What is Utilization in Healthcare?

Utilization can be defined as the extent to which hospitals are making use of products or services. Many hospitals have historically focused on savings related to pricing and standardization. However, with seemingly relentless financial pressures and complexities of the healthcare supply chain, utilization opportunities are the next wave to spark interest of savvy hospital executives.

Opportunity for improvement in utilization can exist due to over, under, or improper use of a hospital’s goods, equipment or services. Being able to conduct an accurate assessment of current operations to determine if utilization opportunities exist is a challenge for most hospital leaders due to several factors such as unreliable documentation data and constantly evolving market options for products and services.

Successful implementation of utilization opportunities delivers the following benefits to an organization:

• Financial benefits ranging 7-15% depending on the category
• More efficient use of time and resources
• Discovery of other deep issues within a category, often quality related

Key Opportunity Indicators

Poor Asset Management

In today’s environment, hospitals have a broad mix of assets across the organization. Understanding the true total cost of those assets is a challenge. Total cost of ownership for each asset includes not only the acquisition cost but also ongoing expenses related to maintenance, service and consumables. Furthermore, with hospital service lines experiencing continuous evolution, it’s difficult to maintain current lists of assets, let alone track service and maintenance records. As a result, an organization may find many inefficiencies or low returns on investments when true total cost of ownership is revealed.

• Client Example: In our experience, clinical engineering often comes up in client discussions as an area to review due to its costly asset acquisitions, large asset inventory, and significant recurring spend on service and maintenance. Optimizing service levels on under-utilized or low-risk devices can drive utilization improvement. As an example, in outsourced maintenance agreements for ultrasounds, there may be significant savings to move from a platinum to silver or bronze support levels when in-house maintenance capabilities exist or sufficient inventory is available to swap out devices as equipment downtime occurs.

High Volume of Add-on Charges

For outsourced services, expenses can mount quickly due to “add on” charges for line items such as over-time, out of scope requests, volume commitment penalties, etc. These situations can result when service requirements were not anticipated when the agreement was created or if an organization experiences operational changes that impact how the services are now used. For these reasons continuous utilization reviews are important.

• Client Example: Within our client’s clinical purchased services spend, such as dialysis, we discovered a high volume of “delay” charges that increased over several years. This led us to identify an operational bottleneck that was occurring with the patient transport process for treatments performed in the dialysis suite. Once the problem was understood, the transport process was redesigned, resulting in improved patient flow and a significant reduction in delay charges.

Misalignment with Key Performance Indicators (KPIs)

Although the process for determining utilization opportunities does not rely on data alone, using Key Performance Indicators (KPIs) to monitor high level utilization trends is helpful.  KPIs are multi-dimensional, data-driven measurements of key operational data that highlight performance relative to targets and help measure productivity in healthcare organizations. KPIs are a good first place to look for unfavorable utilization trends that may be a symptom of a larger underlying operational issue. We find implementing a KPI reporting tool that ties operational performance to cost can bring more awareness to potential utilization improvement opportunities and ultimately help drive and sustain change.

• Client Example: Appropriate linen utilization is a common issue for many hospitals, and an opportunity that our clients typically believe exists based on operational practices they witness.  However, determining just how much utilization opportunity there is can be difficult to pinpoint. In our experience, a KPI that effectively measures linen utilization levels, including linen loss, reported in a metric of pounds per adjusted patient day helps our clients identify utilization improvement opportunities.

Key Success Factors

Establish Multi-Disciplinary Teams

Discovering utilization opportunity requires a long-term, multi-faceted approach more complicated than identifying opportunities in pricing or standardization, which are common focuses for traditional value analysis teams. Therefore, it helps to have a dedicated team that understands the nuances of the specific utilization elements. Multi-disciplinary teams including nursing, finance, support services and supply chain are most effective. For many organizations, engaging a third party to determine team composition, establish charters, facilitate initial meetings and help cultivate working relationships on the team, has been very beneficial to expediting efficient and effective utilization projects.

Leverage Multiple Tools and Processes

Identifying utilization opportunities is a comprehensive evaluation process. There is no one tool, process or metric that leads to successful utilization-based initiatives. It is often a combination of many tools that effects sustainable change over the long-term.

Find the Right Change Agent(s)

One of the most difficult aspects to pursuing utilization opportunities is effecting lasting operational changes. Once opportunities are identified and an implementation strategy is defined, an important next step is gaining support of those involved in the operation that change is necessary. An influential leader that can gain organizational support for change – whether it is a change in practices, processes or technologies – is crucial for transformation. Individuals need to feel well supported in the direction the organization is taking, especially when that direction requires change. Success will be elusive without stakeholder buy-in and support.

