Group chat: Vizient experts discuss resource stewardship
To maximize the value of every dollar spent in healthcare, it's essential to move beyond the cost of supplies, pharmaceuticals and even labor to redefine how care is delivered.
Central to that is clinical resource stewardship, which involves enacting proper care pathways, efficient operational processes and disciplined financial strategies around cost, reimbursement, procedural profitability and growth.
Sounds simple, right? OK, maybe not. But Vizient experts Bonnie Lai (SVP/GM, clinical and physician preference), Rob Lerman (VP, category management — cardiovascular) and Kirtan Patel (associate principal, clinical integration and value analysis) are ready and willing to explore the importance of — and challenges involved in — embracing resource stewardship and guide providers toward a future where the right resources are provided to the right patients at the right time (and at the right value).
Here, they have a conversation about exactly that.
How do you define resource stewardship and its importance for provider institutions?
Lai: Foundationally, I think of resource stewardship as understanding the value a product or service provides in delivering patient care and working backwards from there to ensure we're good stewards of those resources. From a clinical standpoint — think physician preference items (PPI), pharmacy and med/surg — it's about starting with understanding the patient care delivered. You want to deliver it with high quality and strong patient outcomes, so you have to think about how you'll use your resources to deliver that care in the most cost-effective way possible.
In nonclinical areas like indirect spend and purchased services, it's about how services like food, laundry, landscaping or valet affect patient satisfaction. So, it's worth understanding the impact of those services and again working backwards to understand how you achieve the best value based on that patient impact.
Lerman: At Vizient, we use an expanded definition of resource stewardship that may not be ubiquitous among healthcare organizations. We expand it to include performance improvement, including operational improvements and procedural profitability. We think of it as ways to improve clinical care and maximize the value of each dollar spent that goes beyond the transactional.
Patel: Overall, resource stewardship is about identifying the overuse of wasteful care and the underuse of helpful care that is affecting patients and providers. No matter the term, the goal is defining the right care, executing improvements, and managing healthcare resources responsibly for the benefit of all patients.
From that performance improvement/resource stewardship lens, what are some of the biggest questions or concerns that providers often have when it comes to improving quality and cost in their organizations?
Patel: An individual's particular preference is a common challenge — specifically, the balance between evidence-based practices and a physician's obligation to promote the well-being of individual patients. It can be tricky, but there are value-added decisions that are appropriate for many stakeholders. From my experience, several tactics help in resolving this concern: the utilization of scientifically grounded evidence to inform professional decisions when available, transparency about alternatives — including disclosing when resource constraints play a role in decision-making — and encouraging healthcare administrators and organizations to make cost data transparent. By promoting these pieces, it allows for a productive and efficient path forward. Further, there are best-practice governance processes for engaging physicians and clinicians within a health system, which is the practice I lead here at Vizient.
Lerman: Data availability is a challenge, which is something Vizient can and does help with. When I was working within a health system, we often didn't know which physicians used which products. If we had an initiative, we didn't really know who we needed to collaborate with to affect change. Clinical evidence also is a challenge. We all talk about comparative clinical evidence and using the objective evidence to make choices. But that evidence is not available in many cases — the controlled, randomized clinical trials between different manufacturers making the same product that we'd all love to use are not often available. Being able to leverage resources like the Vizient Clinical Data Base is quite helpful. The third obstacle is aligning incentives among stakeholders, especially when you're working with physicians. If you're trying to minimize unnecessary variation, you often get the "What's in it for me?" conversation.
Can you talk about how appropriate use criteria and model mixing play a key role in performance improvement/resource stewardship?
Lerman: Those are two components of utilization management initiatives through which physicians agree upon the right device for the right patient at the right time. Development of appropriate use criteria is the process whereby physicians determine which clinical scenarios are appropriate for use of a particular type of device, such as a pacemaker.
Model mixing, often known as "demand matching," is the next step in the utilization process once a physician has decided that the patient needs a particular type of product. There are often multiple different products available from which to choose, so we ask physicians to be thoughtful about which product attributes are required for each individual patient. Can they obtain excellent outcomes using a so-called "workhorse product," which provides high quality and efficacy but doesn't necessarily have every bell and whistle? Or does a patient require a "premium product" that has additional features that will provide clinical benefit but at a higher cost?
For example, appropriate use criteria may dictate that both a 45-year-old active patient and a 90-year-old highly sedentary patient require a pacemaker. However, the type of pacemaker those two patients need is likely very different based on their respective activity levels. You don't want to deprive a patient of a premium product that meets their needs just because of cost, but you want to be intentional about matching the model to the patient need.
Lai: It seems like it's hard to operationalize consistently, right Rob? You have to do a lot of education.
Lerman: It is all about education, and unless you have the more sophisticated tools that Vizient brings to the table, it can be difficult to track. I'm not saying it's easy, but it is feasible. One underrecognized benefit of utilization management initiatives is that they can often drive value without asking physicians to change their preferred product supplier. And it helps to have a supplier as a willing partner.
Patel: Physicians are sometimes handed supplies that are perhaps not consistent with the most cost-effective use from a demand management perspective. But they're unaware.
Lerman: Unquestionably. A physician may have a high-level conversation with the medical device representative before the procedure and then use whichever device they are handed across the table without a great deal of consideration. Many times, in the absence of a utilization management initiative, that device will be the more expensive premium product. Whether that is because of active upselling, habit or because the representative believes their premium product is best for the patient probably varies. But in the optimal situation, you have a partnership between the supplier and the physician, and you sit down before every procedure and collaboratively talk about the patient, talk about the product options, and determine the right fit for the right patient with resource stewardship in mind.
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