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Exclusive Download: Value Analysis' Contribution to Transforming Healthcare

Posted By Peg Tinker, Tuesday, October 18, 2016

With the advent of the Affordable Care Act (ACA) the healthcare industry has begun a transition from volume to value.  While this transition is not necessarily as sweeping and rapid as once proposed, changes are occurring as most healthcare organizations recognize the need to transform.  To understand contributions that value analysis healthcare professionals can make, it’s important to comprehend concepts involved in moving from a “curve 1” to a “curve 2” environment and what that means for care delivery.
Curve 1 is largely referred to as the fee-for-service environment.  In this traditional model, care providers are paid for the volume and type of services they provide, not the outcomes. The industry is recognizing that this reimbursement method does not motivate healthcare organizations to work collaboratively to improve care and reduce redundancy and costs.  In a curve 2 environment the focus is on value, with organizations rewarded for coordinating care, reducing costs and improving outcomes.  Thus, the move from curve 1 to curve 2 is also referred to as moving from volume to value.

This transition is largely fueled by  the  Centers for Medicare & Medicaid Services (CMS) in an effort to curb healthcare costs and keep the Medicare system viable.  For example, Health and Human Services set a goal that 50 percent of Medicare fee for service (FFS) payments will be linked to quality or value by 2018.  Metrics for determining value are transitioning to outcomes, patient experience and cost efficiencies.  To help drive this transformation, CMS is transitioning from voluntary to mandatory bundled payment programs for such conditions as comprehensive care for joint replacement and cardiac care.

On the commercial front, the Healthcare Transformation Task Force , an organization comprised of 20 health systems and commercial payers, has committed to move 75 percent of their business to value based arrangements by 2020.  This task force pushes the case for transformation and is highly collaborative in sharing strategies and tactics to improve health and healthcare in a value-based environment.
From a healthcare consumer view, large employers have begun to press payers and health systems to reduce the cost of care for their employees by negotiating more aggressive discounts and health programs designed to improve wellness or more effectively manage care.  Consumers are increasingly savvier about healthcare, asking for increased access, convenience and transparency in their care.  As a result, new apps and Tele-Health capabilities are emerging to address consumer demands, and such organizations as Leapfrog and CMS provide web sites where provider quality is transparently reported .

As your organization transitions you may hear these terms related to the type of reimbursement received.

  • Fee for service - Uses a retrospective payment where each item of service provided is reimbursed based on certain billing codes that are submitted as a claim to the health insurance company.  The focus in a FFS environment is on volume.
  • Shared savings and shared risk – Typically includes a modified FFS schedule with deeper discounts and the opportunity for the health system to receive a bonus (shared savings) based upon quality/cost.  Likewise, the health system could contract for shared risk where they are penalized if they do not meet quality/cost targets.
  • Capitation or global payment system – Pays a predetermined per member rate to healthcare organizations, regardless of the delivered services.
  • Bundled payments – Provide  reimbursement for a discrete course of treatment rather than paying for each clinical interaction and procedure.  Typical reimbursement can be for a course of treatment for the procedure and the following 90 days of recovery.

In working towards a value-based environment and moving to risk based models of payment, one thing is clear: There is significant variation across the country. At one end of the scale, some organizations are just beginning to focus on value since they’ve been highly successful in a FFS market.  Those organizations know that moving too quickly can reduce FFS revenues when there may not yet be a need. 

On the other side of the scale are organizations that are in areas of the country with highly concentrated managed care markets.  They began this shift years ago, perhaps as participants in Medicare’s Pioneer ACO Model, and have a variety of risk based contracts and curve 2 capabilities within their organization.  They’ve recognized the need to collaborate and partner with others to ensure full network capabilities to care for the patients in their market.  They also recognize that this transition is creating significant opportunities to advance clinical capabilities in the ambulatory care setting. 

With this wide variation, it’s important for providers to understand their organization’s transformation strategies.  Most providers struggle in their transformation to value and like with any other significant change, leadership direction and engagement is important.  In a recent white paper, Peter Banko, president and CEO of St. Vincent Health System in Arkansas, put the ambiguity and struggle of the transition very aptly,

It’s like having your feet in two boats at the same time. One is a fee-for-service and the second is in the new infrastructure. The challenge is to make sure the legacy model doesn’t drag you down as you shift to the new paradigm. The pacing and timing of the work needed to be done is what is always on my mind.

