A set of reporting and benchmarking tools helped CHE Trinity Health drive change in product spend and supply utilization

In July, a multidisciplinary team from CHE Trinity Health took the stage at the 2014 HealthTrust University (HTU) Conference in Nashville, Tennessee, to accept the first HealthTrust Innovation Grant—an award to be used for enhancements to an enterprisewide business intelligence platform. The Web-based platform helped drive more than $10 million in savings during fiscal year 2013 for the 82-hospital system, formed last year by the merger of Livonia, Michigan-based Trinity Health and Newtown Square, Pennsylvania-based Catholic Health East (CHE).

The platform pulls data into the analytics tool from a mix of sources, including point-of-care materials management and decision support systems, helping CHE Trinity Health identify variation, overutilization and product waste—from patient slippers to implants.

The HealthTrust Innovation Grant, provided as a $25,000 cash award and another $25,000 in HealthTrust service line support, will help the CHE Trinity Health team further expand the platform’s efficiency and usefulness as a cost-savings tool. The team will present an education session detailing the effort during the 2015 HTU Conference next August in Nashville.

“Solid information and analytics enable options for overall business performance improvement to surface,” says Melanie McMeekan, vice president of Business Solutions at HealthTrust. “What CHE Trinity Health has created is a forward-thinking approach to compiling the entire financial picture throughout the organization—from products being purchased to clinical choices being made. The data has also been tied to reimbursement information to demonstrate case profitability and capture the overall picture.”

Creating the System

Like many innovations, this one started with a simple question: What could be done with the supply utilization data the OR staff was inputting at the point of encounter? “In 2010, technology platforms had been consolidated into a single enterprise resource planning system, and we saw that we had a very robust data set,” says Scott Gasiorek, informatics director of Supply Chain and Fixed Assets Management at CHE Trinity Health.

The team tasked with answering that question included Kelley Young, director of Strategic Sourcing, and Lynne Farkas, clinical resource manager, Value Analysis. Gasiorek led brainstorming sessions that uncovered a desire to create a reporting system that could be used across the enterprise. The system envisioned would provide supply chain personnel with value analysis opportunities and give service line leaders timely information about product spend and utilization.

What they didn’t want was a tool that left decision-makers scratching their heads about what all the data points meant for them.

CHE Trinity Health’s tool includes common indicators for measurement and benchmarking. “With the addition of key performance indicators (KPIs), we can compare hospitals against a set of outcome objectives and point to areas of highest opportunities more effectively.” —Kelley Young CHE Trinity Health’s tool includes common indicators for measurement and benchmarking. “With the addition of key performance indicators (KPIs), we can compare hospitals against a set of outcome objectives and point to areas of highest opportunities more effectively,” says Kelley Young, director of Strategic Sourcing.

 

“Our goal was to create a tool that included common indicators for measurement and benchmarking,” Farkas says. “It’s what we needed to be able to compare hospitals with substantial differences in size, volume and case mix—and still be able to quickly identify variant product use.”

Initially, they worked in spreadsheet programs like Excel and EssBase, before building out the dashboard design in 2011 with the help of Brett Wist, manager of advanced analytics.

Gasiorek describes the quality assurance process as exhaustive (and manual at first), but necessary. “Peer comparisons among hospitals often lead stakeholders to question the accuracy of the data, so data integrity is paramount,” he says. “This allows us to focus on using the information for action rather than reviewing the accuracy of the analysis.”

Today, the platform is designed as a self-service dashboard, and users can change the look of the data without having to make a formal request to the team. The rest of the process is automated as well, with the dashboard refreshing automatically each month with new data. Visualization tools such as heat maps help users quickly identify problem areas, while trending tools help them track progress.

Putting the Tools to Work

The first of two platform tools produced by supply chain management was the implant dashboard reports on volume, cost, waste, revisions, reimbursement and supplier market share of orthopedic joint and spine implants. Providing detail to the patient case level, the implant dashboard is used by executive and service line leaders to monitor cost and volume trends, as well as by physicians who can compare their performance to other providers in the system. The other tool—value analysis supply utilization—uses UNSPSC (United Nations Standard Products and Services Code) to categorize spend data on thousands of products and normalizes the data using a selection of 25 diverse indicators, including average daily census, acute staffed beds, total surgeries and equivalent discharges.

“Having more than one denominator for comparison lets us show our product utilization and spend from different points of view according to what department or outcome we are trying to address,” Gasiorek says.

