Collaboration Track. Best Practices in Internal Collaboration. Parallon Supply Chain Services

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1 Collaboration Track Best Practices in Internal Collaboration Kathy Chauvin System Director - Resource Utilization & Value Analysis FMOL Health System Scott Robins, MD Chief Medical Officer HCA North Texas Division Linda Millington, RN, BSN Director, Orthopedics Parallon Supply Chain Services

2 Moderator : William Mosser Vice President - Supply Chain Services FMOL Health System

3 Kathy Chauvin System Director Resource Utilization & Value Analysis FMOL Health System

4 Collaboration Track Leading Aligning clinicians and physicians using evidence Change: based data in clinical variation decision making at a Health System enterprise level Bill Mosser Vice President - Supply Chain Services FMOL Health System Kathy Chauvin System Director - Resource Utilization & Value Analysis FMOL Health System

5 Objectives: 1. Describe how organizational culture change can impact clinical quality/total cost of care 2. Identify steps taken to gather cost/quality/outcome data needed to drive clinical decision making 3. List the elements needed to drive evidence based decision making beyond price

6 Our Journey: 1. Value Analysis Program development - the early days 2. Healthy setting the organizational tone and structure 3. Clinical / Evidence based decision support

7 Franciscan Missionaries of Our Lady Health System Member&Facili,es& Our%Lady%of%the%Lake%RMC% & St.%Francis%Medical%Center% & Our%Lady%of%Lourdes%RMC% & St.%Elizabeth%Hospital% & Joint%Ventures/Management% Services% Assets& Total&Opera,ng&Revenue& $2.2%Billion% Net&Pa,ent&Revenue& $1.4%Billion% Co<workers& $1.3%Billion% Medical&Staﬀ& 8,887%% Inpa,ent&Discharges& 1,667% Outpa,ent&Visits& Acute:%%68,112% Emergency&Room&Visits& 1,297,771% Surgeries& 210,673% Uncompensated&Care& 33,803% Beds& $102%million% Annual&Spend& 1,667%licensed%beds% $245%million%in%supplies% $224%million%in%services% $216%million%construcUon%&%capital%

8 FMOLHS Mission: Inspired by the vision of St. Francis of Assisi and the tradition of the Roman Catholic Church, we extend the healing ministry of Jesus Christ to God s people, especially those most in need. We call forth all who serve in the healthcare ministry, to share their gifts and talents to create a spirit of healing reverence and love for all of life, with joyfulness of spirit, and with humility and justice for all those entrusted to our care. We are, with God s help, a healing and spiritual presence for each other and for the communities we are privileged to serve.

9 FMOLHS Strategic Objective: By 2016, FMOLHS, a Catholic Healthcare Ministry, will provide clinically integrated, market based health systems which effectively & efficiently manage the health of targeted populations, especially those most in need. FMOLHS, through its Team Members, will provide distinctive value for patients and payors while generating the sustainable financial returns required to ensure the long term viability of sponsored organizations and FMOLHS.

11 Our Journey: 1. Value Analysis Program development - the early days 2. Healthy setting the organizational tone and structure 3. Clinical / Evidence based decision support

12 Value Analysis Program Development (PAC s-product Assessment Committees) OR PAC and Med Surg PAC development-limited participation/projects Structured Value Analysis Program implementation o 6 Teams formed Pharmacy, Surgery, Cardiology, Medical Surgical, Lab, Facilities o Executive support o Supply Chain driven o Contract pricing savings based o Toolkit charters, project timeline, communication plan, tracking tools, etc. New Products Process o E-Form developed o Education Supply Savings goal for FY10 - $13.3M

13 Product Standardization Policy Products, medical devices, and non-clinical services proposed for use will undergo evaluation/approval through the Value Analysis Program Commodity Policy Leadership team has determined that certain product categories shall be classified as non-clinical commodity items Leadership team authorized the Materials Management Department to procure these items based on best delivered value without further clinical evaluation Examples: o Tape, bandages, dressings, sponges, o IV solutions o Patient care paper / plastics, toiletries o Patient underpads, diapers o Sterilizer supplies, sterile wrappers o Paper, copier supplies, toner

