1. health and fitness
2. sports medicine

Clinical Integration Track
Physician Engagement
Presenter:
Ronald A. Scott, AVP Clinical Supply
Chain, St. Joseph Health
FACULTY(DISCLOSURE(
The(faculty(reported(the(following(financial(relaAonships(or(
relaAonships(to(products(or(devices(they(or(their(spouse/life(
partner(have(with(commercial(interests(related(to(the(content(of(
this(CE(acAvity:((
(
Ronald(A.(ScoH,(AVP(Clinical(Supply(Chain,(St.(Joseph(Health(
(
–(No(financial(interest/relaAonship(relaAng(to(the(topic(of(this(
acAvity(
Learning(ObjecAves(
•  Discuss(ways(to(posiAvely(affect(the(
medical(device(marketplace.(
•  Be(able(to(provide(defensible(
methods(for(seUng(the(price(of(
medical(devices.(
•  Discuss(ways(to(gain(physician(input(
and(acceptance.(
•  Founded(by(the(Sisters(of(St.(Joseph(of(
Orange(
•  First(Hospital(established(in(1920Z(
Eureka,(California(
•  Health(System(established(in(1982(
•  NotZForZProfit(Integrated(Catholic(
Health(Care(Delivery(System(based(in(
Irvine,(California(
(
Three(geographic(regions:((
!  Northern(California(
((
!  Southern(California(
((
!  West(Texas/Eastern(New(Mexico(
(
!  Net(Revenues(of($5.6(billion(
!  16(Acute(Care(FaciliAes((
!  Three(Home(Health(Agencies(
!  (Hospice,(OutpaAent(Services,(SNF’s(
((and(Physician(Groups(
!  Nearly(19,000(employees(and(more(
than(1,500(affiliated(physicians(
(
(
(
Total(Supply(Chain(spend:($751M(
(
!  PharmaceuAcals:($190M((((
!  Physician(Preference(Items:($225M(
Mission—Why*We*Exist:**
To(extend(the(healing(ministry(of(Jesus(
in(the(tradiAon(of(the(Sisters(of(St.(
Joseph(of(Orange(by(conAnually(
improving(the(health(and(quality(of(life(
of(people(in(the(communiAes(we(serve(
Vision—What*We*Are*Striving*for:*
To(bring(people(together(to(provide(
compassionate(care,(promote(health(
improvement,(and(create(healthy(
communiAes(
Transforma:onal*Statements(
• We(will(transiAon(our(business(
model(to(a(balance(of(great(hospitals(
and(great(community(care.(
• We(will(embrace(both(an(illness(and(
a(wellness(model.(
Mission*Outcomes(
• Sacred*Encounters(–(Every(interacAon(
will(be(a(sacred(encounter.(
• Perfect*Care(–(For(all(paAents.(
• Healthiest*Communi:es*–(100%(of(
the((communiAes(we(serve(will(be(in(
the(top(decile(for(healthiest(
communiAes(
PPI(Challenges(
•  Vendor(promoAons(directly(to(
physicians(
•  LiHle(clinical(evidence(and(no(pricing(
presented(
•  Upon(physician(request(items(were(
automaAcally(ordered(
PPI(Challenges(
•  Physicians(supported(vendor(
representaAves(over(SJH(
•  No(oversight(to(the(introducAon(of(
new(products(or(the(price(of(a(new(
product((evoluAonary(vs.(
revoluAonary)(
Clinical(Research(
•  Created(to(manage(new(PPI(requests(
•  Approval(and(pricing(based(upon(
either(published(peerZreviewed(trials(
demonstraAng(superior(paAent(
outcomes(or(
•  FDA(510K(and(price(of(predicate(
device(
IntroducAon(of(New(Technology(and(
Products(Policy(
