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Value Analysis GuideThird Edition, 2018

3RD Edition. © 2018 Premier Inc.

http://www.premierinc.com

2018

A Letter from David HargravesValue Analysis Guide

Members and Partners:Top-performing healthcare delivery organizations understand the value of reducing variation and assessing proper utilization to improve quality of care, drive greater efficiencies and reduce the cost of care. Value analysis is a critical component to implementing such improvements. It is the model to collaborate, communicate and make supply chain decisions across disciplines for the betterment of patient care, and for the organization as a whole.

Every day, Premier’s supply chain professionals rely on the value analysis model to drive contracting decisions on behalf of our member organizations. We are committed to getting to true product value and actual cost for our hospital members, their employees and the patients they serve. We take this commitment very seriously.

Since its first release in 2014, this Value Analysis Guide has served as a forum to bring together the expertise and learning from top value analysis professionals within our membership, Premier and the healthcare industry. It is designed to help you set a course to drive, reinforce and reinvigorate your value analysis program. Wherever you are in your value analysis journey, we believe the best practices shared in the pages of this third edition Value Analysis Guide will enrich your program and propel your organization to greater success.

Sincerely,

David HargravesSenior Vice President, Supply Chain, Premier

Value Analysis

2018

Table of Contents

01 Introduction to Value Analysis .........................................................01

What is Value Analysis? The Purpose of Value Analysis Value Analysis Guiding Principles Value Analysis Best Practices for Today’s Healthcare Reimbursement and Payment Reform Considerations Partnering with Suppliers

02 Value Analysis at Your Organization ............................................. 07

Assess Your Organization’s Value Analysis Maturity Create Value Analysis Teams Establish Your Value Analysis Methodology

03 Value Analysis Methodology ............................................................. 14

Identify Gather Information Analyze Implement Monitor

04 Value Analysis Methodology Applied ............................................ 24

A review of female external catheters by Genesis Health System

06 Contributors ............................................................................................37

05 Resources ............................................................................................... 29

Value Analysis Process Flow Implementation Process New Product Request Form Product Value Assement Product Evaluation Form Product Education Rating Scale ValueAnalysisPeerConnectionandCertification

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01

Similar to our supply chain colleagues across the country, we are focused on reducing unnecessary clinical variation, lowering our overall cost and increasing efficiency. Only through establishing and maintaining a reliable and effective value analysis process will we be able to provide safe and reliable products and services to enable exceptional clinical care.

Sofya Mikhelson, FPN, SCSC, BISystem Director, Supply Chain Fairview Health Services, Minneapolis, MN

Introduction to Value Analysis

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Value Analysis Introduction

What is Value Analysis?Though the term may not be familiar to you, value analysis is nothing new. We use value analysis concepts every time we are faced with our own purchasing decisions. Our personal purchasing drivers may be different than those in a healthcare environment, but it is still value analysis.

Let’s look at a real-life example in Figure 1 to help illustrate. You’ve decided to make a salad for dinner, and you’re at the grocery store comparing three different options for lettuce.

As you review the available options, your brain automatically starts to work through their differences and your own drivers that will inform your purchasing decision.

The purchasing decision is made relatively easily, on your own and in a matter of seconds or minutes. Later, when you eat the lettuce, you’ll determine how satisfied you were with your decision and whether you will purchase it again. You’ve conducted a value analysis!

If we evaluate a more complex purchase decision – such as a car or house – the weight of the decision becomes more serious. More stakeholders are involved, the option differences and decision drivers become heavier, and the process may last longer to both come to a decision and evaluate its effects.

In healthcare, this value analysis process is even more complex. Patient care, rather than personal desire, is the focus. And, it requires subject matter expertise from across the organization to determine decision drivers, weigh options and assess outcomes for patients and the organization.

FIGURE 1: Illustrated Real-Life Example of Value Analysis

Individual Head of Lettuce

Organic Head of Lettuce

Salad Kit, Including Dressing

DifferencesIt’s the least expensive,

but you’ll need to buy other items if you want a full salad.

It may be healthier than option A. You’ll still need to buy other items if you

want a full salad.

It’s the most expensive but includes everything you need to make a full salad.

Decision Driver

Your main driver is expense, or you already have the rest of the salad ingredients at home.

Your main driver is only buying organic.

Your main driver is to have a quick and easy salad

option, and the expense is not a factor.

Value Analysis (n.) – a systematic, objective process for providing an evidenced-based methodology to evaluate current and emerging technologies in order to reduce/manage expenses by considering alternate products, services and practices which meet, but do not necessarily exceed, the clinical and end user’s specifications, while maintaining or improving safety and quality of patient care.

Adapted from AHVAP 2017

OrganicFarm Fresh Salad Kit

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The Purpose Of Value AnalysisValue analysis is a process for how healthcare organizations obtain supplies, services and equipment. It considers care delivery, safety and outcomes first, and then factors in total cost. This ensures that high-quality supply and service decisions are made in a fiscally responsible manner.

Value analysis programs, processes and decisions must be structured within a framework of quality and safety, focusing on the appropriate utilization of supplies and services. It must also follow applicable organizational processes and support the health system’s mission, vision and strategic goals.

It strives to balance issues related to quality, patient and staff safety, revenue enhancement and reimbursement optimization across the continuum of care. This is accomplished through:

• Appropriate standardization,• Pricing optimization,• Implementation of cost-savings initiatives, and• Identification and elimination of waste, redundancy and inefficiency.

Value Analysis Guiding Principles

Value analysis programs:• Use value analysis multidisciplinary teams that include

physicians (optimally with a physician co-chair).• Strive to improve and establish relationships with departments to identify new opportunities.• Establish a method for capturing and tracking value analysis cost

savings, process improvements and/or revenue enhancements.

Value analysis teams (VATs):• Engage physician advocates and vital stakeholders in the value analysis process.• Select products and services that promote the highest standard of care at the lowest cost.• Evaluate requests for products and services based on impacts to:

– Clinical outcomes,– Patient and worker safety,– Current processes, and – Total cost of care and other financial influences.

• Establish trial criteria and monitor all trials.• Routinely review the use of products and services that have a high

impact on patient care or the organization’s financial health to assess appropriate utilization and suggest potential alternatives.

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Value Analysis Best Practices For Today’s Healthcare

1. Create a foundation of holistic and robust data to rely on. Inventory current data sources – including internal, external and GPO-based solutions – that can provide decision support around cost, quality, outcomes and reimbursement. If this capability does not exist, work with your IT department to make a business case for acquiring or building access to these information sources. Without data, evidence-based decision making cannot take place.

2. Make your time meaningful. Stay focused and have data prepared in advance of value analysis team meetings. Have a core group of regular attendees at these meetings. For streamlined workflow and more efficient decision making, invite other attendees selectively on an ad-hoc basis to provide targeted expertise.

