Improving medical technology management through Value Partnerships - A new approach for healthcare provider organizations

White Paper Improving medical technology management through Value Partnerships A new approach for healthcare provider organizations siemens-healthineers.com/value-partnerships SIEMENS Healthineers White Paper · Improving medical technology management through Value Partnerships Executive Summary Value Partnerships™ are the enduring relationships that Siemens Healthineers forges with customers in order to optimize operations, expand capabilities, and advance innovation within healthcare enterprises. One of the areas where optimization can transform care delivery and improve patient experience is in the holistic management of medical technology. This whitepaper gives readers an overview of the ways Value Partnerships can enable effective and efficient technology management for healthcare providers. Medical technology has become the ‘central nervous system’ of healthcare, informing and guiding the majority of care-related decisions. Machine learning and other AI technologies will continue to expand the importance and effectiveness of medical technology. This more powerful and complex nervous system requires expert technology management to keep it running at full potential. Value Partnerships provide effective, proactive technology management services that help healthcare providers deliver improved patient satisfaction, best-in-class clinical outcomes and optimized return on technology investments. From procurement to maintenance, from operational efficiency to financing, Value Partnerships enable improved financial, operational, and clinical outcomes for healthcare provider organizations. Improving medical technology management through Value Partnerships · White Paper Contents 1 Medical technology: The central nervous system of healthcare 4 2 The technology management value chain 5 3 Best practices in technology management for healthcare providers 6 4 Value Partnerships: The Siemens Healthineers approach to technology management 7 5 Program management for a successful partnership 9 6 Partnerships for financial stability 10 7 Efficient medical technology management: Five takeaways 11 Bibliography 12 Appendix 13 3 White Paper · Improving medical technology management through Value Partnerships 1 Medical technology: The central nervous system of healthcare Nearly every patient pathway is touched by medical technology. Imaging, diagnostics, and other medical technologies have become the central nervous system of healthcare. Medical technology has opened the door to a more precise, personalized approach to care that puts the patient at its center. But healthcare providers have to carefully manage their medical technology assets to get the most out of them. This is a complex task with clinical and financial implications across the healthcare enterprise. Moreover, it’s a task that is getting more complex with time as powerful new technologies, like machine learning, add to the capabilities of the medical technology fleet. Capital technology purchases are the largest investments in a typical budget cycle. Without clear insight into the return on technology investment, provider organizations run the risk of a mismatch between capacity of, and demand for, critical medical technologies. Vendor-provided technology management solutions are often described in marketing literature in terms of ‘risk transfer’, ‘performance guarantees’, ‘access to latest technology’ and so on. However, this language doesn’t get to the heart of what makes asset management work for provider organizations, or to the value of a robust technology management solution to providers and the patients they serve. 4 Improving medical technology management through Value Partnerships · White Paper 2 The technology management value chain It is important to understand the phases of the medical technology management cycle. This makes it easier to define best practices in and opportunities for improvement in technology management. Planning & Maintaining & Upgrading / specifying Procurement Commissioning monitoring replacing / Recycling retiring T T T T T Technology management IT platform Program management Advisory/decision support Support systems /functions Figure 1: The technology management value chain and support systems/functions Medical technology investment planning is a crucial first Throughout the cycle, every medical technology asset step. These investments have to satisfy current and or equipment fleet is supported by an IT platform, such anticipated future clinical and operational needs. Then a as the computerized maintenance monitoring system competitive procurement process results in asset(s) being (CMMS). Technology management partners also provide installed and commissioned in the facility, together with program management and advisory work at every step initial user training. of the value chain. But this is only the beginning of the value chain. The Healthcare institutions that manage their own medical longest step in the chain, and the step where a lasting technology might overlook important advisory and partnership is of critical importance, is technology management functions, because they lack in-house maintenance and performance monitoring. This phase expertise in these specialties. These functions are critical continues for as long as the asset is in use. The focus for efficiency and value because they connect the value should be on continually improving asset performance. chain phases together into a cohesive and continuous At the end of an asset’s life, an informed decision is made program, and ensure they are an integral part of the whether to upgrade, replace or retire; outmoded medical healthcare provider operation. technology assets are recycled. 