•  Created(by(Clinical(Research(and(3(
(MD’s(from(CEC(
•  Final(policy(approved(by(CEC(
•  SubmiHed(to(clinical(research(using(
NPR(form(
IntroducAon(of(New(Technology(and(
Products(Policy(
•  Approval(process(requirement(based(
upon(open(and(closed(categories(
•  Open:(product(category(has(not(
been(formally(evaluated(and(there(
are(no(vendor(restricAons(
•  Closed:(the(product(category(has(
been(closed(to(new(vendors(
NPR(Approval(Guidelines(
•  Open(
(Z(product(price(</=(either(predicate(
(device(or(contracted(vendor(
(Z(product(price(>(either(predicate(
(device(or(contracted(vendor(
•  Closed:(the(product(must(
demonstrate(superiority(
NPR(Tracking(and(ReporAng(
•  Each(NPR(entered(in(electronic(
database(
•  Database(accessible(to(all(clinicians(
•  Results(reported(quarterly(to(CEC(
•  Clinical(Research(recommendaAons(
reviewed(by(RN,(RPh(and(MD(
FY(2014(–(185(Requests(For(New(Products(
3%( 3%(
20%(
68%(
Clinically(Approved(with(
ContracAng(Requirements(
Clinically(Approved(with(
Pricing(SApulaAon(
Denied:(No(Evidence(of(
Superiority(
6%(
Denied:(Requirements(
Not(Met(
Open(
New(Product(Requests(2014(
(
Case(Study(1(
•  NPR(request(for(new(CRTZD(
•  Manufacturer(claimed(new(device(
would(correct(the(known(problems(
with(CRT(
•  FDA(approval(was(a(supplement(to(
their(predicate(device(staAng(the(
changes(meet(the(same(indicaAons(
Case(Study(1(
•  One(nonZrandomized(clinical(trial(
with(predicate(device(which(showed(
no(significant(differences(in(any(
measured(parameters(
•  Pricing(
(Z(iniAal(56%(increase(
(Z(final(3%(increase(
Appeals(to(Evidence(of(Superiority(
•  MD(may(submit(wriHen(appeal(to(
CEC(
•  Present(addiAonal(published(
literature(
•  CEC(at(its(sole(discreAon(will(approve(
or(deny(the(request(
Case(Study(2(
•  Reverse(Shoulder(
•  Ortho(is(closed(category,(requires(
evidence(of(superiority(for(approval(
•  No(such(evidence(was(presented(
•  Request(was(denied(
(
Case(Study(2(
•  MD(appeal(to(CEC(
•  SubcommiHee(convened(
•  Recommended(to(be(added(if(
contract(price(was(met(
(
Incorpora:ng*Clinical*Input*into*
Supply*Sourcing*Decisions:*
Cleveland*Clinic*Experience(
Presented(by:(
Allen(J.(Passerallo(ATC,(MBA(
Sr. Director Sourcing and
Purchasing
Cleveland Clinic/Excelerate(
FACULTY(DISCLOSURE(
The(faculty(reported(the(following(financial(relaAonships(or(
relaAonships(to(products(or(devices(they(or(their(spouse/life(
partner(have(with(commercial(interests(related(to(the(content(of(
this(CE(acAvity:((
(
Allen(J.(Passerallo(ATC,(MBA,(Sr.(Director(Sourcing(and(
Purchasing(
Cleveland(Clinic/Excelerate(
(
–(No(financial(interest/relaAonship(relaAng(to(the(topic(of(this(
acAvity(
Key*Objec:ves*
•  Understanding(Cleveland(Clinic(philosophy(for(
integraAng(clinical(input(into(supply(sourcing(
decisions((
•  The(role(of(the(Physician(Champion(
•  CreaAng(a(plasorm(for(Physician(Recruitment(
Agenda*
•  Cleveland(Clinic(Landscape(
(
•  Cleveland(Clinic(Supply(ChainZ(History(to(Date(