3. Take control of new product approval. Create an electronic system for new product requests that product suppliers cannot access. This will automate workflows and prevent new product requests from suppliers without requisite proof of value to your patients and organization.

4. Transition from reactive to proactive processes. Dedicate a steadily increasing portion of the value analysis agenda for proactive assessment of critical procedures or DRGs, with a call to examine what is used within a procedure when issues with cost, quality or outcomes are identified.

5. Leverage findings within the organization. Communicate uncovered organizational improvement opportunities (e.g. unjustified variation, improper coding, etc.) to the applicable areas of the organization so improvements can occur.

6. Monitor, monitor, monitor. Ensure your work continues beyond decision and implementation. All implemented changes are done so with an outcome or goal in mind. Track to the goals until you are sure you have optimized the opportunity and ensure that any changes to process are holding strong.

Reimbursement and Payment Reform ConsiderationsThe decision to reimburse is based on three related tenets: coverage, coding and payment.

• Coverage: Is the service or product considered part of an insured patient’s benefits? Coverage refers to the process and criteria used to determine if a product, procedure or service is reimbursable. Medicare is the most influential entity in the coverage process. Private payers follow Medicare’s lead in developing their own coverage policies. So, if it isn’t covered by Medicare, chances are, it’s not covered by other payers.

• Coding: Is the service or product identifiable? Codes are developed through the joint efforts of the American Medical Association (AMA), the American Hospital Association (AHA) and the Centers for Medicare & Medicaid Services (CMS). Some code systems are referred to as CPT, HCPCS-HCFA or ICD-10. In addition, Z-code identifiers are associated with specific CPTs and are related to a very wide array of molecular and genetic testing, including gene sequencing, and have become mandatory for reimbursement. These codes are important for technology manufacturers because they enable an insurer to more easily recognize, process and pay for claims involving the use of a product.

Adapted from “What is the Future of Value Analysis? Hint: Not New Product Approvals.” October 10, 2017, Robin Czajka, CARN BC CMRP.

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• Payment: Is the service or product covered? Payers differ on what they will cover. Recently, there have been shifts in the market on not only what services and products payers will cover, but where that service or product was administered (i.e., what care setting). It’s essential for value analysis leaders to understand the organization’s payer mix, what they currently cover, and how that aligns with the payment programs the organization participates in.

The Affordable Care Act pushes hospitals to become more clinically and financially accountable for improving quality and safety and reducing costs. Hospitals are financially incented or penalized to cost-effectively take care of patients and deliver good outcomes.

There are currently three main programs measuring hospital performance. The goal of these programs is to transition from a volume-based, fee-for-service payment model to one where hospitals are incented to improve the health and outcomes of their patients beyond their direct control.

1. The Value-Based Purchasing program is the only program with a bonus component. This program takes or rewards a percentage of a hospital’s inpatient Medicare base operating payments. Four domains are measured: clinical care (measuring mortality), patient and caregiver experience, efficiency and cost reduction and safety. The program is budget-neutral so the “losers” pay the “winners.”

2. The Hospital Readmissions Reduction program tracks the “all cause” 30-day readmissions for several defined conditions, such as heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease (COPD), total hip or total knee, and coronary artery bypass graft (CABG). The goal is to keep patients healthy and out of the hospital.

3. The Hospital Acquired Conditions (HAC) program penalizes the worst performing hospitals (those in the bottom 25 percent) a portion of their total Medicare payments. The measures are calculated from the Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSI) and the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN). Without a “present on admission” (POA) flag, hospitals are no longer paid additional costs associated with certain conditions considered to be preventable, such as catheter-associated urinary tract infection (CAUTI), patient falls or surgical site infections following certain procedures.

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Partnering With SuppliersIt is incumbent on suppliers to understand the impact of the changing market landscape on the organizations with which they do business. There is so much more to a healthcare purchase than may be conveyed by contracts, purchase orders or invoices. The work leading up to a purchase decision, the implementation of that decision and the monitoring of its success can be complex. Suppliers should take the opportunity to differentiate themselves by expediting and easing the load.

There are many areas where manufacturers are uniquely positioned to support clinical value analysis. One area of strong focus includes providing up-to-date coding and reimbursement information when applicable. Also, manufacturers should be sensitive to the fact that although a device may be new or a new therapeutic use has been developed for an existing device, there may not be any difference in procedural reimbursement. Hospitals no longer have the luxury of absorbing “new to market” costs while insurance catches up, and manufacturers can help drive clinical value by ensuring products are priced accordingly.

Suppliers who actively seek to partner with integrated delivery networks (IDNs) can bring tremendous value. Manufacturers can demonstrate partnership by:

• Demonstrating how a product will measurably improve high-quality patient outcomes.• Providing transparent functional analyses of proposed items against items currently available.• Performing consistent strategy planning to assist healthcare

customers in reducing or managing supply costs. • Offering value-added components that support organizational goals. • Providing educational support to healthcare customers. • Establishing a thoughtful, strategic conversion plan to assist customers with

successful conversion or adoption of new products or technology.

In addition, the advent of bundled payments and accountable care organizations (ACOs) are incenting providers to take financial risk for a defined population of patients over an extended period of time. These are forcing healthcare supply chain leaders to look beyond the four walls of the hospital.

What can supply chain leaders do to ensure that your hospital will be a leader, both clinically and financially?

• Develop robust value analysis programs that truly focus on the intersection of cost, quality and outcomes.

• Look at all criteria in product selection, not just cost.• Understand the long-term implications of the decisions that are made.

A cost-savings decision incurred today by changing or eliminating products could result in a much larger penalty later.

• Become familiar with your hospital’s current results in the payment reform programs and put processes in place to ensure your team is focused on contributing to your hospital’s improvement.

• Expand or improve your department’s reach into the non-acute side by involving key individuals in your decision making and assisting in product selection.

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02Value Analysis at Your Organization

China Krupin, MSN, RNClinical Value Analysis Specialist, Surgical Services Bon Secours Health System, Marriottsville, MD

Bon Secours continues to grow stronger as a healthcare system as we responsibly manage our resources and continue to nurture our Clinical Value Analysis (CVA) program. I am very excited to be a part of the team that continues to strive for best practice in all value analysis domains.

Through close collaboration with clinicians, physicians, contracting, materials management, data management and all of the patients and staff who come into contact with the products and services we offer, at Bon Secours Health Care System, Inc. our culture is one that supports the CVA model as it continues to mature.