5 White Paper · Improving medical technology management through Value Partnerships 3 Best practices in technology management for healthcare providers Best practices in technology management go far beyond simple hardware and software maintenance (Commission, 2017). They begin before the purchase agreement is signed, and continue throughout the medical technology lifecycle. Making informed, optimal purchasing decisions Getting the most out of digital technology Improved visibility of current and future capacity needs management can help providers maximize their capital budgets. A technology management IT platform is vital to the A recent whitepaper from Frost and Sullivan found that clinical and financial performance of a busy healthcare healthcare facilities are over-equipped by 20-30% on provider. Real-time dashboards alert service teams and average (Sullivan). One way to realize savings is healthcare management to take action before issues to manage technology investment strategically at the arise, and display success against service performance enterprise level, rather than taking a departmental indicators. Remote monitoring of assets also enables approach. Departmental budget structures may lead preventive action and rapid responses as needed. Smart some physicians to over-purchase in order to preserve digitalization makes technology management simple, current funding levels. A trusted technology efficient and cost effective. management partner can offer guidance that will benefit the healthcare provider’s financial health. Keeping track of assets Analyzing technology performance and utilization A real-time location system (RTLS) can help healthcare Insight into technology performance enables effective provider organizations keep track of their medical operational decision-making and, in turn, improved technology. Given the scope of healthcare enterprises, service delivery. For example, if there is high demand for many provider organizations struggle to keep track of CT scans from the ED, an under-utilized CT scanner in the which assets are available at any one time and where radiology department can be made available, provided a they’re located. Effective asset tracking can improve workflow is in place to enable its use. Real-time asset efficiency and quality of care - learning from the performance information, backed up with regular reports industrial and consumer goods industries and bringing that highlight trends, maintenance needs, and suggested technologies such as RTLS to the healthcare sector. improvement actions, enable efficient decision-making and significant savings. Driving continuous improvement Unlocking staff potential with training and Effective technology management partnerships provide education ongoing monitoring and optimization of processes and An effective clinical and technology training program is performance to ensure that providers’ technology fleets vital to healthcare enterprises. An IT platform to manage are a good match to capacity needs. These partnerships and monitor training for clinical staff and in-house help providers anticipate changing needs, rather than technical/ medical engineering staff is a best practice for react to new conditions. a modern provider organization. Healthcare providers are focused on patient care, Having a customized, holistic, monitored training and generally lack the time and expertise to focus on program in place is essential as user errors cause large workflow improvements which can improve both the hidden costs within many healthcare provider quality of care and the overall patient experience. LEAN organizations (Kluver). Repeated procedures, incorrect processes are a way to optimize operations and cut waste. diagnoses and inappropriate treatment all compromise In general terms, LEAN methodology assesses a process, the quality of care and strain healthcare institutions’ identifies the steps in the process that produce value, finances. IT-enabled education programs helps providers and reduces or eliminates any steps that don’t add value. avoid errors and improve quality and efficiency of care. Healthcare providers and medical technology vendors can partner in using LEAN methodology to enact rapid and sustainable process improvements in healthcare. 6 Improving medical technology management through Value Partnerships · White Paper 4 Value Partnerships: The Siemens Healthineers approach to technology management Value Partnerships are enduring relationships between Partnership Design Siemens Healthineers and healthcare providers. They The first phase in establishing a Value Partnership around offer a comprehensive range of services, strategies, technology management is the partnership design and solutions to optimize current operations, expand exercise. This establishes shared goals and key perfor- capabilities, and prepare for the future of the healthcare mance indicators, as well as technology and service enterprise. While they typically span 7-15 years, the requirements. This initial engagement is the foundation length of engagement is determined by the provider of an effective Value Partnership between a healthcare organization’s needs. provider organization and Siemens Healthineers. Technology management is a vital service within The partnership design comprises five stages shown the Value Partnerships framework. Providers and in Figure 2. Siemens Healthineers collaborate to develop a partnership around technology management that leverages the strengths and fills the gaps in the provider’s existing technology management infrastructure. 