Preparing supply chain to support population
health
management
by David Hermann, Colleen Vetere and Nick Sears, M.D.
|
David Hermann, VP, Supply Chain Consulting,
MedAssets,
has over 16 years experience in hospital operations and finance, including
supply chain operations, supply chain strategy, PPI cost containment,
inventory management, project management, warehouse redesign, business
intelligence, e-commerce, value analysis programs, and co-development of a
regional purchasing alliance. Hermann holds an MBA, a certificate in Lean
Healthcare Supply Chain and is a member of the Association of Healthcare
Resource and Materials Managers (AHRMM), Healthcare Financial Management
Association (HFMA) and the Data Management Association (DAMA). |
|
Colleen Vetere, VP, Clinical Resource Management,
MedAssets,
has almost 30 years experience in healthcare with a focus on
healthcare operations, clinical and operational performance
improvement, and supply chain improvements, specifically targeting
total joint replacement and spinal fusion implants. |
|
Nicholas J. Sears, M.D., Chief Medical Officer, joined
MedAssets
through Aspen Healthcare Metrics as Senior Vice President of Clinical
Services in 2004. Sears is a Board Certified Cardiovascular Surgeon with
more than 20 years of experience as a cardiothoracic surgeon and physician
executive. |
While healthcare reform in a non-political definition has
been evolving for quite some time, its current configuration poses
significant challenges – and opportunities – for healthcare providers.
An entirely new language has evolved, which includes
provisions such as Accountable Care Organizations, Value-Based Purchasing,
Bundled Payments, Population Health Management, Meaningful Use; and Outcomes
Measurement, to name a few. Understanding these concepts and the strategies
needed to successfully operate under their auspices will be critical for all
healthcare executives moving forward.
Tomorrow’s language here today
Accountable Care Organizations (ACOs), currently
applicable only to the Medicare population, entail the voluntary alignment
of groups of hospitals, physicians and other healthcare providers (such as
rehabilitation centers, skilled nursing facilities, home health agencies,
etc.) to oversee and provide highly coordinated care to their Medicare
patients.1 Inherent in these arrangements is the intent to
implement this model and abide by the Medicare regulations associated with
it, and to include public reporting of care delivery and resultant outcomes.
Bundled payments, arguably a "back-to-the-future"
concept, is today’s iteration of capitating the full Medicare payment for a
select group of diagnoses or procedures, to include pre-admission,
hospitalization and post-discharge care among and between all involved
providers of record.
Value-Based Purchasing (previously referred to as pay for
performance or P4P) is closely aligned with meaningful use and outcomes
measurement. All entail tying Medicare payments and potential incentives to
reported metrics (measures). Meaningful use goes one step further in that
this program provides Medicare incentive payments to providers who
demonstrate successful use of electronic health records (EHRs) via the
resultant data available to guide care.
Finally, Population Health Management builds upon the
foundations set forth in these earlier concepts. Its concept is to shift the
focus from the high expense resulting from treating the chronic sick and
injured to keeping specific patient populations as healthy as possible and
out of the hospital to lower the overall cost of care. The Care Continuum
Alliance has defined Population Health Management from the provider
perspective as follows: "The population health improvement model highlights
three components: The central care delivery and leadership roles of the
primary care physician; the critical importance of patient activation,
involvement and personal responsibility; and the patient focus and capacity
expansion of care coordination provided through wellness, disease and
chronic care management programs.2
Provider evolution needed
The existing healthcare industry evolved in an
environment where a service activity was reimbursed. As a result, the system
participants were rewarded as they increased the treatments, tests and
interventions regardless of care quality and patient outcome.
Population Health Management represents a healthcare
delivery model that is completely different from anything we have
experienced: The underlying center shifts from "sick care" to "preventive
care," from a reactively transactional treatment of diagnoses to a
proactive, collective continuous management of health. It’s imperative for
healthcare systems to respond to shifting payor program requirements and
address the anticipated precipitous influx of newly covered lives under
expanded coverage programs (Medicaid; health exchanges; etc.). Providers
will need to forge stronger alignment with formerly fragmented, if not
competitive, physician groups.
The model actually mimics the supply chain process where
coordination along the whole chain is tight with data and information
flowing across all stakeholders of the care continuum as the patient moves
through the local care community. Leaders will need to take action and make
sure the need for reform is well understood, creating buy-in across the
board from community members to clinicians to staff members. Working
together, hospital executives and board members can build a strong network
of aligned physicians and other clinical providers to carry out the
population health program.
Once physicians and clinicians are aligned with the
processes, workflow and technology must be addressed to assure that
efficient care processes take full advantage of the information that will be
made available. Interoperability of information technology will be a key
component in the success of adopting population health management. Systems
need to enable care providers to coordinate care, which in turn, triggers
the sharing of data among various providers, payors, administrators and
patients – similar to the coordination of the healthcare supply chain.
Keys to supply chain prepping
Supply chain should leverage certain existing practices,
as well as develop new approaches, in order to support this new healthcare
delivery model.
Historically, supply chain leaders have focused their
attention on only those variables that drive costs; in the new world, the
focus will be on automation, clinical effectiveness, service line and
patient outcome analytics, patient engagement and partner organizations that
help reinforce that patients actively comply with care plans to promote
wellness and quality outcomes. There will be an increased requirement for
supply chain managers to provide actionable intelligence on the effect of
utilization and product choice on patient outcomes, then for clinical value
analysis (CVA) managers to help drive sourcing decisions to those products
that the data indicate are best suited to maximize the outcomes for the
population.
It will also be critical for supply chain and clinical
value analysis managers to partner with organizations that specialize in
patient engagement, the crucial component to help assure patients are
compliant with their post-acute care plans. This allegiance becomes
important because beginning October 2012 the non-compliant patients’
additional ER visits, physician visits and acute care are at risk for
non-reimbursement from federal payors if readmission occurs within 30 days.
As healthcare providers continue their evolution under
healthcare reform, supply chain leaders will undoubtedly continue their
journey from the proverbial basement to the boardroom. Securing the best
price for any given supply will no longer be sufficient. Instead, the
successful use of data to drive collaborative decisions with clinicians
around appropriate products and services, delivered to the appropriate
patient at the appropriate time, will be the new order. In much the same way
as pharmacists have moved from the "basement pharmacy" to the bedside to
deliver collaborative care, might it be too far-fetched to see supply chain
value analysis representatives working collaboratively at the bedside with
clinicians to assure the best outcomes? One can never tell. hpn
References
1:
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html
2: Care Continuum Alliance, "Advancing the Population
Health Improvement Model,"
http://www.fiercehealthit.com/story/hennepin-health-project-looks-build-countywide-ehr-program-national-implica/2012-01-10.