JHC April 20

Providing Insight, Understanding and Community

April 2020 • Vol.16 • No.2

A Continuous Journey UHS sees career development as an ongoing partnership between employees and managers.

» PLUS: The supply chain’s response to COVID-19

CONTENTS »» APRIL 2020 The Journal of Healthcare Contracting is published bi-monthly

by Share Moving Media 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Phone: 770/263-5262 FAX: 770/236-8023 e-mail: info@jhconline.com www.jhconline.com

Editorial Staff Editor Graham Garrison ggarrison@sharemovingmedia.com Managing Editor Daniel Beaird dbeaird@sharemovingmedia.com Art Director Brent Cashman bcashman@sharemovingmedia.com Publisher John Pritchard jpritchard@sharemovingmedia.com Vice President of Sales Katie Educate keducate@sharemovingmedia.com Circulation Wai Bun Cheung wcheung@sharemovingmedia.com

Pictured here, L to R – Members of the Universal Health Services (UHS) Supply Chain Team: Jennifer Taylor, Manager, Contracts, Supply Chain Thomas Kayal, Contracts Analyst, Supply Chain Jennifer Ahern, Senior Contract Specialist, Supply Chain Raymond Davis, VP, Supply Chain, Universal Health Services

2 Publisher’s Letter: Takeaways from Federation 4 A Continuous Journey

UHS sees career development as an ongoing partnership between employees and managers.

12 Cyber Awareness The Journal of Healthcare Contracting (ISSN 1548-4165) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 by Share Moving Media. All rights reserved. Subscriptions: $48 per year. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address.

POSTMASTER: Send address changes to Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher.

Publisher cannot accept responsibility for the correctness of an opinion expressed by

14 Cybersecurity and the Healthcare Supply Chain 15 Separating Fact from Fiction

Not all cybersecurity products and services are created equal

18 Threat Assessment

Healthcare providers must first identify where hackers can enter their system before developing effective security measures

20 Breaking Down Silos

Collaboration between supply chain and IT helped one health system streamline its contracting following a merger

26 Outbreak Response

Preparedness is key for hospitals and health systems when responding to an infectious disease outbreak

30 Identifying Gaps

ECRI Institute’s consulting helps providers respond to a multitude of issues related to infection control and prevention

32 More Supply Chain Ripple Effects to Come

At an inflection point, why the supply chain must rise above ‘every man for himself ’ type behaviors

36 Staffing: Post-Acute Care’s Pain Point

Low wages, demographics add up to post-acute staffing shortages

38 OBRA: One Thing the Feds Got Right Study shows 1987 law has led to improved nursing home care

40 Strategic National Stockpile Collaboration with Private Sector Strengthens National Security and Preparedness 42 Group Purchasing Organizations: Supply Chain Leaders in Emergency Response 44 Calendar 46 Contracting News & Notes

Premier releases annual report on national drug shortage programs

contributing authors.

The Journal of Healthcare Contracting | April 2020

1

PUBLISHER’S LETTER

John Pritchard

Takeaways from Federation My compliments to Kerry Price and the Federation of American Hospitals (FAH) team for a great conference in Washington, D.C. Each year, the FAH Conference is at the top of my list of industry events to attend, and this year did not disappoint!

Yet, as I walked through the Atlanta airport to catch my flight to D.C., the airport had an odd feel to it. The coronavirus was certainly on many travelers’ minds and created a solemn setting.

I have been to more than 20 of FAH conferences through the years, and I remember vividly during the swine flu era the amount of people coughing, sneezing and sniffling through the plenary sessions. It was very different this year; it seems people not feeling well wisely chose to stay home. Hopefully that will become a widely accepted norm.

I thought I’d share some takeaways from the meeting that I found interesting, important or new: No. 1: The political atmosphere in D.C. is gloomy.

While this was no surprise pre-COVID-19 outbreak, I think we all hope that our lawmakers will put politics aside in the weeks to come to bring real solutions to this global pandemic.

No. 2: Nurses, doctors and hospitals are all viewed favorably, while insurance and drug companies are viewed unfavorably. This is interesting if you think about it. The frontline care givers are well liked by Americans, but the big, profitable insurers and drug makers are not. Hospitals are still viewed favorably but are slipping because Americans are starting to associate hospitals with rising healthcare costs.

No. 3: The presidential election will be decided by 300,000 to 400,000 people in about 10 regions of the country. These few swing regions are key to deciding whether President Trump gets another term.

2

No. 4: Ken Kuiper of Medical Strategies International did a great job presenting the Corris Boyd award to Kevin Price, senior director, supplier diversity at Novant Health.

The award is to honor the late Corris Boyd, whose vision of building a better way to live and work through leadership and diversity was embodied in the many accomplishments for which he is known.

For 14 years, Kevin Price has supported and featured historically under-utilized businesses. In 2019, Novant’s support of these businesses reached over $1 billion in spend.

Congrats to Kevin on the award. It is well deserved!

No. 5: Value analysis is here to stay and suppliers planning to gain market share need to find a way to make value analysis a competitive advantage. The providers presenting on value analysis emphasized that sales and marketing collateral is not what they want in the information packet.

No. 6: The new leasing regulations are a big deal for capital suppliers. How IDNs book acquisitions of capital has big consequences on the operating expense budget, capital budget and balance sheet. Suppliers that can help IDNs understand the pros and cons of the buy-versuslease decision in the era of these new regulations will certainly be viewed as a trusted advisor.

If we connected in D.C., it was great to see you! If not, hopefully we will next year!

All the best, John Pritchard

April 2020 | The Journal of Healthcare Contracting

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April 2020 | The Journal of Healthcare Contracting

A Continuous Journey UHS sees career development as an ongoing partnership between employees and managers.

For Raymond Davis, vice president, supply chain, Universal Health Services

training is now a daily part of our work.

(UHS), every supply chain endeavor starts with one critical factor – the right people.

Every team member receives yellow belt training and with the training, each

“We need high-performing individuals who provide creative solutions and new approaches to enable our supply chain to be industry leading,” he said.

“Starting with the right human capital is crucial to produce the right solution and product for all of our customers.”

UHS has developed a robust way of identifying and developing talent.

Davis spoke with The Journal of Healthcare Contracting (JHC) about this process, and the benefits it can bring for healthcare supply chain teams and their overall organizations.

JHC: Why is human capital important to the success of your supply chain initiatives? What about your organi-

I learned to focus on leadership as a behavior for all employees, not just employees who are formally titled as leaders.

member must identify and complete an improvement project. In 2019, we had 17 yellow belts certified completing approximately 24 projects with more than $2 million in direct expense reduction.

With improvements in process and service during the past two years, we have taken on additional customers and increased our spend oversight and impact to the organization by more than 20%. Without our valuable team, we would not be able to take on this effort.

The intern program has helped us connect with local colleges and bring in up-and-coming supply chain talent. Our career ladders start at the intern level to create a full trajectory for promotions. We have been able to obtain talent through the intern program transitioning into full-

zation as a whole?

time employment. Through these pro-

Davis: UHS’s supply chain is entering

grams we work to ensure our employees

into year three of our five-year strategy

with the right human capital is crucial

feel empowered to make decisions when

plan. The most important pillar of our

to produce the right solution and prod-

they can and not hesitate to ask ques-

strategy is organization. This pillar de-

uct for our customers.

tions when necessary. We have worked to

fines and outlines our plan and approach to talent.

We have built and deployed training

foster a culture where individuals can fail

and development programs including:

quickly and safely. Employees grow from

Six Sigma, career enrichment tracks and

all mistakes. This approach to learning

als who provide creative solutions and

an intern program with the intent of

and development has helped us create a

new approaches to enable our supply

empowering our employees to create

high-performing and healthy environment

chain to be industry leading. Starting

solutions for their roles. The Six Sigma

for all employees.

We need high-performing individu-

The Journal of Healthcare Contracting | April 2020

5

A CONTINUOUS JOURNEY

JHC: During your career, did you have an “aha” moment as it relates to the importance of talent development for a team and organization?

Davis: Early in my career, I was fortunate to have mentors and leaders who took the time with me to discuss my personal and professional development. One of the more memorable experiences early

When selecting new team members, we are looking for individuals who are driven, emotionally intelligent, team oriented and innovative.

on in my career that helped to shape my perspective on talent was a system-level process improvement portfolio. One of

JHC: What goes into selecting

Two years ago, we started to build

the projects had stalled and the leaders of

the best members for a high-

relationships with local universities to

the group were at odds with each other.

performing supply chain team?

develop our internship program and

One of the team members who was the

What are you looking for?

increase our talent pool. During the fall

only non-leadership position on the team

Davis: Our entire focus during a

semester, we visit various universities to

took it upon himself to realign the team,

recruitment cycle is to identify tal-

give informational presentations about

focus the group, and create accountability

ented people who will bring a new and

UHS and working in the healthcare

for the project. Seeing this example of

diverse perspective to our team. We

industry as a supply chain professional.

informal leadership, drive and initiative

have sourced employees from various

Since the inception of our program, we

really helped to shift my thought process

industries, each bringing different back-

have had two cohorts of interns, lead-

on leadership, behaviors and how to en-

grounds and expertise. We like to see

ing to job offers and employment with

gage the right kind of talent on a team. I

continuity of job experience and a track

our team. We have already completed

learned to focus on leadership as a behav-

record of success. In addition to experi-

recruitment for our third cohort of

ior for all employees, not just employees

ence, we place a strong emphasis on

interns for summer 2020.

who are formally titled as leaders.

trying to bring in new talent from college.