14 Early Results Achieved $13.3 million Supply Savings Goal contract pricing based o Woo Hoo We saved $$, now let s buy that new widget! o Cost / day increasing o Leaders questioned why financial metrics were not reflective of project savings achieved Controls not in place Limited compliance Work-arounds developed

15 Silos?

16 Our Journey: 1. Value Analysis Program development - the early days 2. Healthy setting the organizational tone and structure 3. Clinical / Evidence based decision support

17 Manage to Medicare Healthy 2016

19 Steering Committee Recommendations: Clinical%VariaUon% 3%opportuniUes% Strategic%Growth% 15%opportuniUes% Labor%ProducUvity% 6%opportuniUes% 52%opportuniUes% % >$165M%impact% Shared%Services% 12%opportuniUes% Materials%Management% 10%opportuniUes% Revenue%Cycle% 6%opportuniUes%

20 Steering Committee Recommendations: Vendor consolidation - general Vendor consolidation - PPI System best practice pricing GPO service agreement maximization Reduce utilization for non-clinical supplies Supply Chain improvement at affiliate sites Implement 340(B) at all sites Standardize single dose packaging Purchased services - non-clinical Purchased services - clinical

21 Materials Management Top 10 Opportunities: Vendor consolidation - general Vendor consolidation - PPI System best practice pricing GPO service agreement maximization Reduce utilization for non-clinical supplies Supply Chain improvement at affiliate sites Implement 340(B) at all sites Standardize single dose packaging Purchased services - non-clinical Purchased services - clinical

23 Metrics: Key Performance Indicators Supply Cost per CMI Weighted Adjusted Discharge Supply Cost per CMI Weighted Adjusted Patient Day Supply Cost as a Percent of Net Patient Revenue Cost per Unit of Service Actual cost / prior year cost Actual volume / prior year volume Actual CUOS / prior year CUOS Total Cost of Ownership Labor, Benefits, Supplies, Services, all in cost for a Turnkey solution Used for Make-Buy-Partner decisions General Ledger is the Source of Truth.but there are different interpretations we need to align Results: $15.5 M of a $19M target

24 Our Journey: 1. Value Analysis Program development - the early days 2. Healthy setting the organizational tone and structure 3. Clinical / Evidence based decision support

25 Clinical Evidence Based Decision Support: Physician engagement strategy Evidence based data collection, Maude database searched for adverse events / recalls FDA approvals verified Financial impact New product introduction policy Automated collaborative process - vendor / requester Vendor management policy Product evaluation agreement

26 Support Team Chief Medical Officer Chief Nursing Officer Administrative Div. Director Surgical Services Director of Surgical Services Service Line Administrator Resource Utilization Manager General Surgery (Surgeon) Medical Executive Committee ( Voting Members ) Associate Medical Director Surgical Services Urology (Surgeon) Orthopedics (Surgeon) Cardiothoracic (Surgeon) Neuro/Spine (Surgeon)

27 Medical Executive Committee: CMO recruited service line surgeon representatives Chief of Surgery lead P&T of new products committee Supply product formulary development New technology review Monthly meetings Evidence based research data and financial impact sent out prior to meeting for committee review Surgeon requesting product must present to committee in person

28 Physician Lead Projects: Spine Total Joints Antibiotic Stewardship Rep less models for implants

29 Supporting Tools: Pharmacy dashboard Cardiology dashboard Contract repository Project management workflow

30 Lessons Learned: Physician engagement needed up front Executive leadership support / accountability CUOS reporting $$ saved / reduce budget

31 Journey Timeline:

32 Next Steps: Aligning clinical variation with Supply Chain goals and incentives Clinical outcomes reporting o Quality o Satisfaction o Financial Supply budget based on CUOS

