Advancing Personalized Health Systems by Leveraging Supply Chain Innovation

ADVANCING PERSONALIZED HEALTH SYSTEMS BY LEVERAGING SUPPLY CHAIN INNOVATION Dr. Anne Snowdon, Academic Chair Join the conversation! @WIN_Health @SCAN_Health

© 2018 AHRMM

SPEAKERS

DR. ANNE SNOWDON Academic Chair, World Health Innovation Network (WIN) Scientific Director & CEO, Supply Chain Advancement Network in Health (SCAN Health)

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How does your presentation relate to CQO? Please select from the definitions for Cost, Quality, and Outcomes (CQO) below: CQO: the definition The CQO Movement looks at the intersection of, and the relationship between: Cost: all costs associated with caring for individuals and communities Quality: care aimed at achieving the best possible health Outcomes: financial results driven by exceptional patient outcomes

Š 2018 AHRMM

LEARNING OUTCOMES • Learning Outcome I: Understand the current knowledge and empirical evidence of maturity tools across sectors.

• Learning Outcome II: Explore and examine the current evidence of impact of supply chain infrastructure in three global health systems.

• Learning Outcome III: Examine the value and opportunity to advance health system quality, safety, and cost reduction in health systems leveraging supply chain tools and strategy.

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HEALTH SYSTEM CONTEXT: THE CHALLENGE OF SUSTAINABILITY Rising Global Healthcare Costs:

5.3% per year

(2014-2017)

10.7%

17.4% 6.2% 8%

6.4% 6.6%

Highest global spending as a percentage of GDP is in North America

Deloitte, 2014

TRENDS IN PERSONALIZATION AND PRECISION

• “Omics” technologies – make personalization possible – personalized to the unique genetic make-up of the individual • Information Technologies driving new expectations and demands among consumers © 2018 AHRMM

VALUE OF PRECISION MEDICINE Drive towards Precision Medicine vs. the cost of these therapies for health systems - the 10 highest grossing drugs in the U.S., number of people that improve (blue) vs. number that fail to improve (red) Significant Pressure to find Value at the system level to achieve sustainability Personalized medicine: Time for one-person trials Nicholas J. Schork Nature 2015. Volume 520, Issue 7549

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EVIDENCE OF IMPACT AND OUTCOMES FOR PERSONALIZED MEDICINES OF THE FUTURE

Clinical trials will no longer be “enough” evidence to adopt new medicines and therapies.

System level tracking and traceability will be foundational to quality and safety for the future of health systems © 2018 AHRMM

MEDICAL ERROR IN NORTH AMERICA

Medical Error is now the 3rd leading cause of death in North America.

Clinical trials will no longer be “enough” evidence to adopt …23,000 deaths that are preventable annually, 68 new medicines and therapies. people/day (Baker, 2014)

System level tracking and traceability will be foundational to quality anddeaths safety forU.S., the future of health …251,454 633 people/day (Makary, 2016) systems

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PERSONALIZED HEALTH SYSTEMS: FROM “TRIPLE AIM” TO “TRIPLE VALUE”

Convenienc e

Value Choice

System Focused

Cost

Consumer Focused © 2018 AHRMM

REFRAMING THE CHALLENGE OF PATIENT SAFETY AND CARE QUALITY AS A SYSTEM INFRASTRUCTURE OPPORTUNITY

“Adverse events and medical error can be improved with system transparency, tracking and traceability of care processes, products used in care, linked to outcomes.

Enabled by supply chain infrastructure” © 2018 AHRMM

Framing the Research • System Level Measurement of patient outcomes linked to product use and care procedures does not exist; system infrastructure to support safety is under developed in the health sector.

• Empirical Evidence of the Impact of Supply Chain Implementation in Health Systems is very limited.

• Goal: To Create Empirical Evidence of the Health System Level Impact of Implementing Supply Chain Infrastructure in Health Settings. © 2018 AHRMM

Supply Chain Transformation Globally Case study research examined supply chain transformation as a strategy to strengthen health system performance in three global health systems: • Canada – Alberta Health Services • U.K. – National Health Service • U.S. - Mercy Health System Case studies released February 15, 2018 © 2018 AHRMM

Clinically Integrated Supply Chain Strategy Implementation

• •

• •

• • •

Alberta Province wide integration of supply chain processes into clinical programs and teams – optimized inventory, tracked relative to use creates and safety outcomes, reduced high cost of inventory due to waste Online adverse event reporting province wide NHS – Scan4Safety Digital Tracking of every patient, product, care process, clinician, and location of care in six hospital Trusts, using point of care scanning Creates transparency to reduce variation and waste, enables accurate case costing, releases provider time to care for patients Mercy Scaling supply chain infrastructure across 45 hospitals, traceability of every product linked to patient outcomes–Cardiology, Perioperative Supply chain team fully integrated supply chain processes into the perioperative program, released clinician time for patient care Point of care scanning captured products, patients, providers, outcomes

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Return on Investment: Three Countries Country Canada

Health System Alberta Health System

ROI 7:1 to date from inventory savings only $301,438,786 in savings over 7 years Savings are from inventory only to date

England

National Health Service

4:1 expected by year 3 from inventory savings, £1,034,000,000 savings projected by year 7 (£30M/mon. all Trusts) 16 FTE’s in labour savings/ Trust.

United States

Mercy Health System

$1 billion savings as a direct outcome of optimizing and transforming supply chain processes across Mercy.