When looking for candidates, we strive to diversify our team with individuals of all levels of experience and backgrounds. When selecting new team members, we are looking for individuals who are driven, emotionally intelligent, team oriented and innovative. We often collaborate with internal and external customers, making these characteristics crucial for individuals to be successful in supply chain. Emotional intelligence is necessary as it shows they can monitor one’s own and other people’s emotions, to distinguish between different reactions and label them appropriately, and to use information to guide thinking and behavior. If an individual can develop their emotional intelligence, it will help them be successful.

6

April 2020 | The Journal of Healthcare Contracting

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A CONTINUOUS JOURNEY

ʯ Put customers first. Customers are at the center of what we do. We define value through the eyes of the customers and respond to their needs and wants as balanced with the voice of the business.

ʯ Be inclusive. The people in the process must change their work and they must work together.

ʯ Make problems visible and solve them. We make problems visible through metrics and visual signals and provide the support systems to solve problems quickly, collaboratively and for root cause.

ʯ Strengthen process stability and flexibility. We seek to be JHC: How do you develop the talent

events further fostering the relationships

predictable and responsive by

in your organization?

that individuals have developed.

defining simple, standard processes.

Davis: Our corporate human resources

We develop our talent within the

ʯ Optimize the value stream.

team develops talent in our organization

supply chain in several ways. We have

by offering “m3 for emerging leaders,”

created various levels of development

Building on our stability, we connect

a course designed for employees with

groups based on years in the work-

our material, information streams

strong leadership skills without direct

force, including: a new employee group

reports who often interact with all levels

dedicated to employees who have been

of management. This program focuses

in the workforce for less than three

best assets, so they must be engaged

on accountability, managing conflict,

years, a leadership development group

and developed. We focus on the

communication, change management

for those in managerial positions and

development of people as problem

and overall professional development.

an ongoing career enrichment group

solvers in all levels of the organization.

Employees are also encouraged to

that will be launched this year. These

complete Individual Development Plans

development groups focus on building

to assist them in taking charge of their

and growing employees not just profes-

agile approach to process improvement.

professional development.

sionally, but also personally. At UHS, we

We use Lean, Project Management,

and expertise to create flow.

ʯ Develop people. People are our

UHS Supply Chain uses a holistic and

see development as an ongoing partner-

Six Sigma and Change Management to

dedicated toward enhancing employee

ship between employees and managers.

deliver effective and efficient processes.

experience, known as Team C.A.R.E.

Development is a continuous journey

These efforts are in the framework of

(Connecting, Attracting, Retaining, En-

with milestone goals and should be a

projects or embedded in our daily work.

gaging). The various committees (Health

constant evolution.

UHS has also created a new program

& Wellness, Career Enrichment and So-

8

We see all work as a process.

JHC: How has your investment in

cial & Community) that fall under Team

We have also placed great emphasis on

your supply chain team paid off?

C.A.R.E. are comprised of top employee

process improvement, which focuses on

Davis: Our investment in the supply

volunteers. Since the inception of Team

guiding principles, methods and sound

chain team has paid off greatly. We have

C.A.R.E., hundreds of corporate em-

project management. The principles

established detailed career ladders starting

ployees have participated in the various

include the following:

at the intern level so everyone knows

April 2020 | The Journal of Healthcare Contracting

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A CONTINUOUS JOURNEY

exactly where he or she can advance. It includes two tracks: one for management and one for individual contributors. The ladders also include the base criteria of what an individual needs to accomplish prior to being promoted to the next position. This has proved very beneficial, as it allows us to be transparent with employees, so they understand promotions are

If employees can clearly see their trajectory, it helps them to properly manage their development and career path.

succession planning and ensuring that employees have access to challenging opportunities to learn and grow. Establishing mentoring programs are essential because they contribute to the development of a better-trained and engaged workforce.

They help develop relationships, identify skills that need improvement and can lead to increased job satisfaction as it shows

not just based on longevity but on the

the organization is willing to invest in its

quality and quantity of effort.

employees. Mentoring also helps individu-

From our lean Six Sigma program, we have completed several projects that have resulted in waste elimination, pro-

and a smaller select group will be working toward their green belt certification.

We have also provided contract

als navigate their careers.

Succession planning is also important to develop a focused process for keeping

gram development and overall savings.

training, which includes how to review a

talent in the organization. If employees

Projects ranged from reducing non-

contract and tips for negotiations for the

can clearly see their trajectory, it helps

contract spend, creating a request for

entire supply chain department to ensure

them to properly manage their develop-

proposal submission site, detailing out

everyone is aware of the process and

ment and career path. Providing access

contract terms and conditions guidelines,

feels confident making decisions.

to opportunities outside normal job de-

and creating procedures for the supply

scriptions is crucial as well. All levels of

chain internship program. The success

JHC: What are new skills supply

employees should be given opportunities

of the yellow belt program has led us to

chain leaders will need to develop in

to expand their knowledge regardless of

establish a green belt program. By the

the next five to 10 years?

job title. This allows employees to think

end of 2020, every employee will have at

Davis: Increased focus on emotional intel-

outside of the box and really challenge

least one yellow belt project completed

ligence, developing mentoring programs,

themselves to see what they can do.

Universal Health Services at a glance One of the nation’s largest and most respected providers of hospital and healthcare services, Universal Health Services (UHS), Inc. has built an impressive record of achievement and performance. UHS has served its communities for more than 40 years and cares for about 2.6 million patients each year.

Headquartered in King of Prussia, Pennsylvania, UHS has more than 87,000 employees and through its subsidiaries operates 26 acute care hospitals, 327 behavioral health facilities, 40 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services across 37 states in the U.S., Washington, D.C., Puerto Rico and the United Kingdom. In 2020, UHS again was recognized as one of the World’s Most

10

Admired Companies by Fortune; in 2019, ranked #293 on the Fortune 500; and in 2017, listed #275 in Forbes inaugural ranking of America’s Top 500 Public Companies.

The corporate supply chain team consists of sourcing and contracting, purchasing, value analysis, food and nutrition, pharmacy, process improvement and data analytics.

“We have operations teams across all of our medicalsurgical acute care facilities providing service for our patients and their loved ones,” said Raymond Davis, vice president, supply chain, UHS. “We are a centralized team providing support for all of our business segments including behavioral health, acute care, corporate and our physician practices.”

April 2020 | The Journal of Healthcare Contracting

CYBERSECURITY

Cyber Awareness In 2017, a worm tried to devour the Internet. The WannaCry ransomware

infection), having documented and tested

cryptoworm targeted computers running the Microsoft Windows operating system by

response protocols, and possibly the

encrypting data and demanding ransom payments in the Bitcoin cryptocurrency. The

most important, providing user education

WannaCry ransomware cryptoworm infected hundreds of thousands of computers on a

about phishing scams and social engineer-

massive, global scale, including many healthcare organizations.

ing techniques became priorities.”

The Journal of Healthcare Contracting (JHC) spoke to several industry stake-

12

“Cyberattacks in 2017 provided

weakest spots of the hospital networks

holders about cybersecurity trends,

some extremely valuable lessons learned

and forced many healthcare systems to

including best practices, developing a

for hospital systems,” said Terry Moon,

reevaluate their security posture, disaster

security strategy, screening for the best

assistant vice president of strategic sourc-

recovery procedures and user education

products and services, and the supply

ing, IT and cybersecurity for HealthTrust.

policies. The awareness of having good

chain’s role in preventing or responding

“Namely, it provided a view into the

backups (segmented to be isolated from

to cyberattacks.

April 2020 | The Journal of Healthcare Contracting

The only publication dedicated solely to the healthcare supply chain.

REACHING 4,400 IDN EXECUTIVES, 2,500 HOSPITAL EXECUTIVES, 600 GPO DECISION MAKERS AND 3,500 SUPPLIERS/MANUFACTURERS

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We are proud to partner with The Journal of Healthcare Contracting.

The unique educational content and market knowledge JHC provides serves as a vital resource to the supply chain and GPO communities.

The benefit we receive has far exceeded our investment.

— Bob Davis, AVP, Marketing & Communications, HealthTrust

JHC PUBLISHES YEAR-ROUND • 6 PRINT EDITIONS • 6 DIGITAL EDITIONS VISIT US ONLINE AT JHCONLINE.COM TO READ MORE EDITIONS OR FOR MORE INFORMATION

CYBERSECURITY

Cybersecurity and the Healthcare Supply Chain JHC: How have you improved cybersecurity within your own organization?

