Executive Interview: Durral Gilbert

Durral Gilbert, Premier’s new president of supply chain services, believes that good supply chain decisions rest on good data and collaboration

In July, the Premier healthcare alliance promoted Durral Gilbert to president of supply chain services. As such, he oversees Premier’s core supply chain business, which includes sourcing, contract management and operations, and business analytics, as well as businesses and partnerships that comprise its emerging supply chain efforts.

Prior to serving as the president of supply chain services, Gilbert was senior vice president of supply chain emerging services. In that position, he worked with his team to lead the development of Premier’s pharmacy offerings for providers, while identifying overall supply chain and clinical improvement opportunities. He has also led the design of Premier’s semiannual Economic Outlook publication.
Gilbert recently responded to questions posed by the Journal of Healthcare Contracting.

Journal of Healthcare Contracting: In the announcement of your promotion, a couple of references were made to work you have done integrating practice patterns, clinical efficacy and resource utilization. Can you expand on your efforts in this area?

Durral Gilbert: Premier maintains the nation’s largest clinical, financial and outcomes database, with information on one in every four patient discharges, 2.5 million real-time clinical transactions a day, and close to $43 billion in annual purchasing data. We also offer quality, safety, labor and supply chain technology apps, which are connected on one technology platform. With this integrated data and technology, our members can review utilization, supply and practice patterns, and identify and target waste. Ultimately, this means they’re making streamlined decisions based on a combination of quality, safety and cost information.

For a supply chain executive, this helps inform purchasing decisions based on a combination of price and quality, and decisions are supported by tens of thousands of outcomes. He or she can then interact with peers nationwide to get feedback on products being considered for contracts. Moreover, they’re alerted when new contracts are launched in order to immediately and easily obtain best pricing.

Presbyterian Healthcare Services is saving nearly $2 million a year – without affecting clinical outcomes – through more efficient use of an anticoagulant for cardiac valve patients. In another example, Banner Health in Arizona is saving $1.6 million a year through more efficient use of an abdominal adhesion barrier in C-sections, with no discernible difference in patient outcomes.

In both of these cases, the health systems accessed our comparative database, which is considered credible by physicians since it’s severity adjusted, and shows the performance of top-tier hospitals. These are perfect examples of what we call data-driven, evidence-based decision-making.

The supply chain is ever expanding, integrating non-traditional supply chain data. We’re working alongside our members in cohorts focusing on resource utilization and comparative effectiveness – areas that are and will continue to be a major focus for the alliance. We’re focusing not on just the price, but using clinical data to understand variation across four core areas: supply variation, and pharmacy, lab and procedural utilization.

JHC: Last year, Premier field employees were able to help members save more than $4.2 billion through improved efficiencies. Can you elaborate on who these field employees are? What are your expectations of them? How do they work with members?

Gilbert: Our field specialists are a team of experts, clinically and technically trained, who advise Premier members about efficient and effective supply spend and process improvement strategies. They also specialize in helping members improve quality and reduce costs via our performance improvement collaboratives and technologies. They are incented to safely reduce costs, and their principal means of doing so is driving contract penetration, which creates value for both members and suppliers.
These experts are based across the nation to collaborate with members and scale solutions that disrupt and change healthcare’s future. They share with each other what their top performing hospitals are doing and expand those pockets of excellence across the alliance to operationalize meaningful change.

JHC: One of your goals, as you stated in July, is to “further the alliance’s vision of transforming healthcare through innovation and partnership with our member organizations.” Can you describe what you’d like that innovation and partnership to look like?

Gilbert: Health systems today need an integrated look into utilization, quality, safety, costs and efficiency. And they need to connect care across all of their care sites – hospitals, physician offices, outpatient clinics and more. We’re assisting them in supporting new care delivery models and improving population health by integrating health information from hospitals, other healthcare sites and payors.

Because reform magnifies the need for integrated, actionable information on clinical and supply chain data, we have also connected our supply chain, quality, safety and labor offerings. We’re able to intertwine these traditionally disparate areas through our integrated performance platform, PremierConnect.

We also focus on collaboration among our members, so good ideas can be shared and replicated across our membership. We have learned that working together, with established measures, data transparency and best practice sharing, accelerates improvement to degrees not seen in single-system efforts.

Specific to purchasing, it’s quantifiable value they cannot get on their own. Last year our members validated a record savings of more than $1.45 billion (a number that is audited by a third party firm) by collaborating to improve performance, integrating and comparing data, and using innovative purchasing practices. This is on top of the $2.75 billion in savings that was realized by more aggressive product pricing and increased revenues.

JHC: Which provisions of healthcare reform will have the greatest impact on your members? What role, if any, will supply chain/materials executives play? Will Premier be able to help your members address these challenges?

Gilbert: As a part of our bi-annual Economic Outlook survey, we recently polled 600+ member executives regarding what overall trend – not specific to reform only – will have the biggest influence on them over the next year or so. Reimbursement and all of its uncertainties was cited by 43 percent of respondents, with 75 percent of respondents listing reimbursement cuts among the top three trends impacting their organizations.

Frank Fernandez, assistant vice president of supply chain services, Baptist Health South Florida, Miami – a 30+ year supply chain veteran – summed it up well when he told us that he’d “never experienced such cost pressures before.” Reimbursement cuts are clearly driving these pressures.
Health information technology requirements and new care delivery, such as accountable care organizations, were the other two areas most cited by respondents.

As we all know, health reform has expanded the purchasing dialogue well beyond traditional pricing and into care delivery. Our members are working to close the gap between cost and quality, or the cost of supplies and services required to provide optimal care. As such, purchasing executives are finding themselves interacting more and more with the C-suite.

Likewise, as utilization becomes a target in health reform, clinical users must become more proficient in value analysis to maintain cost efficiency while supply chain managers must strive to better understand clinical protocols to maintain quality. Data is the fundamental tool required to marry quality of care goals with cost-cutting strategies.

JHC: How is the QUEST program affecting your members’ supply chain teams, if at all?

Gilbert: Preliminary four-year results suggest participants saved $6.9 billion. A significant portion of these savings are through more appropriate utilization of drugs, tests and other resources.

QUEST participants played a key role in the development of our efficiency dashboard, which identifies categories of potential savings opportunities in hospitals. Specific to the supply chain, we found annual savings opportunities of more than $4.8 million through more appropriate lab testing, diagnostic imaging, blood utilization and purchase order automation.

Our QUEST Comparative Effectiveness & Innovation Program (QCEIP) generates objective results to inform providers and patients about safe, cost-effective treatments for certain clinical conditions. Suppliers volunteer to participate in the program, which evaluates products and clinical interventions in real-world settings at our hospitals. It also helps the healthcare community better understand patient outcomes associated with the use of certain products, and helps manufacturers understand better how their products are working in the real world.