As the transition occurs organizations must increase their ability to be flexible, identify alternative revenue streams (e.g. employer contracts), and most importantly focus on improved quality, outcomes and cost efficiencies.  Quality, outcomes and cost efficiency are no-brainer strategies for transformation because they are effective in FFS and value based environments.  Following are strategies for value analysis healthcare professionals that will ensure you are taking an active part in ensuring your organization’s successful transition:

  • Work with your leadership to help educate physicians on the need for evidence-based practice and reduced variation.

Rationale:  Adherence to evidence-based care avoids over, under or misuse of treatment regimens, prevents conflicting care plans and ensures a uniform level of quality, cost-effectiveness and patient experience across practice settings. When integrated into point-of-care reference tools, evidence-based care guidelines enable care team members to act as physician extenders.  Standardizing supplies and how supplies are used is an important part of this work.

  • Take an active role in helping your organization integrate cost with clinical data.

Rationale:  Supply chain remains a significant opportunity for cost efficiency in most organizations.  By now you may think your organization has aggressively addressed contracting and standard pricing system wide, but have you explored variation among physicians?  Value analysis professionals have had utilization on their radar for years, but with the move to a value-based environment, organizations are getting much more traction in integrative reports that combine financial, clinical and even claims data to provide greater insights into variation.

  • Partner with quality and performance improvement for change. 

Rationale:  Working together to streamline process, improve quality and reduce costs can be highly impactful.  Bundled payments are an example where this is especially true.  Successful organizations are highly collaborative and recognize that siloes can no longer exist along the patient’s care progression if they are to be successful. 

  • Continue to educate yourself about transformations occurring in healthcare.

Rationale:  As you learn more about what your own organization is doing you will be able to provide important contributions to improve efficiency and quality.

No matter where your organization is on the journey to value, active involvement, collaboration to reduce siloes and innovation are important skills you can bring to the table to improve outcomes and reduce costs.

Peg Tinker is an Associate Director in Navigant Consulting’s Strategic Solutions practice.  She works with a variety of healthcare organizations and Clinically Integrated Networks to advance their capabilities in a curve 2 environment.  Peg is also the Western Regional Director on the Association for Healthcare Value Analysis Professionals Board of Directors.

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Networking Tips

Posted By Administration, Tuesday, October 18, 2016

When asked, members tell us they joined AVAHP to network with value analysis peers and tap into their experience.  The challenge, though, is how to connect with people you may only see once a year.  Sue Knapp, President Elect in collaboration with Nila Getter, an AHVAP Past President, compiled a list of tips to help members network.

Start with a known contact.  If you are shy, approach someone you know to increase your confidence. Typically, our Regional Directors reach out to new members in their region within the first two and three months.  If you have questions, do not hesitate to contact your Regional Director for support and suggestions.

When you meet someone, say the person’s name and then use their name in a conversation.  This establishes a personal link, makes people comfortable, and helps you remember their name in the future.

Be sure to make eye contact and smile; serious expressions are forbidding and failure to make eye contact can be interpreted as dismissive. 
Introduce yourself to speakers, ask questions of them.  Share a genuine compliment. This is encouragement for the speaker and shows you were interested in what they had to say.

Be yourself.  Be authentic.  It’s OK if you are little awkward, do not apologize for it.

Do not let inexperience keep you from joining in.  You bring a unique perspective and view situations with “fresh eyes”.  Share with your peers!

Ask a question: pose a question to the group after getting the gist of the conversation. Share your passions.  Sharing information with new contacts builds creditability.

Be a good listener.

Always have business cards handy and invite others to contact you.

Make sure you follow up if you promise something.  Follow up with an update, with a question or a common interest. Keep in touch. Do not take a lack of response personally.

Take risks.  You never know unless you try. 

All in all, these are some simple but strong suggestions to help one better engage with their peers and get the most out of the in-person opportunities that are not always available.

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AHVAP Shines at the 2016 Fall IDN Summit

Posted By Administration, Tuesday, October 18, 2016

AHVAP members have attended the IDN Summit at the invitation of the organizers for the last few years.  Lisa Ponssa, Executive V.P. of Healthcare Business Media, first contacted AHVAP because the suppliers who attend the Summit Conference were requesting additional information about Value Analysis and how best to engage in the process.  As a result of this collaboration, AHVAP has had the opportunity to provide education on value analysis for the past couple years and hopefully for many more to come.