Campbell: We have dedicated team members in IT that conduct audits and tag information that could be at risk.

We have implemented a formal security assessment as part of the contracting process and require suppliers to make changes when necessary before signing a contract for new equipment. We also send our own phishing tests to see how team members react. We then follow up with education, so the same mistake is The Journal of Healthcare Contracting (JHC) asked Mark Campbell, vice presi-

not repeated. Even senior leaders fall

dent, supply chain for Tampa General Hospital, to weigh in on cyber threats, security

for our phishing tests and they receive

and where the healthcare supply chain fits into the overall cybersecurity discussion.

the same education. Everyone must be vigilant.

JHC: Why is healthcare a big target

JHC: What are some ways that

JHC: Where does the healthcare

for cyberattacks?

organizations can better protect

supply chain fit into the cyberse-

Campbell: There are so many suppliers

their data?

curity discussion? How can supply

in healthcare, each with their own IT

Campbell: Healthcare providers and

chain executives help?

architecture, it leads to many opportuni-

suppliers must be proactive in assess-

Campbell: Supply chain works with IT

ties for an attack. Further, there is a lack

ing and testing their systems. We must

to include the security assessment in the

of controls among the many suppliers

continually remind team members of the

contracting process. We also look for

and a lack of urgency to identify and

ways we can be tricked and how to report

any software-related items in a supply

correct weaknesses.

suspicious email or messages they receive.

item or equipment in the value analysis teams to educate team members on

14

JHC: What are the most prevalent

JHC: Where does staff education

potential risks and identify what IT

ways that a healthcare system’s data

fit in?

should review as part of the evaluation

gets compromised?

Campbell: Team members are the first

process. We notify suppliers early in

Campbell: By far, email phishing is the

line of contact for scams and therefore

the evaluation process that IT security

most prevalent way malware enters the

the first line of defense. We send frequent

is important, and you must be prepared

system. We receive so many emails every

reminders to everyone and will warn of

to pass the security assessment and

day, the opportunity to click on some-

a specific attack when we discover it has

make changes, or your product will

thing that appears legit is constant.

special appeal.

not proceed.

April 2020 | The Journal of Healthcare Contracting

Separating Fact from Fiction Not all cybersecurity products and services are created equal

In repeated healthcare surveys conducted in 2019 and even into this year,

smaller organizations.” In fact, in some

providers indicate that cybersecurity is a growing threat and one that presents a

cases smaller organizations may be more

clear risk to operational continuity, said Richard Mackey, senior vice president of IT

vulnerable to attack because the hackers

for Intalere.

are savvy and understand smaller institutions may not have the latest investments in some of these tools and services,

For instance, in Gartner’s 2020

The reason for that increased invest-

Mackey said.

CIO Agenda: A Healthcare Provider’s

ment is that according to some industry

Perspective (November 2019), almost all

statistics, as many as 1 in 5 health systems

booming during the past five to seven

responding healthcare CIOs now have or

have recently dealt with some form of in-

years, said Mackey. During that period,

are planning to implement cybersecurity

stability related to a cyberattack, whether

the growth rates for products and services

technologies during the next 12 months.

it is to the network in general or to a

touting cybersecurity solutions has hit

And 54% note that cybersecurity is a

specific area. “If anything, those numbers

double digits year over year. “There is

focus area for 2020 with increased invest-

may be underrated,” Mackey said. “It’s

a tremendous need, interest and high

ment and spend planned for this area.

a very common occurrence, even for

demand,” said Mackey.

The Journal of Healthcare Contracting | April 2020

Cybersecurity as a field has been

15

CYBERSECURITY

Needs vary While commodity IT goods and services have long been available in Intalere’s

as security information and

hype factor that sometimes can be mis-

event management)

leading to someone in compliance, supply

ʯ Security aspects of the devices

chain or clinical operational settings that

portfolio, the area of cybersecurity goods

which reside in organizations,

aren’t as close to the IT category. They

and services is newer and more specific,

whether they be computing focused

see the term cybersecurity and are inter-

Mackey said. One of the biggest challeng-

(mobile device management) or

ested, and a lot of the time there’s not a

es related to cybersecurity is scale. Needs

clinical in nature (medical Internet

strong focus or there’s not something that

can vary greatly among Intalere members

of Things (IoT)).

differentiates the product that warrants

due to the differences in size and scope.

“Cybersecurity needs vary depend-

such a high premium. That’s what we talk Another challenge is separating

about – separating the hype.”

ing on the size of the organization, the

“hype from value,” said Mackey. In 2019,

resources invested to date, the class of

Intalere formed a cybersecurity advisory

sition by reviewing best practices by

trade and more,” said Mackey. “We have

board to respond to this industry need.

members of the board.

worked with members to help deliver

It is comprised of leading information

Intalere delves into the value propo-

“In some cases we are looking for a portfolio of solutions that are just as applicable for a small acute facility anywhere in the country as would be for a larger

Operational continuity

system, or even for a non-acute surgery

Intalere’s Operational Continuity and Emergency Management Program was established to assist members in best understanding the products and services available in Intalere’s portfolio to meet operational needs related to continuity of care, disaster recovery and more.

“Often times, members large and small may not always have the resources required to establish or update their own capabilities that are most important in times of unexpected natural or man-made crises,” said Mackey. “Knowing that operational continuity is of the utmost importance to our members, Intalere has curated suppliers that offer unique services and products in which members of all sizes and classes of trade may be interested.”

facilities,” said Mackey. “Being able to

center chain or group long-term care pressure test possible solutions with our board is what we’ve found to be the most useful way to separate those things that may be more of a fad, or trendy with a label of cybersecurity, that may in fact just be the same product or service that’s been out in the market for five to 10 years and yet people are trying to reposition it as a cybersecurity offering.

Resources a custom cybersecurity assessment that

security professionals from provider

Resources which have been created or

delivers a prioritized plan with investment

organizations. Its purpose is to help

made available from the work of the advi-

to meet its short- and long-term goals.”

separate hype from value and provide

sory board are in the area of starting and

members with resources and information

growing a cybersecurity effort, cybersecu-

A variety of themes and subject areas are

that allows for investments to strengthen

rity insurance and cybersecurity training.

often involved, including:

their organization’s capabilities.

ʯ Securing assets and information (data loss prevention)

ʯ Identity and access management for users in the organizations

16

If your hospital or health system’s

“When we talk about the hype, it’s

network is frozen or held hostage by an

not uncommon for some vendors to take

attacker, cybersecurity insurance can often

what they’ve been doing for years and

be the most valuable investment you

slap a cybersecurity label on it, looking

make, according to Mackey.

ʯ Tools and services that focus on the

to justify a higher premium or how they

events themselves (often referred to

charge,” said Mackey. “It’s that kind of a

“That’s one of the best practices that we recommend to all our members,” he

April 2020 | The Journal of Healthcare Contracting

said. “If they don’t have it today, they

back online and being able to do your

breach or lack of protocol,” said Mackey.

should consider it.”

job,” Mackey said.

“Defenses generally work the way they

There are different facets to cyberse-

Intalere’s cybersecurity resources and

should and prevent people accessing a

curity insurance. For instance, there are

education help members understand if

network. Most of the time, a breach oc-

operational components that will cover

they have the right kind of policy and

curs because of social engineering with

the costs to get a health system back up

coverage. Smaller organizations may

workers getting fooled and sending out

and running following an attack. There

need help finding a policy, while larger

information to a hacker’s request that

are also other forms of expenses related

organizations can evaluate if they have

looks like it is coming from a colleague,

to recovery that cybersecurity insurance

the right policy in place.

manager or executive.”

can cover, such as legal services to help

Indeed, cybersecurity insurance

Mackey said that while yearly training

with compensation or investigating the

is no longer a supply chain or IT

is important, it is more successful if an

source of the attack.

team-level conversation.

organization will run shorter, more fre-

Plus, cybersecurity insurance can help with assistance in how a health system manages how they represent the

“This is a board-level issue,” Mackey said.

In the past, the head of supply chain

quent trainings and reminders. These can be short videos sent out on a quarterly basis. Managers can also run simulations

event in their marketplace. What is the

or IT might have addressed the topic

of situations that hackers may try to use

most appropriate way to notify patients,

within their respective departments. But

to dupe workers, and if a worker does

customers and those impacted by the

now, the CEO and C-suite is interested.

indeed get tricked, then the organization

breach? Is the health system complying

Cybersecurity insurance is one of the

can provide education and training so

with whatever laws might be in place in

most common requested topics and deci-

they can avert the issue if it ever happens.

their region or state?

sion points that happen at the board level.

With these training components,

“Those are other forms of expenses you might incur or things to work

Training is also an important piece of a cybersecurity strategy.

through if you are the victim of an at-

“Most of the time hackers, don’t

tack, beyond just getting your systems

get into your network because of some

The Journal of Healthcare Contracting | April 2020

Mackey said organizations are “making it more top of mind and thought about in continuous way and will have more success of being ever vigilant.”

