Mapping the healthcare supply chain

www.SymmetricHealthSolutions.com Mapping the healthcare supply chain

About Symmetric Health Solutions

Solution to Industry Challenges

Contents How Our Platform Works Today

Forward Looking

Symmetric Health Solutions helps health systems improve operations, patient safety and find savings opportunities Overview Symmetric Health Solutions is a suite of subscription software applications with medical products & organizational intelligence built in to build trust and accelerate process improvements within health system supply chains for delivering cost-effective care to patients.

Example use cases • Research medical supplies and pharmaceuticals with cleansed data from over 70+ sources (silos) • Optimize medical products sourcing and standardization decisions • Simplify data management with automatic matching to UDI-DIs • Mitigate/address backorder and recall risks • Increase supplies reimbursements • Identify and correct errors in products data

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We correct key data errors in all our data sources while providing visibility into the source data.

We work to both identify and repair discrepancies found in manufacturer submissions to GUDID, your product database, and other data sources to improve match rates and data quality.

Symmetric Difference on Key Data elements Example Errors corrected

GUDID

Symmetric*

Catalog Number Populated

58%

94%

Labelers consolidated (M&A)

5,700

4,600

Device descriptions populated

80%

96%

Device sizes populated

27%

60%

Premarket numbers populated

45%

58%

Implant flag accuracy

84%

99%

Instrument flag accuracy

0%

99%

• Thousands of rules, generating additional rules, to correct and populate our attributes • Machine Learning combined with advanced text parsing focused on medical device terminology • User feedback to correct and align data discrepancies • Daily report available on data quality and completeness metrics

* as of August 20th, 2019, not all encompassing

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With corrected data we mapped Boston Medical Center to UDI-DIs ● Reviewed and mapped 87% of the item master to UDI-DIs in under a week ● Updated item master to EHR interface ● Identified 1k+ recalled items purchased in the last year and created alerts by DI going forward ● Assisted in resolving 5 back orders in first few weeks (built a sub-list into PO item master) ● Implemented scanning at point of use to improve charge capture and begin perpetual inventory reconciliation ● Symmetric is used by Boston’s MDM team for master data management ○ Making item and contract adds to ERP ○ Managing non-catalog data ● Symmetric is used by the Value Analysis team to review market share and opportunities

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Which allowed us to identify $6M+ bottom-line improvements at Boston Medical Center ● $1mm in pricing credits from contract/purchase order/invoice misalignment ○ Overspend report: https://www.youtube.com/watch?v=ZE6IEfa7xdY ● Up to $2mm in med surg supplies standardization ○ Standardization report: https://www.youtube.com/watch?v=Gqi5dBvYSpg ● $600k in missing supplies HCPCS for outpatient reimbursement ○ Missed reimbursements report: https://www.youtube.com/watch?v=viCEMVaXdIo ● Benchmarked a price opportunity of up to $2mm on med surg supplies ○ Veterans Affairs contract price benchmarking: https://www.youtube.com/watch?v=gsaxvOTteQ8

Request the case study: https://www.symmetrichealthsolutions.com/request?item=case-study 6

Clean data means safer patients, and so we encourage everyone to provide feedback to the industry and data owners.

Benchmarked accuracy improvement

86%

97%+

We shared our recommendations on how to improve implantable device flag accuracy with the AHRMM Learning UDI Community, manufacturers and the FDA. Our recommendations included: 1. Derive implantable device statuses from the assigned GMDN codes instead of the FDA Pro codes.

2. Improve GMDN assignations to identify implantable device more accurately.

Read the workgroup paper: https://www.ahrmm.org/system/files/media/file/2019/11/high-risk-implants-work-group-report-102019.pdf 7

Data silos prevent a source of truth for medical products information and point to broken processes in the industry

Providers

Regulators

Manufacturers

Payers

Distributors

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Data silo example - FDA approval document FDA Approval Example

10,000+ New Medical Device SKUs Every Month

USA Medical Devices Information

• Symmetric uses the latest technologies to extract data automatically from documents • We track important data keys, like the device approval number (e.g. “K061808), which assists in mapping to other FDA data silos Approval Document Uses and Error Checks

• Device descriptions, features, material, etc.

• Product functional substitutes, testing, & research • Intended use for procedure classification • Product classification validation (FDA Pro Code/GMDN) 9

Connecting data silos example - Recall enforcement FDA Recall Example 500+ medical device recalls issued every Month

• Approval numbers live on throughout the life of a product • They are often used to identify supplies in recalls, adverse events, registration listings & other FDA data sources • We use several techniques to accurately map to UDI-DIs

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Data silo value add insights - 510k predicate chain Predicate Chain Uses

• FDA “Substantially equivalent” approved supplies mappings • Approval documentation mapping to find original test/study results for a given item • Determine kit/system component item and their relations • Graph database to transverse product relations and attributes quickly

