No one wants to read a study on the health effects of soda pop that's commissioned by Coca-Cola, or a glowing review of a new drug written by a pharmaceutical employee. Why shouldn't doctors be expected to feel the same when it comes to the pacemakers or hip implants they use?
A handful of notable players in the health care industry are taking that question to heart with the announcement last week of another innovative collaboration between hospitals and insurers. UnitedHealthcare is teaming up with three hospital networks serving 7 million patients — Advocate Health Care in Oak Brook, Ill., Baylor Health Care System in Dallas, and Dignity Health in San Francisco — to share supply chain data. They've formed a limited liability corporation, called SharedClarity, to oversee comparative-effectiveness research on a 15 different types of devices, from pacemakers to knee replacements. Physicians from the three systems will oversee the research efforts, which they plan to keep completely free of influence by device manufacturers, says Mark West, president of SharedClarity, who has a long résumé in the supply chain field, including stints at the Cleveland Clinic and UnitedHealth.
"When we built the organization, we cognitively made sure that there is no money that flows between SharedClarity and the device manufacturers," he says. "We didn't want any of that potential risk for conflict of interest."
We've all read about some of the profound harms that can be caused to patients by a simple hip replacement. As the New York Times points out, Johnson & Johnson is facing more than 10,000 lawsuits over a recalled artificial hip that has a 40 percent failure rate within five years. Executives at the manufacturer were apparently aware of the breakdowns but didn't make them public. They're not alone, as only about half of all clinical trials see the light of day, and they're about twice as likely to if the results are positive, the article goes on to say.
Whispers are turning into shouts for the industry to use evidence-based research to choose devices. Yet there's been some pushback, from politicians and clinicians alike, that such studies might lead to a one-size-fits all approach to medicine. Other challenges remain, too, such as how to fund these studies, which can be costly, and how to quickly translate the findings into practice, Peggy Naas, M.D., vice president and leader of physician strategies at VHA, told our sister publication in an interview last fall. She expects more and more payers to seek value out of device manufacturers in the near future.
"Suppliers are looking for new ways to demonstrate the value that they are adding to the equation, and insurers or payers are going to expect them to do that in a much different way than the historic ‘is this a covered procedure or not?' " she said in the interview.
Some doctors also feel wedded to the particular stent or valve that's always done them right. But West believes that docs won't be able to ignore the evidence, once the effort starts producing it.
"We believe physicians are scientists and they really have a thirst for the data," he says. "In our experience, they've been asking for this type of independent information to help them make better decisions."
SharedClarity is based out of Arizona and will operate as a for-profit entity whose bottom line will be derived from service fees paid by health systems to buy off shared device contracts. After gathering the evidence, they'll negotiate two different price tiers with those manufacturers, West says, one for members and the other for UnitedHealth's network of providers. The company is actively seeking other health systems to jump on board, and has several that are interested.
Along with members' physicians, studies will also be overseen by scientists at Optum Labs, in Cambridge, Mass., a research facility created out of a similarly innovative relationship between UnitedHealth and the Mayo Clinic. That work has yet to begin, as SharedClarity is still laying the groundwork for the effort. As of now, West says they plan to keep the findings among members, though they may release results from time to time to the general public.
Jake Groenewold, senior vice president of supply chain at the University Health Consortium and an expert in the field, is excited to see what the collaboration finds. Such large-scale partnerships between insurers and health systems around supply chain costs are rare in the industry, he says, despite clinicians clamoring for such information.
"We really need to get at understanding and/or try to determine: Are there better outcomes with different pieces of equipment or certain medical devices, and what's their long-term effectiveness?" he says. "This is a good, independent opportunity to get at some of these challenges."
He, too, agrees that clinicians will have a hard time ignoring the data once they see it.
"There will be resistance, I would venture to guess, on every front," Groenewold says. "But at the end of the day, they don't ignore data. They're going to draw their own conclusions and then make the decision as to what to do since they may be held liable. It doesn't mean they won't be up for dialogue."