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PERISCOPE


Navigating around, through the Value Analysis Maturity Curve


by Dee Donatelli, RN, BSN, MBA, CMRP, CVAHP, Vice President, Professional Services, TractManager, and Principal, Dee Donatelli Consulting, LLC


s healthcare reform and new technolo- gies change the way hospitals deliver and are reimbursed for care, the abil- ity to measure and improve upon patient outcomes is becoming more important than ever. To ensure these efforts are success- ful, hospitals must be able to evaluate and improve the maturity of the various value analysis processes at work within their or- ganization and at an enterprise level, which includes clinics and extended care. To do that, hospitals must fi rst understand


A


where they exist on a Value Analysis Matu- rity spectrum. Then, they must increasingly engage leadership and clinicians to opera- tionalize best practices. The result is a culture of truly collaborative, evidence-based decision-making, resulting in the only metric that really matters: Improving quality of care, and thus the overall health of the community being served. At its heart, value analysis is a frame- work for making better decisions. Those decisions are meant to balance the needs of multiple constituents in the healthcare delivery system: Patients, physicians, pay- ers, administrative and clinical staff. But the basic function of any Value Analysis team


THE VALUE ANALYSIS MATURITY CURVE


Standardi zation Price Strategy No Strategy No formal process


Purchases driven by demand Minimal criteria


Many brands/ duplication for same use


Often single site


Process begins with review of new products


V.A. Committee created


Cost reduction is primary driver of decisions


Reliance on supplier- provided data


Data driven decisions based on usage across all sites


Strives for system wide involvement


Clinician engagement with supply chain limited.


V.A. Committee makes fi nal decisions


Limited development of objective non- fi nancial criteria


Price & Standardization


Focus moves beyond cost reduction


Clinical and supply chain integration


Reduce or eliminate waste and variety


Objective non- fi nancial criteria strives to use evidence


System device formulary established


Incorporates forum for new technology assessment


Quality, Waste Reduction,


Population Management


Focus on safety, quality, and total cost of care across the patient experience


Data driven decisions utilize information from:


• EMR • MMIS


• National metrics • Outcome protocols


Policy requires that all decisions are evidence based


Adapted from “Value Analysis: A new model for healthcare” by Strategic Marketplace Initiatives (SMI) 2015 52 September 2019 • HEALTHCARE PURCHASING NEWS • hpnonline.com


Utilization, Reduced Variation,


or process is to support clinical committees with a framework that assists with evaluat- ing the planned introduction of products, services, and technology into the portfolio of care. The goal is to drive measurable im- provements in outcome. Depending upon an individual committee or facility’s matu- rity, value analysis does that by providing clinical committees with clear charters, policies, evidence-based decision-making procedures, key performance indicators and on-going measurement.


In mature facilities and committees, the


physicians/providers/clinicians support and endorse the end result of this process, and can apply not just the fi nal result of any indi- vidual decision, but also the decision-making framework itself, to their daily routine. Value Analysis teams, who are tasked with evaluating requests for new technologies, while reining in costs and simultaneously im- proving outcomes, are at the (stressful) center of a process beset by shifting market forces. The process is stressful for several reasons: The process is political: For years, the


VA team existed to approve new product requests and, let’s face it, to keep the physi- cian happy.


The process is high-visibility and ac- countable for cost reductions: Because VA teams have been tasked by hospital leadership with reducing costs and stan- dardizing products, in part due to a grow- ing awareness that value-based medicine, which is on the horizon, will change how things are done. Because of this, physicians have come to see the VA and Purchasing teams as gatekeepers, increasing stress for everyone.


To successfully navigate these pres-


Clinically driven teams target utilization/variation


sures, hospitals must operationalize best practices in value analysis throughout the location of care — replicating successful decision-making frameworks that improve patient care, standardize technologies, procedures, and products like implants and med/surg devices, while simulta- neously providing enough fl exibility to accommodate variability in individual patient circumstances and indications. Before you can improve your value anal- ysis process, it’s important to understand how mature the framework is within your organization. A project was conducted by the Strategic Marketplace Initiative (SMI) and the Association for Healthcare Value Analysis Professionals (AHVAP) defining the following value analysis maturity curve. Advanced and best practices have developed guidance documents and automated frameworks that help provide structure around what indications and patient populations a medical technology will be used. By focusing on improvements in care, overall costs are also reduced, sometimes dramatically. The goals of the stakeholders in this stage are now the same rather than divergent. This represents the true clinical integration of supply chain and value analysis processes.


The maturity of value analysis is a


result of cultural, fi nancial and clinical considerations. And when that hap- pens, truly innovative advances in how to evaluate technology’s impact upon patient care, profi tability and outcomes becomes possible. HPN


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