Clinically Driven Supply Chain Methodologies. The Clinical Component of Value Analysis

Transcription

1 Clinically Driven Supply Chain Methodologies The Clinical Component of Value Analysis Dee Donatelli Vice-President, Performance Services VHA Inc.

2 Many Faces of Value Improved Bottom Line Alignment with Evidenced-based Practice Improved Outcomes Improved Safety for Patients and/or Staff Improved Patient Satisfaction Increased Productivity Improved Market Standing Compliance with Regulatory Requirement Decreased Risk

3 Clinical Value Analysis Vendor articulates products to meet need Evidenced Based Practice researched Hospital articulates financial concern Clinician articulates needs Decision based on cost, quality and clinical effectiveness Patient outcomes measured

4 Opportunities and Challenges Communication Administrative Support Physician Champions Lack of trust Lack of awareness or understanding Inconsistent or poorly defined process History of failed attempts Failure to recognize value of clinical alignment Lack of incentives or mal-aligned incentives

5 Five Critical Factors for Building a Supportive Culture Executive Support Accountability Clinical Champion Process Communication

6 Communication Message The single biggest problem with communication is the illusion that it has taken place. George Bernard Shaw Feedback Communication Messenger Interpretation Receiver(s)

7 Vital Communication Points Understanding the clinical needs versus wants Determining feasibility and design of contracting strategy Seeking assistance in working with vendors post RFP Asking for support of implementation Reporting contract compliance on a regular basis and asking for suggestions if commitments are not being met

8 The Future of Clinical Value Analysis Integration of end user performance, total supply cost, patient outcomes, reimbursement Incorporation of comparative effectiveness Incorporation of project management principles Decision support software (ROI, Total cost/case, physician profiling data driven process) Teams given goals, accountability and incentives

9 Mayo Clinic Supply Chain Performance Consulting Integrated Department Support

10 Mayo Clinic 57,000 employees* 526,000 unique patients* 2,517 licensed beds* $1.6B Supplies & Services *2008 Statistics

11 Who We Are: Organizational and Cultural Factors Mayo is a physician led organization. There is a clinical voice in decisions Physician/administrators/allied health are on salary (no bonuses on production or financial performance) Financial targets are developed by physician and administrative leaders Strong alignment of mission and goals including financial performance and supply expense management

12 Differentiate Mayo through Strategic Vision Unmatched focus on the patient Evidence-based medicine resulting in highest quality, safety & service, Excellent staff working in an environment that supports & recognizes their outstanding efforts Contribute to Mayo s strategic differentiation by adding financial value & improving service through: Standardization Common systems & services Strong collaboration across sites

13 Mayo Supply Chain Management Performance Consulting Mission Mayo Supply Chain Performance Consulting develops and implements strategies to drive improvements in Supply Expense Management. The Performance Consulting Team will provide coordination and delivery of Mayo Supply Chain solutions in order to attain specific and measurable quality and cost outcomes for our customers. Vision Provide world class supply chain analysis and consultative support for all aspects of the supply chain process, by focusing on analytics, auditable controls, and optimization though the utilization of an integrated support team. Quality Purpose Performance Consulting is the process by which we can work with Physicians, Administrative Leadership and others to identify and achieve performance excellence linked to the expense reduction goals of Mayo. Projects

14 Supply Chain Performance Consulting and Customer Integration Inventory Technology Measurements Customer Service Analytical Support Process Integrated Support Team Clinical Practice Patient Care Standardization Utilization Expense Management

