Physician-Engaged Sourcing

Excelerate brings clinical perspective to the supply chain

JHC-Feb2016iStock_000077440453_LargeAs hospital supply chain executives continue to recognize the value of fully engaging their clinicians, more and more are on board with a physician-engaged sourcing model, which makes physicians and administrators mutually accountable for their organization’s healthcare costs while delivering quality patient care. Excelerate – a joint venture between Cleveland Clinic and Vizient Inc. (the new brand identity for the organizations formerly known as VHA Inc., UHC and Novation) – has subscribed to this model since it was formed in 2013. From the start, its mission was to “take the traditional GPO model to a new level,” says Sean Patrick Lyden, MD, FACS, vascular surgeon and associate professor-medical director, clinical supply chain management, Cleveland Clinic Foundation and chief medical officer for Excelerate.

Excelerate has achieved a quality-centric, physician-engaged sourcing model by executing data-driven, market-leading contracts; creating supply utilization guidelines designed to decrease clinical variation; and providing peer-to-peer physician engagement, Lyden explains. “Members joining Excelerate understand that a culture change in product utilization and clinical practices is required for continued success, and they are seeking a business partner to help them achieve their goals,” he says. “The physician-engaged sourcing model allows physicians and administrators to have mutual accountability for costs and patient outcomes.”

In little over two years, Excelerate has added 11 health systems, including three large IDNs with over 40 hospitals, to its membership, according to Lyden. “Health systems such as ProMedica (Ohio), Kings Daughter Medical Center (Kentucky) and Riverview Health (Indiana) all have found value in Excelerate’s physician-engaged sourcing model and value propositions,” he says. “A recent new member cited its decision to join as less of a supply chain initiative and more clinically based, focused on a reduction in clinical variation. And, the purchasing coalition is open to expansion, he adds. “Excelerate is actively recruiting like-minded members interested in making substantive system changes to improve clinical quality, reduce clinical variation in physician preference and clinical preference areas, and engage physicians and clinicians in outcomes-based sourcing. Active discussions are underway with other medium to large health systems across the United States.”

The Journal of Healthcare Contracting recently spoke to Dr. Lyden about the coalition’s initiatives, advantages it has offered to its members, and the processes and protocols that have ensured its success.


The Journal of Healthcare contracting: What advantages has Excelerate provided for its members?

Sean Patrick Lyden: The advantages Excelerate consistently brings its membership is the ability to present and implement a robust, clinically vetted portfolio specializing in physician preference items, like orthopedic, heart and vascular products, along with traditional commodity products. Excelerate encourages greater commitment levels and standardization than other GPOs and members benefit through better-than-anticipated savings and decreased inventory management. Excelerate also leverages tools, internal/external research and resources – like its proprietary supply utilization guidelines – to encourage consistent clinical application; enhance physician engagement; and remain focused on cost-performance transparency for clinicians and administrators for informed decision-making.


JHC: What are some of the top initiatives Excelerate has pursued in the last 12 months?

Lyden: Physician preference and clinical preference items are the foundation of our physician-engaged sourcing model, so improving these has been a primary initiative for us. For example, Excelerate members collaborated and implemented a standardized cardiac rhythm management program at all member health systems. Another key initiative has been the development of supply utilization guidelines designed to decrease clinical variation. Based on extensive research, these guidelines identify market-leading products and make recommendations utilizing clinical evidence and patient outcomes data. For example, in the Hernia Mesh guideline, the member is guided through an algorithm, which directs select usage based upon clinical criteria and outcomes. Finally, peer-to-peer engagement is a key strategic initiative for Excelerate. The physician-to-physician discussions are collaborative and focused on understanding product options, clinical practice patterns and changing behaviors that lead to improved patient efficiencies.


JHC: How has being part of Excelerate enabled members to leverage their buying power?

