Action, application must replace talk about clinical evidence
In 2013, I issued a challenge: Stop talking about the importance of evidence and start incorporating the proof of clinical value into utilization management and value analysis processes. At the time, many health systems continued to rely on physician preference, opinion, and the mantra of “doing what we’ve always done” when it came to attempting to meet clinical and fiscal goals. Factors like a lack of physician buy-in were cited when it came to addressing the difficulty of introducing more cost-effective procedures and technologies, not recognizing the neutral ground that evidence created for physicians and supply chain/value analysis professionals.
Four years later, many of you have risen to the challenge. The continued move away from fee-for-service medicine and towards value-based medicine has provided ample motivation for providers and health systems to change their thinking about evidence’s role in value analysis. However, as far back as 1999, an extraordinary woman had the vision and tenacity to challenge those entities to embrace the inevitable paradigm shift that we’re experiencing today.
PhD, RN, ANP
More than 25 years ago, Winifred Hayes began her evidence-based revolution out of a barn with just herself and a part-time assistant, no external capital, and none of the technological advances available today. Prior to those auspicious beginnings, Dr. Hayes worked as a practicing clinician and nurse educator, both as a nurse and as a nurse practitioner. She leveraged her observations from the field to establish a model of unbiased evidence analysis to assist insurers in determining coverage policy for health technologies. However, during her time as a healthcare provider, Dr. Hayes also noted a significant and troubling trend: The tendency of clinicians to “throw a product at the problem” instead of examining the care aspects that surrounded the product’s use; determine the role that the product played; and whether or not the product was truly necessary and added measurable “value” to the care of patients. Both clinical effectiveness and cost benefit were important.
These decisions, most often influenced by opinion, preference and marketing hype, resulted in an excessive utilization of technologies that lead to a large increase in clinical variation and increased cost. While much of Dr. Hayes’ early success came from her work with evidence in the payer market, she had the vision to realize that the role of evidence, as well as strong clinical research support, was necessary for health systems to improve their health technology utilization and provide care that was safer, more efficient and more cost-effective.
Dr. Hayes not only foresaw the need for health systems to adopt evidence-based decision making long before the systems themselves, but she’s maintained a tenacity to see positive change, fueled by her passion for improved healthcare delivery. In addition, she’s been a vocal and persistent advocate for expanding the role of Supply Chain and Value Analysis within health systems. Today, Supply Chain and Value Analysis increasingly have “a seat at the table” on clinical committees. Dr. Hayes believes and continues to promote the need for Supply Chain and Value Analysis to be present for technology acquisition, deployment and utilization determinations from the start, armed with fiercely unbiased evidence to assist in the decision making process.
Though the adoption of evidence-based strategies continues to occur at an uneven rate in the provider space, I share in my friend and mentor’s confidence and optimism that we will continue to promote and support the use of the scientific method, particularly in the work of the value analysis and quality improvement communities. Dr. Hayes’ continued dedication to evidence-based performance improvement has significantly influenced the shift towards value-based health care. I am certain that she and her company will continue to fulfill this vital mission and I look forward to participating in the use of evidence to promote performance improvement, clinical outcomes and the overall reduction or elimination of unnecessary technologies.
Dee Donatelli
Dee Donatelli, R.N., CMRP, CVAHP, has more than 40 years of experience in the healthcare industry as a registered nurse, supply chain executive and consultant. Donatelli has held leadership positions in hospitals, consulting firms, distributors and GPOs. Donatelli is a past president of the Association of Healthcare Value Analysis Professionals (AHVAP) and is Chair-elect of the Association for Healthcare Resource and Materials Management (AHRMM). An Bellwether Class of 2015 inductee, she also serves on Bellwether League’s Board of Directors. Donatelli currently serves as Vice President, Professional Services, at TractManager and as Principal, Dee Donatelli Consulting, LLC. She is a member of Healthcare Purchasing News’ Editorial Advisory Board and can be reached at [email protected].
