developed for each goal Savings typically used with budgetary process

PREPARING EFFECTIVECOLLABORATIONVALUE ANALYSIS TEAMS

Being PreparedNeed the following information regarding your product, if applicable:1.2.3.4.5.6.A copy of your FDA clearance (510(k), PMA, etc.).An electronic brochure.A copy of your updated W-9, even if you are an active vendor for XYZ Health.Your GPO contract number and our applicable tier.The price you are offering, and the shipping QTY/UOM (ie: Case of 10 each).Appropriate codes for the procedures your product is used for:Outpatient procedures: CPT CodesInpatient procedures: ICD 10 codes and MS-DRG’s.7. A list of 3 -5 Academic Medical Centers and IDNs that currently utilize this item.8. The quantity of product you will offer at no charge and the length of time you cansupport with staff for a clinical evaluation.9. The UNSPSC codes and full descriptions for your items. These are generalcategorization codes that are required to put the item into our MMIS system(PeopleSoft, Lawson). Every product has a category. This link may help you;https://www.unspsc.org/search-code10. A statement of whether or not your product contains Latex, DEHP, etc.11. Expect additional contact regarding a supply agreement, vendor application, etc.

Good “Partner” Tactics Know their Measurable Goals andObjectives Understand Organization Design Expect Benchmarking Tools (HCIQ) Use your own Benchmarks (HG,CMS) Offer Meaningful Information & Tools Expect Various Bidding Processes Know Conversion Processes andDistribution Channels Involve Physicians Prudently

Helping with Education What does the new product do and how does itwork? Communication to everyone involved with the product Customized product evaluations for trials -functions What education is required and available? Hands on with vendor experts – classroom styleOnline tutorialsOnline videos“Super” user classesCompetency or checklistHealth-stream – online education with copyrightpermission from vendor Utilize nursing education department if possible

WHAT IF THIS IS NEWTECHNOLOGY?

While existing value analysismethods are often well-suited forevaluating iterative designs of newmedical products, Providers often struggle to properlyassess truly disruptive technologiesand business models.

The stakes are high with hospitals potentiallymissing out on a transformation in clinicalcare if they pass on the technology or sunkmoney, time and other resources foradopting products that do not live up totheir promise.How should a hospital’s value analysiscommittee properly evaluate a phone appthat does more than any stethoscope? Abiosynthetic material the body can absorb?Or implants that could treat opioiddependence?Frost & Sullivan Virtual Think Tank 3/2018

Unfortunately, hospitals often lack the information,time and expertise necessary to determine whetherinnovations will be the right fit for their organization.Providers may be under-utilizing one of their mostimportant sources of information to support valueanalysis.Frost & Sullivan Virtual Think Tank 3/2018

As the shift toward value-based care hasput pressure on hospitals to examine theiroutcomes and costs over time, leadingedge medical device manufacturers servingthese providers have added their owninternal resources to study technologiesfrom an economic perspective.

This panel conversation pulls from the expertiseof this group to tackle common value analysisteams issues.Discuss the financial, clinical and supply chainlogistics resources available to hospitals fromdevice manufacturer partners, preferably at noadditional cost, and how accessing them canplay a valuable role in vetting and more efficiently implementing healthcareinnovations.

DISCUSSION OPPORTUNITIES How does the data available on an “innovation” differ from what the valueanalysis team might see from an “iterative” product? Why does that matter? What sort of value-based-care information can the best medical devicecompanies provide today that may not have been as available in the past? What should providers ask for from their device partners? How is the information providers receive directly from a device companydifferent from what they might receive from a third-party consultant or GPO? When only limited clinical data is available, what other sources of informationcan hospitals use to evaluate a product? And who can explain that information? How do hospitals confirm the health economics data provided by a medicaldevice company is trustworthy?

Scenario 1: I have a great product and it requires thisamazing “free” equipment which we will ship and installwithout a hitch. Once you sign this agreement topurchase this many a month (which we don’t reallyhold you to) and then we’ll just pick it up when youstop making purchases

Scenario 2: I have met with the surgeon and his officestaff over an awesome in-service dinner with a nationalguest speaker and they are scheduling this procedurefor a special patient tomorrow and I’m dropping offthese instruments

Scenario 3: I was here for my scheduled day in theCath Lab and the interventional cardiologist had areally tough case. I just happened to have my newdoomahfloji in my trunk stock and it saved the day. Ijust need a purchase order .

4.Assign the roles of participants / stakeholders in the healthcare value analysis process 5.Define metrics to evaluate robust clinical and financial outcomes B. Project Management in Healthcare Value Analysis 1.Initiate or reject a healthcare value analysis project 2.Plan a healthcare value analysis project 3.Execute a healthcare value .