The Implications of Comparative Effectiveness Research for

Health System Group Purchasing Organizations

September 17, 2009

OwnersAffiliates

Premier alliance: Uniting 2200 hospitals to improve quality and reduce costs

Envisioned Future: Premier hospitals and health systems will operate at the highest quality levels, while managing costs

How?• Uniting hospitals to aggregate buying• Collecting, analyzing and sharing data• Testing new evidence based quality

measures• Develop national policy that will improve

quality and safety and reduce costs

Premier is dedicated to collecting, analyzing and sharing knowledge nationwide to improve the health of communities

Premier is all about CER

• Put products in head to head competition:– Quality– Effectiveness– Price

• Clinical committees comprised of hospital experts– Nurses– Physicians– Hospital executives

• Use of clinical data to compare products– Largest clinical database in the world– Detailed data

• Premier will be a user and supplier of CER

Premier Data Assets

• 623 hospitals• Over 42 million discharges• 5 million new discharges per year for the past

7 years

Inpatient Data

Data Assets

• 442 hospitals• 210+ million total visits• 25+ million visits per year• ER, same day surgery, observation,

chemotherapy clinic, dialysis clinic• Drugs, diagnoses, procedures

Hospital-based Outpatient Data

Large, Nationally Representative Drug & Device Utilization Database

1 out of every 5 discharges in the U.S.

1 out of every 5 discharges in the U.S.

Data Acquisition and Collection

Demographics

- Patient - Hospital

Hospital Information System

Hospitals Diagnosis Cost of Care PhysiciansDrug

ProceduresDepartment Detail

- Type - Admissions - Discharges

- Principal - Secondary - DRG

- Costs - Charges

- Type - Specialty - Brand Name

- Route of administration

- Principal - Secondary

Perspective Data

Warehouse

- Utilization - Quantity

-

Data Validation & Reconciliation

- Validation (e.g., fields missing records

- 3M APR-DRG severity adjustments Reconciliation

Premier Research Services

•Therapeutic Datamart•Feasibility Study•Custom Research•Market Trend Reports•Cost of Illness Analysis•Drug Utilization Analysis•Market Analysis

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Level Day of Stay Detail

Patient Detail Department Detail Pharmacy Detail Day of Stay Detail1 2 3 4

4

Granularity of Data

PharmacySystem

PISRadiology

SystemRIS

ADTSystem

Surgery System

SIS

LaboratorySystem

LIS

Interface Appliance

SafetySurveillor Real-TimeDatabase

SafetySurveillorPrimary

DatabaseAnalyticEngine

SafetySurveillorWeb Interface

InfectionControl

PharmacyStaff

QualityStaff

Reporting

Streamlining Data Architecture making Information Actionable with SafetySurveillor

Partnership with the FDA

Since 2000, Premier has served as the exclusive provider of inpatient data for post-marketing drug surveillance.

Access all inpatient discharges & patient-based drug utilization data including the following information:

Patterns of drug usage over timeDosing & administration patternsComplications during hospitalizationNew drug usage patternsOff label usage

CMS

CMS/Premier P4P Demonstration was awarded to measure the effects of financial incentives on hospital performance

Financial incentives improve hospital quality & performanceHypothesis

• Link reimbursement with quality measures for five conditions• Increase Medicare payment by 2% for top decile and 1% for second decile performers• Publicize hospitals that rank in the top half of all project participants for each condition• Apply a standard set of industry accepted quality indicators scored through Premier’s

Perspective™ clinical database.

Demonstration Project Overview

QUEST Comparative Innovation Program (CIP)

• Focused on testing effectiveness of new healthcare innovations to improve patient care.

• Innovations will be assessed based on their ability to help hospitals achieve the goals of QUEST.

• QUEST hospitals will test, validate and substantiate technologies within the hospital environment.

• Program will accelerate patient access to technologies proven to be safe and effective.

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Framework for High-Value Healthcare

Defining value in healthcare.

QUEST CIP: Wave 1 Finalists

• Bard Medical Division Bardex I.C. Foley Catheter to reduce catheter- associated urinary tract infections.

• BD (Becton, Dickinson and Company) - BD GeneOhm™ MRSA Assay to rapidly identify MRSA carriers, enabling clinical intervention to prevent infection and transmission.

• Covidien Mallinckrodt Hi-Lo Evac Endotracheal Tube to reduce ventilator-associated pneumonia.

• Remel (part of Thermo Fisher Scientific) Spectra™ MRSA to detect nasal colonization of MRSA to aid in the prevention and control of it.

• Sage Products Inc. Toothette Q-Care Oral Cleansing and Suctioning Systems to reduce ventilator-associated pneumonia.

• Vocera Communications Vocera Communications Solution to reduce emergency response times and improve doctor-nurse communications.

Position on CER policy

• Federally sanctioned, private organization with broad stakeholder involvement

• Include a methodology committee that establishes standards and protocols for comparative effectiveness research and consults with stakeholders in the healthcare system for guidance with this process

• Funded by government and private stakeholders• Should prioritize and sponsor research, including meta-analysis,

cohort studies, literature reviews and controlled clinical trials• Research findings should not slow the introduction and coverage of

new, FDA-approved technology but should inform subsequent coverage and payment decisions

• Process to rapidly and fully communicate research findings to providers

Implications

• Augment negotiating and contracting – Redesign processes:

• Increased information distribution• Shorten contract terms• Premium for some products/less for others

• Information source for Committees and providers• Inclusion in clinical database• Inclusion in VBP in time• Premier Research Services to analyze and contribute• Potential participant in stakeholder group