Clinical Alignment Via Decision Support – published 2022 by symplr
Value analysis has long been the process used to make well-informed, evidence-based decisions in healthcare organizations. Today, the ability to make expeditious, defensible decisions that align with value-based care, and subsequently value-based payment methods, has become one of the most important functions in every healthcare organization. However, COVID-19 exposed two fundamental realities particularly pertinent to value analysis teams and hospital leaders.
Those individuals and others charged with evaluating their product introduction strategies should take heed:
1. Value-based decisions cannot be made, and value-based care cannot be achieved, without high levels of clinical alignment.
2. The majority of decision-making processes across health systems have proven to be inadequate in handling modern complexities such as mitigating risk, protecting governance, and ensuring compliance across the continuum.
As a result, health systems are evaluating how they can involve the right people, at the right time, and in the right capacity to approach evidence-based decision making within a digital framework. Key to this discussion is how clinical evidence and operational data combined can be a foundation for clinical alignment and serve as key components of the decision-making infrastructure (technologies, tools, etc.) that support virtual workflows and standardization.
Clinical Alignment: A Definition
Clinical alignment is unique to traditional value analysis frameworks, as it is rooted in high levels of executive and clinical engagement, and promotes an outcomes-focused culture across the organization. Clinical alignment is guided by interdisciplinary partners working in coordination to pursue the common goal of providing exceptional value and evidence-based care. A sign of clinical alignment is when decisions consistently coordinate with a standard of care defined and supported by the larger organizational culture, as opposed to maintaining event-based decision making.
Taking a Step Back from the Traditional Value Analysis Committee
Historically, the traditional value analysis committee has been highly structured, maintaining in-person meetings, with the majority of knowledge and processes centralized to a relatively small stakeholder group. And, while committees may be large in composition, critical expertise from clinical, financial, and operational perspectives may not be present. However, disruption in supply chain and care delivery has challenged this traditional approach. During COVID-19, physicians and other clinicians were exposed to supply chain realities like never before, thus requiring them to elevate their engagement and provide clinical validation for the allocation of products.
This presented an inflection point in the healthcare landscape, and in many cases, opened the door for clinical alignment between stakeholders traditionally lacking accord. Marking another significant shift, the collapse of inperson meetings presented challenges for systems operating without established virtual capabilities in their decision-making infrastructure. In these cases, a lack of flexibility, barriers to data visibility, and an inability to make expedient decisions crippled teams across the country.
As an industry, we would be remiss in failing to take a step back to recognize the significant shifts that took place during COVID-19 in both the architecture of and activities among value analysis committees and related stakeholders. For those of us who have seen the devastating realities of supply chain duress in the field, it’s clear that the impact has extended beyond individual processes and product decisions.
Moving forward, what does this mean for health systems with a strategic, outcomes-focused strategy? Strong governance is critical for process continuity; risk mitigation is central to patient outcomes; and compliance is a non-negotiable factor for maintaining objective, centralized decision making. Without mature governance, risk awareness, and compliance mechanisms, supply chain simply doesn’t have the infrastructure to withstand the complexity of the modern healthcare ecosystem, never mind expecting it to contribute to clinical alignment or excel in a virtual environment.
To move forward as an aware and equipped industry, we must first pause and answer critical questions about current value analysis methodologies, including the following:
• Does the traditional model, utilized by the great majority of health systems, afford the level of flexibility required to meet today’s complex, fluctuating challenges?
• How do we strategically move forward to better engage clinical stakeholders?
• What processes do we need to reevaluate?
• What foundational data have we historically neglected to consider? • How have we framed and understood risk in the new product introduction process?
• What infrastructure do we need to build to consider that data?
• And, critical to maturing value analysis programs: How well were we able to pivot to a virtual environment and maintain decision-making integrity?
In an effort to evolve from an old-world approach surrounding new product introduction to a new-world, virtual infrastructure, core components must be considered.
Clinical Alignment: Sometimes Mystifying, Always Critical
In a contemporary healthcare ecosystem, clinical alignment is required to achieve strategic, financial, and clinical objectives. A focus on value-based care and quality excellence makes process collaboration, in partnership with strong data, a non-negotiable. An underlining theme is the need for a new level of flexibility and willingness to challenge perspectives, accomplished through collaboration on how to deliver the best value across the continuum.
During COVID-19, the disruption in daily workflows and responsibilities opened a rare window of opportunity to expose and address a deep lack of alignment among stakeholders. Ultimately, clinical and non-clinical stakeholders are collaborative partners in improving patient care, elevating population health, increasing value, and sharing risk. The community has seemingly agreed to this standard on paper, but the supporting culture has not seen the evolution that progress demands.
In a new-world context, the larger healthcare organization, as well as physicians, clinicians, supply chain, value analysis, vendors, payers, etc., all take part in this shared responsibility. In forward-looking organizations, this responsibility is borne out in greater acceptance of shared risk. COVID-19 and the complexities it wrought have proved that organizations can no longer function in siloes; without clinical alignment, organizations are not equipped to adapt and make strategic decisions expeditiously.
Moving forward, clinical alignment will require a new level of collaboration, flexibility, digital capabilities, data-sharing, and dedication to cultural change. However, while the need for strong clinical alignment is clear, the pathway to its improvement has historically been considered more of an unobtainable ideal than an actionable process.
Common Challenges to Achieving Clinical Alignment
While every healthcare organization varies with regard to its leadership and committee structures, culture, values, mission, and other factors, there are common hurdles to the ability to achieve clinical alignment, including the following well-documented factors:
• There is poor cultural alignment and a lack of clarity surrounding organizational goals and norms
• Organizational goals are not well-socialized and/or are not visibly supported by leaders
• The physician/clinician requestor does not have a defensible “why” behind a product request
• Clinical and non-clinical stakeholders operate with contradictory objectives that motivate decision making
• Inconsistent communication standards and event-based interactions/decisions are normalized
• Processes lack engagement mechanisms and standardization
• Stakeholders operate with different standards or sources of data
• Data is not democratized across the organization
• Siloed processes support a lack of transparency throughout the decision-making process
• Physicians follow a culture of taking on the limited role of case-by-case product promoters rather than system-wide clinical process champions
• Clinical expertise and data are not shared/considered at the start of the request/review process
Technology supports automated processes
Through the standardization of decision-making and use of technology, organizations can elevate clinical alignment while improving costs, quality, and outcomes. For mature supply chain teams and health systems, that is the “why” that unifies disparate processes, focuses energies on elevating patient outcomes, and streamlines the introduction of life-saving technology into the hands of clinicians. With this framework, a subset of organizations are evolving to meet the complex challenges of the modern, value-based ecosystem. However, for those who continue to preserve the status quo with siloed, manual data and processes, supply chain disruptions, shrinking operating margins, and changing reimbursement structures will continue to threaten their viability and potential to maximally serve patients. An evolution toward the golden standard of evaluation does not take place overnight. However, elevating patient outcomes through a value-based model should always be the first priority for members of the healthcare community. Today, executing on this standard requires a digital infrastructure for evaluation. The value analysis profession should be seen as a compass for new product introduction and clinical integration across the continuum. Ongoing change management and the prioritization of outcomes must guide the transition to a new-world value analysis infrastructure, where clinical alignment and technology serve as cornerstone partners in evidence-based decision making.
This paper was co-authored and published by symplr, a leader in enterprise healthcare operations software and services. To download this paper in its entirety, visit symplr.com