Lyden: Excelerate’s quality-centric focus promotes physician engagement, which leads to more clinicians willing to adopt products that maintain positive outcomes. By providing a formulary-based and evidence-driven approach for procurement, healthcare systems create the ability to standardize and affect supply utilization management. Creating transparency to clinicians provides the ability to hold both providers and suppliers contractually accountable to helping lower supply/service costs.


JHC: How much in savings has Excelerate achieved since it began in 2013?

Lyden: Over the past two years, Excelerate has saved members significant dollars, as well as provided a process to engage clinicians in their most expensive product areas, while keeping quality its underlying focus. Excelerate’s membership is realizing on average over 25 percent in the high-dollar, high-usage physician preference items.


JHC: Please explain your process whereby your supply chain executives meet and make their decisions.

Lyden: Excelerate uses a clinically vetted process in making sourcing decisions. Discussions are clinical, not contractual or financial. Extensive product research is conducted, reviewing clinical evidence, patient outcomes, product attributes/trials and data analysis for the service line categories. An in-depth product report and recommendation is presented to develop the sourcing strategy. Contract discussions occur only after clinical input, product attributes and clinical evidence have been extensively reviewed and agreed upon. Excelerate’s resources manage every facet of operations, including clinical and product evaluations, sourcing, guideline development, and sales and marketing.


JHC: How do you co-exist with your GPO?

Lyden: As a joint venture between Cleveland Clinic and Vizient, Excelerate is structured as a full-functioning GPO and uses Vizient as its contracting agent, ensuring complete portfolio options and customer service.


JHC: How do you ensure that the interests of each of your facilities are considered and that each facility’s needs are met?

Lyden: Excelerate’s collaborative process includes engaging key member stakeholders (clinicians, supply chain, finance, administration, etc.) and soliciting their clinical input and expertise in making sourcing recommendations, which provide the best option for patient care and outcomes. Physicians are absolutely essential in providing input from their clinical and financial vantage point to help strike an essential balance in providing current clinical information, which sourcing can utilize to negotiate on behalf of members. Members have designated physician champions for hospital service lines, who provide their clinical input during the evaluation process and assure us the most up-to-date information, data and outcomes necessary for contract negotiations. This provides a strategic structure to combine our membership’s combined knowledge and data, and to carefully evaluate the best products for the best price that will lead to the highest level of compliance and patient outcomes.


JHC: Is it difficult to get buy-in to Excelerate’s contracts from each of your facility’s physicians and staff?

Lyden: Members that join Excelerate are like-minded and confident in the physician-engaged sourcing model. They understand that physicians are highly data-driven individuals who make decisions based on achieving superior patient outcomes. They trust the portfolio has been developed with the highest level of clinical evidence review and clinical input. Excelerate offers members peer-to-peer engagement, where physicians consult with one another on clinical decisions, share data, and review clinically proven supply utilization and standardization guidelines.


JHC: Other than cost-savings Excelerate has achieved through greater volume purchasing, what has been the greatest benefit of the coalition to its members?

Lyden: In addition to offering members substantial savings on the clinical and physician preference items within our portfolios, Excelerate’s value is how it immediately aligns physicians around clinically vetted preference items and protocols, helps eliminate unnecessary practice variation and improves comprehensive care coordination.


What the future holds

JHC asked Sean Patrick Lyden, MD, chief medical officer for Excelerate, where he envisions the RPC in the next five years.

As executives strive to reach that ultimate balance of quality and savings, they must ensure they have a voice in a collaborative forum where supply chain, administration, finance and physicians can come together to make the smartest, data-driven purchasing decisions that account for each stakeholder’s respective area. These decisions have to be scalable and applicable across caregivers and they need to be flexible to allow for practical application in the clinical setting (e.g., the introduction of new technology). Over the next five years, we believe Excelerate’s innovative model will be nationally known as the foundational process and structure allowing member hospitals to collaborate and address some of the most challenging clinical areas. With the assistance of Excelerate, providers will be able to formulate clinical input from front-line caregivers while listening to the evidence and sharing best practices across the Excelerate membership.”