While physicians and surgeons always carry their clinical and professional intelligence and know-how, they expect high-tech and standard devices and equipment to be accessible to them at all times.
This is where Supply Chain comes in and consistently delivers, hopefully satisfying those expectations.
Many times the process works smoothly; sometimes, less so.
To explore the ins and outs of this process, members of Vizient Inc.’s Large IDN Supply Network (LISN) conducted some extensive research on “Managing New Technology.” Their objective: To identify the critical components of the structures and processes for managing new medical technologies, identify key elements considered leading or innovative and share successes and challenges.
Vizient’s LISN includes Supply Chain executives from 21 of the group purchasing organization’s largest IDNs. Formed in 2004 under one of Vizient’s heritage GPOs, Novation, LISN aims to share leading practices and data to help address IDN challenges, drive supply chain performance improvement across the industry and assist in the development of high-value, differentiating supply chain solutions.
Supply Chain executives from two LISN members – Mayo Clinic, Rochester, MN, and Novant Health, Winston-Salem, NC – agreed to share their insights on their technology evaluation and procurement structure and processes with Healthcare Purchasing News Senior Editor Rick Dana Barlow.
HPN: How do you see Supply Chain’s professional relationship changing with physicians and surgeons when it comes to technology horizon scanning and evaluating “new” technology?
Jim Francis, Division Chair, Supply Chain, Mayo Clinic: Over the last 10 years, we’ve seen the relationship with physicians become much more collaborative. Physicians used to simply want the latest technology because it was “new.” Now they want to have Supply Chain involved in the process much earlier to evaluate the necessity of that technology. This early involvement helps support the physicians and ensure that purchasing decisions are on track organizationally and clinically.
Mark Welch, Senior Vice President, Supply Chain, Novant Health: Our CEO instituted the practice of including physicians in leadership and decision-making across the organization – not just supply chain. When we have a business issue, the physicians are included from the beginning and this helps us achieve results quickly. We certainly see this new, more collaborative relationship with physicians in the Supply Chain department. Historically, physicians would request new technology and then simply expect Supply Chain to bring it in. Today, we have formed a true partnership with physicians that allow us to collaboratively vet new products and make strategic decisions that ultimately benefit patients. Physicians are now deeply embedded in our supply chain processes – they have a seat at the table. Together, we look at how the new technologies can benefit clinicians and patients, while also lowering costs for the organization.
What benefits can Supply Chain gain by working so closely with physicians and surgeons to identify and evaluate new technology?
FRANCIS: In short, Supply Chain will benefit by buying fewer things that do not work out operationally or clinically. Often in the past when new products came to market, Supply Chain would buy immediately – usually due to physician/clinician request – but then quickly realize just because it was “new,” it was not the best for the patient. Now, in contrast, we first ask the physician what the business need is before buying new technologies. What does the physician need the technology to do to enhance patient care? What technology attributes are important? Then Supply Chain can compare those desired features with “new” technology to see if clinical needs will be met before making any purchases. We no longer act in isolation, but in concert.
Alisha Hutchens, Senior Director, Supply Chain Administration, Novant Health: Supply Chain benefits by learning how physicians differentiate products and technology, how a product impacts current patient populations or how new technologies could open up new service opportunities. Partnering with physicians and working collaboratively helps appropriately address any issues or questions related to products or services. They support Supply Chain and help us get things done. We can go straight to the physicians to understand what works well and what needs to be improved. They are our valued partners of Supply Chain.
Conversely, what benefits can physicians and surgeons gain by working with Supply Chain to identify and evaluate new technology?
Terri Nelson, Director, Value Analysis, Mayo Clinic: Physicians are realizing that “expense management” is not a bad thing. Rather, physicians are considering financial impact as part of the care equation. As healthcare organizations feel more financial pressures and weather lowered reimbursement, we can collectively choose not the cheapest products, but rather the most effective products. Physicians work with supply chain to look at value analysis, technology attributes and patient outcomes to find the most clinically effective and cost-efficient options. Now physicians enjoy a productive relationship with Supply Chain, where both parties work together early to find positive solutions. Physicians now feel they are being heard.
HUTCHENS: Physicians now see and understand the critical information that Supply Chain can provide that a sales rep doesn’t give them. We give them third-party clinical perspectives, financial analysis, price benchmarks and other insights that they otherwise wouldn’t have. Another benefit comes in the area of budgeting for new technology. We track changes related to new technology to understand the ROI and demonstrate how a new technology is improving care and lowering costs.
Theoretically, physicians and surgeons want the “best” products to provide the highest quality care while Supply Chain also wants care delivered cost-effectively. Why the disconnect and how might it be eliminated?