Having various indicators also helps strengthen the case against blatant outliers—hospitals, departments or individual physicians whose utilization or spend is higher when viewed through the lens of all the indicators.

“We’re not going to debate the merits of which indicator is correct for every single commodity,” Gasiorek says. “That’s why we’ve picked 25 standard indicators, and when the heat map is red across all 25 standard indicators, there might be a utilization issue.”

That was the case with one hospital’s utilization of patient slippers. “No matter which way you looked at the data, we had one hospital that was off the charts,” Gasiorek says.

The platform allowed Gasiorek’s team to drill down to specific departments within the hospital, which pinpointed the source of the slipper problem. “We called the supply chain manager and, after visiting that floor, she discovered that some of the clinicians were issuing multiple pairs of slippers per patient per day,” Gasiorek says. “It was a quick fix of re-educating the staff on the clinical protocol.”

The data pointed to utilization challenges with other products, too. “One of our hospitals brought to our attention a problem they were having with a premium underpad that was designed specifically for bedbound incontinent patients,” Farkas says.

Once the premium product was implemented, it went viral among hospital staff—from clinicians who were using them to move patients to janitors who were using them to soak up spills—resulting in a $150,000 increase in costs.

“We used the value analysis supply utilization tool to search specifically on these underpads and found that several other hospitals were having similar utilization issues based on the normalized data,” Farkas says. “As a result, some hospitals removed this pad completely and changed their mix of products, while others had their wound/ostomy nurses determine which patients met criteria for this premium underpad. This became a system initiative.”

“This is really about turning data into information, and that is just what we are doing through our collaboration with HealthTrust on the analytic toolset.”
—Lou Fierens, senior vice president of Supply Chain and Fixed Assets Management at CHE Trinity Health

As a result, two hospitals successfully reduced their utilization from a combined $384,000 to $10,000 per year.

The platform allows users to see product utilization not only at the hospital level, but also at the individual physician case level—a key driver of change among clinicians. “When they think about how they deliver care, clinicians think in terms of types of cases and types of patients,” Young says. “That’s why having the case-level detail is so important … that’s where you can have a meaningful conversation about change with your clinicians.”

Young recalls one meeting with a spine surgeon whose waste was higher compared to other spine surgeons in the system. “I was able to show actual wasted product as a line item all the way down to the case level,” she says. “And he was able to recall those cases and explain exactly why the waste occurred.” The meeting did not result in a reduction of waste (since it was found to be merited), but it did help illustrate the value of the tool. “From that point on, he trusted the platform because we could show him good data that was absolutely validated,” Young says.

One of the platform’s most impressive features is its ability to benchmark across the enterprise, which helps support reduction in variation of care. “With this tool, we can see the different products used in what should be similar situations,” Gasiorek says. “When we can call attention to that variation in care, supply chain becomes the cart pushing the horse.”

That’s exactly what happened when a recent review of the implant data yielded an important insight—there was too much variation in the units of bone cement used per procedure.

“We took that information to our physician team and it came up with utilization guidelines, which have resulted in decreased utilization of bone cement overall,” Young says.

Updates will soon allow the tool to identify the top 25 outliers as a system, or by hospital, as well as perform an automated quarterly analysis of product categories that CHE Trinity Health has standardized as an organization.

“What we are finding is that once product standardization is in place and outliers are removed, the benchmarking capability of the tool becomes even more impactful,” Farkas says. “Significant spend variation in a standardized portfolio is highly indicative of utilization and/or care process variation.”

Enhancing the Platform

While the business intelligence platform has yielded valuable insights and savings for CHE Trinity Health, Gasiorek says the work is far from over. Upcoming enhancements include adding a third-party data cleansing service to the process, providing more granularity in classifying supply spend data, which will in turn produce more accurate analysis.

The team also plans to focus efforts on better integrating various IT systems that feed data to the platform, as well as driving CHE Trinity Health’s Supply Chain Information System to the point of use. This will substantially increase the number of products linked to the patient case level.

“This is really about turning data into information, and that is just what we are doing through our collaboration with HealthTrust on the analytic toolset,” says Lou Fierens, senior vice president of Supply Chain and Fixed Assets Management at CHE Trinity Health.

“It’s helpful having a partner that understands the challenges we face and will invest in finding solutions because our clinically driven supply chain strategy is focused on just that,” he continues. “We are grateful to share this vision with HealthTrust and to have the hard work of many people at our organization recognized through the Innovation Grant.”

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