From the Department of Pediatric Orthopaedics, Stanford University (Gupta, McFarlane, and Shea); the Division of Supply Chain Management, Stanford Healthcare (Lee, Chawla, Rajagopalan, Kohler, and Moelling); the Department of Orthopaedics, Stanford University (Ratliff, Hu, and Shea); the Department of Neurosurgery, Stanford University (Ratliff, and Hu); and the Department of Pediatric Surgery, Stanford University, Stanford, CA (Sheth, Wall, and Shea).
J Am Acad Orthop Surg. 2023 May 1;31(9):470-476. doi: 10.5435/JAAOS-D-21-01008. Epub 2023 Feb 17.
Orthobiologics are increasingly used to augment healing of tissues. Despite growing demand for orthobiologic products, many health systems do not enjoy substantial savings expected with high-volume purchases. The primary goal of this study was to evaluate an institutional program designed to (1) prioritize high-value orthobiologics and (2) incentivize vendor participation in value-driven contractual programs.
A three-step approach was used to reduce costs through optimization of orthobiologics supply chain. First, surgeons with orthobiologics expertise were engaged in key supply chain purchasing decisions. Second, eight orthobiologics formulary categories were defined. Capitated pricing expectations were established for each product category. Capitated pricing expectations were established for each product using institutional invoice data and market pricing data. In comparison with similar institutions, products offered by multiple vendors were priced at a lower benchmark (10th percentile of market price) than more rare products priced at the 25th percentile of the market price. Pricing expectations were transparent to vendors. Third, a competitive bidding process required vendors to submit pricing proposals for products. Clinicians and supply chain leaders jointly awarded contracts to vendors that met pricing expectations.
Compared with our projected estimate of $423,946 savings using capitated product prices, our actual annual savings was $542,216. Seventy-nine percent of savings came from allograft products. Although the number of total vendors decreased from 14 to 11, each of the nine returning vendors received a larger, three-year institutional contract. Average pricing decreased across seven of the eight formulary categories.
This study demonstrates a three-step replicable approach to increase institutional savings for orthobiologic products, engaging clinician experts, and strengthening relationships with select vendors. Vendor consolidation permits a symbiotic win-win relationship: Health systems achieve increased value by reducing unnecessary complexity of multiple contracts, and vendors obtain larger contracts with increased market share.
Level IV study.
骨生物制剂越来越多地用于促进组织愈合。尽管对骨生物制剂产品的需求不断增长，但许多医疗系统并未享受到大量采购所带来的预期节省。本研究的主要目标是评估一项旨在（1）确定高价值骨生物制剂的优先级和（2）激励供应商参与以价值为导向的合同计划的机构计划。
采用三步法通过优化骨生物制剂供应链来降低成本。首先，让具有骨生物制剂专业知识的外科医生参与关键的供应链采购决策。其次，定义了八个骨生物制剂配方类别。为每个产品类别设定了人头定价预期。使用机构发票数据和市场定价数据为每个产品设定了人头定价预期。与类似机构相比，多个供应商提供的产品价格设定在较低的基准（市场价格的第 10 百分位），而价格设定在市场价格第 25 百分位的稀有产品价格则较高。定价预期对供应商是透明的。第三，一个竞争性招标过程要求供应商提交产品定价提案。临床医生和供应链负责人共同将合同授予符合定价预期的供应商。
与我们使用人头定价产品预测的 423946 美元节省额相比，我们的实际年度节省额为 542216 美元。79%的节省来自同种异体移植物产品。尽管供应商总数从 14 家减少到 11 家，但九家回归的供应商每家都获得了一份更大的、为期三年的机构合同。八个配方类别中有七个的平均价格下降。
本研究展示了一种可复制的三步方法，通过聘请临床医生专家并加强与选定供应商的关系，为骨生物制剂产品增加机构节省。供应商整合允许建立共生双赢关系：医疗系统通过减少多个合同的不必要复杂性来实现更高的价值，而供应商则通过获得更大的合同和更高的市场份额来获得更大的合同。
四级研究。