We attended the educational sessions and it was a pleasant surprise to recognize the following members who presented or moderated sessions:

  • Sandra Achee, RN, CNOR, Manager Purchasing Product Analysis, Ochsner Health System
  • Kathy Chauvin, RN, Health System Director, Resource Utilization and Value Analysis, FMOL Health System
  • Gloria Graham, DNP, RN, CVAHP, Clinical Materials Specialist, Cincinnati Children’s Hospital Medical Center, President AHVAP, AHVAP Representative
  • Dee Whittington, RN, CEO DKW Consulting
  • In addition to presenters, the following members attended as representatives of their organizations:
  • Becky Severson, Clinical Resource manager, Avera Health
  • Georgia Robson, Clinical Supply Program Director, Banner Health
  • Jennifer Grabski, Value Analysis Manager, Centegra Health System
  • Sandee Schoby, Director Contracting and Resource Utilization, CHRISTUS Health
  • Mark Preston, Director Supply Chain, Confluence Health
  • Cheri Berri Lesh, Value Analysis Manager, Group Health
  • Robert Pimentel, Value Analysis Coordinator, University Health System
  • Jeffiny Shutts, Director of National Accounts, MedApproved, LLC
  • Robin Lane, Senior Manager Value Analysis, Pensiamo, AHVAP Representative
  • Susan Toomey, Value Analysis Coordinator, Lehigh Valley Health Network, AHVAP Representative
  • Mary Potter, AHVAP, Past President, Independent Value Analysis Consultant, AHVAP Representative

Thanks to all of our members for their contributions to Healthcare Value Analysis and helping shed light on what we do and the benefits of our organization.  We hope to welcome soon those that we met as new members as well.

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Message from the President - October 2016

Posted By Administration, Tuesday, October 18, 2016
Gloria Graham

The opportunity to be President of AHVAP has afforded me such an amazing experience, which I will be forever grateful.  As I begin to collect my thoughts for the last newsletter of this year, I would first like to take the opportunity to express my sincere gratitude for all of the hard work and dedication by so many over the past nine months. Your tireless efforts have been inspiring and it has truly been an honor and privilege to work a long side each and every one of you.

As the summer season comes to an end and the earth begins cooling off to slowly prepare for the upcoming fall and winter season, there is an excitement building around the colorful transformation on the horizon.  Soon the trees will be crowned with vibrant hues of crimson, gold and glowing orange that will shortly fall from their branches dancing among the crisp autumn air.  Samuel Johnson said, “No man can taste the fruits of autumn while he is delighting his scent with the flowers of spring”.  It is these seasonal changes that provide the ability to survive during the freezing winter months that rapidly follow autumn. 

So in your pursuit of value for your organization, are you prepared for the ever evolving seasonal changes within the landscape of healthcare? In order to survive the ongoing budget reductions, decrease in reimbursement, pursuit of quality and outcomes, value analysis processes are now more critical than ever to the success of surviving the cold harsh “winter” of healthcare.  Value analysis professionals have the opportunity to be at the forefront of their healthcare organizations, leading and influencing the countless supply chain decisions made every day.  It is crucial for us to prepare for the continual ebb and flows of the various seasons we encounter yearly within our organizations.  Take advantage of this “cooling” down time of the year to reflect and review your process and shake lose the “dead” leaves that might be clogging up the system.  Attending our Annual Education Conference and Supplier Showcase October 19th through the 21st in Scottsdale, Arizona will provide a wonderful opportunity to network, recharge and gain new insights that will help you transform your value analysis program. 

There have been so many incredible accomplishments this year and we look forward to the continued growth and success of AHVAP.  However, in order for our organization to remain relevant and sustainable, we need action by all of our members.  Martina Navratilova said “The difference between involvement and commitment is like ham and eggs. The chicken is involved; the pig is committed”.  Are you the ham or the egg? I encourage you to take this opportunity to figure out how you can be involved and committed as the rewards you reap will be tremendous. 

Thank you again for this remarkable journey and I look forward to seeing everyone at the conference!

Kindest Regards,
Gloria Graham, DNP, RN, CVAHP
President, AHVAP

Tags:  ahvap  message from the president  october 2016 

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Conference Sneak Peak - Summer 2016

Posted By Administration, Tuesday, July 12, 2016
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AHVAP Annual Conference and Supplier Showcase - Value Analysis: A Team Effort

Susan D. Knapp, RN, MS, CVAHP

We are back to Scottsdale, Arizona for the AHVAP 13th Annual Conference and Supplier Showcase. The Chaparral Suites has always been a superb venue for our conference. Your reservation at the Chaparral includes a true 1-bedroom suite with refrigerator and microwave, an American breakfast each morning as well as a cocktail reception in the evening.  

Within walking distance is Fashion Square Mall which has over 255 stores including Kate Spade and Louis Vuitton to name a few. Old Town is not far away along if you want to shop and walk around. Chaparral provides free transportation to local shopping and dining experiences and to the casino. It is also a golfer’s paradise plus there is plenty of history, nightlife, restaurants, and things to do. Come early and take a day trip to the Grand Canyon. I highly recommend it. If you take a guided tour, you will make stops at the Red Desert, Sedona, plus see the different scenery of the Arizona climate zones.

