Transcript ECRI PRESENTATION

Evidence Based Purchasing
WSHMMA
Vancouver, WA
April 18, 2013
Anthony J. Montagnolo
Executive Vice President and COO
[email protected]
610-825-6000 ext. 5175
1
1
©ECRIInstitute.Montagnolo.2013
Surprise! We now work for
Cheesecake Factory Hospital
2
©ECRIInstitute.Montagnolo.2013
Resistance
is futile
3
©ECRIInstitute.Montagnolo.2013
The math does not care who is in charge.
Neither should you.
Sources: Centers for Medicare
and Medicaid Services
What Is Driving U.S. Health Care
Spending? America’s
Unsustainable Health Care Cost
Growth, Bipartisan Policy Center
4
©ECRIInstitute.Montagnolo.2013
Once upon a time in merry old
England I stayed at a quaint
cottage hotel……..
5
©ECRIInstitute.Montagnolo.2013
6
©ECRIInstitute.Montagnolo.2013
Outside and inside
expectations
match
High quality requires
standard systems.
7
©ECRIInstitute.Montagnolo.2013
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
8
©ECRIInstitute.Montagnolo.2013
MARCH 2010| IN VIVO: THE BUSINESS & MEDICINE REPORT| www.ElsevierBI.com
9
©ECRIInstitute.Montagnolo.2013
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

10
©ECRIInstitute.Montagnolo.2013
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?
11
©ECRIInstitute.Montagnolo.2013
And what are outcomes in
healthcare?





12
Longer life?
Better life?
Higher productivity?
Healthier populations?
Happier people?
©ECRIInstitute.Montagnolo.2013
Where is technology headed?
13
©ECRIInstitute.Montagnolo.2013
ECRI Institute’s Top 10 C-Suite Watch List:
Hospital Technology Issues for 2013
1. Electronic Health Records
2. mHealth (mobile health)
3. Alarm Integration Technology
4. Minimally Invasive Cardiac Surgery
5. Imaging in Surgery
14
©ECRIInstitute.Montagnolo.2013
ECRI Institute’s Top 10 C-Suite Watch List
(Cont’d)
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
15
©ECRIInstitute.Montagnolo.2013
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
16
©ECRIInstitute.Montagnolo.2013
Cleveland Clinic Names Top 10 (Cont’d)
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
17
©ECRIInstitute.Montagnolo.2013
Bariatric Surgery for Control of Diabetes
► Experts suggest earlier
intervention for diabetes
treatment
► Possibly curative
18
©ECRIInstitute.Montagnolo.2013
Digital Breast Tomosynthesis
►Provides tomographic
view –reduces
overlapping tissue
blurring
►May cost 20-60% more
than digital mammo
19
©ECRIInstitute.Montagnolo.2013
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
20
©ECRIInstitute.Montagnolo.2013
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
21
©ECRIInstitute.Montagnolo.2013
Technology that improves service
will matter more.
William G. Huitt, May 2002
22
©ECRIInstitute.Montagnolo.2013
Focus on Real Outcomes
23
©ECRIInstitute.Montagnolo.2013
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
24
©ECRIInstitute.Montagnolo.2013
Source: Nudge: Improving Decisions About Health, Wealth, and Happiness.
Thaler and Sunstein, 2009. Page 17.
25
©ECRIInstitute.Montagnolo.2013
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.
26
©ECRIInstitute.Montagnolo.2013
Framework used to assess new
healthcare supplies/technologies
We 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)
27
©ECRIInstitute.Montagnolo.2013
Follow Technology Decision Rubric
Technical &
Operational
Issues
Clinical
Evidence
and
Outcomes
High Quality
Decision
Process
Financial
Issues
28
©ECRIInstitute.Montagnolo.2013
Strategic
Issues
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
29
©ECRIInstitute.Montagnolo.2013
Intermediate Outcomes
Shorter term measures; may or may not
predict long-term patient outcomes, such as





30
Hospital length of stay
Tumor response rate after treatment
Disease-free survival time after treatment
Weight loss 6 mo. after bariatric procedure
Restoration of normal heart rhythm after afib
©ECRIInstitute.Montagnolo.2013
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
31
©ECRIInstitute.Montagnolo.2013
Quick Test: Digital Breast
Tomosynthesis
►Provides tomographic
view –reduces
overlapping tissue
blurring
►May cost 20-60% more
than digital mammo
32
©ECRIInstitute.Montagnolo.2013
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
33
©ECRIInstitute.Montagnolo.2013
A Final thought on Technology
Assessment
 Just because something does what it is supposed to
doesn't mean it does good.
Source: Littenberg B. Technology Assessment in Medicine.
Academic Med 1992 Jul; 67 (7).
34
©ECRIInstitute.Montagnolo.2013