29.5% decline in labour costs and 33% decline in supply costs. © 2018 AHRMM

Strategic Supply Chain Pathway to Quality and Safety

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Development of a Supply Chain Maturity Model • Critical Analysis of the Literature: what is known, not known • Very limited empirical study of health system supply chain • Conceptual Mapping of Key features of supply chain in healthcare • Qualitative Interviews of system stakeholders • Conceptual Analysis of Existing Supply Chain Maturity Tools published for all sectors (n=26) • Examined levels, major concepts across maturity levels • Relevance to Health sector • Early Draft of Maturity Tool • Expert Advisory review • Heath system case studies for validation (NHS England, Mercy, Alberta Health Services) © 2018 AHRMM

Literature Review Grey Literature

• Reports, business documents, published supply chain models • 25+ articles

Research

• Health care supply chain, supply chain literature, case studies, current WIN research • 40+ articles and documents

Expert option and suggestion

• Supply chain researchers, field experts • 10+ articles © 2018 AHRMM

Literature Review Healthcare Supply Chain

• Healthcare supply chain information is limited and currently an evidence based measurement tool linked to health system evidence does not exist • Healthcare has unique challenges: • • • • • • •

Evolving technology Need for physician preference Short product cycles Difficulty in acquiring data Lack of standards Lack of capital Inadequate supply chain knowledge

• There is a need for adapting data standards and unique identifiers (GS1, HIBCC)

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METHODOLOGY

* Adapted from: Chen, I. Paulraj, A. Towards a theory of supply chain management the constructs and measurements. Journal of Operations Management (204). 119-150

Article search

Grey literature, studies, expert suggestion 423 articles reviewed

Models in Results supply chain 5 Frameworks

Country ModelsRoadmap Level

Matrix 1 and Indicators Feedback Matrix 2 and Indicators Delphi Survey Matrix 3 and Indicators

Empirical Research Consulting

Dimensions

Levels Indictors

Consulting

Matrix Expert Opinion

Matrix Expert Opinion

Matrix Š 2018 AHRMM

Critical Review of Five Frameworks EMRAM (HIMSS)

• Scores hospitals on the adaption and use of the Electronic Medical Record • Uses a eight-level model with self-reporting measures • Used by 44,947 outpatient facilities

Gartner Model

• Emphasizes the role of IT and movement from a disconnected system to one of integration and connectivity • Four-layer model and indicates technology adaption

GTIN model

• Designed for organizations to self-evaluate the advancement of GTIN and GS1 adaption • Defines five different levels for implementation of GTINs

Supplier Relationshi p Manageme nt

• Designed for hospital assessment of supplier relationship management through a bottom-up approach • Uses five different levels with 36 reference points for advancing forward

GS1 Data • Designed to assess an organizations supply chain data quality Adoption • A generalized framework for consumer goods and retail supply chain Standard

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Key Themes Emerging: Inventory Optimization “Knowing exactly what we are buying and what we paid for”

Inventory Transparency to Support System Engagement: “We’re going to know exactly what we’re buying, and in what volumes, and what we’re paying, and we’ll benchmark it based on the others, and then we can start working collaboratively, we’ll get better value.” (NHS trust Leader) “We figured that in the NHS hospital system, we think it’s 1.5 billion Pounds worth of inventory savings.” (Department of Health Leader) © 2018 AHRMM

Tracking and Traceability of Every Care Process, Product, linked to Patient Record

• Track, trace every product (ex. medication), linked to individual uploaded into EMR to ensure accuracy, cue providers to risk, reduce adverse events • Future: Predictive Analytics fueled by Artificial Intelligence to proactively identify which products offer best outcomes to individual patients

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Supply Chain Integration into Clinical Program Strategy Supply chain staff are embedded in the clinical program teams: • Provide data on utilization, product cost/patient indicator and value, • Solicit feedback on new products, contracts and procurement • Supply chain team fully understands team needs, enable and inform team decisions “…So really, the strategy comes down to, we embed our people into their teams and into their operations.”

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Strengthen Quality of Work life for Clinicians and Provider Teams • Automating work environments for Clinicians, point of care scanning • Automated cues for patients at risk, transparency in adverse event reports and recalls • Product use during care uploaded into EMR, reduced documentation, enables automated recall, identifies expired items (OR Nurse, MRI example) © 2018 AHRMM

Accuracy and Transparency to Inform Strategy in Healthcare Organizations • Automated safety reporting • Objective data to support standardization of products, reduce variation, case costing • Accurate data on value to inform innovation procurement

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Enabler of Innovation Procurement Attention to value in procurement, understood broadly, beyond financial/cost value Uses Outcomes Based Specifications (OBS) Desired future state (or outcomes) are defined, but functional/technical solution specifics are not. Allows for innovation and creativity to meet outcomes Facilitates fair, accountable, transparent dialogue between vendors and purchasers Value-focused innovative procurement Improve patient outcomes while controlling costs through purchasing innovative solutions for the healthcare system.

Value = Health outcomes/ Cost of delivering these outcomes Š 2018 AHRMM

Questions & Discussion © 2018 AHRMM

CONTACT US! Dr. Anne Snowdon, Scientific Director & CEO, SCAN Health, Academic Chair, WIN Anne.Snowdon@uwindsor.ca Ms. Lori Turik, Interim COO, SCAN Health, Executive Director, WIN Lori.Turik@uwindsor.ca Find us online at: www.scanhealth.ca & www.worldhealthinnovationnetwork.com Follow us on Twitter: @SCAN_Health & @WIN_Health Like us on Facebook: Supply Chain Advancement Network in Health & World Health Innovation Network Follow us on LinkedIn: Supply Chain Advancement Network in Health & World Health Innovation Network Subscribe to us on YouTube: WIN Health

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