34 Place%headshot%here% Linda Millington, RN, BSN Director, Orthopedics Parallon Supply Chain Services

35 Scott Robins, MD Chief Medical Officer HCA North Texas Division

36 Clinical%Excellence% Integra(ng)Physicians)Into)Supply)Chain)Decisions) ) April&7,&2014&

37 Clinical Excellence Summary Clinical Excellence

38 HCA Clinical Excellence HCA s approach to reducing avoidable clinical variation The goals of Clinical Excellence include: o Improving patient outcomes o Enhancing physician engagement o Ensuring appropriate resource utilization Aims to reduce avoidable clinical variation through: o Transparent review of clinical performance data o Thorough analysis and application of best clinical evidence o Collaborative dialogue among hospital staff, medical staff, and clinical leaders The improvements in patient care will be delivered through a culture of shared accountability and ownership

39 Strategic Value of Clinical Excellence Clinical Excellence differentiates HCA in market as a premier clinical organization through: Collaborating with physicians to align practice choices with best practices Rapidly sharing best clinical practice and process among our hospitals Teaching facility leaders to leverage HCA s disciplined operational management culture to achieve the same rigor around clinical performance

40 Traditional Value Analysis Facility Initiatives Contracting Standardization Evidence Based Value Analysis Clinically Driven Process Clinical Evidence is the Foundation

41 Facility Level Current process for introduction of new products and technology is through the facility Supply Management Analysis Team (SMAT) Establish Clinical Value Analysis Team (CVAT) by creating or utilizing existing physician teams to: o Review and approve physician product or technology requests o Present corporate supply chain initiatives and a mechanism to provide feedback In order to ensure success of CVAT, the facility will: o Have a CMO or identified Physician Leader o Have a full time Clinical Resource Director (CRD) o Meet on a regular basis to review physician request for products or new technology.

42 Facility Clinical Value Analysis Team Team Membership o Physician Leader as Chairperson o CMO or Medical Staff Leader o CFO o Clinical Resource Director o Supply Chain Director o Quality Director o Physician Leaders identified by facility CEO/CMO o Critical thinkers o Breadth of surgical specialties Suggested Ex-Officio Members o CEO o CNO/COO o Clinical Directors/Service Line Leaders

43 Reaching beyond price levers with utilization management gets the right product, to the right patient, at the right cost

44 A simple question: Changing the Game

45 Shifting Culture How things usually work How things should work Physicians may have limited say on what items are used in the OR and minimal influence on quality initiatives Physicians take a more active role in deciding which products are best for patient care and are leaders in improving quality of care Purchasing decisions are sometimes made with limited clinical quality, operations and financial measures Decisions are made with physician input and after evaluating clinical best practices, emphasizing both quality of care and value There may be limited transparency on clinical quality, operations and financial measures Analytical support provided to determine current baseline performance across quality, operations and cost Process mainly focuses on new product introduction The same process can be used to examine optimal use of existing products or utilization policies

46 Collaboration is key to CE success Clinical Excellence requires a multi-faceted approach to improve results Success requires communication and collaboration between all levels of the organization Opportunities and BDPs are identified and shared across the organization

47 Clinical Variation with Usage of Adhesion Barriers in C- Sections In HCA North Texas Division

48 Quality and Service Agenda Improve&Our&Services& Performance% Service%Lines% Clinical% Excellence% DIVISION&CVAT Adhesion&barrier&in&C<sec,on& Adhesion%barrier%spend/month% C\secUon%volume/month% 48

City Dallas : Estimated Annualized Savings:

49 Evidence% Based% Medicine% Facility Successes Financial% Transparency% Reduce%Clinical% VariaUon% Facility&CVAT:&&ACell&U,liza,on&&& Medical City Dallas : Estimated Annualized Savings: $400,000 Oklahoma University Medical Center: Estimated Annualized Savings: $538,000

50 Crafting the Culture of Excellence Tell the Truth about Performance Managers own the Job of Creating Great Teams Leaders own the Job of Creating the company Culture Data Engage Execution Manage

PSI-15 Lafayette General Health 2017 Nicholas E. Davies Enterprise Award of Excellence

PSI-15 Lafayette General Health 2017 Nicholas E. Davies Enterprise Award of Excellence Rachel Brunt, RN, BSN, MBA-HCA, CIC, CPHQ, Director Quality Jessie Hanks, BS, RHIA, Director HIM Lafayette General