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Solving the New-Technology Puzzle
"Innovation Celebration" kicks off Premier Breakthroughs Conference

Regardless of whether full-blown "healthcare reform" ever really occurs, few would dispute the fact that the continuing rise in healthcare costs needs to be addressed, somehow. JHC readers will no doubt continue to be under pressure to hold the line on costs. Payers - especially the federal government - will continue to demand that they’re getting their money’s worth for all the claims they’re paying. And clinicians will continue to fight for their right to practice medicine as they see fit, mindful of the clinical as well as financial ramifications of their decisions.

How does new medical technology fit in all this? Uncomfortably.

As one specialty distributor recently pointed out to JHC, the scary thing about the government’s emphasis on comparative effectiveness research - designed to put numbers, dollars and cents to different medical procedures - is that it will look primarily at retrospective data, that is, at what has already occurred. But it won’t be able to examine the effectiveness of new medical technologies, which lack the track record needed for broad retrospective studies.

And what supply chain executive hasn’t agonized over his or her clinicians’ demands for a new, but relatively untested, medical technology? Will it produce the results the vendor promised? How much will it really cost once it is put into use? And will the clinicians use it, or will it sit under plastic in a closet or hall somewhere, before finally being relegated to the scrap heap - another expensive toy?

GPOs and new technology
Traditionally, GPOs have shied away from contracting for new technology. For one thing, such technology usually flies under their radar screen; in its early stages, such technology is, by definition, used only sparingly, or only in certain pockets of the country. Second, vendors who introduce new technology simply don’t have to sacrifice margin, particularly if they’re the only game in town; it is in the early years of its use that a new technology has the greatest potential to help that vendor recoup R&D costs.

But if a new technology can, indeed, improve patient care and reduce costs, shouldn’t GPOs jump into the fray? At least one GPO - Premier - feels it can, and should. But that’s partly because Premier doesn’t see itself as a traditional GPO.

The Charlotte, N.C.-based alliance kicked off its recent annual Breakthroughs Conference in Anaheim, Calif., with what it called an "Innovation Celebration." Part trade show, part expo, the evening event showcased 25 new products that could have a big impact on healthcare. Premier Purchasing Partners President Mike Alkire reportedly was thinking of auto shows when he came up with the idea. The "Innovation Celebration" turned into a showcase not only for what’s new, but for what might be coming in future years. And rather than simply viewing new products, clinicians also got a chance to offer manufacturers input on how to improve them.

Innovation criteria
Months before staging the event, Premier assembled a team of members and staff to review applications for participation. The team included clinical field specialists, nurses, pharmacists, medical technologists, supply chain professionals and others. They scored and ranked applications based on a wide range of criteria, including:
  • Date product was introduced into the market.
  • Potential to address and solve patient- and/or healthcare-related opportunities.
  • Ability to measure success.
  • Revolutionary nature of the product or service.
  • Ability of the supplier to articulate the product’s benefits.
  • Evidence to support the review of included documentation.
There was no cost to suppliers to showcase their products at the Innovation Celebration.

Burden of proof
Speaking with JHC after the event, Alkire said that GPOs are a viable outlet for manufacturers of new technologies, and that, given its large clinical database, Premier is the ideal candidate.

"If you have a breakthrough product, a traditional GPO will be able to provide the legwork and access to a market that you might not be able to develop quickly enough," he said. This is especially true for small companies, which typically lack a large enough field sales force to make an impact on the market.

Over and above that, though, Premier can offer manufacturers what the latter desperately need - clinical data to back up their assertions on a technology’s effectiveness, he continued. "People come to us because they want an independent perspective on whether their products are performing from a clinical perspective," he said. The reason is that 6.5 million patient records - including information on products used and clinical outcomes - are entered into Premier’s clinical database every year.

Increasingly, manufacturers that conduct business with Premier are asked to state how their products or processes can help Premier members achieve one or more of the five stated goals of Premier’s QUEST program:
  • Save lives by achieving a mortality rate 17 percent less than expected.
  • Safely reduce the cost of care to below the midpoint among participating hospitals.
  • Deliver the most reliable and effective care for each patient.
  • Improve patient safety by preventing incidents of harm in 20 categories, such as healthcare-acquired infections and birth injuries.
  • Increase patient satisfaction by improving the patient care experience.
But simply stating what a new product can do isn’t enough, said Alkire. Manufacturers are being asked to identify the parameters by which Premier can measure - and assign financial value to - the effectiveness of the product or process.

