2018 AHRMM Cost, Quality and Outcomes (CQO) Report on the Clinically Integrated Supply Chain
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The AHRMM Cost, Quality, and Outcomes (CQO) Movement was launched in 2013 to advance the role of the health care supply chain in delivering better quality care at a more affordable cost and in a manner that delivers the highest value to patients. The CQO Movement explores the inter-relationships between cost, quality, and outcomes (as defined below) as opposed to the more historic view in which these factors were considered separately, often by different functions within the hospital environment, e.g., clinical, financial, etc. The CQO Movement encompasses all activities designed to support both better health and patient care across the entire patient journey.
“In health care, higher quality leads to lower costs,” says Karen Conway, Vice President, Healthcare Value, Global Healthcare Exchange. “When we can reduce errors and never events, lower readmission rates, and better yet, keep people healthy and out of the hospital, we can make a significant reduction in total health care expenditures.”
Each year AHRMM assembles a task force comprised of individuals who are playing a central role in advancing the principles of the CQO Movement, both within their organizations and across the health care field. The task force is charged with providing insights and best practices of CQO in action.
The theme of this year’s CQO Report is the clinically integrated supply chain. The AHRMM Clinical Integration Task Force has defined clinical integration in terms of the health care supply chain as follows:
“An interdisciplinary partnership to deliver patient care with the highest value (high quality, best outcomes, and minimal waste at the lowest cost of care) that is achieved through assimilation and coordination of clinical and supply chain knowledge, data, and leadership toward care across the continuum that is safe, timely, evidence-based, efficient, equitable, and patient-focused.”
A poster depicting the role of supply chain in supporting the vision of clinical integration is included in the report.
This year’s task force report also includes case studies, from six different health care systems, with a focus on the role of supply chain in advancing their respective objectives. While each program is different, a closer look uncovers similarities across the case studies that can serve as guideposts for those undertaking CQO-related initiatives.
At their core, each of the case studies demonstrates the creation of value for multiple stakeholders, most importantly patients. Below are executive summaries of each case study (with the full studies contained in the body of the report).
Data-Driven Care Redesign — Duke Health
Interdisciplinary collaboration on care redesign is best built on a foundation of accurate, timely, and comprehensive data. Supply chain leadership at Duke Health has created cross-organizational partnerships and the technology infrastructure to enable integration of detailed data on products used in patient care with information such as length of stay, infection rates, and reimbursement. This integrated approach to data management provides insights into where variation exists, total costs per procedure, and opportunities for quality improvement.
Supply Chain’s Expanding Role in Population Health — Geisinger Health System
To address the high incidence of Type 2 diabetes in its communities, Geisinger Health System looked beyond clinical care to meet unmet social needs. Geisinger’s Fresh Food Farmacy program provides patients with nutritional meals, education, and one-on-one support, with early results indicating better disease management, more engaged patients, and lower emergency room visits and readmission rates. With rising chronic disease consuming the bulk of U.S. health expenditures, Geisinger believes there is an expanded role for supply chain to manage the contracting, procurement, and delivery of products and services to meet the social determinants of health.
Physician Alignment for Co-Management Success — HonorHealth
Providing higher quality, cost effective patient care begins with physician alignment. HonorHealth created the structure through which employed and independent physicians could collaborate to co-manage various service lines and create care pathways across multiple settings. The supply chain organization provides executive and physician leadership with data on product efficacy, utilization, and cost to help guide decision making. In addition to supporting physician incentives, supply chain has raised the level of engagement with suppliers, moving beyond price to true partnerships.
Improving the Patient Experience through Standardization — Intermountain Healthcare
Intermountain Healthcare is committed to improving the health of the populations it serves and, whenever possible, keeping people out of the hospital. That requires close coordination across the full continuum of care and in some cases extending specialty services into rural communities. Supply chain supports the effort by 1) helping clinicians standardize on products and services that deliver a consistent and quality experience for patients no matter where they receive care and 2) extending its logistics capabilities beyond acute care hospitals into both communities and homes.
Redesigning Sepsis Care for Better Outcomes — Ochsner Health System
The primary driver for readmissions and a leading cause of mortality in U.S. hospitals, sepsis was considered a challenging but necessary area of focus for Ochsner Health System’s care redesign efforts. Supply chain plays a consultative role in the physician-led organization that recognizes the importance of cross-functional collaboration when developing new initiatives to impact patient care. By redesigning the sepsis care pathway, Ochsner has standardized processes for treatment based on national three-hour and six-hour bundles for perfect care, increasing compliance by up to 90 percent.
Sustainability and Standardization Drive Value — Stanford Health Care
In order to consistently deliver optimal patient outcomes, hospitals and health care systems need sustainable and repeatable processes, including in supply chain. To support efforts to lower the overall cost structure of the organization while maintaining its exceptional record of quality care, Stanford is transforming its supply chain to ensure clinicians have products that deliver the highest value to patients. Tighter integration between clinical and supply chain systems, along with data standardization and analytics, is enabling a new value-based approach to product selection, while leveraging clinician expertise for process improvement.