(
•  (IncorporaAng(Physician(and(Clinical(Input((
•  Case(PresentaAon(Successes(
(
•  CreaAng(a(Culture(of(Value(Base(Purchasing(
CLEVELAND*CLINIC*OVERVIEW*
Cleveland*Clinic*Overview*
• 
• 
• 
• 
• 
Employees:*43,430*employee*caregivers*
Beds:*4450*
27*ins:tutes*providing*care*in*120*subspecial:es*
Pa:ent*visits:*In*2013,*5.5*million*total*visits**
Loca:ons:**
– 
– 
– 
– 
main(campus((with(44(buildings),((
8(community(hospitals((
16(full(service(family(health(centers(throughout(Northeast(Ohio;((
AddiAonal(locaAons(in(Florida,(Nevada,(Toronto(and(Abu(Dhabi(
•  Addressable*spend*on*goods*and**services*~$1.8B*
Cleveland*Clinic*Landscape*
•  Staff*model**
– 2100(Physicians((
• 60%(employed(
• 40%(private(pracAce(
•  Service*Line*focused*
•  Brand*strength*
•  Highest*acuity*
•  Size*
•  Global*&*U.S.*growth*
HOW*DOES*CLEVELAND*CLINIC*
VIEW*AND*RESPOND*TO*HEALTH*
CARE?*
The(“new(normal”(will(
require(…a(fervent(belief(in(
our(ability(to(not(only(
weather(the(changes(and(
challenges(ahead,(but(to(
embrace(them(as(an(
opportunity(to(improve(
value(for(our(paAents(and(
transform(the(healthcare(
landscape.”(
Toby(Cosgrove,(MD(
Cleveland(Clinic(CEO(
The Winds of Change
•  Economic &
demographic trends
•  Health care reform
•  Changing consumer &
employer expectations
•  Reimbursement tied to
value demonstration
Value =
Quality
Cost
•  Increasing transparency
around pricing, quality
and clinical outcomes
Patient Quality and Safety
Pa:ent*Experience*
Innova:on*in*Research,*Educa:on*
and*Pa:ent*Care**
Clinical*Excellence*
“Pa:ents*First”*
Physician*Lead*Organiza:on*
Pa:ent*Centered*Model*
Adap:ng*to*the*Changes*in*Health*Care*
Supply*Chain*Organiza:onal*
Structure*
Execu:ve*Director*
Simrit*Sandhu*
Medical*Director,**
Clinical*Supply*Chain*
Dr.*Sean*Lyden*
Asst.*Medical*Director,**
Clinical*Supply*Chain*
Execu:ve*Secretary*
Dr.*Sri*Chalikonda*
Administrator*
Lori*Simonelli*
*
Sourcing**
Senior*Director*
Allen*Passerallo*
Materials**
Management*
*Director*
Jus:n*Gallo*
Pharmacy**
Procurement*&*Contrac:ng*
Senior*Director*
Jeff*Rosner*
Supply(Chain(Philosophies*
•  Act(as(business(
consultants(
•  Supply(Chain(
facilitates(the(
debate(
•  Physicians(
integrated(into(
everything(
Sourcing*Commieee*Structure*
•  Supply*Chain*SME*
•  Physician*Champion*
•  Clinical*Representa:on*
– ClinicalZPhysician,(Nurses,(OR(techs,(OR(Directors(
-  Quality(and(safety(as(needed(
– NonZClinicalZ(Physician(Champion,(OperaAons(
Leadership,(Administrators(
Provider*Value*
Enablers:*
• *Lowest*price*for*clinically*
comparable*products*
• *Access*to*appropriate*range**********
**of*technologies*
Success*through*the*use*of:*
•  Tech*assessment*
•  Compara:ve*evidence*
•  Protocols*
•  Appropriate*use*
•  Pricing*differen:als*based*on*
demonstrated*outcomes**
Clinical, Economic, QOL
Outcomes
+
Optimal Cost Per Case
Supply*Chain*Value*
Crea:on*
Health*Technology*Assessment*
