A Clinically Integrated Supply Chain & Value Analysis Maturity Model  

Understanding the importance of clinical integration 

For healthcare leaders, a clinically integrated supply chain is no longer a “nice to have”; rather, it’s required to navigate the complex challenges of the modern healthcare ecosystem. However, most supply chain leaders don’t have to think far back to remember scenarios when clinical integration was placed on the back burner at their organizations and challenges quickly followed. Siloed teams, unnecessary product and process variation, excessive spending, and poor clinical outcomes are all common side effects of weak clinical integration. These shortfalls put health systems at great risk amid rising costs, decreasing reimbursement, and an urgency to focus on quality.  

Value-based care accelerated the need for clinical integration, which is now widely accepted as the golden standard with the Cost, Quality, and Outcomes (CQO) movement for health systems. According to AHRMM, clinical integration in health care supply chain is an interdisciplinary partnership to deliver patient care with the highest value (high quality, best outcomes, and minimal waste at the lowest cost of care) that is achieved through assimilation and coordination of clinical and supply chain knowledge, data, and leadership toward care across the continuum that is safe, timely, evidence-based, efficient, equitable, and patient-focused.  

While this is the holy grail for healthcare supply chain, achieving optimal patient outcomes and cost profiles with cross-functional collaboration, data, and product consensus is not an easy feat. To develop and maintain an integrated supply chain, health systems must tap into the collective power of their people, processes, data, and technology. 

Health systems aren’t alone in their clinical integration journey  

Health systems are not alone in this journey. Wellstar Health was struggling with a lack of product standardization and low physician engagement in supply chain management, which hindered their ability to make evidence-based decisions. When they relaunched their Clinical Quality Value Analysis (CQVA) program, they focused on creating a hospital system policy to address their challenges, focusing on processes and solutions for streamlining product requests, physician sign-offs, request tracking, team workflow and communication, product data research, and clinical evidence research. The outcome? Wellstar Health was able to achieve new levels of clinical integration, boasting an 80% increase in physician engagement, faster product decisions, and 100% participation among medical chairs. Learn more about their story here.  

Strategic clinical investment has never been more critical. However, one building block alone will not suffice in achieving clinical integration; rather, each element works collectively to encourage cultural change throughout the organization.  

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A maturity model for clinical integration  

The work of clinical integration is never complete. However, there is still significant variability between health systems when it comes to advancing clinical integration. Many organizations are still struggling to engage clinicians in the supply chain process while others are making strides to incorporate outcomes data and high levels of physician engagement in their process to drive a systemwide culture of standardization and evidence-based decision making.  

Five stages of maturity:

1. Physicians and Supply Chain Act Independently  
   • Clinical and supply chain stakeholders operate in silos without alignment and lack mutual trust 
   • Lack of formal processes and governance for clinical engagement, and lack of executive support 
   • Priorities are not mutually defined and executed, with purchases driven by demand rather than evidence 
2. Physician Involved 
   • Physicians are involved during the review of their product request, but clinicians are not proactively engaged in the supply chain structure 
   • Alignment on responsibilities and mutual goals is still unclear 
   • Cost, quality, and outcomes priorities are not considered holistically  
   • Reviews may be reliant on supplier-provided and potentially biased data 

3. Physician Leader Proactively Engaged  
   • Physician leader is a standing member of the value analysis program and can speak fluently for clinical and supply chain integration 
   • Addressing unnecessary variation and waste is a priority  
   • Focus shifts beyond cost reduction to consider complete safety data, clinical evidence, and operational factors 

4. Clinically Driven Value Analysis  
   • Products and processes are standardized across facilities 
   • Hospital policy requires that decisions are evidence-based, with key leadership and department heads supporting clinical integration 
   • Supply chain and clinicians are aligned on mutual goals and physician leaders drive a systemwide culture focused on outcomes  
   • Comprehensive ROI in relation to cost, quality, outcomes, and operations of medical products is clear 
   • Hospital has clear governance for supply chain, supplier, and clinician collaboration  

5. Patient Outcomes & ROI (Future State)  
   • Supply chain, value analysis, and clinicians are strategic partners and are tightly integrated  
   • Utilization data is scrutinized to identify unnecessary variation and optimization opportunities   
   • Line item purchasing data is connected to patient outcomes for continuous improvement  
   • Hospital achieves focus on safety, quality, and total cost of care across the patient experience  

Components of a Clinically Integrated Supply Chain 

As organizations progress through the maturation model, the importance of collaboration between clinical and non-clinical stakeholders is elevated. Looking ahead, the future state of clinical integration combines patient outcomes with spend data to assess the real risk and return on investment (ROI) of products and practices.    

Governance & executive oversight  

• Has strong governance structure with defined processes to drive smart, coordinated action  
• Hospital policy requires that decisions are evidence-based  
• Adopts a shared governance structure where clinicians and supply chain teams have ongoing, mutual representation 
• Product review governance is strong enough to introduce flexible meeting structures: in addition to regular meetings for core procedural areas, hospitals introduce ad hoc teams for specific initiatives that can be stood up or stood down for a set time on a project basis.  
• Executive leaders set the tone and actively champion clinical transformation across all levels 
• KPIs: Throughout decision time and process consistency and compliance across facilities

Clinical engagement and education   

• Evidence-based decision-making drives integration efforts and are at the center of alignment efforts  
• Adoption through a systemwide clinical leadership model where education and benchmarking are pillars of change  
• Physicians and clinicians are elevated to serve as process champions rather than just product cheerleaders  
• Physician engagement champions serve as partners, are embedded in the supply chain to aid in standardizing processes, and consider engaging in supply chain activities the norm rather than the exception     
• KPIs: Physician engagement levels and amount of clinical representation in supply chain initiatives and committees

Process and product standardization   

• Sourcing practices by supply chain and value analysis teams evolve with an aim toward clinical outcomes   
• Cross-functional teams review all product and process data, keeping everyone focused on outcomes 
• Cost evaluations and operational use considerations across the product portfolio reduce unnecessary product variation  
• Clinically driven teams go beyond initial product decision to target utilization and variation  
• KPIs: Reduction in non-essential variation

Financial, safety, and clinical data   

• Stakeholders align around a wide range of historical and aggregated data (e.g., safety, regulatory, clinical, reimbursement, contracting, utilization, purchase order spend, quality, outcomes data, etc.) to make evidence-based decisions 
• Decision making is focused on total value, not just immediate cost, where product and process decisions support the highest quality and outcomes at the lowest cost   
• KPIs: Cost savings met and clinical outcomes impacted

Change management   

• A systemwide culture shift toward clinical integration is ongoing  
• Behavioral change reduces legacy, event-based behavior across all stakeholder groups, including suppliers  
• Value analysis and supply chain teams are seen as strategic partners in efforts to improve clinical outcomes  
• People, processes, data, and technology are all engaged to drive forward-looking integration frameworks with a united front for decision making 
• KPIs: Clinical and supply chain satisfaction levels, mutual perception, and process consistency over time

Developing a clinically integrated supply chain is a continuous evolution for even the most mature health systems. One area of opportunity for many is connecting the right stakeholders with the right processes across the healthcare ecosystem.