On April 9, 2013, the biggest insurer in the U.S. and a large chain of hospitals announced they are teaming up to figure out if they’re getting their money’s worth from manufacturers of medical devices.
SharedClarity Alarms Device Makers
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Mark West, president of the joint venture called SharedClarity, reportedly said one might call this the first stages of medical consumerism kicking in as patients and doctors become more aware of medical expenses and how to control them.
The insurer, UnitedHealth Group Inc. and the hospitals—Baylor Health Care System in Dallas, Dignity Health in San Francisco and Illinois-based Advocate Health Care—want to try to get a handle on skyrocketing costs and get unbiased ratings of various devices. The hospitals treat 7 million patients a year and UnitedHealthcare insures 40 million.
Device Scorecard
Jim Spencer reported in the StarTribune on April 11, 2013, that SharedClarity aims to provide a score card that rates the most widely used heart, neurological and orthopedic devices. The ratings will include such measures as performance, the need for replacement and readmission to hospitals.
The studies will lead to rankings of devices that doctors and other professionals in the SharedClarity network use to make treatment decisions. Test results will also help determine how UnitedHealthcare will cover devices.
West said that device manufacturers have been the primary testers of their own products. SharedClarity’s members are concerned that manufacturer funding and involvement in those studies influenced the results.
Nervous Manufacturers
The effort is making AdvaMed understandably nervous. The trade group put out a statement that said research should not be used to “deny patients and physicians their choice of the most appropriate treatment option.”
According to the announcement, physicians in the joint venture will study the performance of artificial hips, knees and other devices. UnitedHealthcare will share claims data. UnitedHealth Group’s Optum Labs will be a research partner with SharedClarity, as will the Lewin Group, another UnitedHealth subsidiary.
Group and Bulk Purchasing
West said individual health care systems in the SharedClarity system have committed to negotiate as a unit to buy their top-rated devices in bulk, garnering a better price for the often-used, costly products. UnitedHealth will use the study results to negotiate a separate, slightly less favorable price structure for devices that it will offer to all of its customers, West said in the StarTribune article. Those prices do not require bulk purchases.
The results of the device effectiveness studies will only be available to SharedClarity members initially, but the company may eventually make them available to the public at large.
The venture is actively recruiting new providers.
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Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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