Recruiting, staffing the Value Analysis Dream Team

In the clinical and budgetary playoffs, who would you place on the field?

During the last three decades when value analysis migrated to healthcare from the manufacturing industry the practice began the arduous journey of adapting to the peculiarities of its new adopter.

Unlike manufacturing, healthcare presented a multi-faceted customer base. This included patients who did not pay directly for the services they received from service providers (hospitals and clinicians), thirdparty payers who actually paid for those services and influenced the buying decisions of both the patients and the service providers in the process, and service providers (physicians and surgeons to some degree) who may not have been employees in the organizations in which they "worked" but merely enjoyed access privileges and "shared" revenue with the host hospital.

In manufacturing, value analysis was conceived and implemented to streamline and make more efficient a clear and simple production process that culminated with a widget in a consumer's hands.

In healthcare, value analysis was "modified" and implemented to streamline and make more efficient an opaque and complicated (some might say, convoluted) production process that culminated with a healing patient.

Against that backdrop in the mid-1980s following the debut of managed care and drug-related groups (DRGs), healthcare value analysis, by and large, proceeded and arguably progressed along parallel lines. One line emerged from the business side, with Materials Management recruiting a nurse to serve as its clinical connection to the Operating Room. The other line emerged from the clinical side, with Surgical Services and Nursing recruiting a business manager to serve as its financial and operational connection to Administration.

Such a scenario seemed familiar to Mary (Beth) Potter, R.N., BS, Director, Clinical Value Analysis, UnityPoint Health Consolidated Services, and President, Association of Healthcare Value Analysis Professionals (AHVAP), who shared her recollections.

"I was one of those nurses recruited to Materials to promote the concept of being 'clinician-friendly,'" Potter told Healthcare PurchasingNeivs. "In spite of my presence, the cost was most often the determining factor. On the flip side, as a Materials Manager, I saw clinicians making decisions based on emotions and good intentions. Both Medicine and Nursing are professions grounded in science. Both professions are committed to the well-being of patients through evidencebased best practice. Value Analysis provides a disciplined, objective process to calculate the measureable value (both clinical and economical) of a decision based on the best available evidence. Mastering the process is critically important to future sustainability."

Sometimes these efforts would work independently of one another; other times in tandem. Both would strive for results in the form of patient outcomes - which we might classify as the progenitor of today's evidence-based philosophical motivations. Where Materials Management felt that one of its professionals could learn clinical jargon and function effectively as a liaison, the OR felt that one of its clinical pros also could learn contracting, inventory and purchasing and function effectively as a liaison.

Metaphorically, these two efforts resembled spinning tops navigating through a pinball machine.

So how can healthcare truly take the concept of value analysis and make it its own? Does the industry really benefit from two equivalent, parallel efforts - one businessdriven through Supply Chain vs. one clinically driven through Surgical Sendees? Does placing a surgeon "champion" in the chairperson's seat placate clinicians enough that their clinically justified tools - no matter how costly - won't be taken away? Or should Supply Chain chair the process, bobbing and weaving as it tiptoes on eggshells to satisfy the C-suite expense concerns without irritating the clinicians who bring in the revenue from which expenses are covered?

In lieu of competitively parallel efforts or even conjoined process twins, might there be a third option that more accurately represents evidence-based clinical value analysis?

Imagine a group that pursues true value management, weaving the clinical and business together with a financially and operationally savvy surgeon champion as chair and a patient- and outcomes-minded supply chain leader as co- or vice-chair, both of whom have the economic health of the organization in which they work - either as employees or one merely with privileges - in mind.

Until then, might healthcare organizations likely see incremental improvement at best as two wheels with divergent interests and personalities grind against each other?

As HPN readers enjoyed the professional basketball and hockey playoffs as well as the professional football draft in April, HPN polled a variety of value analysis experts about their fantasy value analysis team picks - not specific individual names, of course. Instead, HPN asked them to focus on expertise, personality traits and specialties, for example, and determine whether to establish a "general purpose" (GP) team with a flexible roster to call in for reserve help or gear multiple teams toward service lines (SL).

Filling the roster

Several took the sports analogy handoff to the hilt and ran with the ball.

Julie Ware, R.N., BSN, CMRP, Senior Consultant, VHA Performance Services, and AHVAP Secretary, assembled her team akin to a sports franchise, involving all levels of an organization. For example, the CEO or COO serves in a role similar to the sports team president or owner, "providing vocal executive support of the value analysis process across the organization and driving overall accountability."

The Chief Quality or Medical Officer would serve as the "Team Captain" and a "respected clinical executive leader within the organization," Ware continued. "This role supports and communicates the overall strategy anci serves to drive the value analysis process such that the focus remains patient-centric and evidence-based."

The Vice President Nursing/Chief Nursing Officer, Supply Chain Executive and CFO represent "key position players that support the team captain, serving to hold their areas responsible for decision making, strategy and timely participation in the process and tasks," she said.

