1. A Formula for Success Standards and Communication Product formularies help drive savings and create standards for multiple items in a large integrated delivery network.

2. Cheri Berri-Lesh, CMRP Value Analysis Manager

3. A picture is worth a thousand words

4. Knee Brace in MMIS (Lawson)

5. Knee Brace in Visual Formulary

6. Integrated Delivery Network Member Governed 600,000 Members 25 Medical Centers 9,750 Staff 1,055 Providers Insurer and Delivery System Operating Revenue $3B Revenue $3B

7.  To achieve best contract pricing   Reduction in variation  No durable medical equipment license  Some Healthcare Common Procedure Coding System (HCPCS) codes eliminated  Create standard process  Changing the culture of “if I want it, I get it” to one of collaboration and standardization Reasons to Consolidate & Standardize

8. How it Began!

9. Gemba Process Walk

10. Road to Reducing Variation

11. Representation of Initial Choices

12. Physician Attendance Varied

13. Orthopedic Vendor Representatives  Key objectives included standardization & cost savings  Partnered with Materials Management to captured all product categories and annual usage  An opportunity to identify products improvement or elimination  Identified products for item and cost savings reduction Partner Collaboration

14. 2008 $521,000 720 Items Orthopedics Soft Goods - Before

15. 2008 $521,000 720 Items 2011 $419,000 250 Items REDUCTION Spend = 19.5% SKU = 65% Manufacturers From 84 to 29 Orthopedics Soft Goods - After

16. Sample of Ortho Soft Goods Visual Formulary

17.  More commodities added ◦ Wound Care: Advanced & Acute ◦ Cast, Padding & Splinting ◦ Medical Tapes ◦ Disposable vaginal speculum systems ◦ Infection Prevention Expanding Use of Visual Formularies

19. Product Standards & Formularies

20. Advance Wound Care - Before

21. Advance Wound Care - After

22. Cast, Padding and Splinting

23. Tapes

24. Disposable Vaginal Specula

25. Infection Prevention: Hand Products

27. Infection Prevention: Face Protection

29. Infection Prevention: Nonsterile Gloves

30.  Orthopedic physicians, physician assistants & technologists  Wound Care RN & University of WA Professor  Infection Prevention Team  Perioperative Services  Safety and Environmental Health Officer  Materials Management Specialists Partnering with Experts for Visual Formularies

31. The Benefits to a Visual Formulary Visual Formulary Benefits Standard Work Clear Communication Patient & Staff Safety Rapid ID of Errors or Defects Increases Contract Compliance Provides Shopping list Reduction in Spend

32. Challenges addressed  Consolidating needs of multiple physicians  Working with preferences versus needs  Seeking agreement  Large geographic area  Finding quality pictures  Formatting for ease of viewing Summary

33. Steps/process created  Order history review  Collecting multiple product samples  Product demonstrations road shows  MMIS cleanup including description improvements  Formatting images  Entering into Excel  Engaging with staff & active listening Summary

34. Key players involved  Materials Management  Participating departments  Vendors  Distributors  Physicians & nurses  Infection Prevention Summary

35. Outcomes achieved  Established supply formularies  Visual communication tool used as shopping list  Defines best practices  Managed by Value Analysis Program  Reduced costs & SKU’s  Promoted Lean visual systems in other areas Summary

36. Pre-requisites  Product familiarity  Engaged vendors and distributor  Engaged Materials Management staff  Support of Purchasing & Contracting Staff Summary

37. Questions?

38. Contact information Cheri Berri-Lesh berrilesh.c@ghc.org