15 SCMPC Continuum of Service Customer Value Metrics Development Provides a snapshot of current state Shows data trends over time Enables comparisons to other sites or benchmark data Analytical Support Uncovers data abnormalities and inconsistencies Identifies actionable opportunities Leads to tactical recommendations Maturity of Supply Chain Operations and Customer Relationship Metrics Development Provides a snapshot of current state Shows data trends over time Enables comparison to other sites or benchmark data Project Management Leverages analytical findings Executes on opportunities Moves strategic plans into operations Analytical Support Uncovers data abnormalities and inconsistencies Identifies actionable opportunities Leads to tactical recommendations Metrics Development Provides a snapshot of current state Shows data trends over time Enables comparison to other sites or benchmark data Supply Chain Consultation Facilitates supply chain communications Clarifies supply chain service options Assists and consults on supply chain activities Supply Chain Consultation Facilitates supply chain communications Clarifies supply chain service options Assists and consults on supply chain activities Supply Chain Consultation Facilitates supply chain communications Clarifies supply chain service options Assists and consults on supply chain activities Supply Chain Consultation Facilitates supply chain communications Clarifies supply chain service options Assists and consults on supply chain activities Services Delivered

16 Mayo Clinic Integrated Department Support Teams

17 Objectives Commit to consistent and active participation to enable enterprise-wide collaboration, decision-making, implementation and compliance Establish a framework to share best practices, process improvements, patient safety, compliance and risk reduction Optimize the standardization of products/devices and develop the creation of a supply formulary for departments across the enterprise. Reduce the acquisition cost of products and devices and increase overall value. Assess, monitor and manage variation among clinicians on a cost/case or procedural basis.

18 Objectives Provide Support of Mayo Clinic contracting philosophy and process Monitor on/off contract spend and correct to ensure compliance. Analysis and support - make versus buy decisions. Manage assessment and availability of new products/devices. Manage and analyze non labor spend versus plan or budget.

19 Supply Chain Internal Structure Supply Chain Management Integrated Department Support Focus What are customer dept goals? What are the key performance metrics? How do we coordinate supply chain optimization plan? ( Projects, Technology, Contracting) Is SCM delivering intended results? Office of Expense Management (Specialty Councils) Departmental Customer Service Needs Department New Technology Assessment Meetings Purpose: Coordinate support of SCM projects and Specialty Councils, including plan development, resources, timeline, and roles and responsibilities. Deliverables: Align SCM teams and support activities associated with the SCM Strategic Plan, Projects and Specialty Councils on an ongoing basis Tools: Standard Work Plan Standard Tracking Tools Standard Measurements of Success Project plans where appropriate Agenda with standing items DLMP Team Surgery Team Champion Leadership Team Champion Leadership Team Member Member Facilitator Performance Consulting Facilitator Performance Consulting Procurement Contracting Value Analysis Logistics Coach Director Performance Consulting Procurement Contracting Value Analysis Logistics Coach Director Performance Consulting Radiology Team Champion Leadership Team Member Facilitator Performance Consulting Procurement Contracting Value Analysis Logistics Coach Director Performance Consulting DOM Team Champion Leadership Team Member Facilitator Performance Consulting Procurement Contracting Value Analysis Logistics Coach Director Performance Consulting Purchased Services Team Champion Leadership Team Member Facilitator Performance Consulting Procurement Contracting Value Analysis Logistics Coach Director Performance Consultinge

20 Customer Support Structure Mayo Clinic Board of Governors MAYO CLINIC SUPPLY CHAIN INTEGRATED DEPARTMENT SUPPORT Mayo Clinic Clinical Practice Committee Supply Expense Management Committee (SEMC) Plans Policies Scorecards Medical Surgical Lab Radiology GI/Endo Cardiology Surgery Research Formulary Clinical Equipment Acquisition and Maintenance Pharmaceutical Formulary Dept. Sponsor TBD Dept. Sponsor TBD Dept. Sponsor TBD Dept. Sponsor TBD Dept. Sponsor TBD Dept. Sponsor TBD Dept. Sponsor TBD Dept. Sponsor TBD Dept. Sponsor TBD SCM Sponsor SCM Sponsor SCM Sponsor SCM Sponsor SCM Sponsor SCM Sponsor SCM Sponsor SCM Sponsor SCM Sponsor SCM Contract Mgr SCM Contract Mgr SCM Contract Mgr SCM Contract Mgr SCM Contract Mgr SCM Contract Mgr SCM Contract Mgr SCM Contract Mgr SCM Contract Mgr SCM Perf Cons. SCM Perf Cons. SCM Perf Cons. SCM Perf Cons. SCM Perf Cons. SCM Perf Cons. SCM Perf Cons. SCM Perf Cons. SCM Perf Cons. Satisfy Our Patients Achieve Mission-Advancing Financial Performance Improve and Demonstrate Quality, Safety, Service and Value Attract, Develop and Retain the Best People Note* A specific support team has not been established for Purchased Services. This area of expenditures crosses multiple areas and will be reviewed on an opportunity or contract basis. Specific task forces or councils may be established on an ad-hoc basis to address a purchased services opportunity.