The value equation
From there, manufacturers must be able to convey a clear message to hospitals and IDNs. "If you think you have a product that truly is a breakthrough, we want to hear about it," said Alkire. "But it’s about how you can articulate that value and what it really means. Manufacturers struggle with putting a value equation in terms of hospitals’ needs."

Premier can help, with such tools as its value analysis program, which allows hospitals and IDNs to share the results of their value analysis programs with other Premier members. "But to take it back, it’s how do you [the manufacturer] communicate in a way that hospitals see the value associated with your products?" The Innovation Celebration might be a start.

Indeed, the Innovation Celebration was conceived as more than a trade show. "The whole idea was, we could create an environment with 3,000 people or so," said Alkire. "You’re with some clinicians who have actually used the products, or who understand their value. And you’re talking with other clinicians, who may have a gap in providing care that this product might fill."

Once the program got underway, another dynamic occurred, he continued. "People said [to the manufacturers], ‘If you could change the product to do this, that would be an opportunity to make an impact on the quality of care.’" Establishing that kind of dialogue throughout the product development cycle "was my favorite part of the event," he added. At different points in the evening, attendees’ attention was drawn to different technologies. "It was a significantly different twist on just a trade show," said Alkire.

"What I believe we’ll build on is this: Clinicians will come to these shows and tell the vendors, ‘I want to hear what you’re saying, but I want you to listen to me too, because there are some innovations I think you can create.’"

Sidebar 1:
"Innovation Celebration" participants

The following companies were selected to participate in Premier’s recent Innovation Celebration at its annual Breakthroughs Conference in Anaheim, Calif.

Agfa Healthcare: DX-S is a digitizer for projection radiograph, said to present a solution for neonatal radiography, minimizing radiation exposure up to 50 percent compared with traditional CR.

Applied Medical: Fios® First Entry is said to separate tissue layer under direct visualization and allow surgeons to gain initial access with only a 3-mm intrusion into the peritoneal cavity for laparoscopic procedures.

Bausch & Lomb Surgical: The Stellaris system is designed to allow surgeons to perform cataract surgery using smaller surgical incisions.

Baxter Healthcare: Gelfoam Plus is a homeostatic device used in surgical procedures when control of capillary, venous, and arteriolar bleeding by pressure, ligature, and other conventional procedures is either ineffective or impractical, according to the manufacturer. HYLENEX is a purified preparation of the enzyme recombinant human hyaluronidase, said to facilitate the subcutaneous delivery of fluids and the absorption and dispersion of other injected drugs.

Cardinal Health: The HemCon Patch is a chitosan-based, hemostatic dressing for hemorrhage control. It is designed to control hemodialysis bleeding after interventional and diagnostic procedures and is indicated for the control of bleeding from the skin at percutaneous needle access, vascular access and percutaneous catheter access sites. It is one of the only hemostatic products with FDA clearance as an antibacterial barrier against a wide spectrum of microorganisms - including MRSA and VRE.

CHF Solutions: Aquapheresis Therapy with the Aquadex FlexFlow is designed to remove salt and water from patients suffering from fluid overload due to heart failure.

Covidien: Duet TRS is said to provide fully assembled reloads with a thin, fully synthetic absorbable film to reinforce stapled tissue and reduce bleeding at the staple line in thoracic, metabolic, colorectal and other general procedures. SILSTM Port allows surgeons to perform multiple procedures traditionally done with four to five ports through one incision, minimizing invasive surgery.

Davol (a C. R. Bard subsidiary): The Ventrio Hernia Patch is a prosthetic implant for the repair of ventral hernias. Features an absorbable recoil ring that is said to eliminate the need for stay sutures and to be completely absorbed by the patient in six to eight months.

Dell: The ecg@homeTM is small enough to fit in the palm of a hand and can record a 10-second ECG rhythm strip without electrode cables by using the thumbs, according to the manufacturer.

GE Healthcare: LOGIQe®, a compact ultrasound system, is said to combine real-time ultrasound images and control capabilities on the single touchscreen monitor, eliminating the need for clinicians to transition between entering patient data and attending to the patient scanning procedure.