17

CYBERSECURITY

Threat Assessment Healthcare providers must first identify where hackers can enter their system before developing effective security measures

Because of their sensitive nature, medical records are a big target of hackers.

valuable than a single item of the same,

In 2018 alone, HHS’ Office of Inspector General investigated nearly 400 reports of

with less effort to obtain.”

medical data breaches that potentially impacted thousands of patients, according to the Advisory Board.

Once an intrusion has been verified, systems need to deploy network forensic experts to identify the root cause and bring a systematic approach to isolating

Stolen healthcare records can have an

18

“In most cases, victims of fraud are

the issues, mitigating the impacts of the

enormous financial impact to a hospital

not even aware that their information has

breach and implementing permanent cor-

system, said Terry Moon, assistant vice

been stolen until it’s way too late,” he said.

rective actions.

president of strategic sourcing, IT and

The rich information in a medical

“Depending on the data exposure

cybersecurity at HealthTrust. The main

record could include social security num-

and local laws, breach notification, credit

concerns with stolen medical records are

bers, credit card numbers, birth dates,

monitoring and more are also put in place

identity theft and filing false medical claims.

addresses and more, and is far more

to help protect patients,” Moon said.

April 2020 | The Journal of Healthcare Contracting

Know the threats

“Hospital systems can continue to

devices’ components and protocols used,

Phishing scams via email chains are

add protections by only acquiring medi-

dataflow diagrams, configuration options

a well-known threat. But Moon said

cal devices that have security controls

and implementation requirements,” Moon

one of the main ways hackers can

and making sure that each device is

said. “From there, depending on the

breach a hospital system is through

identified in an asset management data-

initial findings, deeper analytics may

unsecure medical devices attached to

base so that if a vulnerability is identi-

need to be performed, including the pos-

the network.

fied, the susceptible devices can be

sibility of getting a device into a lab and

quickly located and patched or isolated

trying to infiltrate it to determine what

from the network,” he said.

mitigation steps may need to be deployed

“These devices are critical for patient care and must be protected from cyberattacks,” he said.

if implemented.”

Historically, hospital systems have

The assessment should also include

secured their networks at the perim-

Security assessment

the collaboration of a cross functional

eter using various methods, as well as

At the point of contracting with a service

team that includes security engineers,

deploying micro-segmentation internally

provider, HealthTrust conducts a formal

clinicians and business owners so that

throughout the enterprise to reduce the

security risk assessment on medical

all stakeholders are fairly represented to

scope and risk of cyberattacks.

devices and supplies. Each system has to

ensure the best possible outcomes.

“While this has mitigated the issues considerably, the sophistication of attacks has also improved over time with

determine what is in their best interest according to their business strategy.

“A security assessment should be

“As a final result, the contracting process should anticipate that a supplier who has implemented better security measures

social engineering becoming the most

multifaceted and include working with the

would be given higher considerations

prevalent method used by attackers,”

device manufacturers to understand the

for an award,” Moon said.

Moon said.

Today, additional efforts are needed by the medical device manufacturers to implement security controls within the medical devices themselves to create a defense in-depth approach to combating this extremely serious situation.

“Working together, hospital systems and manufacturers can create further barriers to reduce attack vectors and provide a safer environment for our patients,” Moon said.

Within the hospital or health system itself, Moon said ensuring that connected devices are protected is a highly complicated task due to the number of devices, the size and architecture of the network environment and the management of asset inventory. Many electronic systems and discovery tools need to be implemented to identify

Lessen the impact In the event of a cyberattack, a hospital or health system should have a plan in place for disaster recovery.

“First and foremost, health systems should have a documented, verified, and repeatable defense along with an in-depth recovery plan that is tested routinely before any event takes place,” said Moon.

This should include: ʯ Aspects of real/near time backups of critical systems (isolation from the rest of the network for protection) ʯ A dedicated officer of the company to champion this initiative and provide insight to the rest of the executive leadership ʯ Continuous education to the end users and various other teams to ensure that when a disaster is declared, all hands are on deck with a full understanding of their responsibilities.

“Having all of this in place before a disaster happens will lessen the impact to our organizations and the patients under our care,” Moon said.

threats, manage inventories and control the flow of traffic.

The Journal of Healthcare Contracting | April 2020

19

MODEL OF THE FUTURE

BY GRAHAM GARRISON

Breaking Down Silos Collaboration between supply chain and IT helped one health system streamline its contracting following a merger

Implementing standardization across an organization following a merger

“This ultimately led to the renegotia-

of two entities can be challenging. Jordan Scott, supply chain – IT program man-

tion and termination of 50-plus contracts

ager at HonorHealth, has another term for it – natural turbulence. HonorHealth

across our network, which allowed for

was formed by the merger of John C. Lincoln Health Network and Scottsdale

a standardization of vendors, and the

Healthcare in 2015.

opportunity to obtain excellent pricing,” Scott said.

It also led to supply chain and IT

“As expected, there was natural tur-

meeting HonorHealth’s stretch savings

bulence during the forming and storming

goal for 2018. But in order to meet

phases of our organizational develop-

those goals, changes were needed in

ment,” he said.

the way the organization’s departments

However, through an extensive

worked together.

integration process, IT and supply chain

“Historically, our IT contracting was

identified duplicate software, hardware

decentralized within functional silos

and service contracts at different price

where ensuring all contracts received

points that were in place pre-merger across the organization.

20

proper review and scrutiny presented a Jordan Scott

challenge,” Scott said.

April 2020 | The Journal of Healthcare Contracting

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MODEL OF THE FUTURE

Category versus contract management

perspective translated well into a category

of goals were unified, without sacrific-

management role within supply chain

ing organizational excellence,” he said.

At HonorHealth, Supply Chain Strategic

shared services where I needed to engage

“Searching for cost saving opportunities

Sourcing & Engagement (SS&E) man-

stakeholders, anticipate strategic questions

required close communication between

ages the day-to-day supplies and services

and map a complete implementation plan.”

the end users, stakeholders and the cat-

contracting for the organization. The

Traditionally, IT led their own initia-

collaboration between the supply chain

tives, built the vendor relationships and

with the process and allowed for organic

and IT departments initially surfaced as a

negotiated pricing. Once their action

integration, which was more collaborative

request for assistance with IT contracts.

items were completed, the contracts were

than the top down mandate.”

Through standardization of the process,

passed on to supply chain to manage and

strategic sourcing proposed creating an IT

advance through the legal review process,

a focus throughout the organization,

value analysis team (VAT) to align supply

Scott said. Through the new collabora-

Scott said he has seen increased satisfac-

chain sourcing opportunities with the

tion, supply chain was now part of the

tion with supply chain shared services

technology forecast. An early success with

whole initiative from inception of the

by the clinical departments. “A big part

print management that improved price

project through the implementation.

of this is due to supply chain being able

points and service levels gained inertia for

“The value received from this collabora-

to proactively identify contracts with IT

establishing a presence for IT category

tion includes alignment of organizational

implications and proactively collaborat-

management within supply chain, Scott said.

strategies, refined processes and control-

ing in the early stages of the process,”

ling costs more effectively.”

he said. “This has allowed for a more

The organization soon realized it could foster better outcomes by taking this tactical approach to a strategic one. In order to better steward its resources, HonorHealth’s supply chain shared services department adopted the methodology of category management versus contract management, which meant evaluating contract categories from a holistic approach versus individual point-in-time reviews.

“This shifted our department’s focus from attempting to review 3,000-plus contracts annually, to 300 categories, where we can better identify key strategic

As IT integration became more of

streamlined process, increased leadership

As IT integration became more of a focus throughout the organization, Scott said he has seen increased satisfaction with supply chain shared services by the clinical departments.

visibility, reduction of time executing and implementing critical projects.”

On the horizon HonorHealth will be opening its sixth hospital, Sonoran Crossing Medical Center, in September 2020. Scott said supply chain has partnered with the organization’s enterprise project management office to ensure current contracts include the new location and that services are fully functional on opening day.

opportunities,” said Scott.

“Working with various departments

Scott was in a unique position to help with the collaboration. In his previous

Three key items were needed to make the

throughout this process has provided new

role at HonorHealth, he worked in IT

collaboration work, Scott said:

insights on the challenges and resources

as an operations coordinator where he managed the budget, tracked termination dates and developed project plans. The IT operations coordinator role provided

ʯ Trust ʯ Alignment of goals ʯ Senior leadership support from both IT and supply chain.

technology plan, application schedule and

required for successful hospital operations,” he said. “Striving to be a future leader in healthcare, this project has allowed me the opportunity to learn new strategies and gain a more thorough un-

insight into HonorHealth’s organizational

22

egory administrators. We were also patient

“Bringing together a new team

derstanding of all service lines through-

value of formal customer requirements

required the collaboration and solution-

out the hospital and dependency required

gathering, Scott said. “This experience and

focused approach to ensure the alignment

from IT to thrive.”

April 2020 | The Journal of Healthcare Contracting

SPONSORED

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Are You Thinking Long Term?

