©ecriinstitute.montagnolo.2013 1 evidence based purchasing wshmma vancouver, wa april 18, 2013...

©ECRIInstitute.Montagnolo.20131

Evidence Based PurchasingWSHMMA

Vancouver, WA

April 18, 2013

Anthony J. MontagnoloExecutive Vice President and [email protected] ext. 5175



Surprise! We now work for Cheesecake Factory Hospital


Resistance is futile


Sources: Centers for Medicare and Medicaid ServicesWhat Is Driving U.S. Health Care Spending? America’s Unsustainable Health Care Cost Growth, Bipartisan Policy Center

The math does not care who is in charge. Neither should you.


Once upon a time in merry old England I stayed at a quaint cottage hotel……..


Outside and inside expectations

match

High quality requires standard systems.


Healthcare Reform

The Affordable Care Act (2010) Reduces the number of uninsured Encourages more accountability for patient care through

integrated delivery systems―Value-based Purchasing; payments based on quality of care―Accountable Care Organizations; vertical care alignment with bundled

payments―Patient Centered Medical Homes; proactive case management of

high-risk patient care


MARCH 2010| IN VIVO: THE BUSINESS & MEDICINE REPORT| www.ElsevierBI.com


Healthcare Reform

What to know for supplies and technology Less money to spread around Value matters more than price Clinical evidence and real world outcomes will

drive judgment of value


But what is value in healthcare?

Do we have the best healthcare system in the world?

Do we have worst healthcare system in the world?


And what are outcomes in healthcare?

Longer life? Better life? Higher productivity? Healthier populations? Happier people?


Where is technology headed?


1. Electronic Health Records

2. mHealth (mobile health)

3. Alarm Integration Technology

4. Minimally Invasive Cardiac Surgery

5. Imaging in Surgery

ECRI Institute’s Top 10 C-Suite Watch List: Hospital Technology Issues for 2013


6. PET/MR Systems

7. Bariatric Surgery for Control of Diabetes

8. MR-Compatible Pacemakers

9. CT Radiation Dose Safety

10.CT Lung Cancer Screenings

ECRI Institute’s Top 10 C-Suite Watch List (Cont’d)


Cleveland Clinic Names Top 10 Medical Innovations for 2013

1. Bariatric Surgery for Control of Diabetes

2. Neuromodulation Device for Cluster and Migraine Headaches

3. Mass Spectrometry for Bacterial Identification

4. Drugs for Advanced Prostate Cancer

5. Hand-held Optical Scan for Melanoma


6. Femtosecond Laser Cataract Surgery

7. Ex Vivo Lung Perfusion

8. Modular Devices for Treating Complex Aneurysms

9. Digital Breast Tomosynthesis (DBT)

10.Health Insurance/Medicare Program/Rewards for Better Health

Cleveland Clinic Names Top 10 (Cont’d)


Bariatric Surgery for Control of Diabetes

►Experts suggest earlier intervention for diabetes treatment

►Possibly curative


Digital Breast Tomosynthesis

►Provides tomographic view –reduces overlapping tissue blurring

►May cost 20-60% more than digital mammo


Transcatheter Aortic Valve Implantation for Treating Aortic Stenosis

►New therapeutic alternative to drug therapy

►CMS proposed conditional reimbursement

►Adoption could drive need for hybrid ORs


MRI-compatible cardiac pacing system (REVO) for patients who may require future MRI

►May be used in up to 80% of patients needing a dual chamber pacemaker


William G. Huitt, May 2002

Technology that improves service will matter more.


Focus on Real Outcomes


Focus on Real Outcomes

Evidence may be available for 3 general types of outcomes:

1.Patient-oriented clinical/health outcomes

2.Intermediate outcomes

3.Surrogate marker outcomes


Source: Nudge: Improving Decisions About Health, Wealth, and Happiness. Thaler and Sunstein, 2009. Page 17.


A bat and ball cost $1.10 in total. The bat costs $1.00 more than the ball. How much does the ball cost?

______ cents

Source: Nudge: Improving Decisions About Health, Wealth, and Happiness. Thaler and Sunstein, 2009. Page 21.


Framework used to assess new healthcare supplies/technologiesWe consider these factors:

1.Intended patient population/disease/condition for the technology

2.Comparison technologies

3.Outcomes of interest

4.Short- and long-term follow up time points

5.Care delivery process (e.g. inpatient/outpatient/home care)


High Quality Decision Process

Clinical Evidence

and Outcomes

Technical & Operational

Issues

Strategic Issues

Financial Issues

Follow Technology Decision Rubric


Patient-oriented Clinical Outcomes

What a patient experiences, such as

Quality of life Pain Function: physical, cognitive, social Ability to perform activities of daily living Adverse events Short and/or long-term complications Survival Patient satisfaction


Intermediate OutcomesShorter term measures; may or may not predict long-term patient outcomes, such as

Hospital length of stayTumor response rate after treatmentDisease-free survival time after treatmentWeight loss 6 mo. after bariatric procedureRestoration of normal heart rhythm after afib


Surrogate Outcomes

Surrogate outcomes are Indirect Disease-oriented Not discernible by the patient

Blood tests such as cholesterol, PSA Imaging test results such as angiography, PET, MRI, CT,

bone density


Quick Test: Digital Breast Tomosynthesis

►Provides tomographic view –reduces overlapping tissue blurring

►May cost 20-60% more than digital mammo


What can you do?

Create better match between resources used and true patient needs

Deliver objective information about the VALUE of technology

Empower your clinicians for the rationale use of technology


Source: Littenberg B. Technology Assessment in Medicine.Academic Med 1992 Jul; 67 (7).

A Final thought on Technology Assessment

Just because something does what it is supposed to doesn't mean it does good.

©ecriinstitute.montagnolo.2013 1 evidence based purchasing wshmma vancouver, wa april 18, 2013...

Documents

melanoma slide

futile slide

judgment of value slide

health care spending

csuite watch list contd

bariatric surgery

healthcare reform

affordable care act