Hemostasis: stopping the bleed

Hemostasis as a category and opportunity

Hemostasis is a multi-step, interlinked process that concludes with the formation of a plug closing the damaged site of the blood vessel to control the bleed. It has four distinct stages resulting in the formation of a clot and the promotion of tissue healing:

• Constriction of the blood vessel
• Formation of a temporary platelet plug
• Activation of the coagulation cascade
• Formation of a fibrin plug or the final clot ¹

Once the injury heals, the plug dissolves and normal tissue restoration occurs.

Hemostatic agents are classified as active (for coagulopathy or anticoagulated), passive (normal coagulations) or combo (elements of both active and passive). Many manufacturers have products in this category, and they're used in multiple surgical sub-specialties including cardiovascular, spine and general surgery.

The products are expensive from the perspective of both pricing and product utilization. Physician preferences, workflow issues, financial considerations and difficulties in sourcing all complicate managing this challenging category.

But one West Coast academic medical system decided to take on the challenge. The system’s surgery governance group recognized hemostasis as an area of opportunity for financial and quality improvement. Working with Vizient, the group took an eight-month journey to become more efficient and realized nearly $1 million in cost savings as well as improvements in the evidence-based product selection process for common clinical indications.

A journey begins: how one surgery governance group transformed their health system

This project took place in an academic health system, consisting of five community hospitals and an academic medical center. The system provides care in multiple specialties and focuses on teaching, innovation, meeting community needs and practicing financial responsibility. They knew a review of the hemostasis category was long overdue but needed the structure and support to create, execute and sustain the gains.

The surgery governance group, chaired by a general surgeon with membership made up of multiple sub-specialty physicians and surgical services leaders, agreed to proceed with a full category review. The group identified two physician champions to lead the effort, along with surgical services and sourcing leadership.

Vizient provided the surgery governance group with multiple data points on hemostasis to show its clinical and financial significance. This started a conversation on how to improve safety, efficiency and achieve cost savings.

The process began with all crucial stakeholders to understand the current state, physician preferences, supplier and contractual considerations. Simultaneously, through a literature review, the group researched the latest high quality scientific studies in hemostasis and how this knowledge might aid in decision-making with a focus on delivering consistent, high-quality care.

Vizient consultants assisted in this process using robust datasets and advanced technology platforms as needed to support the project, including price visibility, market data, benchmarking, speed to value and procedural insights.*

Phase I of the project focused on pricing, and phase II centered on variation and utilization, including identifying areas of waste, choosing the best product for the specific indication and reducing variation where clinically possible. The group collected data by observing surgical cases and utilizing the EMR. Based on extensive data analysis, the group created a detailed roadmap with a timeline, tasks and a clear endpoint for success

Success achieved: the journey continues

The organization achieved savings of greater than $500,000, and an additional $386,000 in utilization savings, which also decreased product waste. The provider’s surgeons and surgery governance group felt validated throughout the process, building credibility and trust, fueling success in other areas. The process is ongoing as products, workflow and practice evolve. By regularly measuring and reviewing specific metrics, the team makes sure they choose the best hemostasis agent for each patient’s needs.

*Vizient Supply Analytics and Procedural Analytics; aptitude Direct Contracting Platform