Purchasing Departments Figure Standardization into Imaging Platform Decisions

Video: it’s everywhere in a hospital now. From ENT to urology and gynecol-

difficult to share the video and still-image

ogy, to pulmonology to general and thoracic surgery and GI, video is a standard

information with patients, payors and

function of these practices, and more applications for using video surface all the time.

other healthcare providers.

Increasingly hospitals and health systems are thinking about how their video-oriented purchases are going to fit the bill in the long term.

That said, with a need for improved integration and the need to prepare for data-driven advancements like AI, the industry is on the cusp of change. The po-

For all the video that is gathered by

there or there may be compatibility issues

tential for improved patient care is great.

hospitals, it’s not always being harnessed in

and technical challenges preventing dispa-

Imagine, for example, proof-of-concept

a way that will optimize patient care. Physi-

rate systems from connecting with each

work happening now toward the develop-

cians don’t always take recordings or store

other. As a result hospitals often find their

ment of an AI algorithm that can comb

images, for fear that the storage won’t be

videos siloed from each other – making it

over the past 100 recorded surgeries of

The Journal of Healthcare Contracting | April 2020

23

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each physician in a facility. The physician

But every OR case is different, so pin-

Azure Databox Edge with Azure Machine

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Connecting Disparate Systems, Saving Money, Reducing Physician Burnout

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Let’s just look for a moment at the hos-

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OR technology into a single workflow

prove productivity and patient outcomes

be learned from the data points gath-

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The on-premise appliance allows Olympus Customer Solutions Group to develop AI models that follow the activity in the OR from video, audio, surgical data, and system interactions.

concerned with the Institute for Healthcare Improvement’s Quadruple Aim of healthcare: including the fourth, reducing physician burnout. We predict a smoother experience for physicians through these systems integration advantages.

The Full Picture of the Patient The platform that will grow with the hospital is one that will set the stage for connecting all video assets, while also connecting those assets to electronic

healthcare workers in the room, visual

ence, the Olympus Customer Solutions

medical records. One patient’s record can

insights from surgical devices, patient

Group has proved that the power exists

include 10 independent records from as

vital signs, a case’s perioperative stage,

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many independent technologies. From

and other second-by-second procedure

efficiency cues in real-time, all from data

the GI Lab to pathology, from surgery

insights — can mean opportunities

points that are routinely used, including

to diagnostics and drug therapy, records

for process improvement, and this is

audio, video, and surgical device sources.

and visuals must talk to each other and

another area where proof of concept is in the works.

An OR can be the largest cost and

ensure that duplicative care is eliminated,

matter, it’s necessary to process such mas-

and that nothing is missed in terms of

sive amounts of data as close to the action

improving that patient’s outcome.

Recognizing that open source is the

profit center of a hospital, which means

as possible. Hospitals need to capture,

hospital CFOs are hyper-vigilant in ac-

analyze, and execute this data right on site

future, Olympus is working toward an

counting for each minute in the OR. In

or “on the edge” if they hope to take ad-

open platform, having made the com-

fact, research estimates that the average

vantage of real-time efficiencies to improve

mitment to allow hospital access to the

OR minute costs the hospital $62 —

OR performance and save costly OR time.

system for their own algorithm-building

1

and with unchecked inefficiencies present, the minutes can quickly add up.

24

In an OR where speed and efficiency

Olympus has been able to achieve this on the edge advantage using the

activities. Useful integration requires a vendor-neutral approach, and Olympus

April 2020 | The Journal of Healthcare Contracting

through its ImageStream Medical and MedPresence solutions, is making the agnostic approach a priority as well.

The approach is gaining the attention of hospitals, not just for the innovation edge it brings them, but for good dollars and cents reasons. Avoiding duplicative tests and ensuring better patient outcomes will mean more efficient use of resources toward better bottom-line results. Fully integrated and interconnected scenarios may feel overly complex now, but most facilities with a long-term view agree there is no other way to ensure continuous improvement.

Case Study in Transplantation Unique situations also can be helped

In the center’s first year, it’s estimated 90 people will benefit from organ donations and more than 21,000 others will benefit from tissue donations.

more generalized integration of imaging systems. Although every facility’s needs are unique, the benefits that a standardized use of imaging can bring seem increasingly universal.

The Checklist: What to Ask So Your Platform Will Stand the Test of Time ʯ Does the platform serve multiple needs across the hospital?

ʯ As you grow the number and types of endoscopes, energy devices, capture and storage systems and EHR integration technologies, will this platform be able to support that growth? For how long? If you’re just

by standardization. A good example

looking out 3-4 years, you might want

can be found at an innovative facility

to look further out.

ʯ Is the platform vendor neutral? To

in San Antonio recently launched to

patients one-on-one. The surgical suites

address transplantation.

equipped specifically for the recovery of

truly improve patient care, it will be

organ and tissue donation and transplan-

important to share across a wide

Hospital, managing an organ donor and sur-

tation and also connected to standard-

range of facilities and technologies

gical procedures can be a challenge to doc-

ized Olympus video systems are reducing

and to have compatibility with

tors and hospitals due to lack of resources.

travel for expert surgeons and preserv-

other platforms.

Through the Center for Life, Texas

ing organs until the right match can be

According to San Antonio University

ʯ Will storage be accessible on your network? Is it secure?

Organ Sharing Alliance (TOSA) and

made. Doctors at the center plan to use

University Hospital will work closely with

the cameras to allow medical examiners

community partners such as GenCure and

and coroners to view the surgical pro-

biomeds, algorithm developers — it’s

the San Antonio Eye Bank, to ensure more

cedures to obtain organs, which could

time to give them the power to build

efficient organ matching for a wide swath

lower the rate at which those offices

their own algorithms. Consider a

of the region’s population on waiting lists.

disallow transplants because of ongoing

cloud-based solution that, if it’s not

Clarissa Thompson, senior communica-

death investigations.

already there today, is at least moving

tions coordinator for TOSA, said the time

In the center’s first year, it’s estimated

it takes for doctors to decide if an organ

90 people will benefit from organ dona-

can be a match for a recipient on the wait-

tions and more than 21,000 others will

ing list can be decreased immensely with

benefit from tissue donations.

the state-of-the-art equipment.

In this 24/7 facility, Thompson said, specialty care teams can focus on

ʯ Is it an open platform? Clinicians,

in the direction of something akin to an “App Store” for clinical AI.

ʯ Does your standardized video platform leave room for clinical research?

The center could serve as a model

Is it capturing and managing data that

for facilities looking to update their tele-

could one day inform the future of AI

medicine capabilities or even to ensure

in healthcare?

https://www.ormanagement.net/Clinical/Article/06-18/What-Is-a-Minute-Worth-in-the-OR-/48791 http://www.ihi.org/communities/blogs/the-triple-aim-or-the-quadruple-aim-four-points-to-help-set-your-strategy

1

The Journal of Healthcare Contracting | April 2020

25

CORONAVIRUS

Outbreak Response Preparedness is key for hospitals and health systems when responding to an infectious disease outbreak

The novel coronavirus (2019-nCoV) is not the first, nor will it be the last,

to care for patients and keep healthcare

infectious disease outbreak to make global headlines.

workers safe,” Dr. Hanrahan said.

“There have been a number of

26

SARS, MERS-CoV and Ebola have

Being prepared

outbreaks that have taught us that routine

been transmitted in healthcare facilities

The Society for Healthcare Epidemiology

healthcare infection prevention is not

and preventing the spread of infection

of America (SHEA) emphasizes the im-

enough when dealing with a novel infec-

in hospitals is critical to containing

portance of supporting novel Coronavirus

tious disease or an infection that has po-

these infections worldwide.

(2019-nCoV) preparedness efforts with rig-

tential for causing a lot of morbidity and

“These outbreaks have shown that

orous commitment to infection prevention

mortality,” said Jennifer Anne Hanrahan,

emerging pathogen outbreaks can oc-

and science-based decision making. SHEA

DO, an infection disease specialist from

cur with little forewarning and cause

members – healthcare epidemiologists and

the University of Toledo.

disruption to hospitals and their ability

other experts in infection prevention and

April 2020 | The Journal of Healthcare Contracting

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infectious diseases working in collaboration with public health – are experienced in outbreak management, having overseen preparedness and management of 2019nCoV, SARS, MERS-CoV, H1N1, influenza and other infectious diseases, and are working diligently to ensure safety.

SHEA works closely with the Centers for Disease Control and Prevention (CDC), and over the past several years has given particular focus and investment to strengthen the infection prevention and control infrastructure for preparedness and response to emerging pathogens. The

Identifying gaps Both Ebola and SARS demonstrated that routine personal protective equipment (PPE) was not sufficient to prevent infection in healthcare workers, said Jennifer Anne Hanrahan, DO, from the University of Toledo. “Learning how to don and doff the personal protective equipment properly takes time and practice and is specific to the type of equipment being used. Training is critical to properly donning and doffing PPE.” A number of other issues have also been identified and these are outlined in the SHEA Expert Guidance: Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals https://doi.org/10.1017/ice.2017.212 Tool kits: https://ortp.guidelinecentral.com/

SHEA/CDC Outbreak Response Training Program (ORTP), created from 2016 to 2018, is a comprehensive program for hospital epidemiologists to be maximally effective to protect their patients, colleagues and community from facility-level outbreaks to emerging pathogens, such as 2019-nCoV. The ORTP provides expert-authored and selected resources in incident management, with tools and trainings for development and implementation of policies and identification of resources.

