Category: Professional Posters
Purpose: Indiana University Health is a sixteen-hospital system challenged with managing costs. The system has established robust contracting practices, a system Pharmacy & Therapeutics (P&T) Committee and a system formulary. In an effort to gain additional cost savings, clinical councils were implemented to drive prescribing best practices and reduce unwarranted practice variation.
Methods: To accompany the long-established system Pharmacy and Therapeutics (P&T) Committee, nineteen clinical councils were implemented to address variable drug use practices across the system. Implemented clinical councils included the following specialties: Anesthesia, Cardiology, Critical Care, CV Surgery, Emergency Medicine, General Surgery, GI, Infectious Disease, Medical Oncology, Neurology, Neurosurgery (Spine), Newborn, OB-GYN, Ortho Fracture, Ortho Joint, Palliative Care, Transplant, and Vascular. In order to achieve significant cost savings, a method to standardize prescribing practices for selected agents was established. Agents for evaluation were identified by reviewing overall drug costs for the system, the breadth of use across hospitals, and comparing costs to both internal and external benchmarks. Once an agent was identified for a cost savings initiative, drug use practice data was needed. Many drugs have multiple indications, so understanding which clinical practices were the primary users was key to directing it to the appropriate clinical practice council. Use of practice data from the electronic medical record facilitated this analysis. This practice data not only helped identify which clinical specialty boards the initiative was directed to, but also helped identify stakeholders. One or more of these stakeholders could become the initiative champion as the initiative moved through the clinical specialty boards toward implementation. Tracking the results of each initiative and sharing that data back to the clinical specialty boards was important in keeping these groups engaged.
Results: The team approved and implemented six initiatives through the clinical specialty boards within the first year. Practice areas and their respective initiatives included:
• OB-GYN: dinoprostone conversion to misoprostol;
• OB-GYN: hydrocortisone acetate 1% and pramoxine hydrochloride 1% foam conversion to benzocaine spray;
• Medical Oncology: development of utilization criteria for intravenous calcitonin
• Medical Oncology: removal of the intravenous formulation of allopurinol from formulary;
• Ortho Joint: restriction of liposomal bupivacaine;
• Anesthesia: restriction of sugammadex.
Annualized savings for these ongoing initiatives are expected to exceed two million dollars. Cost savings are monitored by tracking changes in cost per pharmacy adjusted patient days (PAPD) for twelve months. For example, the calcitonin initiative is anticipated to re duce cost per PAPD by 40% yielding a twelve month savings of over $500,000.
Conclusion: Each successful practice change was influenced by engaging physician champions.
This process has resulted in significant cost savings as well as establishing a standard of care and reducing practice variation.