GlaxoSmithKline: Entereg® (alvimopan) is an oral, peripherally acting mu-opioid receptor antagonist that blocks the adverse effects of opioids on gastrointestinal motility without reversing central analgesia. It is the only FDA-approved product indicated to accelerate upper and lower GI recovery following partial large or small bowel resection surgery with primary anastomosis.

Greiner Bio-One: VACUETTE QUICKSHIELD Complete Plus with VISIO PLUS needle is said to simplify the process for blood collection by signaling phlebotomists of a successful venipuncture through a "flash" in the needle hub and eliminating the need to attach the blood collection tube.

Grifols USA: MISTERIUM is a modular clean room, which can be configured and installed to any institution’s requirements in order to bring hospital pharmacies into compliance with USP <797> for sterile compounding, according to the manufacturer.

Medrad: P3T Cardiac software is designed to help develop an individualized CT contrast injection protocol for each specific patient by taking into account such variables as the patient’s condition, the scan parameters, and contrast.

Medtronic: The PRESTIGE® Cervical Disc is an artificial disc replacement designed to maintain motion for patients suffering from the symptoms of degenerative cervical disc disease or acute unresolved cervical disc herniation. It allows for the following motions of a natural intervertebral disc: flexion, extension, side bending and rotation.

NEC Unified Solutions: The M155 Messenger is a wearable watch device designed to bring non-obtrusive mobile messaging and speakerphone communications to mobile, clinical staff. It can be integrated to other clinical databases as an end-point receiving device for lab values, test results.

Olympus America: The TriPort Access System is a sterile, disposable endoscopic multi-instrument port designed to enable surgeons performing minimally invasive laparoscopic surgery to make one small incision at a patient’s umbilicus and gain access into the abdominal cavity for single-site bellybutton procedures.

PAR Excellence Systems: PAR Bins point-of-use system utilizes weight-sensing technology to automatically know the quantity-on-hand of all items in a location.

Sanofi Pasteur: ADACEL vaccine is the first combination tetanus, diphtheria, and acellular pertussis (Tdap) booster vaccine available for both adolescents and adults 11 through 64 years of age. Pentacel is the first U.S.-licensed five-in-one combination vaccine indicated for active immunization against diphtheria, tetanus, pertussis, poliomyelitis, and invasive disease due to Haemophilus influenza type b (Hib). It reduces the total number of shots a baby needs to be fully immunized to potentially seven fewer injections.

Stryker: WiSe HD Wireless Video Endoscopy System is said to offer a platform where a true high-definition signal can be received by wireless monitors in the operating room.

Tennant Company: Tennant features a system designed to electrically charge water to clean the floor using the naturally cleaning properties of water and eliminating chemical reside left on the floor.

The Medicines Company: Cleviprex is a new IV therapy designed for the reduction of blood pressure used in hypertensive emergencies and perioperative cardiovascular surgery.

Toshiba American Medical Systems: Aquilion ONE CT system has 320 detector rows covering 16-cm per gantry rotation.

Sidebar 2:
Premier award-winners

The 2009 Premier Annual Breakthroughs Conference and Exhibition in Anaheim, Calif., recognized scores of hospitals and suppliers for a number of accomplishments. Here are some of those award-winners.