“ These outbreaks showed that education in incident management and preparation to work within an emergency response framework is essential in stopping an emerging pathogen crisis.”

– Jennifer Anne Hanrahan, DO

“The ORTP was developed to make sure that those working in infection prevention, specifically healthcare epidemi-

ORTP was created so the experts tasked

hospitals and healthcare workers have to

with preparedness and response can apply

knowledgeable in incident management

think about in terms of their process for

their expertise to stopping the outbreak,

and the structures, frameworks and re-

taking care of patients. For example, these

rather than spending precious time track-

sources that help limit facility disruption,

outbreaks have demonstrated that training

ing down resources and navigating new or

supplement resources, and prevent the

in proper donning and doffing tech-

unpracticed roles.

spread of the pathogen,” said Hanrahan.

niques for personal protective equipment

“These outbreaks showed that education

(PPE) is critical in order to decrease risk

bit more and it is important to incorpo-

in incident management and preparation

of infection to healthcare workers and

rate these lessons into future planning,”

to work within an emergency response

other patients, Hanrahan said. The ORTP

said Hanrahan.

framework is essential in stopping an

guides healthcare workers in the com-

emerging pathogen crisis.”

ponents of preparedness and response,

CDC Outbreak Response Training

including successful implementation of

Program (ORTP), visit https://learn-

said. “It can feel overwhelming when

policies, and provides quick, direct access

ingce.shea-online.org/content/sheacdc-

starting from scratch, and these tools help

to resources and tools selected by experts

outbreak-response-training-program-

make preparation manageable.”

as the most important and useful. The

ortp#group-tabs-node-course-default4

Being prepared takes time, Hanrahan

28

There are several different things that

ologists and infection preventionists, are

“Every outbreak has taught us a little

For more information on the SHEA/

April 2020 | The Journal of Healthcare Contracting

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Identifying Gaps ECRI Institute’s consulting helps providers respond to a multitude of issues related to infection control and prevention

On any given day in the United States, about 1 in 25 hospital patients has at least one healthcare-associated infection (HAI), according to estimates.

“ECRI’s engineering team has performed comparative evaluations in our testing laboratory of automated hand hygiene devices and equipment to help

Indeed, there are quite a few areas

30

For example, lapses in sterilization

hospitals know which products are best

that create vulnerabilities for infections

and high-level disinfection are especially

for reducing infection risks,” said Davis.

at hospitals and health systems, said

concerning, he said. There are environ-

“Other areas of vulnerability involve in-

James Davis, senior infection preven-

mental and construction-related factors.

fection prevention program management,

tion & patient safety analyst/consultant,

Hand-hygiene is a well-known concern

medical device issues broadly, as well as

ECRI Institute.

for the spread of infections.

infection prevention considerations in the

April 2020 | The Journal of Healthcare Contracting

selection and procurement of equipment and devices.”

The following are best practices ECRI helps hospitals and health systems develop for better infection prevention: ʯ Situational awareness processes, policies, procedures, supply procurement and facility risk assessment – (EBOLA, SARS, Influenza, COVID-19) ʯ Health IT: For example, modification of the electronic health record to capture process and outcome measures for infection-related issues.

The Partnership for Health IT Patient Safety, a multi-stakeholder collaborative convened and operated by ECRI Institute looks at these types of issues and our infection preventionists add to the content where/when appropriate. ʯ Regulatory and certification preparedness and response to regulators/inspectors.

Consultation ECRI receives a broad range of requests from hospitals and healthcare systems for infection prevention and control (IPC) consultation. To meet those requests, ECRI has developed an IPC consultation that is led by certified infection control-prepared experts with advanced degrees.

“Behind each consultant stands the power of ECRI’s full knowledgebase of multi-disciplinary experts, making ECRI unique in these consultations,” said Davis.

ECRI Institute’s certified infection preventionists conduct on-site consultations, while ECRI staff of medical device engineers, epidemiologists, ar-

ʯ ʯ ʯ ʯ ʯ ʯ

Systems (physical and electronic) Devices (medical and standard) Mechanicals/plant engineering Staffing Workflow Infection prevention

chitects, accident and forensics special-

program effectiveness

ists and clinicians review findings and provide additional recommendations.

ʯ Data validation ʯ Surveillance techniques

“For example, if we are onsite for

(manual and electronic)

an outbreak and the consultant suspects that that the potential reservoir is medical-device related, we immediately call in the expertise of the clinical engineering staff in our health devices group,” said Davis. “That instant expertise advises us, in real time, about the nature of the

ʯ ʯ ʯ ʯ ʯ

Epidemiologic data and analysis Human factors/ergonomics Cleaning and disinfection Sterilization/high level disinfection Environmental factors/ industrial hygiene

ʯ Infection control risk assessment

device and potential mechanisms that

for construction (consultation,

would put the device at risk for being a

planning, program evaluation,

causative factor. If we need an engineer

onsite and online training)

or a medical forensics expert onsite (or

ʯ Policy and procedure review ʯ Implementation science ʯ Infection forensics

any other expert), we fly them out to get the job done right the first time.”

Davis said the ECRI infection preven-

“ECRI is basically a one stop

tionists look at a variety of inputs to

shop for infection prevention and

develop the gap analysis and action plans

control consultation and resources,”

from (but not limited to):

said Davis.

The Journal of Healthcare Contracting | April 2020

ECRI has been updating its Coronavirus Outbreak Preparedness Center on a regular basis. The resources include very specific information on emergency preparedness supplies. www.ecri.org/coronavirusoutbreak-preparedness-center

31

COVID-19 RESPONSE

More Supply Chain Ripple Effects to Come At an inflection point, why the supply chain must rise above ‘every man for himself’ type behaviors

The COVID-19 pandemic has brought us to an inflection point. More specific

supply chain-related topics linked to the

to our industry, we might be at one of the more important inflection points in the his-

COVID-19 pandemic to The Journal of

tory of the U.S. supply chain, said Jeromie Atkinson, supply chain leader and essentialist,

Healthcare Contracting.

Supply Chain Sherpas. In the last few decades, we’ve seen progressing healthcare supply chain maturity, technology solutions and a more global supply chain all converge.

The Journal of Healthcare Contracting (JHC): Can you provide us with some insights into what is going on at a

However, “the supply chain’s inherent

chain, if we do not react at this time, may

national level in the U.S. healthcare

inability to sustain longer term disruption

end up being exposed as one of the weak

supply chain? How is the govern-

with greater resilience should be a call

links in the health system value chain.”

ment coordinating with providers,

to action for supply chain profession-

In the following two-part interview,

GPOs, associations, etc.? What are

als globally,” Atkinson said. “The supply

32

Atkinson provided his thoughts on several

the conversations like?

April 2020 | The Journal of Healthcare Contracting

Jeromie Atkinson: I haven’t heard

people are seeking. It’s been more dif-

JHC: What about at an individual

of many direct federal government to

ficult than expected to get to one source

health system or even hospital level?

health system interactions currently tak-

of truth about current status on topics

What does it look like?

ing place at the level of the supply chain,

related to COVID-19. Collaborating, at

Atkinson: Many individual hospitals

other than monitoring where shortages

least at a high level of conversation, does

or individual health systems are fending

are occurring or likely to occur. There

appear to be happening directly in health

for themselves and doing the best that

tends to be more communication and

system to manufacturer or distributor

they can. Typically, the smaller the health

connection at the state and local level

types of interactions, most typically to

system, the more impacted they will be

(governor and mayor offices) as officials

cover inventory gaps and to look for solu-

by the unavailability of inventories and

stay in contact with health system leader-

tions to cover the immediate needs.

the allocation efforts of distributors and

ship and monitor the situation to be able

wholesalers (for smaller systems, they

to react appropriately to the factors that

often have less purchasing power and less

they can control.

influence and may receive less allocation

However, the federal government

of the available inventory).

appears to be working on a more direct

The impacts seem to be more strongly

basis with health systems on other types

felt in rural hospitals, those who simply

of topics, primarily through organizations

don’t have the space or the purchas-

like the Centers for Disease Control and

ing power for large safety stocks of the

Prevention (CDC), and that guidance is

inventory that is needed today, but we are

typically more focused on supply utiliza-

also in a settling period where invento-

tion documentation like how to optimize

ries and ‘what is real demand’ vs. ‘what

their PPE through restricting use to only

is panic demand’ is not well understood.

those in care areas, reducing face-to-face

Just like many U.S. citizens made the rush

encounters, cancelling elective procedures, and maximizing telehealth to name a few.

to the grocery store to stock up on unJeromie Atkinson

The federal government is also working

needed supplies or supplies in excess of what they could consume, there was an

with supply chain’s upstream partners on

initial rush by many to purchase medical

trying to determine where products may

There are some discussions taking

be impacted. For example, the Food and

place obviously from health system peer

was in excess of need or adequate supply

Drug Administration (FDA) has been

to health system peer. At Sherpas, we’ve

based on need since we are still unable to

working with drug manufacturers to

had a number of colleagues over the last

test or predict the COVID-19 growth at

remind them of their responsibilities in

couple of weeks reach out, primarily for

this point and where patient populations

notifying the FDA on any supply chain

insights or for general information on

may be most intense.

disruptions, including analyzing their API

what we are hearing nationally. We’ve seen

and other components manufactured in

some interest in health system to health

JHC: What product categories are

China to anticipate shortages. They are

system collaboration among some of

most effected by COVID-19?

also monitoring the situation with the

the providers nationally, but that doesn’t

Atkinson: This is far more complex

60-plus medical device manufacturers in

seem to have gained the traction that it

than most people realize at this point,

China as well as other commodity manu-

potentially could. The GPOs are offering

because we are too often only focused

facturers, but it might be too early to tell

guidance where they can and are trying

on the emergency needs of today – PPE,

yet how those will be impacted.

to work proactively with their members

respirators and very likely ventilators.