Team*Process*Orienta:on*
(((((((((CRM( (
(((((((((((((((((((Total(Joints(
Planning/Development
• Opportunity Assessment
• Define Scope
• Form Team- Physician Lead
((((((((((((SPINE((IMPLANTS)(
Execution
Implement and Monitor
•  Kick off
• Quantify Value
•  Health Technology
Assessment
•  Protocol and Negotiations
COMMODITIES
• Implement
• Track and Review
• Results
$$
CLINICAL PREFERENCE
PHYSICIAN PREFERENCE
$$$
$$$$
Supply*Chain*Innova:ons*
•  Health*Care*GPO*
–  CoZowned(Cleveland(Clinic(and(VHA(
(
•  Based*on*success*of*Cleveland*Clinic*and*Physician*
Integra:on*model*of*strategic*sourcing*
•  Unique*offerings*different*than*standard*GPO’s*
–  StandardizaAon(
–  UAlizaAon(guidelines(
HERNIA*MESH*CASE*PRESENTATION*
Path*to*Value*
Our Mission:
Enable health care systems to realize significant and
sustainable expense savings
Our Approach
Our Structure
Physician
Led
1
Physician
Driven
Clinical
Alignment
2
Evidencebased
Decisions
3
Supply
Chain
Value
Based
Sourcing
Clinicians
Quality
Analytics
Case*Study:*Mesh*(U:liza:on)**
1(
Physician*
driven*clinical*
alignment*
Plan*and*
develop*
Execute*
Cross*func:onal*team*and*buyjin*
Physician*champion*
Supply*chain*
•  Perform(most(complicated(hernia(
cases(
•  Involved(in(naAonal(research(
•  Involved(in(outcomes(studies(
(
Physician*commieee*
•  Acts(as(business(consultant(
providing(data(and(facilitaAng(
discussion(and(process(
(
Administra:on*
*
*
•  Employed(physicians(from(general(
and(plasAc(surgery(
•  Private(pracAce(physicians(with(
surgery(rights(at(Cleveland(Clinic(
faciliAes(
*
*
•  Reimbursement(specialist(
•  Finance(
Implement*and*monitor*
Challenges*
•  Physician(preference(
for(type(of(mesh(
•  The(merits(of(
syntheAc(mesh(over(
biologic(mesh((
Case*Study:*Mesh*(U:liza:on)**
1
Physician*
driven*clinical*
alignment*
Plan*and*
develop*
Execute*
Implement*and*monitor*
Understand*impact*of*new*product*
Conflict*of*interest*
Review*of*clinical*data*
•  All(members(of(commiHee(must(
disclose(financial(conflict((
•  NaAonal(peer(reviewed(studies(
•  Clinical(white(papers(
•  Internal(outcomes(data(
(
Contract*strategy*design*
*
•  Conflict(does(not(prevent(
parAcipaAon(in(discussion,(but(
excludes(from(voAng(on(awarded(
supplier(
•  Policy(protects(the(process,(while(
looking(at(objecAve(data((
*
*
•  Risk(and(rewards(of(
standardizaAon((
U:liza:on*opportuni:es*
Challenges*
•  CMS(consideraAons(
•  Health(care(quality((
•  Quality(vs.(Volume(
payment(
•  Commercial(payer(
changes(
Case*Study:*Mesh*(U:liza:on)**
2
Evidencej
based*
decisions*
Plan*and*
develop*
Execute*
Clinical*Informa:on*(sample)*
Biologic*comparison*
•  Itani(KM,(Rosen(M,(Vargo(D,(Awad(SS,(
Denoto(G(3rd,(Butler(CE,(RICH(Study(Group.(
ProspecAve(study(of(singleZstage(repair(of(
contaminated(hernias(using(a(biologic(
porcine(Assue(matrix:(the(RICH(Study.((
Surgery.(2012(Sep;(152(3):498Z505.(Epub(
2012(Jul(3(
(
Synthe:c*vs.*Bbologic(