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We bridge many silos, connecting over 70 data sources, which are updated and cleansed daily • 70+ databases cleansed, mapped, and analyzed, ready for your analysis, utilizing OCR, NLP, and ML • Supplies classified with UNSPSC and Snomed hierarchy with the Global Medical Device Nomenclature • Accurately link your contracts, item master, preference cards, and spend to UDI-DI • Product substitutes utilizing 510(k) predicate mappings and premarket approvals • Ability to see any of your data sets next to our 300+ attributes • Cleanse purchase orders to accurately capture non-catalog supplies • Veterans Affairs contract pricing for benchmarking • Supplies manufacturing, reprocessing, and sterilizing locations • Recalls and adverse events statistics & insights by item • Pharmaceutical ASP, FUL, and Therapeutic Equivalence

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We simplify health system improvement opportunities by giving supply chains market visibility and automation Master Data Management

Supply Chain & Operations

• Automate item and contract adds

• View standardization opportunities

• Analyze non-catalog items and spend

• Compare contracts, optimize decisions like UOM Bulk vs. Lum, avoid contracted overspend

Revenue Integrity • View items by Charge Code and HCPCS to see potentially missed reimbursements • See predictive pricing based on similar supplies for charging process flow • Validate diverse supplier spend https://www.youtube.com/watch?v=KohDSB GiAUI

• Populate item master with UDI-DI’s simplifying: • Point of use scanning & inventory reconciliation • Consignment and trunk stock tracking • Purchasing EDI processes • Prepare to manage Pharmacy SCO https://www.youtube.com/watch?v=daAObmen zME 13

You can use the application with data feeds and/or ďŹ le uploads for both master & transactional supply ďŹ les Master Supply File Matching

Transactional Supply File Matching

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We make it easy to get started using UDI-DIs everywhere starting with simplifying mapping to existing item masters ● ●

● ● ● ●

Video overview: https://www.youtube.com/watch?v=d_4ptCL2-bQ Upload excel/csv and have hundreds of additional attributes added to your data in minutes ○ DIs necessary for scanning (GTIN, HIBCC, ICCBBA) ○ Manufacturer location Quickly review any remaining data lines via an optimized review tool Submit feedback on data discrepancies to improve future match rates Download the same dataset with the additional attributes as an excel/csv file for ad-hoc analysis Create custom data feeds to other systems

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Our application lets you see your data matched against both source and cleansed fields • Over 85% UDI-DI match rate to Item Master • Over 90% UDI-DI match rate to Preference Cards • Learning from previous match reviews to increase automated match accuracy •

Over 95% auto match on new records, not requiring any manual review

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By loading transactional supply files we allow you to prioritize standardization efforts by total potential savings or category ●

Standardization video overview: https://www.youtube.com/watch?v=Gqi5dBvYSpg

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Find savings opportunities within your item universe and prioritize reviews by: ○ ○ ○ ○ ○

●

Total item spend GMDN UNSPSC HCPCS Company

Drill into an opportunity and compare items side-by-side

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Quickly compare savings opportunities on relevant fields taking into account all available information ● Verify that items are similar using their classifications (GMDN, UNSPSC, etc.) and cleansed, consistent descriptions ● Easily compare important flags for determining substitutability ○ NRL ○ Single-use ○ Implant ○ Sterilization requirements ● Visual cues on which fields have differences that might need further attention (e.g. number of recalls)

Option A

Option B

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Quickly analyze market share by vendor and category, saving time optimizing your spend and contracts After uploading or feeding purchase order matched invoice data, the searchable spend tree shows vendor breakdowns of categories. Clicking into the categories allows you to export all relevant spend details.

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We then learn from your feedback on what is actionable in order to further prioritize data improvement efforts ● Track the status of savings opportunities to see the progress made so far ● Identify and correct errors in supplies data based on opportunities that are not actionable ● Actionable items are passed back to the system for re-incorporation in the substitutability algorithms to provide better substitute suggestions going forward ○ More accurate savings opportunities ○ More relevant options when searching for backorder substitutes

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A path forward only works with collaboration and improved feedback channels ● Enable direct feedback between industry participants on data quality: ○ Health system <-> Manufacturer ○ Health system <-> Regulator ○ Health system <-> Payer ○ Health system <-> Health system ○ Regulator <-> Regulator ● Increase market share of health systems willing to collaborate on data quality. ● Continue collaborating with the FDA, manufacturers and Learning UDI community on improving GUDID and other FDA/NLM hosted data (e.g. recalls, MAUDE, etc...) ● Expand regulatory collaboration to other regulatory bodies (e.g. EUC’s EUDAMED, Health Canada, etc...) ● Expand standards organization collaborations to improve collective schemas (e.g.

GMDN, HL7, OMOP, ISO, etc...)

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Start a conversation

Tomรกs (TJ) Dardet, VP Industry Engagement TJ.Dardet@SymmetricHS.com

General questions and requests: contact@SymmetricHS.com Learn more at: https://SymmetricHealthSolutions.com 22