Improve Continuously

Continuously re-evaluating operations by looking to leading practices inside or outside your organization is important to maintain proper utilization. Take advantage of healthcare industry associations, roundtables and whitepapers that are regularly published to stay aware of key trends. Utilization opportunities, unlike pricing, are not proprietary and can typically be shared through collaborative discussions with peers.

What is Make vs. Buy in Healthcare?

Make vs. buy in healthcare can be defined as the extent to which hospitals choose to use in-sourced or out-sourced resources.  Many clients often do not pursue this lever because each evaluation is unique; it requires robust data analysis, deep operational knowledge, change management and a longer timeline to successfully implement. However, the benefits that come with the make vs. buy lever can be enormous to any healthcare organization.

Key Opportunity Indicators:

Significant Change in Volumes

A significant change in volumes, regardless if products or services are outsourced or provided in-house, can be a good signal it is time to evaluate the make vs. buy value lever. As demand changes, hospitals need to determine if either a make or buy model is best suited to maintain costs and quality levels over the long-term. Often, an increase in volume can serve as a strong leverage point for negotiations with suppliers. Conversely, with a significant decrease in volumes, organizations need to evaluate if its service delivery model has a flexible cost structure that can match current demand or if it is heavily burdened by fixed costs.

• Client Example: Pathstone recently worked with a large health system that was experiencing continuous growth in annual bed rental spend. Although renting beds provided benefits such as procurement flexibility and third-party maintenances services, our analysis showed the increase in volumes was large enough that an investment in purchasing hospital beds was more favorable to the organization. As a result of our recommendations, the health system was able to reduce rental costs by 20%.

Increasing Program Costs & Decreasing Quality

If annual costs related to a service are increasing while quality is decreasing, it may be worth evaluating make vs. buy opportunities. From a cost perspective, organizations need to understand the key drivers of increased costs. Is it price, volume or productivity? Furthermore, hospitals can partner with third parties (GPO, consultants, benchmarking service, etc.) to determine how costs compare to the market and begin to measure key performance indicators for their  health system. From a quality perspective, performance on key service level agreements (SLA) and end-user feedback can be gathered to understand key drivers of decreasing quality levels. Is it bandwidth, staff capabilities or limited resources?  By understanding the current state, hospitals can then effectively evaluate the benefits of transitioning to a make or buy model.

Fragmented Service Delivery Models

If your organization has a different mix of service delivery models, it may indicate opportunities to generate value. Fragmented service delivery models lead to differing levels of productivity, cost and quality, potentially impacting patient care and operations. By selecting a standard make or buy model for a given product or service, an organization is essentially applying another form of the third value lever we’ve covered, standardization.

• Client Example: Pathstone has encountered several clients that have fragmented models for courier services which led to differing levels of staffing, service quality and cost, all of which can also make daily operations challenging to manage. In several of those situations, a decision was made to outsource courier services by working closely with key stakeholders across the health system, leading to more consistent service delivery and lower costs.

Key Success Factors

Develop Business Cases

Organizations that utilize a comprehensive business case to evaluate the pros and cons of an in-sourced or outsourced model will increase their chance of success. The business case is a fact-based tool that allows teams to have an open and objective dialogue when selecting the best strategy.  For complex categories, engaging third parties to develop business cases can provide market information and objective analysis necessary to make the best decision.

Evaluate Program on an Ongoing Basis

Since costs, quality and performance of programs can change over time, organizations that continuously evaluate make vs. buy opportunities position themselves to generate more value over the long-term. Continuous self-assessment can uncover opportunities resulting from minor improvements in supplier relationships to complete transformations for an organization’s service delivery model. For example, one important question for an organization to ask about an insourced operation is: “What else can we do with these resources?” The opportunity cost of those resources can help identify alternatives that drive more value for the organization. Furthermore, alignment of the service with the organization’s overall mission should be evaluated.

Access to Market Intelligence and Best Practices

Hospitals that have conducted extensive market research are well positioned to evaluate existing outsourced or internal programs.  Market intelligence on leading practice cost metrics and performance indicators can be an effective barometer to measure financial, quality and operational performance. Partnering with third party providers that can provide insight on market benchmarks can help an organization set the right targets to measure the competitiveness of existing programs.

What is a Strategic Alliance in Healthcare?

A strategic alliance can be defined as a form of mutually beneficial relationship or partnership between two parties focused on collaboration that achieves results for both organizations they wouldn’t be able to realize on their own. Strategic alliances are an increasing trend in the healthcare industry as a mechanism to achieve cost reduction and increase profitability. There is a broad spectrum of strategic alliances ranging from formal arrangements, such as joint ventures to more loosely affiliated collaborations.