•  Carbonell(AM(,(Criss(CN,(Cobb(WS,(Novitsky(
YW,(Rosen(MJ.(Outcomes(of(syntheAc(mesh(
in(contaminated(ventral(hernia(repairs.(J(Am(
Coll(Surg.(2013(Dec;(217(6):991Z8(
Sample*of*ar:cles*reviewedj*
•  Lack(of(prospecAve(randomized(
studies(in(this(area(
(
•  Reference(to(clinical(white(
papers(
•  Reference(to(internal(experience(
and(outcomes(data*
Implement*and*monitor*
Mesh*U:liza:on*
Ventral*Hernia*
Open*
Primary(Repair(with((
Mesh(Reinforcement(
Laparoscopic*
Defect(to(Large(for((
Primary(Repair(
Clean(Case(SyntheAc(Mesh(
Underlying(Tissue((
SeparaAng(Mesh(
Component(SeparaAng((
with(Mesh(Reinforcement(
Guideline(Based(Use(
Increased(Risk((
Factors,(but(Clean(Case:((
Large(Pore(Monofilament.((
Avoid(Underlay(Placement(
Infected(Field(or(Gross(
ContaminaAon,(Biologic(Mesh(
Bridging(Defect(with(Biologic(is(not(
Recommended.(If(Surgeon(is(Unable(to(
Close,(Referral((to(Physician((with(
Component(SeparaAng(Experience(
ExcepAon(
StraUce(Approval(for(Wound(Class(3(and(4(
where(skin(cannot(be(closed((
Progression*
UAlizaAon(guideline(
biologics(
Dual(vendor(
contract(
((((((((((2008
Single(vendor(
contract(
(
(
(2011
Single(vendor(
contract(
(
((((((2012 (
UAlizaAon(
guideline(biologic/
syntheAc(
(((((((((((((((2014(
Savings(
Phase(1(
StandardizaAon(
25%(
Phase(2(
StandardizaAon(
10%(
Clinical(Data(on(
Biologics(vs.(
Biologics(
Phase(3(
Phase(4(
Clinical(Data(
SyntheAcs(vs.(
Biologics(
Case*Study:*Mesh*(U:liza:on)**
All(play(
•  Varying(price(point(for(
comparable(
technology(
•  No(standardizaAon(of(
product(use(
•  No(reference(to(clinical(
data(
•  Physician(Preference(
(
MulA(vendor(
•  Sourcing(Strategy(
•  Vendor(ConsolidaAon(
•  Physician(Involvement(
•  New(Product(Process(
Controls(
•  CommunicaAon(and(
EducaAon(on(costs(
•  ConAnuous(
measurement(
StandardizaAon((
and(uAlizaAon(
•  StandardizaAon(of(
Suppliers(
•  Involvement(
Z  Physician(and(SCM(
partnership(((
Z  Relevant(Clinical(
UAlizaAon(protocols(
Building/Sustaining*a*Culture*
Culture*of*Value*Based*Purchasing*
Sustainability*
•  Supply*Chain*Management*Academy*
(
(
–  Designed(for(Physician/Clinicians/Supply(Chain(Partners(
–  Course(DescripAon(
•  Understanding(Today’s(Healthcare(
•  Technical(vs(Professional(Billing(
•  Hospital(BudgeAng(
•  Supply(Chain(Strategies(
Allen(J.(Passerallo(ATC(MBA(
(216)448Z8107(
[email protected](
SPINE*IMPLANT*CASE*
PRESENTATION*
Spine*Metal*Implants*
•  Physician*lead,*14*surgeonsj**
–  Half(private(pracAce(physicians(
•  Historical*spend*of*$12M*with*two*suppliers*
Quality*
•  Value=***Cost*
•  Conflict*of*Interest*disclosed*
•  Discussion*on*commodity*of*product*
•  Factors*to*consider*
–  Breadth(and(depth(of(product(and(technology(
–  Service(levels(
Spine*Implant*Outcomes*
•  Strategy*designed*to*look*at*opportunity*
•  Single*source*vendor*for*open*implants*
•  Dual*source*vendor*for*MIS*
•  Savingsj*18%*off*of*previous*dual*vendor*award*
•  Single*price*point*in*