After you have explored the offerings of Scottsdale and Phoenix, we have an impressive lineup of presenters.  You are not going to want to miss this conference. Terry Foster is back by popular demand.  His humorist views on healthcare do not fail to entertain. Participants of the 2015 conference commented that they laughed till they cried.  He was hysterically funny. The keynote speaker is David Jon Bowman, actor, management consultant, thought leader, author, entrepreneur, educator and speaker.  He will engage you with his worldly experience and knowledge. He is an expert on productivity, career management, sales, finance and operations. He has been associated with Fortune 200 companies as well as public service organizations. We are excited to have him speak on team building.

We have many awesome presenters; some who have presented at previous conferences and some who have not. Wini Hayes will be there. She never fails to deliver a presentation that keeps us totally transfixed with her knowledge on applying evidence to resolve clinical problems. Past AHVAP President Barbara Strain will also be speaking on a new topic based on her work in identifying strategies health care has adopted in response to the Accountable Care Act. Bob Yokl is another past presenter back again to talk about creating your own internal evidence based system.  And additional speakers will be lecturing on topics about physician engagement, decision making, communication, value analysis processes and so much more.

Don’t miss this conference! This experience and the networking with like-minded professionals are well worth it.  We are planning several receptions and cocktail parties including one for new members-first time attendees. You will meet up with old friends and make new friends. 

Please join us in sunny Scottsdale in October.

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Ask the Experts - Summer 2016

Posted By Administration, Tuesday, July 12, 2016
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Last month we posed a question to five experts in Value Analysis, and the responses were phenomenal.

What do you feel having the CVAHP certification will do for you, your career, or others?

Gloria Graham

“The CVAHP and underlying knowledge demonstrates your level of experience and capability within the field of value analysis.  A certification shows that you’re capable of learning along with retaining knowledge which are fundamental elements for continued professional development. The degree of dedication and time necessary to obtain a certification validates that you’re committed to your chosen profession.  The CVAHP can be the stepping stone to help you advance or align your potential for the next promotion within your role or onto to the next level of professional development.”

Wanda Dupree-Lane

“The CVAHP certification illustrates a validation of the work, effort, and creativity born from a relatively small group of healthcare professionals striving to provide quality work product for their organizations. Value Analysis is on the cusp of emerging as a separate and unique discipline within healthcare. This certification signifies mastery of this discipline and denotes a desire to grow and expand the profession.  Holding this certification elevates the level of respect afforded to those who have committed themselves to stellar performance in their field”

Sue Knapp

“I have always supported being certified in the field of nursing or business that I am working in as a matter of personal growth and achievement.  I like to learn as much as I can and I like to test myself.   In my efforts to be the best I can be, personally and professionally, CVAHP validates my knowledge and expertise in Value Analysis.  I believe it lends credibility to my position at the hospital and substantiates the work I do.  People don’t always understand what Value Analysis is or what I do. Sometimes they think I just buy stuff for them.  Being certified tells them that there is a specific body of knowledge and skills needed to perform in this position. 

I also feel that by being certified, the bar has been set for those that may come after me in my facility as well as future employment.  CVAHP will be recognized throughout the nation as the leading Value Analysis certification.   Employers will be looking for this certification when they recruit VA professionals.  I see it as being part of the requirements to hire for Value Analysis positions.  Wherever I go in the future, I will have the credentials and skillset sought after by employers.  I am so proud to be a part of the AHVAP organization as well as having had a hand in the creation of CVAHP.  I will always cherish this relationship and accomplishment.”

Jane Torzewski

“The CVAHP certification is a significant outcome and metric of an important process that health care facilities use to manage expense reductions in an efficacious way. The certification gives credence to the discipline of Value Analysis (VA) and provides a benchmark for achieving excellence to those individuals who are VA professionals.

The certification process is meaningful in its own right; professionals who utilize VA procedures will enhance and deepen their understanding of the concepts and key steps in the process.  Engagement with fellow CVAHP professionals provides essential networking on both a professional and personal level; peer to peer dialogue and interaction stimulates creativity, curiosity and builds skills for all who are willing to participate.”

Susan Toomey

“Although my organization does not currently recognize the CVAHP certification, becoming CVAHP certified was a personal professional goal that I established for self-enrichment.  The CVAHP certification affirmed my knowledge of having quality Value Analysis skills by testing my ability to perform objective assessments and provide logical conclusions to support the growth and development of products, services, and technologies across my organization’s continuum of care.  As an increased number of Value Analysis professionals become CVAHP credentialed, it will set precedent to the value of providing optimal patient care and establish career incentives for Value Analysis professionals that may not be occurring in today’s health care environment.”