I’ve heard frequently from my health-

supplies, and it is still unknown if that

where possible, and of course the sup-

PPE is affected in two ways. Many medi-

care colleagues, however, and getting

plier community is trying to be proactive

cal goods like PPE are manufactured in

good information is most often what

in serving their customers.

China at factories that were affected by

The Journal of Healthcare Contracting | April 2020

33

COVID-19 RESPONSE

China’s suspension of operations during

The full impact of how that will affect

man for himself ’ type behaviors with a

their height of their case growth, in ef-

the drug supply chain remains to be seen

rush on hoarding products for their own

fect, limiting some of the available supply.

and may take months to develop. The

use just like we have seen our neighbors

Add in the world’s increased need for

medical device industry is also likely to

rush out to hoard toilet paper. Both are

PPE and you can see the makings of the

be impacted and U.S. reliance on Chinese

understandable, if misguided responses.

problems we have in some areas. There

medical devices has been a topic with

We have to avoid only putting out the

are manufacturers who are shifting to

some visibility even prior to the coronavi-

fire on our own house while the whole

produce more inventory, but that shift

rus outbreak. Even when you get outside

neighborhood is smoldering, because as

does take time to influence current on-

of the medical products people typically

soon as we get one section put out, it will

hand inventories.

think of when it comes to healthcare,

catch again in another section we weren’t paying attention to.

It is OK to have missed the signals on supply continuity, and maybe many of us have up to this point, but to miss it now and going forward would be a potential catastrophic failure for our organizations yes, but mostly for the responsibility we owe our patients and communities that we operate in and are a part of.

We are at an inflection point in history and maybe one of the more important inflection points in the history of the U.S. supply chain in the last few decades as progressing healthcare supply chain maturity, enabling technology solutions, and a more global supply chain all converge. The supply chain’s inherent inability to sustain longer term disruption with greater resilience should be a call to action for supply chain professionals globally. The supply chain, if we do not react at this time, may end up being exposed as one of the weak links in

The next round of products is those

there are likely to be supply chain ripple

you may not have heard as frequently

effects from everything to food products,

about in the news. When you look past

to linens and textiles, and capital equip-

supply continuity, and maybe many of us

the immediate supply chain shortages

ment like beds and monitoring equipment

have up to this point, but to miss it now

and needs, the future category potential

and supplies.

and going forward would be a potential

shortages become more complex in other

34

the health system value chain.

It is OK to have missed the signals on

catastrophic failure for our organizations

categories and the full scope of that im-

JHC: How are you advising hospitals

yes, but mostly for the responsibility we

pact will take time to develop. I mentioned

and health systems to navigate any

owe our patients and communities that we

pharmaceuticals earlier, but approximately

supply disruptions?

operate in and are a part of. COVID-19 is

13% of the API – active pharmaceutical

Atkinson: Because this is an emergency

our current crisis but is extremely unlikely

ingredients – in drugs are manufactured in

situation, our human nature and the

to be the last, and shame on us if we

China, so manufacturers in other countries

cultural nature of our industry is to focus

don’t use these experiences to be more

besides China have also gone through

inwardly, to huddle up with our own

prepared the next time.

lengthy suspension of operations to try

teams and solve the problems that no one

and ‘flatten the curve’ in their own coun-

is going to solve for us. At best, some

always humbled by the talent and com-

tries and workforces. Additionally, the U.S.

organizations will reach out to others and

mitment in this industry. Once we get

has a high usage (about 90% of the total

try and share information at a very high

through the immediate crisis, we can

prescriptions) of generic drugs. Many of

level only, to determine where they might

use this time to regroup, to think pro-

these are Chinese made including antibiot-

work together to solve problems that they

actively on how we will address these

ics, diabetes drugs and birth control drugs.

both face. At worst, you will see ‘every

challenges in the future to build more

There is good news though! I’m

April 2020 | The Journal of Healthcare Contracting

collaborative and cohesive relationships with our upstream supplier partners and their providers of raw materials.

As today’s supply chains become more interconnected, and as more manufacturing continues to be located in lower cost countries and regions, they become more susceptible to global external factors like COVID-19 and natural disasters.

When supply chains have visibility as far upstream as possible, they can more proactively react to these external forces in proactive ways. We can use this time to build systems to more accurately shift excess inventories to regions of need (heat mapping). We can use our process expertise to support and lend guidance and leadership on the human supply chain

When you look past the immediate supply chain shortages and needs, the future category potential shortages become more complex in other categories and the full scope of that impact will take time to develop.

ʯ Build collaborative networks outside of our own ecosystems.

Consider supply chain response teams at the local level, but also work to bring colleagues along for a national discussion.

ʯ Collaborate, collaborate, collaborate. Not just at conferences over drinks, but at formal levels with industry groups, with your GPOs with other members, with informal or formal peer groups, with your supplier partners, with suppliers who are innovative even if you do not have a current contract with them but they are advancing the supply chain agenda nationally, with local governments, and with clinical leadership in

through shifting caregivers to where they are needed. Ultimately, we should use

to disrupt, in a positive way, the

and outside of your companies.

some time to reflect on how we can be

industry. Not all of those will be

Collaboration is very much a key

influencers, champions and leaders of the

successful, but in an Internet of

enabler of success in the supply

supply chain shift that our own internal

Things (IoT) environment, we will

chain and in a time when we have

customers, and more importantly, our

have to continue to sift through the

more national dialogue around

patients need us desperately to be.

traffic and find which introduce

collaboration and more technology

meaningful progress and change

enabling collaboration, we do not

JHC: What are a few things that every

and which are noise. When we find

seem to have improved measurable

supply chain team should being do-

something worthwhile, celebrate it

collaboration around the topic of

ing today as a result of COVID-19?

and spread the word.

supply continuity.

Atkinson: Every supply chain team individually should be looking forward to how they can actively help prevent supply chain shortages in the future.

This doesn’t necessarily mean increasing safety stock levels.

ʯ Building upstream visibility and understanding where our products come from, the market forces they may be susceptible to, and how to appropriately respond to any one of those individual supply chains breaking down.

Jeromie Atkinson leverages more than two decades of strategic customerfocused experience and extensive knowledge of the healthcare supply chain, both as an internal transformation agent and external business partner, Atkinson is a passionate educator and advocate for helping organizations develop solutions tailored to their own internal DNA and to discover and unlock their own supply chain abilities.

He earned his supply chain credentials in a variety of industries prior to joining some of the nation’s most progressive health systems where he applied his focus and passion to elevate supply chain discourse nationally.

For more information, visit: www.supplychainsherpas.com.

ʯ Look for and support emerging technologies that will continue

The Journal of Healthcare Contracting | April 2020

35

POST-ACUTE

Staffing: Post-Acute Care’s Pain Point Low wages, demographics add up to post-acute staffing shortages

A recently released report points to a crisis in the direct care workforce, that

Some facts from the report:

ʯ Nearly 20 million adults in the

is, nursing assistants, home care workers and residential care aides.

United States require assistance completing self-care and other Long-term-care employers are strug-

36

York-based advocacy firm PHI.

daily tasks due to physical,

gling to recruit and retain enough workers

Meanwhile, consumers are struggling

cognitive, developmental, and/

to fill vacant positions, while existing work-

to access the care they need, piecing

or behavioral conditions. This

ers are shouldering the burden of growing

together support from family and friends;

number includes about 17 million

demand without enough resources or sup-

waiting months or even years to receive

individuals living in the community,

port, according to the report, “It’s Time

formal services; moving into nursing

1.5 million residing in nursing

to Care: A Detailed Profile of America’s

homes sooner than necessary; or simply

homes, and nearly 1 million in

Direct Care Workforce,” by Bronx, New

going without.

residential care.

