©ECRIInstitute.Montagnolo.20131
Evidence Based PurchasingWSHMMA
Vancouver, WA
April 18, 2013
Anthony J. MontagnoloExecutive Vice President and [email protected] ext. 5175
©ECRIInstitute.Montagnolo.20131
©ECRIInstitute.Montagnolo.20132
Surprise! We now work for Cheesecake Factory Hospital
©ECRIInstitute.Montagnolo.20133
Resistance is futile
©ECRIInstitute.Montagnolo.20134
Sources: Centers for Medicare and Medicaid ServicesWhat Is Driving U.S. Health Care Spending? America’s Unsustainable Health Care Cost Growth, Bipartisan Policy Center
The math does not care who is in charge. Neither should you.
©ECRIInstitute.Montagnolo.20135
Once upon a time in merry old England I stayed at a quaint cottage hotel……..
©ECRIInstitute.Montagnolo.20136
©ECRIInstitute.Montagnolo.20137
Outside and inside expectations
match
High quality requires standard systems.
©ECRIInstitute.Montagnolo.20138
Healthcare Reform
The Affordable Care Act (2010) Reduces the number of uninsured Encourages more accountability for patient care through
integrated delivery systems―Value-based Purchasing; payments based on quality of care―Accountable Care Organizations; vertical care alignment with bundled
payments―Patient Centered Medical Homes; proactive case management of
high-risk patient care
©ECRIInstitute.Montagnolo.20139
MARCH 2010| IN VIVO: THE BUSINESS & MEDICINE REPORT| www.ElsevierBI.com
©ECRIInstitute.Montagnolo.201310
Healthcare Reform
What to know for supplies and technology Less money to spread around Value matters more than price Clinical evidence and real world outcomes will
drive judgment of value
©ECRIInstitute.Montagnolo.201311
But what is value in healthcare?
Do we have the best healthcare system in the world?
Do we have worst healthcare system in the world?
©ECRIInstitute.Montagnolo.201312
And what are outcomes in healthcare?
Longer life? Better life? Higher productivity? Healthier populations? Happier people?
©ECRIInstitute.Montagnolo.201313
Where is technology headed?
©ECRIInstitute.Montagnolo.201314
1. Electronic Health Records
2. mHealth (mobile health)
3. Alarm Integration Technology
4. Minimally Invasive Cardiac Surgery
5. Imaging in Surgery
ECRI Institute’s Top 10 C-Suite Watch List: Hospital Technology Issues for 2013
©ECRIInstitute.Montagnolo.201315
6. PET/MR Systems
7. Bariatric Surgery for Control of Diabetes
8. MR-Compatible Pacemakers
9. CT Radiation Dose Safety
10.CT Lung Cancer Screenings
ECRI Institute’s Top 10 C-Suite Watch List (Cont’d)
©ECRIInstitute.Montagnolo.201316
Cleveland Clinic Names Top 10 Medical Innovations for 2013
1. Bariatric Surgery for Control of Diabetes
2. Neuromodulation Device for Cluster and Migraine Headaches
3. Mass Spectrometry for Bacterial Identification
4. Drugs for Advanced Prostate Cancer
5. Hand-held Optical Scan for Melanoma
©ECRIInstitute.Montagnolo.201317
6. Femtosecond Laser Cataract Surgery
7. Ex Vivo Lung Perfusion
8. Modular Devices for Treating Complex Aneurysms
9. Digital Breast Tomosynthesis (DBT)
10.Health Insurance/Medicare Program/Rewards for Better Health
Cleveland Clinic Names Top 10 (Cont’d)
©ECRIInstitute.Montagnolo.201318
Bariatric Surgery for Control of Diabetes
►Experts suggest earlier intervention for diabetes treatment
►Possibly curative
©ECRIInstitute.Montagnolo.201319
Digital Breast Tomosynthesis
►Provides tomographic view –reduces overlapping tissue blurring
►May cost 20-60% more than digital mammo
©ECRIInstitute.Montagnolo.201320
Transcatheter Aortic Valve Implantation for Treating Aortic Stenosis
►New therapeutic alternative to drug therapy
►CMS proposed conditional reimbursement
►Adoption could drive need for hybrid ORs
©ECRIInstitute.Montagnolo.201321
MRI-compatible cardiac pacing system (REVO) for patients who may require future MRI
►May be used in up to 80% of patients needing a dual chamber pacemaker
©ECRIInstitute.Montagnolo.201322
William G. Huitt, May 2002
Technology that improves service will matter more.
©ECRIInstitute.Montagnolo.201323
Focus on Real Outcomes
©ECRIInstitute.Montagnolo.201324
Focus on Real Outcomes
Evidence may be available for 3 general types of outcomes:
1.Patient-oriented clinical/health outcomes
2.Intermediate outcomes
3.Surrogate marker outcomes
©ECRIInstitute.Montagnolo.201325
Source: Nudge: Improving Decisions About Health, Wealth, and Happiness. Thaler and Sunstein, 2009. Page 17.
©ECRIInstitute.Montagnolo.201326
A bat and ball cost $1.10 in total. The bat costs $1.00 more than the ball. How much does the ball cost?
______ cents
Source: Nudge: Improving Decisions About Health, Wealth, and Happiness. Thaler and Sunstein, 2009. Page 21.
©ECRIInstitute.Montagnolo.201327
Framework used to assess new healthcare supplies/technologiesWe consider these factors:
1.Intended patient population/disease/condition for the technology
2.Comparison technologies
3.Outcomes of interest
4.Short- and long-term follow up time points
5.Care delivery process (e.g. inpatient/outpatient/home care)
©ECRIInstitute.Montagnolo.201328
High Quality Decision Process
Clinical Evidence
and Outcomes
Technical & Operational
Issues
Strategic Issues
Financial Issues
Follow Technology Decision Rubric
©ECRIInstitute.Montagnolo.201329
Patient-oriented Clinical Outcomes
What a patient experiences, such as
Quality of life Pain Function: physical, cognitive, social Ability to perform activities of daily living Adverse events Short and/or long-term complications Survival Patient satisfaction
©ECRIInstitute.Montagnolo.201330
Intermediate OutcomesShorter term measures; may or may not predict long-term patient outcomes, such as
Hospital length of stayTumor response rate after treatmentDisease-free survival time after treatmentWeight loss 6 mo. after bariatric procedureRestoration of normal heart rhythm after afib
©ECRIInstitute.Montagnolo.201331
Surrogate Outcomes
Surrogate outcomes are Indirect Disease-oriented Not discernible by the patient
Blood tests such as cholesterol, PSA Imaging test results such as angiography, PET, MRI, CT,
bone density
©ECRIInstitute.Montagnolo.201332
Quick Test: Digital Breast Tomosynthesis
►Provides tomographic view –reduces overlapping tissue blurring
►May cost 20-60% more than digital mammo
©ECRIInstitute.Montagnolo.201333
What can you do?
Create better match between resources used and true patient needs
Deliver objective information about the VALUE of technology
Empower your clinicians for the rationale use of technology
©ECRIInstitute.Montagnolo.201334
Source: Littenberg B. Technology Assessment in Medicine.Academic Med 1992 Jul; 67 (7).
A Final thought on Technology Assessment
Just because something does what it is supposed to doesn't mean it does good.
Top Related