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President's Corner - Summer 2016

Posted By Administration, Tuesday, July 12, 2016
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Hello AHVAP members!

Summer is here and hope you have the opportunity to enjoy the outdoors and the warm weather.  I am happy to report there are many sizzling activities happening for AHVAP!  I would like to thank all of the committee members, chairpersons and the Board members who have been diligently working towards achieving our goals to increase AHVAP’s influence in the industry, grow our memberships and strengthen the AHVAP community.  Here is what’s going on at AHVAP!

Certification Updates
We are very excited to report that AHVAP along with AMP, the testing agency, are in the final stages of completing the validation process for scoring of the certification.  We are very appreciative of your patience while we journey through this new endeavor.  To the brave pioneers who have already taken the exam, be on the lookout in the very near future for information regarding your scores.  For those who have not taken the exam, what are you waiting for?  The CVAHP elevates your professionalism to the next level!  Thanks to Cheri Berri-Lesh, Shannon Candio, Beth Potter and Cindy Christofanelli for their leadership throughout the certification process. 

Quarterly Webinars
The first two webinars so far this year have been outstanding!  On March 10th, Brenda Lambert, Director of Clinical Services for Medbuy, presented on “Risk Identification and Mitigation in Healthcare Procurement”.  Medbuy is one of Canada’s leading healthcare group purchasing organizations which is a not for profit organization levering clinical expertise and maximizing buying power to offer quality products at the best price.  She provided great insight on how to incorporate risk anticipation within the healthcare supply chain.  On June 9th, Wanda Dupree-Lane, Southeast Regional Director, shared with us about “Value Analysis - New Challenges, New Solutions: Insights from the AHVAP Southeast Regional Conference” which was held on March 4th in Charlotte, North Carolina.  The Southeast Regional meeting had 11 in attendance where a “think-tank” atmosphere provided the opportunity for those attending to walk away with valuable tips & tricks, and left them excited for more interaction and information. 
Be sure to mark your calendar for the upcoming webinars hosted by the Central Region on September 8th and by the Northeast on December 8th.  More information to follow!

Industry Business Education Collaborative (IBEC)
AHVAP is on the move influencing the industry through education of healthcare based industry suppliers, organizations and associations about the principle concepts of value analysis.  AHVAP was well represented at the Spring IDN Summit where myself, Sue Knapp, Melanie Miller, and Cindi Christofanelli were able to enjoy great dialogue with the attendees, educating them on value analysis and AHVAP.  We were delighted to have the opportunity to engage with other AHVAP members such as Nila Getter, Jeffiny Shutts, Sue Toomey and many others who were there representing their organizations.   In addition to the IDN Summit, AHVAP has contributed to increasing the healthcare supplier community knowledge through several presentations with associations such as the Independent Medical Specialty Dealers Association (IMDA).  Shannon Candio and I shared how value analysis professionals are the bridge between the clinical and financial worlds within healthcare organizations.  Additionally, they were pleasantly surprised to learn how the goals of value analysis professionals and IMDA are parallel - to ensure optimal patient outcomes through clinical efficacy of healthcare products and services for the greatest financial value.  Looking forward to the exciting IBEC opportunities in the near future!

Annual Education Conference & Suppler Showcase
Don’t forget to mark your calendars for the upcoming Education Conference and Supplier Showcase in Scottsdale, Arizona October 19th – 21st, 2016!  The Conference Committee has been putting together the final details for this amazing and exciting opportunity to learn up-to-date information in the world of value analysis as well fabulous networking opportunities!
There are so many fantastic activities occurring within AHVAP! I am so proud and honored to be a part of this incredible association serving as your President.  I encourage you to be engaged and share your knowledge and expertise through your involvement with the various committees, as well as sharing on our website.  Don’t forget to connect with AHVAP through Facebook, Twitter and LinkedIn!  As a result of the hard work and dedication among the countless individuals within AHVAP, we are destined to experience a tremendous growth and so glad you are a part of this journey! 

Kindest Regards,
Gloria Graham, DNP, RN, CVAHP
President, AHVAP

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President's Corner

Posted By Administration, Tuesday, March 8, 2016
Updated: Tuesday, March 8, 2016

Greetings!  I am so excited about everything that is about to happen for AHVAP in 2016 and beyond!  

