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HIGHLIGHTS
  • * Validated evidence-based approach to decision making
  • * Gained physician buy-in after initial appeal
  • * Demonstrated improved healing rates

About the Health System

A major healthcare network in the Northeast began pursuing a merger and acquisition strategy. To realize consistent care delivery across divisions, the system established a centralized, system-wide value analysis process that emphasized physician engagement and clinical evidence. Vital to this was the development of a consistent, objective appeals method.

Challenge

A value analysis request was submitted to standardize the compression wraps utilized in across outpatient wound healing centers. Following an evaluation of available products, the value analysis committee recommended the approval of one manufacturer’s compression wraps. One physician appealed the decision, citing new evidence supporting use of compression wraps from a different manufacturer.

Solution

The value analysis committee thoroughly reviewed the appeal, with Lumere providing updated data on adverse events and peer-reviewed for total compact cast systems. The team established the necessary proof points to reconfirm their initial decision. Importantly and provider the appealing physician with additional support from the supplier.

Impact

  • The appeals process validated the team’s approach to evidence-based decisions and consensus-building.
  • All physicians continue to successfully utilize the recommended system.
  • Healing rates for the appealing physician’s patients have outperformed evidence-based benchmarks.

Lumere’s research supports a value analysis process rooted in unbiased, fact-based decision-making. By providing objective, up-to-date, peer-reviewed literature, Lumere enables meaningful conversations and elevates the discussion from being about just devices to being about delivering the best patient care.

Senior Value Analysis Director

at a Major Health System in the Northeast