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Value Analysis

Incorporate patient perception into value equation

Acute and post acute providers

and patients participate in

high performance VATs

Greater assumptionof risk by providers

Clinical decision support tools

include appropriate-use data accross

the continuum

Clinical registriesconnect outcomes

with products and devices

Data aggregationcapture outcomes

of patients andpopulations overtime at different

levels of the system - micro,

macro, communityand region

Dedicated serviceline multi-

disciplinary teamsin place (physician

co-chair)

VATs align withorganizational

culture and goals

VATs always takinginto consideration cost, quality and outcome data to drive decisions

(EMR, MMS, protocols,

national metrics)

Appropriate use forphysician preference

products

Value managementsoftware (includesanalytics, projected

savings, valuemeasurement)

Training is expectedand certification is

encouraged

Formal structure ofteams with moderate

multidisciplinaryrepresentation

Deliberations on cost, quality and outcomes

occur moderately

Frequent use of evidence

Reduce or eliminatewaste and variety

Appropriate use forclinical preference

items

New technology assessment

Project managementsoftware for planning,tracking and reporting

VA training encouragedand provided

Shared responsibility,but varies bydepartment

Process is led bysupply chain

Moderate use ofevidence

Process typicallybegins with new product request

Tracking limited tocost savings

Infrequent VAtraining

Responsibility limitedto supply chain

Reliance on supplierprovider data

Infrequent use ofevidence

Little process and/or process

variation

Reactiveand pricefocused

Cost reduction

withsome

standardization

Quality,waste

reductionand

standardization

Totaleffectiveness

in accutecare

Totaleffectiveness

across continuum

Low

Medium

High

Best Practice

Future

At Your Organization

Assess Your Organization’s Value Analysis MaturityWith a variety of considerations to balance when making purchasing decisions, including clinical, quality, safety and cost, how do you apply a rigorous value analysis process at your organization?

After surveying our members – including academic medical centers, integrated delivery networks, community hospitals and stand-alone hospitals – we learned that value analysis programs vary in depth and maturity across the membership.

To help assess your organization’s maturity level, we’ve created a few tools:

Value Analysis Maturation Scale

Designed to assist you in assessing your organization’s level of maturity with value analysis, this scale will help you understand your current state and provide guidance on what you need to accomplish to move to your ultimate future state.

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Value Analysis At Your Organization

An accompaniment to the Maturation Scale, this video provides additional information about the scale, explaining each step.

This tool (for Premier members only) allows you to perform a self-assessment to help your organization understand its current state, identify current tools and process, and give you a path for growth. We recommend completing this self-assessment annually to track progress along the Maturation Scale.

Value Analysis Maturity Video

Value Analysis and Contract Complexity Rating Tool

The Value Analysis Maturity and Contract Complexity Rating Tool is available in the PremierConnect ® Value Analysis Community. Download it here.

https://communities.premierinc.com/display/VA/Premier%27s+Value+Analysis+Guide?preview=%2F12616460%2F18175898%2FPremier+VA+Maturity-Contract+Complexity+Rating+Tool+final.XLSX


https://vimeo.com/282902267/12da3fcc6c

https://vimeo.com/282902267/12da3fcc6c

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Create Value Analysis TeamsFor any value analysis program to work properly, you need engagement and discipline from your value analysis teams (VATs). Below are some pointers to consider when setting up and managing VATs.

Identify participants and roles:• Each VAT should have C-suite support, ideally from the CFO.• Strong clinical leadership is needed for each VAT. Ensure your VATs are physician led.• The VAT manager needs to develop a good working relationship with product end users.• VATs should be multidisciplinary with stakeholders from

a variety of departments and service lines. – Create discipline-specific VATs: Operating Room, Cardiac Catheterization Lab, Clinical

Lab, Pharmacy, Medical/ Surgical Units, Facilities/Environmental Services, etc.– Include participants from other patient care disciplines like infection control,

sterile processing, etc.

Develop and maintain rigorous process:• Hold routine meetings.

– Prepare an agenda ahead of time to improve flow of topics/discussion.– Track attendance.– Document the discussion clearly and completely.– Clearly communicate to anyone impacted by the decisions made during meetings.

• Organize projects with timelines and responsibilities. Keep task owners accountable for on-time delivery.

• Allow the team to make commodity product changes with little to no evaluations.• Remain cost conscious but do not risk quality.• Document all goals and subsequent cost savings achieved. Report regularly to stakeholders.

Enable consistent and abundant communications:• Establish consistent communication pathways for all stakeholders, including

routine reporting to department and service line meetings. • Since including VAT participants who are geographically disparate can be difficult,

investigate tools that will allow and enable participation no matter the location.• It can sometimes be difficult to receive evaluation forms for feedback on a project.

Look at tools and resources that will make this process more efficient so you get the feedback and information you need to make informed decisions.

• Research analytical tools available for value analysis so you and the VAT can assess progress and document achievements.

• VAT decisions do not always reach staff who are directly caring for patients. In addition, VAT members don’t always communicate with their facilities. Secure technological resources and put standards in place to ensure down-the-line communications of your decisions and their impact.

• Develop a feedback loop to solicit feedback on communication effectiveness from stakeholders and implement improvements as necessary.

• If available, use electronic dashboards and automated notifications.

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Provide continuous education:• With any new product or change in product, ensure appropriate

education is delivered to appropriate staff and stakeholders.• Coordinate education efforts across departments and service lines to ensure

integration. Complex conversions may require follow-up to ensure adherence. • Provide generous notice for educational events and subsequent product

conversions so staff and stakeholders have time to prepare.• If in-services are required, document attendance and follow-up with absentee

staff. Determine who is responsible for follow-up with absentee staff.• Confirm supplier support in education efforts, but do not rely

on the supplier to document the education. • Outline all plans for trials, conversions and education, with specific dates for

each. Make sure that all parties are on board with start and end dates.• Send regular emails to clinical areas with details and information of upcoming trials/

conversations, implementations, issues with sourcing (i.e. backorders, FDA issues), etc.

Challenges to prepare for:• Suppliers may go around the process to get a product into the

system. Have a plan to address vendor submissions. • Staff and physicians may also try to work outside the value analysis

process. You will need rigorous process standards and C-suite support to change the culture and status quo behaviors.

• There can be a lack of consistent understanding of how a cost-benefit analysis is performed. Educate members of the VATs and other stakeholders so this can work to your advantage.

• Plan for potential delays in decision making.• Lack of critical clinical stakeholder involvement is common due to competing

priorities. Have a back-up plan for clinical participation if and when needed.• Lack of standardization, whether around products, processes or suppliers, can be difficult. • Prepare for hold-out facilities within the system. You’ll need sufficient evidence

and C-Suite support to get them on board with the VAT decision.

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Establish Your Value Analysis MethodologyValue analysis methodology is a set of processes on which your value analysis projects rely. It is used to set the tone, values and expectations of your value analysis program, and it requires communication and buy-in across the many stakeholders who influence the goals and success your program delivers.

For a sound value analysis methodology, we recommend that your value analysis projects follow five key processes:

1. Identify. Uncover the opportunities to address.

2. Gather Information. Determine and gather the requisite data, content and information to evaluate the opportunity.

3. Analyze. Weigh all of the evidence gathered to make the right decision for your organization and the impacted stakeholders.

