“Practice change is really where sustainability is. Providing physicians with the evidence from Hayes
to make good decisions is where the real value comes from.”
- Karla Barber, RN, BSN, CVAHP, System Director of Clinical Value Analysis
Centura Health leveraged a subscription to the Hayes, Inc. Knowledge Center and their Evidence Advisor service for two large projects. In an effort to reduce clinical variation, they utilized the unbiased evidence assessments and recommendations for product standardization and utilization management.
Successes of the initiatives included:
- Annualized cost savings from $600,000-$900,000 for one procedure
- Successful vendor renegotiations while maintaining physician preference/patient choice
- Utilization of evidence for comparisons regarding future new health technology acquisition
Centura Health connects individuals, families, and neighborhoods across Colorado and western Kansas with more than 6,000 physicians and more than 21,000 of the best hearts and minds in health care. Through their 17 hospitals, senior living communities, health neighborhoods, home care and hospice services, Centura Health is making the region’s best health care, accessible and affordable in every community they serve.
Centura Health had significant variation in the utilization patterns of antibiotic-impregnated bone cement in total joint replacements. Some were using it on every patient, regardless of whether or not it was a new joint replacement or a revision, as well as whether or not it was a healthy patient or one with multiple comorbidities. There was also variation in the type of antibiotic used along with the dosage, as well as disagreement as to whether to use a premixed cement or to compound on site.
Centura Health physicians presented to the value analysis (VA) team that they agreed there were no significant differences in outcomes for hip replacements with unipolar versus bipolar heads. In reporting this, they also noted a $400 price differential for the two products, with bipolar being the more expensive of the two. However, some physicians preferred the bipolar head for their patients.
How Hayes Helped
The dedicated Hayes Evidence Advisor (EA) pulled existing evidence assessments from their Knowledge Center (a comprehensive library of health technology assessments) at Centura’s request. The Centura VA team, with recommendations from the Hayes EA based on the analysis of the research, then presented the information to their physicians. This collaboration between Hayes and the multiple stakeholders (including pharmacy and the antibiotic stewardship team) in the Centura Health System resulted in an algorithm for a standard of practice in the use of antibiotics in bone cement that took into account:
- When to use an antibiotic and for which patients
- Proper dosing
- Use of premix versus compounding
The Centura VA team again consulted their dedicated Hayes EA to provide evidence regarding the outcomes of unipolar versus bipolar heads in total hip joint prosthetics. In this case, some older information already existed, but the Hayes EA completed a rigorous search to find the most current research, which confirmed the physicians’ hypothesis that no significant difference in outcomes existed. The Centura VA team utilized this information to renegotiate their vendor contract.
Prior to their subscription to the Hayes evidence solution, Centura partnered with a competing health technology assessment provider. However, Centura sought a replacement as the company was unable to provide customized reports or product comparisons. Similarly, their evidence assessments did not include regulatory information or summary checklists.
Results, Return on Investment (ROI), and Future Plans
Preliminary discussions of the existing clinical variation around antibiotics created immediate changes in practice, resulting in a savings of more than $100,000. Annual estimated savings from standardization are from $600,000-$900,000, based on the health of the patient and type of procedure (revision versus total joint).
Vendor renegotiations resulted in Centura paying the same amount for the bipolar head as for the lower cost unipolar head, realizing a savings of approximately $400 per prosthetic while continuing to allow for patient and physician preference.
Future plans for the use of Hayes and the Evidence Advisor Service may include risk sharing with vendors as relates to benchmarks for CMS reimbursement by gathering clinical evidence in partnership with said vendors.