21 2011 Primary Goal Physician Preference Products Formulary Development Important Factors Building Trust with Physicians and Senior Executives Utilize data that is meaningful to physicians Work with consultants to develop standards by which comparative effectiveness can be measured Seek partnerships with the Quality Office that drives decisions driven by the science Physician engagement through Mayo s Enterprise Integrated Department Support Teams Integration of Category Management processes and methodology (A Mayo Supply Chain Strategic Direction) New Technology evaluation based on evidence Value Based Purchasing and Comparative Effectiveness Research methods Door to Discharge thinking that considers total cost factors (Reimbursement included) Measurements and Benchmarks facilitated by Lean/Six Sigma tools Sustainability

22 CARILION CLINIC Methodologies of Clinically Driven Supply Chains

23 Carilion Clinic Carilion Clinic operates eight community hospitals and outpatient centers throughout western Virginia. 600 Physicians representing 60 specialties 152 Practice sites 768,576 Primary care visits Licensed beds 1,215 RMH 60 bed Neonatal Intensive Care Unit RMH Level 1 Trauma center Virginia Tech Carilion School of Medicine and Research Institute (VTC) Jefferson College of Health Sciences National Quality Award from The National Committee for Quality Healthcare (2002) Top 100 Most Integrated Healthcare Network in the United States (by SDI Health as published in Modern Healthcare Magnet status (Carilion Roanoke hospitals) from American Nurses Credentialing Center Consumer Choice #1- National Research Corporation Level 3 Patient-Centered Medical Home, Carilion Clinic Family Medicine practices from the National Committee for Quality Assurance (NCQA)

24 Managing Through an Economic Downturn Four Categories of Strategic Focus Source: The Advisory Board, Implications for Hospital The Financial Meltdown 2008

25 Interim Value Analysis Structure Executive Board Value Analysis Leadership Team Surgical Products Value Analysis Team Nursing Products Value Analysis Team Non-Clinical Products Value Analysis Team Focus Group (as needed) Focus Group (as needed) Focus Group (as needed) Focus Group (as needed) Focus Group (as needed) Focus Group (as needed)

26 Objectives Provide framework Define roles and responsibilities Communicate Awareness and Accountability Decrease expenditures Assure timely, consistent product trial and evaluation Monitor and Measure Assure enterprise utilization monitoring

27 Guiding Principles Quality Effectiveness Cost Storage/space Availability Product Availability Operations Education/Training Safety/Infection Control/Waste Management Service and Repair Packaging

28 Sourcing and Contracting Cost Reduction Strategies Price of Products Request for Proposals Vendor Standardization or Decentralization Product Line Compression Utilization Elimination Rebate Implementation and Capture Procedure Price Caps or Shelf Pricing Bulk Purchases Vendor Management Early Payment Discounts Freight Reduction

29 Clinical Alignment Working Across the Supply Chain Achieved Savings GE Contrast Media $280,256 Orthopedics $2,800,000 Identified Savings Pharmacy Benefits Management $1.8 m Sealant/Hemostatics $100K Clinical information References >$150K Oncology Clave Devices $30K

30 Together We Have Implemented FY10 Savings of $8 Million On Track for FY11 $10 Million Goal Services, $947,286 Price Reductions, $708,480 Minor Equipment, $89,998 Food, $209,701 General Supplies, $1,183,166 Implants, $2,585,343 Medical Supplies, $2,276,026