4. Implement. Efficiently implement the decision.

5. Monitor. Measure and report on decision sustainability and value over time.

These processes are often fluid, requiring a revisit of one process while you are in the middle of another. For example, you may be in the midst of the analysis phase and find that you need to go back and gather more information. Or, as you monitor, you may notice that an area of implementation needs to be re-addressed.

Throughout all processes, engage the appropriate value analysis team and stakeholders. Opinions may be strong, but healthy discussion is good – it can promote buy-in as all parties are heard, concerns are unearthed, holistic decisions are made and any subsequent conversions become much more collaborative. By having ongoing communications from the onset, any concerns or questions are more likely to be vetted out early and late stage surprises mitigated.

ValueAnalysisProcesses

Methodology sourced from AHVAP and adapted based on subject matter expertise from Premier members and staff.

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Potential Project Roadblocks or Detours

• Conflicts of Interest Check to see if your organization has a policy regarding conflicts of interest. If so:– Understand individual stakeholder conflicts when inviting them to participate in a project.– Determine project participation level as organization policies prescribe.– Ensure value analysis project stakeholders are aware of any

impact the policy may have on the stakeholder role.– On a project level, ask suppliers for a disclosure of anyone their

company is actively working with in your system.

• Supplier Marketing It can be difficult to unravel all the information that may be available regarding a product or service. Whenever possible, ensure the information you are reviewing as to product or service efficacy or claims of differentiation are based on third-party reviews, white papers or studies.

• Clinician or Physician Preference The first question you may want to ask is “Why?” Understanding the clinical preference of a product may allow for:– The introduction of products with similar characteristics that

maintain or improve care while reducing costs.– “Aha” moments that surface related to where the preference derived. Perceptions

and preferences may have come from any number of experiences.– Preference backed by efficiency, patient satisfaction or outcome

evidence should be considered in the final purchasing decision.

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03Value Analysis Methodology

Hunter Chandler, MBADirector of Supply Chain Information Systems Wake Forest Baptist Medical Center, Winston-Salem, NC

We tout the use of data as the next frontier of value analysis, but we often fail to respect the translation skills required to move from data to value. We have to approach the use of data the same as we approach traditional value analysis, with empathy for the end-user and what they need to care for their patients.

This takes listening, collaboration and a natural curiosity around the data itself. Let the question ‘Will presenting the data this way provide value to the people who are able to make change?’ nag you at all times. If the answer is ‘no,’ keep working it. If the data does not speak to the change agents and the end-users, it is useless.

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Value Analysis Methodology

Identify

Value analysis project suggestions or imperatives come from a variety of sources. Depending on your organizational culture and engagement, there may be several internal and external stakeholders suggesting value analysis projects via a formal or informal request process.

Below are some ways you can ensure you are creating a value-driven project queue that meets your program goals:

• Respond to strategic initiatives at your organization.• Examine quality and safety issues that impact patient care, outcomes or readmissions.• Review payer and reimbursement changes to proactively react to market changes.• Review contract compliance to ensure you are meeting contractual

obligations for value received (e.g., price, rebate, etc.).• Look for potentially unjustified variation to assess standardization opportunities.• Assess new regulations and new evidence-based practice

that may call for organizational change.• Address defective products and recalls for uninterrupted quality care.• Review capital budget requests to align work where applicable.• Identify savings opportunities.• Actively strategize with suppliers to reduce supply cost where feasible and appropriate.

With any identified opportunity, always assess two items:

1. Validate the need. For a value analysis project to occur, you should define what current problem the project is designed to address and identify future requirements.

2. Rate the project complexity. To eliminate re-work during the project and expedite decision making, identify and define:

• The level and type of evidence required, and• End-user input required.

40%

Roadblocks to Identifying Opportunities

Lack of process forbusiness case analysis

32% – Conflicting goals for priority and time

12% – Discipline to complete request forms

8% – Manual process

8% – Lack of resources

4% – Cultural challenges around process adoption

Data source: Premier Solution Design Workshop, September 2017. Respondents allowed to choose multiple roadblocks.

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Premier Member Resource: Premier’s Contract Complexity Rating ToolPremier’s Contract Complexity Rating tool consists of 27 attributes within nine domains. The level of complexity is directly related to the time and resources necessary to evaluate and implement product contracts. Within the tool, you will also find best practice considerations, estimated timeframe and resources required.

The Value Analysis Maturity and Contract Complexity Rating Tool is available in the PremierConnect® Value Analysis Community. Download it here.

Level I Level II Level III

Value-Based(Minimal Conversion)

Value-Based / Evidence-Based

Regulatory, Patient Safety, Utilization, Reimbursement,

Clinical Leap

• Contract renewal

• Minimal contract modification

• No trial required

• Same provider

• General financial analysis

• Low impact on patient outcome and can be used interchangeably

• Item is regulated and/or legally required

• Contract renewal

• Tier modification

• Some conversions - vendor consolidation

• Limited trial or clinical validation

• Department head or clinical service line approval

• Input from multiple stakeholders

• Can affect patient outcome with minor clinical or operational practice

• New/alternative items that currently have an equivalent that cannot be interchanged without staff or physician education or discussion

• New/alternative items that do not have an equivalent but are not physician preference

• Standardization - moving from many to one or two suppliers and/or products

• Input from multiple departments or committees needed

• Complex analytics

• Structured in-depth trial is required

• Known political or other sensitivities

• Almost always need support of physician or service line director

• Clinical requirements may outweigh desired financial outcomes

• Requires evidence or equivalence study

• Usually affects physician or nursing practice change

• Items specific to a limited group of physicians

• May be the “only” or one of a few solutions to perform service or deliver care


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Gather Information

Each opportunity and project will dictate the type of information and the depth of evidence required. As you start to gather information, consider the end goal and analysis needed to get there. There are some common information sources that you’ll want to pull from to validate project complexity, information and evidence requirements, relevant stakeholders, and work plan design.

Below are common information sources from which to gather all information required:

• Collect annual spend and usage data.• Identify supplier capacity – historic and projected.• Obtain all pertinent cost and support data.• Identify key clinical and non-clinical stakeholders and utilization practices.

– Assess current practice related to supply, equipment and purchased services.– Identify like and current products being used and determine

percentage of conversion (full vs. partial conversion).• Conduct a literature review.• Obtain benchmarking data – price, cost, quality, labor and outcomes as applicable.• Identify product specifications and compare to defined clinical requirements and outcomes.• Collect reimbursement information when applicable.• Use information from regulatory agencies.• Review policies, procedures and guidelines.

38%

Roadblocks to Gathering Information

To difficult togather information

33% – Determining functional equivalence

13% – Missing payer data

8% – Lack of access to peer-reviewed evidence

8% – Difficult to gather data on new products

Data source: Premier Solution Design Workshop, September 2017. Respondents allowed to choose multiple roadblocks.