First, I want to take a few minutes to reflect on the past year to gain perspective on where we are going.  History is made in the present and didn’t happen on its own.  Our history happened as a result of our hard working, dedicated members who contributed to all of the phenomenal accomplishments we have seen over the past several years. Understanding the past helps us to build our future – it provides the foundation for our continued success; additionally it is an important vehicle that shapes our approach to the critical issues we face today and is a factor in our future decisions.  

For example looking at our Annual Education Conference & Supplier Showcase.  In 2007 in Phoenix we had 52 registrations with 12 exhibitors/sponsors growing to 117 registrations and 38 exhibitors/sponsors in 2015!

Now let’s look at the trends with our membership.  In November of 2014 there were 230 members with a loss of 17 members and had a 60% annual retention rate.  In December of 2015, we had 303 members, gaining 66 for that month and a steady retention rate at 78%! 

Last but not least, AHVAP introduced the industry’s first and only healthcare value analysis credential which is known as the Certified Value Analysis Healthcare Professional (CVAHP).  

All three of these astounding accomplishments are the foundation and leverage needed to keep the momentum and the passion alive within the association to help us achieve even more substantial achievements in the future. 

We heard numerous times at the conference about the shift to reimbursement based on value versus volume and the importance of value analysis contributing to healthcare organizations to avoid reimbursement cuts without forsaking the delivery of safe and quality patient care.  As a result, it is more apparent than ever how value analysis is on the minds of healthcare professionals who facilitates the delivery of outcomes-driven; patient-centered care.  Our plan is to increase AVAHP’s influence in the industry, grow our membership levels, and strengthen our community.  Each and every member is a vital part of making that a reality. It is about the collective strength we have together as a whole, than it is just one or two working together.  John O’Leary stated: Friends, real victory isn’t about what we can do for ourselves, but what we can achieve together”.

What does it take to get us there and ensure these three areas truly drive impact? 
Our plan is built on three, key initiatives:

  • In order to influence we need to leverage our members - that means you!! Yes, AVAHP is primed to provide industry best-practices to help increase the impact of value analysis within healthcare across the country.  However, our organization cannot sustain itself without the involvement and engagement of all members and we need your help to create rich and engaging original content.  It is imperative for AHVAP to increase its visibility by being in the forefront of leading best practices within Value Analysis which is our Vision – “Value Analysis is recognized as an essential component of the delivery of healthcare. Healthcare Value Analysis Professionals is nationally recognized as the preeminent clinical resource in providing education and resources and networking to its membership and promoting Value Analysis in the healthcare community”.
  • In order to grow we need to get social in a whole new way. Leveraging social media avenues such as LinkedIn, Facebook, and Twitter can spread our message and attract new members.  However, we need to hear from our membership what content and activities will bring the most value to you as a member.  What are the essential programs or information which will increase your knowledge and skill level which leads to increasing your value as an expert in your organization?  If social media is not your forte, we need your ideas on how to grow the association through other avenues.  In this day and age of multi-generational work cultures, we need members from all generations involved like we never have before. We need to learn from each generation how to effectively collaborate resulting in growth within the organization. 
  • In order to strengthen our community, we need to use value analysis best practices and apply them to our own organization.  Just as it is important to have clinician involvement and engagement within the value analysis teams, we need our members to be engaged and communicate among themselves. This sharing of knowledge and data among our peers empowers us to build a stronger value analysis community and helps us make decisions improving our organization.  Think of the power we have among ourselves to strengthen and grow AHVAP if each member would recruit one person to join AHVAP – we could double the size of our organization in just one year! 

Let’s use what we know, to get where we need to be.
Our goal for 2016 is to prepare for the future by developing, documenting and deploying operational policies, procedures, and guidelines to help us influence, grow and strengthen the association!

Thank you for allowing me to have this opportunity to share my thoughts with you. Based on the words of the late John F. Kennedy, “ask not what your country can do for you, ask what you can do for your country”, I challenge each and every one of you to take a few minutes to reflect how you can become involved and engaged with AHVAP!

Kindest Regards,
Gloria Graham, DNP, RN, CVAHP
President, AHVAP

Tags:  AHVAP  grow  membership 

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Theme: What is truly innovative technology

Posted By Administration, Thursday, March 3, 2016

By Laura L. Polson, RN, BSN, CVAHP

Value Analysis teams are continually bombarded with requests for “new technology”. But when do you consider a medical device or capital equipment acquisition as a “new” innovation versus something substantially equivalent?

When a buyer gets a new item request, and you do not have this item in your purchasing system, it is not necessarily new. If the vendor exists in your database, chances are this is just another version of a current item, and if it’s merely a variance in size or formation, the VA team will not need to review this for approval.