Supply Chain Excellence Award
Premier recognized 26 members as winners of its second annual Supply Chain Excellence Award. The award goes to hospitals achieving superior supply expense performance as measured by Premier’s recently upgraded SupplyFocusTM, a database of operational and supply chain cost information for acute care hospitals. Winners were identified using four industry standard supply expense ratios and a case-mix-index-based peer grouping methodology to ensure that organizations of diverse sizes and complexity were considered equally. To be eligible, each organization had to submit four quarters of calendar 2008 data to SupplyFocus by April 30, 2009. With 40 indicators measuring and trending performance in cost and operations, SupplyFocus is said to enable hospitals to compare supply expense performance to that of similar facilities and easily identify improvement opportunities. Winners are:
  • Bayfront Medical Center of Florida
  • Bon Secours Community Hospital of New York
  • Cabell Huntington Hospital Inc. of West Virginia
  • Dan C. Trigg Memorial Hospital of New Mexico
  • Detroit Medical Center of Michigan
  • Detroit Receiving & University Health Center of Michigan
  • DMC Surgery Hospital of Michigan
  • Espanola General Hospital of New Mexico
  • Genesis Medical Center - De Witt Campus of Iowa
  • Greene Memorial Hospital Inc. of Ohio
  • Henry Ford Health System of Michigan
  • Henry Ford Hospital of Michigan
  • Hutzel Hospital of Michigan
  • Marcum & Wallace Memorial Hospital of Kentucky
  • Mercy Hospital - Western Hills of Ohio
  • Mercy Hospital Fairfield of Ohio
  • Northridge Hospital Medical Center - Roscoe of California
  • Page Hospital of Arizona
  • Sinai-Grace Hospital of Michigan
  • Socorro General Hospital of New Mexico
  • St. Elizabeth Healthcare of Kentucky
  • St. Elizabeth Medical Center Grant Co. of Kentucky
  • St. Mary’s Medical Center of Campbell County of Tennessee
  • Union Hospital of Maryland
  • University of Louisville Hospital of Kentucky
  • Weirton Medical Center of West Virginia
Supply Chain Innovation Awards
Three Premier members were recognized with the third annual Supply Chain Innovation Award for achieving successful innovations that have created new levels of performance and competitive advantage. The winners, which were determined by a panel of external, internal and member judges, are:
  • Henry Ford Health System (HFHS) of Detroit, which developed a database that captures supply chain contracting timelines.
  • Fairview Health Services of Minneapolis, for deploying an integrated instrument tracking and processing system, which includes interfaces with surgery scheduling, supply chain case cart building and on-site hospital turn center processing.
  • Alamance Regional Medical Center of Burlington, N.C., whose supply chain purchasing department changed the culture of the department by adopting "lean thinking" principles to operations.
Pinnacle and Performance Awards for suppliers
Premier’s fourth annual Pinnacle and Performance Awards recognize the efforts of contracted suppliers in meeting or exceeding operational expectations. In selecting recipients, performance data is collected and scored over four successive calendar quarters. Contracted suppliers scoring 95 percent or higher earn the Pinnacle Award; organizations scoring between 85 to 94 percent earn the Performance Award. Additionally, Premier honored select winners of the Pinnacle and Performance Awards with its first annual Polaris Award. Cardinal Health of Dublin, Ohio, and Owens & Minor Inc. of Mechanicsville, Va., received the award, which recognizes suppliers that have exceeded operational expectations and excelled at the qualitative aspects of service.

The 19 Pinnacle Award winners for 2009 are:
  • Aesculap Inc. - a B. Braun Company
  • Aspen Surgical
  • AVID Medical Inc.
  • Cardinal Health
  • Edwards Lifesciences
  • Fisher HealthCare
  • Iris Diagnostics
  • Kreisers Inc.
  • Covidien
  • MEDRAD Interventional/Possis
  • Michael Foods Inc.
  • Owens & Minor Inc.
  • Southmedic/Personna Medical
  • Phoenix Textile Corporation
  • Precept Medical Products Inc.
  • Trident Seafoods
  • Siemens Healthcare Diagnostics
  • Sysmex America Inc.
The following suppliers received the Performance Award in 2009: AFFLINK, Agfa HealthCare, Ambu Inc., Apotex Corp., Atrium Medical Corp., Bard Electrophysiology Division, Bard Peripheral Vascular Inc., Bio-Rad Laboratories, Cadwell Laboratories Inc., CONMED Corp. Country Pure Foods, LLC, Datascope Patient Monitoring - A Mindray Global Company, DeKroyft-Metz & Co. Inc., First Healthcare Products, Fujifilm Medical Systems USA Inc., GE Healthcare, Clinical Systems, GE Healthcare, Diagnostic Imaging, Getinge USA Inc., Gregory Packaging Inc., Hill-Rom Company Inc., HLS MedFreight, I-Flow Corp., Instrumentation Laboratory, Kimberly-Clark Health Care, Lumenis Inc., McCarthy Building Companies Inc., Merit Medical Systems Inc., Mobile Instrument Service & Repair Inc., Molnlycke Health Care, Olympus America Inc., Philips Healthcare, Imaging Systems Division, Philips Healthcare, Ultrasound & Monitoring Division, Possis Medical Inc., Professional Hospital Supply, ReNu Medical Inc., Sage Products Inc., Sara Lee Foodservice, Seneca Medical Inc., Shamrock Labeling Systems, SKYTRON, The Standard Register Company, Toshiba America Medical Systems Inc., Tremco Inc., U.S. Foodservice, W.L. Gore & Associates, Wells Dairy Inc., White Wave Foods, ZOLL Medical Corp.

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