Formed from two S.C. health systems, Prisma Health tackled challenges of different approaches.
By Daniel Beaird
October 2023- The Journal of Healthcare Contracting
Dylan Lawlor is the director of value analysis for Greenville, S.C.-based Prisma Health, which was created by a merger between Greenville Health and Palmetto Health in 2017. He’s been with Prisma Health and Greenville Health since 2002.
“It’s almost a guaranteed system to be different in the way value analysis is handled because the cultures of every system are different,” Lawlor told The Journal of Healthcare Contracting (JHC) in a Q&A. It was his team’s challenge to merge the two South Carolina health systems’ value analysis programs together and then take on the pandemic.
JHC: Tell us about your professional background.
Lawlor: I’m a lab technologist by trade. I started with 10 years in the military and moved to Greenville in 2002. I started with Greenville Health on third shift in the lab and within about a year was moved into a management position and spent another six years in the lab before moving to supply chain and taking the manager’s role in value analysis.
Back then, we didn’t have a formal program. When we introduced it, the program was very corporate-level and senior-level in terms of what ideas could be applied to find savings for the system. It was more project oriented.
Over the years, it morphed and grew as people realized the value we bring to an equipment review, new product review or capital review. Today, we do it all for Prisma Health. We are connected to anything new coming into the system, even service related. My team pulls together some of the benchmarking, standardizations and quality efforts – making sure that when we implement something, we are doing it as a system.
JHC: How’s it been since the merger between Greenville Health and Palmetto Health?
Lawlor: We’re getting everyone on the same page. I mentioned how different each value analysis program is – well, I consider it fortunate that Prisma Health employs the bulk of our physicians. So, they have a vested stake in how we go about things. Our value analysis program has been built on collaboration with our physicians in everything we do.
Many larger initiatives are brought to me by our physicians, or I go to our physician leadership to make sure a program like hip and knee is one that they’re going to support and help me drive compliance around it. Compliance helps keep the vendors accountable for the support and structure we’re putting in place.
We’ve won different awards for the value analysis program here through Vizient. We are progressive in our approach and in driving the savings and standardization initiatives we are able to get done.
JHC: Expand on physician engagement within the value analysis program since Greenville Health and Palmetto Health became Prisma Health.
Lawlor: We’ve had our challenges. The program that Palmetto Health had in place was slightly different from the one Greenville Health had in place. Eventually, it all rolled up under me. It was standardized under one process, which made it easier. We’re still fighting cultural differences that were established in Columbia, S.C., and Greenville, S.C., but we’ve had great collaboration from both sides. I’m not worried about the Midlands market versus the Upstate market.
Our value analysis coordinators do a great job to make sure when physicians request product that they are looking at it from a true Prisma Health level. We don’t want to do it on a market level because we don’t get the standardization or the clinical advantages of standardized outcomes across the system if we have multiple products in place.
Our teams are based on clinical swim lanes and during the initial merger, I also had the contracts team reporting to me. Tying those pieces together is integral so all parties know who buys the product to who contracts it to who works with the clinicians to drive the product choice. So, everybody is hopefully on the same sheet of music within supply chain driving these things home.
JHC: How does Prisma Health integrate suppliers during the process and what parameters are set?
Lawlor: Our process is designed so I don’t have to meet with the vendor prior to them talking to our clinicians. I don’t presume that I know everything or that I need to know everything or that I need to be part of the initial discussion between vendors and clinicians on products.
Our program ties in when the physician wants to look at something. That’s where my team will get engaged. That’s the standard we hold our suppliers to. It isn’t my team’s job to sell the product. But at the point of interest, we need to be engaged to help walk suppliers through the process.
Suppliers have a place to bring new products, new technology and new ideas to our clinicians for vetting. That’s their job. I support them in that. The suppliers must understand our job is to vet a request and how it needs to be engaged at Prisma Health. How do we need to look at that new technology? Is it evolutionary? Is it revolutionary? And what advantages is it going to bring to us?
Another parameter in recent years is we’ve been connected with our IT department. We’re the gatekeeper with IT when bringing in new equipment connecting to our networks or housing patient health information. We look at those connections to make sure we’re not the next ransomware victim. So, it’s not the vendor going to IT. It’s our department that connects the vendor and IT together to get the review done.
JHC: How has the value analysis process changed after the pandemic?
Lawlor: We’re a little bit different because we own our own distribution center. My value analysis team is connected to that group and the products we have in the warehouse and how we maintain it. The backorders, product substitutions and recalls during the past two to three years have been crazy and my team is the bridge between supply chain and the clinical teams.
It came with some opportunity, though, because some of the sacred cows we couldn’t touch went on backorder and we had to touch them. We had to work with the clinical teams on product change because we didn’t have a choice. It opened the door for us to challenge things and change the status of what was termed a commodity product.
We went from five vendors to one vendor. So, why do we want to go back to five? What advantages is that bringing us? What clinical outcome improvements are we getting by going backwards in the standardization?
We’ve done bulk purchases and brought in products through our warehouse. We had to refocus, but we were always able to find something by working with the clinicians and different vendors to meet our needs.
JHC: How did processes used during the pandemic improve value analysis for the future?
Lawlor: I’ll answer that in two ways – something I’d like to see change on the value analysis side and something on the supplier side.
I’ll address the value analysis side first. We changed GPOs coming out of the pandemic. So, we’re using that as an opportunity to standardize products and standardize clinical outcomes. My team is now more directly involved with the quality team at Prisma Health to help make those connections.
We’re starting to look at physician choice in some products and how it’s driving costs and outcomes. We used to ask clinicians what it would replace. Is it truly a new product? Because 99% of the time it’s not. It’s an add on or a replacement.
But is there opportunity here to compare different vendors and their products to get a top-to-bottom approach with subcategories? How do we categorize these to drive a better contract for system savings and standardizations across clinicians? That’s a more complete analysis instead of just Product A to Product B.
On the supplier side, some of these evolutionary changes are not worth the cost that vendors are bringing to us. We can’t afford them. I’m asking vendors to go back to their companies and to save that money for the revolutionary changes. Take the money they’ve been using on the evolutionary changes, invest it back into the infrastructure and reduce the cost of producing the products they’re producing now?
Hospitals can’t keep absorbing this cost for minor tweaks and improvements. Vendors must look to reduce their costs and pass that back to the hospitals. We know there have been challenges with raw materials and transportation, but just passing that along to the hospitals isn’t plausible.
Companies that can do this are only helping themselves because it frees up money for us to purchase the capital we need going forward.
JHC: How much more transparency is there, if any, in supply chain processes post pandemic?
Lawlor: We do things differently because of our distribution center. We’ve established our own direct deals and cut out the middleman, and work with a vendor to cut their costs. With our unique relationship with vendors, our physicians understand there’s a place for vendors and we can’t do this without them. But our physicians usually come to us before going to the vendors with requests. We’re transparent with our clinicians and our vendors.
This is a cyclical business. The deal done today isn’t necessarily the deal done in three to five years. That business may circle around, so we do our best not to burn bridges. It’s all about timing and our evolution at Prisma Health.