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Premier Member Resource: Value Analysis ToolkitsWith nearly every launch of a new product or service category, Premier releases value analysis toolkits in Supply Chain Advisor® to expedite member value analysis processes, helping them select the most appropriate product for the patients they serve.

Gathering Data that Speaks to PhysiciansWhen physicians want to understand which products provide value and impact outcomes, they typically look to their peers and peer-reviewed journals. It’s important that supply chain and value analysis leaders serve as a resource for comparative information, bringing evidence and outcomes to the table.

How Suppliers Can HelpAsk suppliers to provide:

• Manufacturer position on how new products support improved patient outcomes over their own current technology or competitive items in the marketplace. This should routinely be part of their product literature!

• Up-to-date coding and reimbursement information.• Total cost projections.

Best practices sourced from AHVAP and adapted based on subject matter expertise from Premier members and staff.

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Value Analysis

Analyze Data,Content andExperience

Validateor Evaluate

Based onAnalysis

Negotiatewith Supplier

During theProcess

Methodology

Analyze

The analysis phase in the methodology is critical. During this step each opportunity is vetted for cost and quality outcomes. Depending on your value analysis maturity, different analysis processes will be used. Best-in-class organizations combine both cost and quality analysis, as well as industry-driven impacts, physician preference, and reimbursement and payment reform considerations. It is important to note that while this guide outlines best practice, the analyze phase can and should be modified based on the organization’s needs and structure.

Analyze Data, Content and ExperienceThe purpose of the Analyze phase is to bring disparate information that has been gathered to tell a story. In the end, you should have a total cost, quality and outcomes story along three areas that looks at both the historic or current picture versus the potential landscape of change. These areas include:

• Clinical and product information – Viability and availability• Quality, safety and operational information – Experience, process and outcomes• Financial and contract information – Total cost and reimbursement

Validate or Evaluate Based on AnalysisTo ensure product viability, process differences and overall experience, organizations typically validate or evaluate products. The choice of which path, validate or evaluate, and the scope of the initiative will vary by project.

When to validate:• A clear winner emerges from a clinical or financial perspective.• A product conversion may be easy to achieve.• A new vendor is not being considered.• The product is already in use at the same location.• Conversion will not have a far-reaching impact.

Validations can be done in one day if the right focus group is convened.

93%

Roadblocks to Analyzing Opportunities

Absence of holisticdata to evaluate

3.5% – Lack of appropriate resources to conduct analytics and evaluate

3.5% – Lack of consistent and repeatable process for communication, trials and negotiating

Data source: Premier Solution Design Workshop, September 2017

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When to evaluate:• No clear winner is apparent from a clinical and financial perspective.• Product conversion may be difficult to achieve.• Conversion will have a far-reaching impact.

Prior to either process: • Facilitate the process with the supplier.• Select areas who will participate (service lines/departments/

facilities) based on volume of use or special needs.• Select individual(s) to champion evaluation/validation.• Obtain product samples. Avoid using a free product for evaluations.

If you do, then no-charge purchase orders must be issued.• Provide any necessary training for clinicians participating in validation/evaluation.• Ask for input from potential product users on clinical acceptability.• Identify key criteria to measure: quality, safety, outcomes, effectiveness.• Develop an evaluation tool based on key criteria, avoiding

subjective words such as “like” or “dislike.”• Define timeframe parameters.• Keep evaluations short – less than two weeks for most products.

Suppliers can help by facilitating pricing concessions with initial uses/adoption of new technology in exchange for institutional evaluation of the product.

Negotiate With Supplier During The ProcessYour potential total costs will depend on supplier negotiations and your due diligence.

• Complete cost analysis to ensure soft costs and reimbursement are considered, as applicable.• Conduct negotiation.

– Identify purchase versus lease benefits, if applicable.– Evaluate consignment or supplier-managed opportunities.– Consider applicability of risk-based contracting.

• Determine final financial impact.

Evaluate Total Cost Of OwnershipTotal cost of ownership is the sum of all costs associated with a product or service or its life. It considers the product or service itself, rebates, training, education, warranties, maintenance, service, consumables, shipping, etc. Only by calculating total cost of ownership can you truly understand the financial impact of your decision.

Establish Committee DecisionThe analyze stage will conclude with a committee decision – ensuring a balanced decision does not always mean giving equal weight to each piece of information. Depending on what is being reviewed, the balance between clinical outcome and financial impact may be uneven. In the case of an agreed commodity, financial impact may weigh very heavily. In the case of an emerging technology, the clinical outcome information may prevail. During your decision point, restate the rationale for the decision and expected outcomes or goals.


2018 | 21


Implement

Implementation is really a four-step process. It requires:1. Planning 2. Communication of the Plan 3. Education 4. Implementation

PlanningEngage your key stakeholders in creating the plan. We suggest you consider the following questions:

• How do your key stakeholders define a safe and effective implementation for this project?• What do your key stakeholders need to fulfill their role with this new implementation?• What ongoing support is needed beyond implementation?

Communication of the PlanWhen you begin communicating the plan, remember:

• Communications must be accessible, consistent, timely and directed to the appropriate parties.

• Communication starts at the onset of a project and considers what needs to be messaged to whom and at what time.

• Use existing communication templates/processes where possible.• If your organization does not have a template communication plan or messaging templates,

look to past initiatives to see what worked and repurpose success wherever possible.

36%

Roadblocks to Implementing Opportunities

Implementingacross a system

28% – Consistent and appropriate communication

12% – Involving the correct stakeholders

12% – Training and education for all users

8% – Balancing against other priorities

4% – Defined success metrics


2018 | 22


EducationProvide education that is specific to the need and is accessible to participants. By applying a score to the following questions, healthcare organizations have been able to determine whether education is as simple as basic information in a memo, requires a mandatory in-service program, or lies somewhere in between.

• How complex is the product/equipment?• How high is the potential for harm – patient and clinician?• How high is the margin for error?• What is the amount of new knowledge that is necessary?• Will staff need to change their standard procedures to use the product or service?(Please see resource example on page 35.)

ImplementationDuring the implementation:

• Ensure adequate support is provided by the vendor.• Conduct rounding and provide active oversight during

the implementation to address any issues.(Please see resource example on page 31.)


Suppliers can assist in implementation by providing:

• Implementation plan with calendar.

• Systematic education plan and roll out plan for IDNs that can be tailored to need.

• Communication plan and/or communication materials.

• Timely contract activation acceptance and proactive conveyance of information to partners including distribution.

2018 | 23


Monitor

The outcomes that you measure and the control team that will track progress will vary based on initiative. Reflect on your original project goal and the requirements of success to ascertain how often and by whom outcome measurement is required.