When vendor partners design upgrades for current items, the VA team may need to review and see if the improvements and benefits outweigh the conversion/training efforts or potential increase in costs.

There are many variations on the criteria each Value Analysis professional may use to identify topics for their teams to review, but here are a few questions to consider which may indicate what’s new for you:

  • Does this device perform a function which you’ve not been able to do previously?
  • Does this device perform a procedure which has no current reimbursement codes?
  • Does this technology offer a significant innovation for an existing intervention?
  • Has your facility hired a new clinician with expanded skillsets, and how will you deal with all these additions if they leave?

There are technology conferences held every day showing new innovations. While we’ve seen amazing improvements with wireless, smaller batteries, robotics, treatment surfaces and physician preference items, hospitals still seem to function pretty much as we did in the past.

We must be able to look at the development cost and comprehend where to focus our future efforts. Will robots be educating patients with discharge instructions while texting new physician’s contact information to a cell device and scheduling a follow up appointment? Will advanced wound care grafts be printed in 3D to precisely fit while in the OR as a complete stem cell replacement? Will patient medications wirelessly communicate when they’ve been swallowed and chart their effectiveness? Can we watch our family member’s surgical procedure live on our smart phones? Will each bed function as a transport, lift/position, chair, therapeutic and bactericidal surface integration unit with sound interface and telemetry continuously monitoring all vital signs? You know it! Now, ….what will it cost, and how do we calculate its value?

Tags:  bactericidal  calucuate  clinician  cost  criteria  CVAHP  device  effectiveness  facility  family member  function  Laura L. Poison  professional  skillsets  teams  technology  therapeutic  Value Analysis 

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Bridging the Gaps between Pharmacy and Finance

Posted By Administration, Thursday, March 3, 2016

By Kathy Schwartz, Solutions Owner, AVP Strategic Messaging, Craneware

Healthcare industry trends are squeezing provider margins through payment cuts and value-based reimbursement models. In response, these providers’ clinical teams are recognizing the need to collaborate and communicate more closely than ever before with their business office, finance and revenue cycle counterparts.
The pharmacy and its purchase history and formulary data can be low-hanging fruit for organizations looking to better manage cost, improve charge capture, and reduce compliance risk. But where to start? Both Heidi Larson, Pharm.D, Pharmacy Business Manager for Hennepin County Medical Center in Minneapolis and Tara Hunuscak, Business Director of Pharmacy Service for OhioHealth’s network of 11 hospitals and other health services in Ohio chose to partner with Craneware to help address these challenges.  
Hennepin knew that there were gaps and issues going undiscovered because of silos in their organization. “Like many organizations, pharmacy was viewed as separate from the hospital and clinics,” said Larson. “People didn’t communicate regularly and frequently across departments. Information was scattered, duplicative and unclear. The electronic health record (EHR) information needed ongoing review to be clean, current and complete.”

Prior to OhioHealth embarking on a major health information system (HIS) conversion for 7 of its hospitals, outpatient clinics and owned physician practices, it took the opportunity to ensure its revenue cycle and pharmacy charge processes were operating as a cohesive unit to minimize financial risks.  “We recognized the need to align critical business functions for optimal financial performance and risk mitigation as 55% of pharmacy charges were impacted by the HIS conversion changing from charge on dispense to charge on administration. Effective checks and balances for ongoing accuracy was paramount considering the complexities inherent to the pharmacy chargemaster and the revenue loss and/or costly penalties if billing units or HCPCS code assignments are incorrect,” said Hanuscak.

People, Process, and Technology

Both Hennepin and OhioHealth saw the need for technology investment to gain visibility across pharmacy and finance, prevent gaps and manage exceptions. Both organizations chose Craneware as the vendor to help them achieve their goals.

Hennepin brought together teams to validate information and educate physicians and staff about compliance and financial aspects of care. With everyone understanding their part in the larger process, Hennepin County Medical Center was able to identify and remove redundancies, obsolete NDCs, and other mismatches. “The Pharmacy and Therapeutics team are helping to educate about the impacts of formulary choice and the best practices during the occasional industry-wide drug shortages,” said Larson. “Building pharmaceuticals correctly into the EHR, and validating NDCs, billable units, and HCPCS helps to keep Hennepin current with coding changes and to ensure that compliance requirements are met ongoing.