Meanwhile, the Value Analysis Professional may be the more versatile, according to Ware. "This team member is a blend of coach, statistician, game-scheduler and cheerleader," she noted. "[He or she] serves to bring continuity, consistency and best practice to the value analysis process. [He or she] participates in identifying the key stakeholders and end users who should be on the value analysis work group, such as clinical leaders, clinical end users, materials managers, infection prevention, etc."

The Supply Chain Professional represents "a critical offensive team player who provides relevant, non-clinical information to the team and conveys the initial 'field borders' (i.e., contractual obligations, preferred suppliers, timelines, etc.) to the clinical team members for consideration."

Ware indicated a number of key professionals who should be "available for special team play and move on and off the field as needed for the initiative or project," she said. They include risk management, infection prevention, direct-care clinical staff, finance/ reimbursement experts, environmental services, facilities, physicians and extenders, rehabilitation services and education staff.

Dee Donatelli, Director, Healthcare, Navigant, and past President, AHVAP, assembled her Xs and Os along strategic and tactical field positions.

"The dream team of the future will be clinically driven with supply chain on the bench ready to come in to the game and provide expertise when and as needed," she recommended. "A strong bench is how the game is ultimately won. The captain of the team is clearly clinical - I would vote for the CMO. However, you need co-captains and those form a triad. We need the CNO to drive clinical decisions and the CEO to provide governance and hold all accountable.

"We need a standardized play book/' Donatelli coached further. "Clinical transformation must reduce variation in practice and as a result we will be able to standardize products. If we play the game one quarter at a time we will work our way through all aspects of care and will be able to establish the coveted supply formulary. Once standards of care are established standardization of products will follow with much less push back or resistance. Everyone needs to be operating out of the same playbook."

Any team organization must reflect a shifting clinical and corporate culture, emphasized Nancy Masaschi, Senior Director, Clinical Resource Management, Med Assets.

"As healthcare organizations focus on the shift to pay for performance and value-based purchasing, traditional value analysis cultures need to shift as well, focusing on the total value of care being provided to the patient," Masaschi said. "This evolving best practice is driving the development of Medical Economic and Outcomes Committees (MEOCs) within organizations. This physician-driven process is designed to improve quality and reduce costs while utilizing evidence-based, clinically sound, financially responsible methodologies for the introduction or consolidation of new supplies, devices and technologies.

"Leading organizations partner with their clinicians and physicians to normalize practices and standardize sourcing and contracting initiatives," she continued. "These committees are value-based and data-driven, and led by key physicians incorporating senior leadership into the structure, including CEOs, CFOs, CNOs, COOs and CMOs to focus on the organizational strategic goals of ensuring high quality care delivery."

Masaschi suggested a Steering Committee that includes the C-suite administrators, physician chairs of subcommittees, a Supply Chain executive, service line leaders, and leaders from infection control, Quality, Pharmacy, Laboratory, Reimbursement, Finance and IT. The sub- or service line committee would include an active physician as Chair, a C-suite representative as the "executive sponsor," three to four practicing physicians, a service line leader, department director and key end users on staff.

Potter stressed that UnityPoint Health's teams collaborate considerably with physician leaders to identify evidence-based best practices for the best outcomes.

As such, she said her "General Purpose Value Analysis Dream Team" would be chaired by the CMO and include representatives from Infection Prevention, BioMed, Facilities/EVS, Supply Chain, Med/Surg Nursing, QI/Risk Management, Reimbursement Specialist, Pediatric Nursing Critical Care Nursing Perioperative Nursing, Home Care, Clinics and Mental Health, as well as Data Analytics support. "This team will make decisions that satisfy clinical requirements across the continuum of care/' she directed. "Team members will review all new product requests and review supporting evidence. Decisions for which there is no clear evidence will be assigned to a sub-team of subject matter experts for review and recommendation."

Potter would convene Sub-teams, or Service Line Teams "to review requests for new products specific to their area of expertise. The team would be chaired by a serviceline physician recruited by the CMO, and likely include Infection Prevention, QI/Risk Management, Supply Chain, Reimbursement Specialist and subject matter experts supported by data analytics/' she added.

"As reimbursement is increasingly allocated based on quality indicators and patient satisfaction, physicians and clinical experts must provide clear direction for decisions that potentially impact patient outcomes, quality of care, safety and satisfaction," Potter stressed. "Pursuant to the basic principles of value analysis, however, all decisions must be supported by evidence and based on measurable value."

To optimize business practices and deliver superior care, hospitals must recruit Value Analysis team members with selective expertise that represent "a greater potential than the sum of its parts," according to Christopher O'Connor, CMRP, FACHE, President, GNYHA Services and Nexera Inc., and past Chair, Association for Healthcare Resource and Materials Management (AHRMM).

"Supply Chain Managers with knowledge of prices and negotiating experience represent a financial cornerstone in a Value Analysis team charged with fiscal savings," O'Connor said. "Clinicians familiar with certain products and their related results contribute to financial bottom line by optimizing utilization and minimizing complications, ensuring that patient outcomes aren't compromised by reallocations. Ultimately, the ability to make rational choices around spend and product selection must be grounded in comprehensive, accurate data. Inviting analysts experienced in data collection and well-versed data presentation can prove invaluable in supporting the Value Analysis team's timely, on-target decision making."