• Cost savings efforts may be reviewed on a quarterly basis by the responsible financial party (e.g. supply chain executive, CFO). If part of this effort requires a new process of vendor management, ensure there is someone on the control team who can report on process successes and challenges.

• Quality efforts such as infection reduction (e.g. CLABSI, CAUTI) may require ongoing surveillance by your infection prevention and quality teams. If part of this effort requires new clinical processes, ensure there is a clinician responsible for reporting process change adherence for impacted areas.

• Review compliance metrics to evaluate the success of a project (clinical, financial, safety, quality, outcomes and impact).

It seems simple enough. Know what you need to measure, who are the best to measure and report back. But if not done well and with considered thought, entire projects can be abandoned and considerable work lost.

59%

Roadblocks to Monitoring

Data is difficultand manual

18% – Lack of escalation process and oversight

14% – Need more data to evolve past focus only on savings

9% – Don’t inspect what we expect


Suppliers can assist in monitoring by:

Developing and/or helping to measure key performance indicators to monitor clinical and financial results.

2018 | 24

Pamela Darnell, RN, MSNClinical Resource Consultant Billings Clinic, Billings, MT

Each implementation is an opportunity to review the processes that were used and identify problems or defects. We now use a Lean/Six Sigma process to make sure we don’t forget steps or key stakeholders for future projects. This is a huge step forward in developing standing value analysis teams for our organization.

04Value AnalysisMethodology Applied

2018 | 25

Value Analysis Methodology Applied


Member Organization: Genesis Health SystemProduct Reviewed: Purewick – Female External CatheterProduct Classification: New Technology

Comments: Product brought forward to the Clinical Value Analysis Team by Infection Control for use at all Genesis Health System facilities. Indicated for non-invasive, short-term urinary output management. Potential decreased risk of CAUTI and improved patient satisfaction.

Value Analysis Interventions Member Interventions

• Validate the need– Define current problem– Identify future requirements

• Review GPO contract compliance and identify opportunities

• Assess for standardization opportunity

• Assess new regulations and new evidence-based practice

• Address defective products/recalls

• Review capital budget requests

• Identify savings opportunities

• Respond to strategic initiatives

• Examine quality safety issues

• Complexity Rating

• Labor

Female patients with excoriated skin or urinary incontinence issues that require accurate intake and output of urine had to have a catheter insertion, which increased risk of CAUTI.

Identify a product that would be less invasive and reduce infections.

Materials Services reviewed GPO contracts and determined two products on contract – Purewick and Sage.

VAT determined Purewick product would be trialed. Decided against the Sage product because it was twice as large and twice the cost. A review of both products resulted in determination to trial Purewick for standardization in EDs, ICUs and inpatient floors.

This required no capital investment and an increase in costs to the health system vs. catheters would be $2,600 annually.

Improvement in patient satisfaction scores is one of the health system’s strategic goals. Trials of the product in CIU showed patients’ skin remained dry and intact, resulting in patient satisfaction.

Conversion to this product would require minimal staff training and little effort by materials or nursing to implement.

#1Step Identify

2018 | 26



• Collect annual spend and usage data

• Identify supplier capacity

• Obtain all pertinent cost and support data

• Identify key clinical and non-clinical stake holders and utilization practices

• Assess current practice related to supply, equipment and purchase services

• Identify like/current product being used and determine percentage of conversion (full vs. partial conversion)

• Conduct literature review

• Obtain benchmarking data

• Investigate community standards and list serves

• Identify product specifications and compare to defined clinical requirements/outcomes

• Analyze reimbursement information when applicable

• Utilize information from regulatory agencies

• Review policy/procedures/guidelines

Would result in annual cost increase of about $2,600 vs. catheter cost. We pulled usage of indwelling urinary catheters for one month and eliminated anyone who had retention, catheter was inserted for surgical procedure, or if catheter was already present upon admission. The remaining patient number was multiplied by 12 to give estimated annual usage.

The Clinical VAT was presented with the information by Infection Control. The VAT included representatives of all key stakeholders. The Materials Contract Specialist worked with the vendor to assess their ability to meet our supply demands.

The VAT recommended approval, but since this was an addition to formulary it had to then go before the New Technology/PPI Committee, made up of physicians and other key leaders in the health system.

The system research department pulled independent data and research on the product to determine clinical outcomes. The PPI Committee determined that research indicated positive clinical benefits and approved.

Our Business Intelligence Office and Reimbursement Office assessed reimbursement vs. cost and determined there would be no additional reimbursement as it was considered part of patient stay cost.

Clinicians in conjunctions with the VAT determined the product would not be appropriate for patients who are confused, have urinary retention or long-term indwelling catheters.

Gather Information#2Step

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• Complete cost analysis

• Conduct negotiation

• Identify purchase versus lease benefits, if applicable

• Evaluate consignment or supplier- managed opportunities

• Determine if evaluation is necessary

• Establish evaluation parameters

• Determine final financial, clinical, safety, quality and potential outcomes impact

• Explore educational needs and opportunities

• Establish committee decision

Done as stated above.

Pricing was per Premier contract and required no additional negotiation on pricing or contract terms.

A limited trial was approved by the VAT and completed within 30 days.

VAT determined a need to bring in the vendor to provide education during the trial and then after approved use of the product.


• Determine inventory management strategy– How existing inventory will be managed– Supplier/distributor notification

• Identify logistical plan

• Build item master and charge master, if applicable

• Develop and execute education plan– Include training schedule and process

• Design communication plan– Include rollout process outlining specific

tasks, due dates, accountability, etc.

• Collaborate to ensure policy/ procedure/guidelines are updated

The product is being stocked in Distribution and on ordering templates for all areas that carry indwelling urinary catheters.

Par levels were determined for each area based on potential usage.

The product must be ordered directly from the manufacturer since it is not approved to run through a distributor. On hands were adjusted in distribution to allow for extra time for direct purchases.

Staff Development worked with the vendor to educate all nursing units. Fliers were made and distributed to all units for discussion at Safety Huddles, emails were sent to nursing leaders and discussions occurred at the Education Committee’s monthly meeting.

No updates on policies were required since this is considered non-invasive. No doctors’ orders are required.

Analyze

Implement

#3Step

#4Step

2018 | 28



• Cost savings efforts may be reviewed on a quarterly basis by the responsible financial party.

• Quality efforts, such as infection reduction, may require ongoing surveillance by your infection prevention and quality teams.

• Review compliance metrics to evaluate the success of a project (clinical, financial, safety, quality, outcomes and impact).

Determined that cost increase would be more than offset by drop in one associated CAUTI. Infection Control to bring forward review of CAUTI numbers in six months after implementation to the VAT to compare to the baseline.

Monitor

Example used with permission from Genesis Health System, May 2018.