1 Data collection 5 Conclusion – & current state 2 Interviews & 3 Gap 4 Future partnership goals analysis on-site visits analysis state analysis & technology roadmap Figure 2: The Value Partnerships design methodology for technology management Stage 1: Data collection and current state analysis. Stage 4: Future state analysis. Establishes baseline asset/fleet performance A projection of procedure volumes, informed against international benchmarks, best- by thorough research and expertise, determines practices and future demand future asset operational requirements. Stage 2: Interviews and on-site visits. Stage 5: Conclusion. Structured talks with key stakeholders identify The partners finalize longer-term partnership the provider’s strategic focus, clinical develop- goals in a multi-vendor technology ment initiatives and existing pain points. management roadmap that will ensure success. Stage 3: Gap analysis. A deep dive into asset use uncovers gaps between current clinical needs, benchmarks and medical technology operational capability/ capacity. Filling these gaps is a critical near- term partnership goal. 7 White Paper · Improving medical technology management through Value Partnerships A Value Partnership around technology management brings together the right blend of competencies under a single partnership contract, unlocking significant operational efficiencies (see figure 3). This enables a reduction in technology management costs and more efficient use of facilities and staff. This leads to greater staff satisfaction, better clinical outcomes and a more positive patient experience. 33% reduction in patient waiting time for CT at Royal Stoke University Hospital 25% reduction in administrative costs at Los Arcos del Mar Menor Hospital Patient reschedule rate reduced to zero at Los Arcos del Mar Menor Hospital 50% reduction in equipment management time at Santa Lucia Cartagena University Hospital $3.7M projected cost savings over 15 years for Ministry of Health, Murcia, ESP Increase of 100 MRI patients/month at VieCuri Medical Center, Netherlands Achievement of 99.3% uptime and 8% cost reduction at VieCuri Medical Center, Netherlands Figure 3: Value Partnerships around technology management results For a deeper outline of the value drivers behind each step in the value chain of technology management and how a partnerships and the embedded support systems/functions drive performance, see the Appendix. 8 Improving medical technology management through Value Partnerships · White Paper 5 Program management for a successful partnership Following completion of partnership design, and effectively in a complex change environment. Siemens Healthineers employs a comprehensive set of The tailored blend of service elements – including program management processes to ensure that the full management processes, decision support, efficient benefits of the technology management partnership maintenance workflows, and more – helps maximize are realized. the value of the delivered by the partnership. The Value Partnerships technology management process Figure 4 outlines the sub-components of our technology framework and governance structure enable partners management programs. and other stakeholders (e.g. suppliers) to work efficiently Partnership contract signed Primary Transition phase Operational phase process (6-12 months) (7-15 years) Sub processes • Overall detailed program • Program reporting & partnership governance planning • Risk & issue management • Risk evaluation • Contract change management • Roll out IT systems /tools, • Continuous improvement derived from performance KPIs and performance monitoring dashboards • Ongoing asset selection and • Establish governance structure commissioning / decommissioning • Initial asset selection and • Technology & IT system updates / upgrades commissioning • Ongoing technology-related training & • Technology management education management training • Management of preventative maintenance schedules and reactive maintenance events • Management of asset safety alerts & recalls Figure 4: Technology management process framework Critical activities like partnership design take place in the transition phase, which sets the stage for the enduring operational phase. The partnership delivers on its goals throughout the operational phase, usually for a term of 7-15 years. Joint program management and governance keep the partnership focused on creating value throughout the operational period. 9 White Paper · Improving medical technology management through Value Partnerships 6 Partnerships for financial stability A clear benefit of technology management through a Value Partnership is medical technology cost stability over the life of the contract. This provides cash control advantages and budgetary predictability for healthcare provider CFOs. Payment models fall into 3 broad categories, described in Figure 5. Regular/milestone Unitary payment Pay per use payment Capital investments paid on Capital investments and Payment per scan /test/report. equipment installation (as per service fees rolled up into a ‘transactional‘ deals). regular flat fee (monthly, Aggregated service fees as quarterly, annually). unitary payments. Key considerations: Key considerations: Key considerations: • Timing of invoices • Contractual criteria • Volume guarantees • Payment terms to enable financing (floor payments) • End of term /termination • Opt-out clauses in case conditions business case volumes are not forthcoming • How to measure usage reliably Figure 5: Technology management service payment model categories Milestone and unitary payments are the most common models for technology management programs. The pay per use model is challenging to build and relatively rare (except in laboratory technology management deals, owing to larger variable costs in diagnostic labs). Siemens Healthineers works with its partners to develop contracts and payment models that best support the goal of maximizing technology availability. Value Partnerships might also contain risk/benefit sharing arrangements. Shared investment in the success of the healthcare venture can improve financial outcomes, quality of care, and patient experience. 