NELSON: Supply Chain now brings evidence-based purchasing to the table. Value Analysis departments can synthesize literature to look at evidence and outcomes, and Supply Chain can now more closely speak the same language as physicians and clinicians as a result. We’ve heard of other facilities that just hire value analysis staff, but do not put the proper processes in place to help that value analysis staff interact with supply chain or physicians. Without those processes in place, it’s just another headcount.
WELCH: In the past – and in some organizations still today – physicians would request new technology and supply chain would immediately say no because they were only looking at the cost of the product, rather than also considering clinical data, reimbursements, analytics, etc. If the decision is always just about cost then there will always be a disconnect. We have eliminated that disconnect by collaboratively looking at the clinical and financial landscape when vetting new technology. In some cases, new technology, while it may cost more, improves patient outcomes and lowers overall costs. In other cases, new technology provides no incremental benefits. So decisions should be thoroughly reviewed from different angles by both physicians and Supply Chain working in tandem.Additionally, we follow up with physicians to understand how the product is performing. If it is not performing or delivering the value expected then we will take it out of the system. The goal is always to benefit patients and that result comes from collaboration.
What impresses a physician or surgeon the most about working with Supply Chain?
NELSON: In our experience, it has been the leadership. Because of the collegial relationship between our Supply Chain leaders and the physician liaison who works with Supply Chain, Supply Chain is very well respected among the physicians and clinical staff at our organization. Supply Chain has also built relationships with the different practice chairs, and this has led to an environment of mutual respect and trust.
WELCH: The data and insights we can provide on products – they really appreciate the transparency and it builds a high level of trust between the two groups. We have also found that they appreciate it when Supply Chain reaches out to them directly with a problem or a question about the products they are using. In the past we assumed they would be too busy. However we’ve found they appreciate and enjoy the direct contact. They also enjoy that Supply Chain can now provide data that includes clinical findings and outcomes. And they appreciate when we provide transparent timelines.
Conversely, what ticks them off?
FRANCIS: The thing that will irritate our physicians the most is when they are not included in a purchasing decision. We never want a physician to hear about a decision after it’s been made. We want them to participate in the evaluation process. Physicians want to be fully engaged from the beginning so they have a complete understanding, can help implement new technologies and get their colleagues on board.
HUTCHENS: They are frustrated when they do not have a seat at the table or when they do not understand how product decisions are made. They also are frustrated if they feel Supply Chain has not taken the time to understand the patient population they are serving. It’s critical that Supply Chain take the time to understand their perspectives and clinical needs. Bottom line, Supply Chain has to remember that physicians have the responsibility for providing care to the patient so they should have a voice in product decisions.
How might the concept of value analysis/management bridge any gaps between Supply Chain and physicians and surgeons?
FRANCIS: Value analysis is absolutely a step in the process. Once that step occurs, questions the physicians may have had are now off the table. It’s important to keep the process consistent and rely on data findings.
NELSON: Value analysis also helps Supply Chain stay consistent in its decisions. One of the worst things Supply Chain can do is immediately switch products after a decision is made when a physician complains. This undermines the process. Instead Supply Chain is best served to engage value analysis when a physician complains so everyone can understand the process and the rationale for the decision. Everyone may decide a change is necessary, but that decision should be deliberate and thoughtful. Ultimately, our collective goal is optimal patient care and outcomes.
WELCH: Everyone handles this differently. We’ve found it invaluable to have clinicians embedded in our supply chain supporting our value analysis process. They assist with translating product features/benefits between clinicians and Supply Chain to help ensure communications are clear and consistent. When we have challenges with conversions or clinical applications of new products, they immediately speak directly with our physicians and clinicians to fully understand and address the issues. Finally, they are critical to successful new product conversions and implementations. We could not be as successful without our value analysis colleagues.
Where does the emerging “repless” model for “physician-preference items” and new technology fit into the developing relationship between Supply Chain and physicians and surgeons?
NELSON: I think the real question here is why is the supplier missing from this equation? Suppliers must also work in collaboration with Supply Chain and physicians. If all stakeholders can engage in the product development and marketing – moving sales out of the way – then we can support common goals of patient care. But all stakeholders must come together to build a relationship.
HUTCHENS: The short answer is it is the wave of the future. We aren’t there yet, but I believe we will get there within the next two-to-five years.
Rick Dana Barlow | Senior Editor
Rick Dana Barlow is Senior Editor for Healthcare Purchasing News, an Endeavor Business Media publication. He can be reached at [email protected].