#5Step

2018 | 29

Steve Thomas, MBA, CMRPManager, Purchasing Genesis Health System, Davenport, IA

One of the most difficult and frustrating parts of value analysis is getting true physician engagement. There are organizational ways to attempt this, such as co-management. What has worked for me is getting involved in understanding their world - like asking to observe an open heart procedure or hip replacement. The rewards are huge, and it definitely gets us non-clinicians out of our comfort zones.

05Resources

2018 | 30

Value Analysis Resources

Value Analysis Process Flow

Value AnalysisCommittee Approval

Value AnalysisCommittee Notified

Value AnalysisCommittee Approval

RequestorNotified

RequestorNotified

RequestorNotified

Materials MgntNotified

Materials MgntOrders Product

In-ServiceTraining Engaged

Product Scheduledfor Evaluation

Product Evaluatedby Materials

Product Evaluatedby Product Expert

RequestorNotified

EvaluationCompleted

Urgent?

Recommended?

Recommended?

OTHERSALES REPPHYSICIANSTAFFDEPARTMENT HEAD

Value AnalysisCommittee Notified

Materials MgntNotified

Product ExpertNotified

Initial Review

YESNO

YESYES

NO

NO

Urgent?

Developed by Premier’s 2013 Value Analysis Advisory Council.

2018 | 31

Value Analysis Resources

Implementation Process

DISTRIBUTORSUPPLY CHAINCLINICAL KEYSTAKEHOLDERS

VALUEANALYSIS TEAM

BUSINESS KEYSTAKEHOLDERS

Product(s) Approvedfor Implementation

Consider if product willbe sourced direct fromvendor or via distributor

Is there acurrent product(s)

being replaced?

Key stakeholders areidentified (end users,

education, safety, etc.)

Training needs areassessed/trainingplan established

Determine if we use upexisting inventory orimmediately convert

Establish internalitem numbers/ prepare to order

Policy change needed?

Update EMR

Establish revenue codes

Add to change master

Notify distributorfor price/agreement

loading

Item established atdistribution center for

ordering (volumesordering info, etc.)

Conversion timelineestablished and finalized

Training provided to key stakeholders

Post-ImplementationFollow-Up

Communcation ofconversion plan sent out

Conversion

Developed by Premier’s 2013 Value Analysis Advisory Council.

2018 | 32

Key questions / information to collect for new product requests: Product and manufacturer information:

• Product/service name • Description of the purpose and function of product/service • Vendor/manufacturer • Catalog/manufacturer # • Sales representative name, email and phone number

Requestor or contact information:

• Primary requestor (name, title, email, phone, pager) • Clinical resource/subject matter expert (name, title, department, email, phone, pager)

Current practice and product/service request rationale

• On what diagnoses/procedures would you expect to use the request product? (description/CPT code) • Anticipated number used per year • What are you currently using to treat the types of patients on whom you would use the requested product?

o Current product name(s): __________________________________________________________ o Current product catalog number(s): __________________________________________________ o Current product MMIS number(s): ___________________________________________________ o List any concerns with existing product(s):

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

• How is this product more effective than what you are currently using to treat the same types of patients? • What other physicians or healthcare providers have agreed to change their practice if the requested product

is approved? • Where will this product be used?

o Main OR o ASC o OSC o Buyers o Cath Angio o Endoscopy o Imaging Services o Clinical Lab o Patient Care Units o Other _________________________________________________________________________

• Will this product be used in conjunction with a piece of equipment? o If yes, define: ___________________________________________________________________ o Is the required equipment already available within the health system?

• Does this product require training or in-service? • Does this product fall into the classification of green initiative? • Are there budgeted/approved funds for this product/equipment?

Disclosures

• Are you aware of any conflicts of interest (e.g., vendor, staff, physicians)? o If yes, please indicate circumstances surrounding potential conflict.

• Physician requestors: o Do you now, or have you in the past, received research support from the manufacturer? o Do you have a consulting agreement with the manufacturer? o Are you a member of an advisory board or consulting panel for the manufacturer?

New Product Request Form

Insert Health Systemor Facility Logo Here

2018 | 33

Value Analysis

Impact checklists can be converted into a scoring tool or a series of questions. OUTCOMES: Describe the product’s impact on patient outcomes

POINT VALUE Decreases mortality Decreases infections/complications

Decreases readmissions Decreases Intensive Care Unit (ICU) resources of length of stay Decreases procedural times No known impact on patient outcomes N/A

Select the BEST possible option listed below that serves as a Level of Evidence (LoE) to support the product’s impact on patient outcomes

POINT VALUE Meta-analysis of multiple controlled trials or randomized controlled trial Non-randomized controlled trial

Integrative reviews/descriptive or correlational studies Peer-reviewed professional organizational standards Vendor/Manufacturers’ data Theory-based evidence/expert opinion/case study

SAFETY and COMPLIANCE: Describe the product’s impact on safety and compliance

POINT VALUE Addresses Sentinel Event Addresses SAFE or near miss

Addresses survey deficiency Insures compliance-CDPH/The Joint Commission or other regulatory agency/body N/A

PRODUCTIVITY/SATISFACTION: Describe the product’s impact on productivity/satisfaction

POINT VALUE Addresses or reduces safety risk to staff Improves comfort/satisfaction (patient, MD, healthcare provider or staff)

Decreases steps/streamlines or automates process N/A

UTILIZATION: If this request is approved, would it: POINT VALUE completely replace the current product for you and all other users? partially replace the current product for you and all other users?

have no impact on the current product for you and all other users?

STRATEGIC GROWTH: Describe the product’s impact on strategic growth

POINT VALUE This product is linked to an approved business plan. Business plan number: ____________________________________________________ VP/Sponsor: ____________________________________________________________

Product Value Assessment


Sub-Section Title Here

2018 | 34

Value Analysis

Name: ________________________________________ Extension: __________________________

Job Title: ____________________________________________________________________________

Product Name: _________________________________ Manufacturer: ______________________

Start Date of Evaluation: _________________________ Length of Evaluation: __________________

Rationale for Evaluation:

□ Dissatisfaction with current product □ Physician driven

□ Expense reduction □ Physician request

□ New supplier’s product □ IT request

□ Not applicable

Please circle the appropriate rating: Acceptable Neutral Unacceptable 1. 5 4 3 2 1 2. 5 4 3 2 1 3. 5 4 3 2 1 4. 5 4 3 2 1 5. 5 4 3 2 1 6. The product does what it is expected to do. 5 4 3 2 1 7. Accessories are easy to use. 5 4 3 2 1 8. Safety features operate reliably. 5 4 3 2 1 9. Functionality is acceptable. 5 4 3 2 1 10. The product performed reliably. 5 4 3 2 1

Comments/Opinions:_______________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________ Education or in-service needed? □ Yes □ No □ N/A Did this product meet your clinical needs? □ Yes □ No □ N/A Would you recommend this product for the health system? □ Yes □ No □ N/A Would you recommend and support conversion to this product? □ Yes □ No □ N/A Evaluator Signature: _________________________________ Date: ___________________________