Strategic alliances can offer the following benefits to an organization:

• Incremental cost savings or revenue
• Increased sustainability of long-term cost savings
• Increased access to additional resources (knowledge, capital, etc.)
• Expanded reach in the community through new partnerships

Key Opportunity Indicators

Minimal Investment in Outpatient Services

The healthcare industry is rapidly changing on a local level with competing hospitals establishing strategic relationships around the community, which can significantly increase competition for patients. With an on-going shift towards outpatient care in the market, hospitals continue to evaluate opportunities to increase outpatient offerings. Hospitals are often turning to suppliers for partnership opportunities to increase patient reach

• Client Example: Dialysis services is an example where we see hospitals partner with the external service providers in joint venture arrangements with a goal of expanding offerings in the local market. Becker’s Hospital Review released an article, Joint ventures and collaborations across healthcare services (August 2017), which reported hospitals are increasingly turning to dialysis services as an area with clear benefits to hospital and supplier strategic partnerships. Since managing costs and the complexity of care for dialysis patients is difficult on both an inpatient and outpatient basis, it’s not a surprise that we see the industry leaders like DaVita and Fresenius partnering with hospitals across the country in joint ventures to deliver care. Negotiating such arrangements with competitive rates for dialysis inpatient services while also delivering competitive revenue share for the hospital through the joint venture is very challenging.

Strong Existing Supplier Relationship

Many hospitals have been successful capitalizing on a history of strong relationships with their suppliers by taking the relationship to the next level through creative new partnerships that deliver greater value for both organizations.

• Client Example: Pathstone has encountered hospitals that have formed joint ventures with air ambulance providers that have been long-time service providers for those hospitals. In a service category such as this, hospitals have limited supplier choices in the market due to significant supplier consolidation over the years. When the two parties embark on a joint venture, one common goal may be the expansion of medical services to under-served areas that either the hospital or air ambulance company is challenged to serve on their own. By partnering, both organizations benefit from expanded market reach.

Merger and Acquisition (M&A) is Not an Option

Although M&A activity in the healthcare industry is occurring at an increasing rate, some hospitals are seeking alternatives that can still deliver the financial and operational efficiencies necessary to survive in the current market. M&A transactions are often very long, complex ordeals that come with heavy scrutiny of potential competitive implications, which we believe is one reason there is an increase in strategic alliances.

• Client Example: Regional or local Purchasing alliances are becoming more popular across the country as an enhancement to hospital centric or national GPO purchasing. This is one example of hospital collaborations that can be achieved without formal mergers or acquisitions.

Key Success Factors

Align Goals

Ensuring a “win-win” mindset for all parties involved in an alliance is no easy feat. At the outset, the alliance must agree on their mutual purpose to keep everyone committed on a common goal and consistently seeking out the synergies for both parties, while still pursuing their individual organization’s goals. Many alliances will develop a charter and detailed workplans to keep on track. Sharing institutional knowledge and best practices can be invaluable to help each party achieve their mutual and individual goals.

Manage Conflict of Interest

Although collaboration in the healthcare industry is commonplace today, limitations do exist regarding those that can collaborate and the degree to which they collaborate. This is especially true for physician-hospital relationships because of Stark Law, where potential conflicts of interests can carry the threat of litigation and hefty fines. What makes matters more complicated is that Stark Law does lack clarity which is why you should pay careful attention to any relationships that may involve physicians. For example, we sometimes encounter hospital employed nephrologists that enter into partnerships to open dialysis outpatient clinics in the same town. On top of this, the hospital that employs the nephrologist sometimes engages in a joint venture with the nephrologist partnership for the dialysis outpatient clinic. This is especially complex and needs to be managed appropriately because the situation runs the risk of having business interests interfere with patient recommendations for outpatient dialysis services.

Maintain Effective Leadership

The right leadership is a key success factor for strategic alliances. Without this the best designed and well-intentioned alliance will often fail. Collaborative leadership teams that effectively utilize Steering Committees to manage key decisions should be required to help work out any issues and review progress towards the mutual goals.

SCM & Hospitals

Supply chain leaders within healthcare are under immense pressure to reduce cost across their systems. In the US alone, hospitals are estimated to lose $54 billion in net income in 2021.

Robust utilization data is one way that healthcare supply chain leaders can increase their bottom line and improve the revenue management cycle. Dynamic access to “centralized, consumable, and real-time data allow health systems to determine what’s needed, what’s in stock, and the scope of future demand.” Hospital supply chain systems employ data across their system to capture demand, eliminate waste, and avoid redundancy.

Eliminating waste and redundancy across the medical supply chain is just one example. Supply chain knowledge and data can be employed across a health system to achieve price reductions, utilization optimization, and standardization that drive value to the health system.

Does the Healthcare Supply Chain Affect Patient Outcomes?

In today’s value-based care model, health system leaders are required to improve patient outcomes despite the necessity to reduce cost. In particular, supply chain management in the healthcare industry plays a critical role in improving patient outcomes to achieve reimbursement through incentive alignment.