OhioHealth hired a pharmacy charge analyst to serve as the primary end user of the Craneware software, followed by a pharmacist coordinator to focus on work requiring clinical expertise (e.g. diagnosis coding/ treatment indications; reconciling orders, and medical necessity.) Customized HIS training was provided for these individuals to ensure full access to relevant pharmacy, charge analysis and revenue cycle functionality. Finally an enterprise-wide, multidisciplinary advisory committee was formed to ensure successful HIS conversion in both short- and longer-term perspective, and to enhance net operating income amidst industry shift from volume to value based reimbursement.  

“With representation from pharmacy, revenue cycle, compliance, charge analysis, finance, coding, information services, internal audit and nursing, our group served as the decision making forum addressing pharmacy revenue items impacting the HIS build, testing and go-live. Among our objectives were to standardize price updates, align charge methods across hospitals, and automate data integrity process controls throughout the HIS conversion. This pharmacy led team complemented the system-wide focus on revenue integrity and helped build momentum for pre and post go-live initiatives,” said Hanuscak.

Craneware’s pharmacy validation software helped Hennepin and OhioHealth identify common issues with pharmacy reimbursements that often remain hidden and unaddressed:  

  • Incorrectly Coded Drugs
    In order to receive proper reimbursement, a hospital must enter the correct procedure and revenue codes for the drugs. Doing that completely and correctly is nearly impossible manually. Further complicating the task are constant changes to coding rules. For example, Medicare changes its pharmacy coding rules quarterly, and Medicare rules do not always align with commercial payor rules. Missing, inaccurate and incomplete coding is a common source of both missing revenue and compliance risk. Charge items missing HCPCS codes often go undetected and can pose a serious but hard-to-detect reimbursement risk.

  • Charge Capture Issues
    Volume reconciliation analytics – whether purchased from a vendor or built in-house – can shed light on often significant differences between the volume of drugs purchased and the volume of the same drugs billed. In some cases there are good reasons for discrepancies, but large discrepancies are usually traced to issues in charge capture. For example, a typographical error in an automated dispensing cabinet would go undetected without some form of automation to provide visibility into the missed or incorrect charges. A recent survey by Craneware identified that fewer than 5% of health systems can perform volume reconciliation. This is mostly because the way hospitals bill for drugs and how they dispense drugs is very different.

  • Newly Purchased Drugs Missing from the Formulary or Chargemaster
    With the volume of specialty and new drugs coming onto the market, it is imperative for providers to have visibility into these purchases. A provider must be able to quickly and accurately identify these drugs: descriptions, procedural codes, revenue codes and billable units of measure all ideally would be integrated into the chargemaster. Purchases not identified in the formulary build often lead to missed charges.

  • Incorrect Multipliers
    One complexity that is unique to pharmacy is the need to calculate the correct units of measure (UOM.) Medication dosages administered to patients are rarely the same units of measure allowable on claims. Because of this fact, pharmacy charge items require multipliers that translate dosage units to the correct number of billing units. The validation of these calculations can be difficult to perform manually, particularly across different clinical order systems and staffs. Unless a hospital has an automated method of tracking those multipliers, maintaining and applying them requires manual calculations that can result in over or underpayments. Using automation, Hennepin uncovered two ocular drugs that had mismatched purchases compared to volumes dispensed – accounting for $384,641 in missed charges that would have been lost revenue.

  • Inappropriate NDCs Captured on Claims
    Purchase and use of medications is an important aspect of managing costs, and accurate National Drug Codes (NDCs) improve cost management and claims processing. Often formularies are set up with a default NDC but gradually become out-of-sync with purchases, and NDCs reported on claims eventually do not match the drugs purchased and administered. What is purchased and used often isn’t what is billed, creating a substantial compliance risk as well as undermining the quality of data used for clinical efficacies in population health management. “Inaccurate documentation can lead to a double loss for your hospital. If you are not charging for the medications administered, you are losing revenue. And if you are not able to track accumulations in a split billing system, you end up purchasing on the more expensive wholesale acquisition cost (WAC) account,” notes Larson. “For 340B facilities like ours, there needs to be close management and communication on purchase practices and formulary changes.”

With frequent pricing changes and new drugs always being added to the market, it is increasingly difficult for provider organizations to stay on top of pharmacy charges, and many organizations wind up leaving significant revenue on the table. It’s never too late to start bringing together the right people, ensuring those people clearly understand the processes involved, and providing them with the tools and support needed to proactively identify and fix issues. While pharmacy has unique challenges, correctly aligning costs and reimbursement in pharmacy is an important first step for small hospitals to a larger health systems in navigating the transition away from fee-for-service into value-based reimbursement.

Tags:  AHVAP  Craneware  formulary data  Healthcare  Hennepin  history  hospitals  Kathy Schwartz  Minneapolis  OhioHealth  pharmacy  Tara Hunuscak 

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