Product Evaluation Form


2018 | 35

Value Analysis

Product: _________________________________ Date: ___________________________________

Company: ____________________________________________________________________________

Company representative: ________________________________________________________________

Please circle each area rated: Complex Simple Product/equipment use 1 2 3 4 5 Patient risk 1 2 3 4 5 Clinician risk 1 2 3 4 5 Need for accuracy 1 2 3 4 5 Potential for error 1 2 3 4 5 Amount of new knowledge necessary 1 2 3 4 5

Total score: _________________________________________________________________________ Score (recommended level of education) < 12 Certification program – quiz/competency validation/checklist 13-25 In-service program (no certification required) 26-30 Communication of information by memo or through staff meeting Circle which education applies: Communication In-service Mandatory In-service competency

Product Education Rating Sacle


Value Analysis

2018 | 36

Resources

Value Analysis Peer Connection and Certification Want to continue your education journey beyond this guide? Below are some resources for additional instruction and certification.

Association of Healthcare Value Analysis Professionals (AHVAP)AHVAP is nationally recognized as the preeminent clinical resource in providing education, resources and networking to value analysis professionals and promoting value analysis in the healthcare community.

Value analysis professionals drive value for their organizations by collaborating with clinicians and multi-disciplinary teams to deliver optimal patient outcomes in a cost-effective manner. AHVAP’s mission is to provide and promote processes and information to assist value analysis professionals in evaluating healthcare services for clinical quality and cost effectiveness.

AHVAP was a partner in developing the industry’s first and only healthcare value analysis credential: Certified Value Analysis Healthcare Professional.

Certified Value Analysis Healthcare Professional (CVAHP)CVAHP was created to meet a growing need in the healthcare industry – skilled value analysis professionals who can deliver outcome-driven, patient-centered care.

To be eligible for the CVAHP examination, a candidate must meet the following requirements:

• Associate degree or higher equivalent from an accredited college or university, and 3 years of associated healthcare resource and materials management experience.

• High school diploma or equivalent, and 5 years of associated healthcare value analysis experience.

For more information, visit the AHVAP website.

https://ahvap.site-ym.com/default.aspx

2018 | 37

Sandra Monacelli, MBA, BSN, RN, CNORVice President Acurity/Nexera, Inc., New York, NY

06Contributors

Value analysis is more than a process. It is a mindset. It is a culture. And when it is done right, it can transform an organization.

2018 | 38

Value Analysis Contributors

2018, 3rd Edition• Hunter Chandler, MBA – director of supply chain information systems,

Wake Forest Baptist Medical Center• Pamela Darnell, RN, MSN – clinical resource consultant, Billings Clinic• Roger Esparza, MBA – supply chain management, value analysis project manager, Harris Health• China Krupin, MSN, RN – clinical value analysis specialist,

surgical services, Bon Secours Health System• Don Landek, MS, MT(ASCP), SC(ASCP) – administrative

director, laboratory services, University Hospitals• Sofya Mikhelson, FPN, SCSC, BI – system director, contracting, Fairview Health Services• Amy Monroe, RN, BSN – corporate manager, supply chain management, McLaren Health Care• Laura Polson, BSN, RN-BC, CVAHP – system services director, clinical quality value analysis,

Baptist Healthcare System, Inc.• Jennifer Raltz, PharmD, R.Ph – senior director, clinical services, Yankee Alliance• Bill Richmond, CST – value analysis coordinator, Evergreen Healthcare• Cindy Siegel, MBA, CRA, CAAMA – corporate director

imaging operations, Universal Health Services• Steve Thomas, MBA, CMRP – manager, purchasing, Genesis Health System • Kitty Williams, RN, CMRP – VAT director, Riverside Health System

2014, 1st Edition• Cindy Christofanelli, RN, MSN, CMRP – system director,

supply chain management, SSM Healthcare• Pamela Darnell, RN, MSN – clinical resource consultant, Billings Clinic• Mary Gentile, RN, MSN – clinical value analysis manager, Baystate Health• Jim Gleich, RN – interim director, supply chain management, St. Anthony’s Medical Center• Kevin Hunt, RN, BSN, MBA, CMRP – system director, supply chain value analysis, PeaceHealth • Janee Macklin, RN, MSN – clinical utilization manager, McLaren Health Care• Linda Moore, RN, MSHA – clinical contracts manager, Rochester General Health System • Ann Marie Polichena, BA, MBA – client services manager, CHAMPS Group Purchasing • Lisa Rogalski, RTR, CMRP – director of materials services, Genesis Health System • Steve Thomas, MBA, CMRP – manager, purchasing, Genesis Health System• Jeannie Vaughn, RN, MSHA – value analysis director, Cape Fear Valley Health Systems• Dee Whittington, RN, BSN, CNOR – clinical supply program director, supply chain, Banner Health • Kitty Williams, RN, CMRP – senior manager, value analysis, Riverside Health System

2016, 2nd Edition• Pamela Darnell, RN, MSN – clinical resource consultant, Billings Clinic• Roger Esparza, MBA – supply chain management, value analysis project manager, Harris Health• China Krupin, MSN, RN – clinical value analysis specialist, surgical services,

Bon Secours Health System• Don Landek, MS, MT(ASCP), SC(ASCP) – administrative director, laboratory services,

University Hospitals• Donnie McLaughlin – director, logistics and value analysis, UT Southwestern University Hospitals• Ann Marie Orlando, RN, RCIS – value analysis specialist, Yankee Alliance• Steve Thomas, MBA, CMRP – manager, purchasing, Genesis Health System • John Vlahopoulos, PharmD, R.Ph – VP clinical services, Yankee Alliance• Kitty Williams, RN – VAT director, Riverside Health System

2018 | 39

Value Analysis Contributors

Thanks to Premier’s team of subject matter experts and contributors:• Shannon Candio, RN, BSN, BSBA, CVAHP, CMRP, Lean Six Sigma Black Belt –

principal, performance partners, Premier• Blair Childs – senior vice president, public affairs, Premier• Robin Czajka, CARN, BC, CMRP – service line vice president, Premier• Heather Dorsett, MBA – managing editor, Premier• Becky Leavitt, MBA – product director, cost management solutions, Premier• Traci McCoy, RN, MBA, CVAHP – senior director, comparative effectiveness, Premier• Karen Niven, RN, BSN, MS, CVAHP – director, performance groups, Premier• Jenny Sydnor, RN, BSN, MBA, CVAHP, Lean Six Sigma Black Belt –

manager, performance partners, Premier

© 2018 Premier Inc. All rights reserved. 13034 Ballantyne Corporate Place, Charlotte, NC 28277 | 877.777.1552

Contact us for more information on value analysis for your organization. [email protected] | 877.777.1552

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