The dream VA team would be a crossfunctional team that leverages the clinical, business and analytics sides of an organization, observed Sarah Willis-Kanter, Director, Product Management, McKesson Technology Solutions. "Depending on the service line reviewed, it should be either led by a lead clinician for clinicallyintensive service lines, such as cardiac rhythm management, Orthopedics, etc., or by the supply chain area for commodity product lines, such as solutions, plastics, etc.," she said.

"Our Value Analysis Dream Team would consist of the Chief Medical Officer or medical staff leader, physicians from multiple specialties, Chief Financial Officer, Chief Nursing Officer, director of quality, supply chain executive and value analysis leader," said Steve Tarkington, MSN, BBA, MBA, Vice President, Supply Expense Management, SolutionsTrust, the supply chain consulting arm of HealthTrust. "It is extremely important to include stakeholders across the continuum of care, enlightening the process from different perspectives to achieve a balance between cost, quality and outcomes."

Personality profiling

Robert T. Yokl, Chief Value Strategist, Strategic Value Analysis in Healthcare, pivoted and called an audible with his strategic picks that countered his peers.

"This may come as a shock, but the worst thing you can do is to pick your Value Analysis team leaders and team's members because of their functions or titles since this doesn't ensure that they will be ideal team leaders and team members," Yokl insisted. "Instead, you want to select them because of their unique personal characteristics."

Based on his 20 years of experience in working with value analysis teams, Yokl's blend of personality traits includes being an analytical thinker, organized, reliable/ dependable, enthusiastic and computer literate; takes initiative, welcomes challenges and change, and looks for growth and recognition.

Ware profiled her optimal Value Analysis team members as possessing four distinct qualities.

"They have persistent curiosity," she noted. "They ask why, when, how, what else? These types help the group understand all facets of the product under review and its use, impact, and don't rush to judgment.

"They see long term," she continued. "These individuals use their organizational understanding and vision to help the team see how a decision may impact the organization down the road. They are empathetic. They relate to the actual use of the product and the impact to patient care/ patient experience. This is an important quality to have so that a true and accurate understanding of the product functionality and impact to patient care or clinical practice is obtained. They are detailed communicators and note takers. These people help capture the details necessary to shape the broader communications and educational tools related to the decision coming from the value analysis process."

Further, one universal trait that everyone on the value analysis team must have is the ability to remain neutral, according to Ware. "Team members must be able to check their personal interests and bias at door. It is critically important that those on the value analysis team go through the evaluation process focused on a clinically supported, organizationally sound and financially prudent decision," she added.

"Value Analysis team members must be committed to the pursuit of credible evidence, be respectful of others, be collaborative and reach consensus," Potter emphasized. "Members must be knowledgeable of operational goals with the ability to 'operationalize' the goals. All team members must meet established timelines and be fully engaged in and actively support the value analysis process."

Robin Lane, Senior Manager, Value Analysis, UPMC, emphasized the big picture.

"Effective VA team members remain mindful of the greater goals of the system," Lane said. "They have strong opinions but remain open to new ideas and are receptive to changes based on evidence-based outcomes. They are subject matter experts who are viewed as leaders by their peers. They have strong interpersonal skills and are able to communicate effectively to a broad audience."

Donatelli concurred, downplaying the management titles in favor of the staff that actually use the products or technology. "Too often we honor the managers by placing them on the team when in fact they never use the items nor truly understand the overall impact of decisions," she noted.

Communications must be improved, too, Donatelli recommended. "Think about someone in that role. All other functions need to be coordinated by the supply chain during the analysis of an opportunity. The supply chain algorithm needs to take multiple aspects into consideration, such as evidence, finance, contracts, risk, waste, logistics, infection, etc. We call upon these area experts to provicie data - not necessarily drive to a decision."

Willis-Kanter stressed the importance of openness as a personality trait. "An effective VA process should not start with a predetermined outcome in a member7s mind as it will affect the results both clinically and financially," she said. "In addition, a quality QA force requires collaboration and recognition of each member's strengths and weaknesses. Some members may have an extremely strong clinical background, but a potentially weak business background, and vice versa. Having members with diverse backgrounds is essential to a quality team."

Kristin Boehm, M.D., Senior Advisor, Nexera Inc., characterized the necessary mindset as one open to change.

"Change doesn't come easy for most within any organization, yet a willingness to embrace change is essential for successful Value Analysis," she said. "Team participants must accept that the status quo is no longer satisfactory and communicate this message to other professionals in the organization. Ideal VA team members want to become highly engaged, and, therefore, are vested in seeing the process succeed. Clinicians respected by colleagues both for their skills and judgment will lend an intangible credibility to the Value Analysis process.

"Effective physician members don't shy away from potentially uncomfortable conversations with their peers - around preference items, for example - and demonstrate persistence in seeing initiatives from inception to completion," Boehm added. "These clinicians are equally facile in engaging others as listening and soliciting feedback to bring back to the larger VA team to develop cost reduction strategies."

Visit www.hpnonline.com/inside/2015-06/1506SP-VABP.html for the sidebars, "Deploying the right VA team" and "Analysts Assemble!"