For example, decisions surrounding supply selection solicit feedback from the hospital supply chain teams and clinicians to optimize patient outcomes and source cost-effective supplies. These teams can be aligned through detailed data. Utilization and clinical outcomes data provide the opportunity for medical supply chain teams and clinicians to make decisions that achieve the goals of the health system. Linking supply chain related items such as product standardization to patient outcomes enable these teams to align on the most cost-effective and clinically optimal choice.

What is the Future of the Healthcare Supply Chain?

Supply chain management is a critical function in the healthcare industry. The elimination of unnecessary costs, patient outcome improvement, and increased reimbursement are only a few of the significant benefits optimal supply chain management provides. Emphasis on data collection and employment, incentive alignment, and vendor management are a few avenues that healthcare organizations can utilize to achieve these goals in the future.

At Pathstone Partners, we specialize in helping healthcare systems across several different markets navigate the complexities of their supply chain. With our years of experience in clinical purchased service and supplies, we can assist with everything from supplier contract review to price negotiations.

Contact us online to learn more about our healthcare consulting solutions and how we can help create efficiency in your supply chain.

Optimizing the Healthcare Supply Chain

Optimizing the healthcare supply chain is crucial to ensuring patients receive high-quality care. While the healthcare supply chain has strict regulatory requirements, there are areas where it can improve. Enhance efficiency in the supply chain by following these hospital SCM tips:

Improve Visibility

You should be able to tell where products are within your supply chain at any given time and properly manage inventory. To do this, gather your data in a single location. This process includes data from manufacturing sites, distributors, suppliers, products, modes, customers and the like.

You will then need to improve your data analysis capabilities from end to end using software platforms, artificial intelligence (AI) or third- or fourth-party services.

Consolidate Your Supplier Base

Managing your suppliers is an easy way to optimize your healthcare supply chain. Consolidating suppliers can be simple if you:

Build partnerships with your suppliers that are a win-win for all parties.
Start retendering to improve your understanding of the market, improve supplier competitiveness and potentially build open contracts.
Conduct performance reviews on a monthly, quarterly and annual basis.

Center Performance

Define a hierarchy of meaningful outcome-based healthcare supply chain measures. These performance measurements should allow for analysis of the tradeoffs between key performance indicators (KPIs).

You can also create a KPI model focusing on the quality, service, costs and revenue of your entire supply chain. Target each part of the organization’s supply chain and capture real-time performance data.

Implement Standardization

Healthcare organizations often grow by acquiring other entities. This situation can result in all the separate systems and processes affecting one another.

Standardize processes for physical and financial elements using a framework like the Supply Chain Operations Reference (SCOR) model. Doing so allows you to implement and enforce standards across all areas of the medical supply chain.

Know Your Costs

Many organizations would benefit from a greater understanding of their costs, including how much these are and where they come from. Start by collecting data about your costs of goods and services. Using standard categories, you can benchmark and assess the data and look for patterns.

Analyzing the invoice will help you determine where your cost-saving opportunities are. You can identify non-standard patterns and implement new processes that eliminate waste.

What is Healthcare Supply Chain Management?

Healthcare supply chain management involves the procurement of resources, the management of supplies, and an interlinked group of processes that are required for healthcare professionals to carry out their operations and increase productivity. Each link in the medical supply chain influences overall cost, patient outcomes, and service efficiency.

The Importance of Supply Chain Management in the Healthcare Industry

COVID-19 related supply chain disruptions across the United States have expedited the need to optimize hospital supply chain management. This is especially true for health systems that aim to provide high-quality care, ensure service availability, reduce cost and boost profitability. Over the course of the past few years, supply chain management in healthcare has become a central focus due to increasing pressures to reduce cost from the pandemic, while improving patient outcomes and reimbursement. Healthcare supply management and optimization within health systems achieve these goals through improved data collection and employment, attentive vendor management, and incentive alignment.

How Does the Healthcare Supply Chain Work?

The healthcare supply chain for healthcare consists of numerous stakeholders. Each one plays a significant role in how the supply chain operates. These stakeholders include:

• Manufacturers: The manufacturers are the labs, biologists and vaccinologists. They perform the research, development, manufacturing and monitoring. These groups make medical, surgical and pharmaceutical supplies and watch for shortages.
• Distributors: The logistic partners and wholesale distributors sell, deliver and monitor products while following proper procedures.
• Providers: Providers include pharmacies, urgent care centers, hospitals, assisted living facilities, dialysis centers and long-term care facilities. These places receive products from the distributors so they can prescribe them to patients. They submit orders to distributors, look for inventory shortages and call in prescription refills.
• Patients: The patients are the people in the community who use these products or services. They influence the demand for medicines and other products with their unique needs.

Contact Pathstone to discover the critical role of healthcare supply chain management in ensuring the seamless flow of resources and services within the healthcare industry.