10 Improving medical technology management through Value Partnerships · White Paper 7 Efficient medical technology management: Five takeaways This white paper has sought to demonstrate that: 1. A robust medical technology management program is a critical component of a successful healthcare enterprise 2. This necessitates a strategic, forward-looking approach to technology planning and spending 3. Partnerships with a technology provider enable sustainable success in technology management through long-term commitments and deep understanding of every step of the technology management value chain 4. These partnerships enables both parties to work toward common goals – sharing risks and benefits if appropriate 5. Effective partnerships can transform care delivery by increasing efficiency, reducing costs, and improving patient care Technology management from Siemens Healthineers is built on a bespoke Value Partnership that deploys the resources, tools and governance needed to monitor and improve asset performance at every step in the value chain. What makes Siemens Healthineers different? • 170 years’ industry experience as a leader in technology, service and business innovation • Unique partnership-driven approach to technology management • Operational excellence dedicated to continuous improvement • Commitment to collaboration, shared vision and patient-centric goals • Successful technology management partnerships built over 25 years in 14 countries on 5 continents The Siemens Healthineers technology management approach is tried and tested. As the role of medical technology continues to evolve, we look forward to developing this collaborative business model further with healthcare providers all over the world. To learn more about Value Partnerships around technology managent click here or go to: siemens-healthineers.com/value-partnerships 11 White Paper · Improving medical technology management through Value Partnerships Bibliography Commission, W. A. (2017). Retrieved from Management of medical equipment: https://audit.wa.gov.au/wp-content/uploads/2017/05/summary2017_08-MedicalEquipment.pdf Kluver, W. (n.d.). Retrieved from Economics of healthcare quality and medical errors: http://wolterskluwerlb.com/health/resource-center/articles/2012/10/economics-health-care-quality-and-medical-errors Sullivan, F. &. (n.d.). Retrieved from Reduce your cost whilst improving patient care & satisfaction – inefficient use of mobile assets is costing Australian hospitals more than $60M a year: http://www3.gehealthcare.com.au/~/media/downloads/anz/solutions/ge%20healthcare%20and%20fs%20%20 mobile%20asset%20management%20white%20paper.pdf?Parent=%7BDA74C9C8-0FAE-46C5-8581- A34CC7359E09%7D 12 Improving medical technology management through Value Partnerships · White Paper Appendix Planning & Procurement Commissioning Maintaining & Upgrading / Recycling Specifying monitoring replacing /retiring Value drivers Right-sizing assets Quantitative Planning for Asset availability Decisions based on Re-sell capability. based on current/ and qualitative minimal disruption (uptime) and perfor- clinical relevance, future clinical and asset selection and patient impact. mance. Continuous asset performance operational need. criteria. User training and improvement & service costs. education. programs. Technology Historical Historical Data input Service performance Service perfor- management specification data. service quality and data: call-handling, mance data. Parts IT platform performance decision support parts supply, asset supply data. Asset data. governance. reliability. Remote reliability data. monitoring. Preven- tative maintenance scheduling. Perfor- mance reporting. Program Aligning varied Aligning Ensuring timely Driving continuous Aligning varied Managing management needs of varied achievement improvement. needs of decommissioning stakeholders. needs of of quality and Ensuring stakeholder stakeholders. and the commercial stakeholders. budgetary targets. engagement. impact. Controlling performance. Advisory / Analyzing current Assessing Designing tailored Ongoing data-analysis Usage and service decision and future ‘best-of-breed’ clinical user for performance performance support demand (based on technology training. reports and stakeholder analysis to support asset use, future options. engagement. LEAN decision-making. trends and clinical Supplier offer process improvement strategy). Business value analysis. workshops. Business case analysis. case monitoring. Other tools Asset clinical International Training Asset clinical usage & performance usage data sources procurement management data sources: RIS/PACS, location data (e.g. RIS/PACS, databases system databases. (for mobile assets), training data, activity- machine data). (e.g. ECRI). based cost information, revenue or reimbursement data. LEAN tools (e.g. rapid-improvement-event workshops). 13 Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Published by Siemens Healthcare GmbH · online pdf · 6949 0119 · ©Siemens Healthcare GmbH, 2019