April 2020 | The Journal of Healthcare Contracting

ʯ Individuals with personal assistance needs rely first and foremost on

and nursing assistants in nursing homes

with activities of daily living, compared

earn $13.38 per hour and $22,200 annually.

to 8% of those 75 to 84, just under

family members, friends, and

4% of those 65 to 74, and just 3% of

neighbors – an estimated 43 million

those 18 to 64.

ʯ The caregiver support ratio (that is,

caregivers. But for those with limited

Little relief in sight

local caregiving networks, or with

The report suggests that the need for

the ratio of those aged 18 to 64 years

more complex needs, paid direct care

direct care workers will only increase in

old, who are most likely to provide

workers are a lifeline.

the next few decades:

care, to those aged 85 and above,

ʯ The direct care workforce is

ʯ From 2016 to 2060, the number

who are most likely to need care) is

expanding rapidly as our population

of adults in the United States aged 65

projected to fall from 31 to 1 in 2016

grows older, as people live longer

and over will nearly double, from 49.2

to only 12 to 1 by 2060.

with disabilities and chronic

million to 94.7 million, and the number

conditions, and as the supply of

of those aged 85 and over will triple,

potential family caregivers dwindles.

from 6.4 million to 19 million. During

numerous ways to improve job quality

The workforce has already nearly

the same period, the number of adults

and thereby build the direct care work-

doubled within a decade, from 2.9

aged 18 to 64 is projected to increase

force, but the bottom line is, workers

million workers in 2008 to almost

by only 15%.

must be better compensated, in line with

The researchers point out there are

4.5 million in 2018. In fact, the long-term care sector is expected to add 1.3 million direct care jobs, primarily personal care aide positions, from 2018 to 2028. That’s more new jobs than any other occupation in the U.S. economy.

Yet retaining qualified people in all those positions is challenging, according to the researchers. Part of the reason is direct care workers don’t get paid much.

The median wage for all direct care workers is $12.27 per hour, according to

Nearly 20 million adults in the United States require assistance completing self-care and other daily tasks due to physical, cognitive, developmental, and/or behavioral conditions. This number includes about 17 million individuals living in the community, 1.5 million residing in nursing homes, and nearly 1 million in residential care.

the Bureau of Labor Statistics. Due to high rates of part-time employment as well as low wages, median annual earnings

ʯ Population aging is significant because

the value of their contribution. If they are

the need for personal assistance and

not, the long-term service and support

formal long-term service support

sector will continue to struggle to recruit

workers earn the least, at $11.52 per hour

increase with age. More than 21% of

and retain a strong workforce, especially

and $16,200 per year; residential care aides

adults in the community who are aged

given the fierce competition for entry-

earn $12.07 per hour and $20,200 annually;

85 years and above require assistance

level workers across the labor market.

are just $20,200.

Among direct care workers, home care

Editor’s note: “It’s Time to Care: A Detailed Profile of America’s Direct Care Workforce” is the first in a year-long series that will provide a currentday analysis of the direct care workforce and its role in the long-term-care system of the United States. It was made possible through support from the W. K. Kellogg Foundation and the Woodcock Foundation. To view the first report, go to https://phinational.org/caringforthefuture/

The Journal of Healthcare Contracting | April 2020

37

POST-ACUTE

OBRA: One Thing the Feds Got Right Study shows 1987 law has led to improved nursing home care

In 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the nursing home quality assurance system, following published reports about

Facility characteristics ʯ The nursing home industry decreased in size, from 19,068

resident abuse, neglect and a lack of regulation and oversight.

facilities in 1985 to 15,686 in 2016.

ʯ There has also been an increase in In retrospect, it looks like the feds

physical and cognitive function among

the percentage of facilities that are

residents decreased. Findings from

nonprofit (25% in 1985 and 31% in

the study, by researchers at Brown

2015) and that are dually certified by

February 2020 Journal of Post-Acute and

University and the U.S. Department

both Medicare and Medicaid (33% in

Long-Term Care Medicine indicates that

of Veterans Affairs Medical Center in

between 1985 and 2015, the quality of

Providence, Rhode Island, include

nursing home care improved, even as

the following:

made the right call.

An analysis published in the

38

1985 and up to 97% in 2015).

ʯ Between 1995 and 2015, chain membership increased from 51%

April 2020 | The Journal of Healthcare Contracting

to 57%, the percentage of facilities

ʯ Assistance with dressing rose from 74%

with an Alzheimer’s special care unit

to 92%, assistance with transferring

quality-of-care improvements, OBRA

increased from 11% to 15%, and

from 60% to 85%, assistance with

1987 was also successful in implementing

overall nursing home occupancy

toileting from 49% to 88%, and

and enforcing the MDS (Minimum Data

rates declined from 87% to 81%.

assisting with eating from 38% to 56%.

Set) resident assessment survey, which

ʯ There was a decrease in the Resident composition ʯ Data suggest that although the

or Medicaid certified nursing homes, the

bed-bound, from 6% in 1985 to

researchers report.

4% in 2015, but an increase in the percentage of those who were chair-

constant, the percentage of those

bound, from 39% to 64%.

ʯ The percentage of residents with

increased from 7.8% in 1985 to

dementia increased from an average

20.7% in 2015.

of 39% in 1995 to an average of

ʯ The average percentage of females

45% across the facilities in 2015.

decreased from 72% of residents in 1985 to 67% in 2015.

ʯ The prevalence of long-stay

Quality of care

residents within nursing homes

Overall, quality process and outcome mea-

remained stable at 69% of all

sures have improved since the passage of

residents between 1985 and 2015.

OBRA 1987, according to the researchers:

ʯ The percentage of residents

ʯ Average direct care staffing hours

admitted from the hospital increased

have increased over time, with the

from 67% in 2000 to 85% in 2015.

greatest increases observed among

ʯ There has also been a shift of payer types over time. Between 1992

is required for all residents in Medicare

percentage of residents who were

average age of residents remained who were racial and ethnic minorities

In addition to helping bring about

certified nursing assistants.

Data suggest that although the average age of residents remained constant, the percentage of those who were racial and ethnic minorities increased from 7.8% in 1985 to 20.7% in 2015.

ʯ The average proportion of residents

and 2015, the average percentage

being physically restrained decreased

of residents with Medicaid as a

dramatically from 19% to 1%,

primary payer decreased from

and the percentage of residents

ment, we are seeing lower occupancy

64% to 58%, whereas the average

receiving antipsychotic medications

rates in nursing homes,” they write.

percentage of residents with

inappropriately, as a chemical

“Older adults without financial resources

Medicare as the primary payer

restraint, decreased from 16% in

– disproportionality, minority older

rose from 9% to 15%.

2000 to 12% in 2015 (although there

adults – are becoming an increasing

was a peak of 22% in 2005).

proportion of nursing home residents, as

ʯ Resident physical and cognitive function decreased over the years.

The average ADL (activities of daily living) dependency score among

ʯ There was not much change in the proportion of facilities cited for medication errors over this time period.

“Because of the aging-in-place move-

they may not be able to as readily access these care alternatives.

“Current and future policies should

ʯ The proportion of residents with

focus on expanding equitable access to

slightly, from 15 to 17, between 2000

pressure ulcers decreased from

the remaining long-term care services

and 2015.

8% to 6%.

and supports in the continuum of care,

nursing home residents increased

ʯ Residents who required assistance

ʯ Congruent with an increased need

particularly given the policies and initia-

in bathing increased from a national

for assistance, bowel and bladder

tives focused on decreasing nursing home

average of 89% in 1985 to an average

incontinence increased from 42% to

utilization through support of home and

facility average of 96% in 2015.

44%, and 49% to 62%, respectively.

community-based alternatives.”

The Journal of Healthcare Contracting | April 2020

39

HIDA

Strategic National Stockpile Collaboration with Private Sector Strengthens National Security and Preparedness

BY GREG BUREL AND LINDA ROUSE O’NEILL

Within ASPR, the SNS delivers the right products to the right place at the right time to secure the nation’s health, and partnerships are fundamental in ASPR’s approach to readiness and response. HIDA members represent the country’s medical product distributors – the nation’s essential link between manufacturers and patient caregivers.

“The success of the SNS/HIDA partnership is based on a strong commitment by both parties,” said Linda Rouse O’Neill, HIDA vice president of government affairs.

“HIDA and its members recognize that responding effectively to save lives during a public health event needs both the federal resources from the SNS as well as the commercial market. Our The partnership between the Strategic National Stockpile (SNS) and the

partnership with SNS has facilitated

Health Industry Distributors Association (HIDA) strengthens our nation’s health

regular, transparent dialogue that helps

security. As part of the U.S. Department of HHS’ Office of the Assistant Secretary

pre-event planning for better future

for Preparedness and Response (ASPR), the SNS oversees and maintains the nation’s

responses. Together we can realize

repository of emergency medical supplies in order to save lives and protect Americans

our shared goal of creating resilient

from health security threats; that mission success is closely linked to the resiliency of the

communities by strengthening the

commercial supply chain.

healthcare supply chain.”

For more details on the SNS, visit phe.gov/SNS.

“The results produced through the

40

work, collaborate on more scenario-based

SNS and HIDA partnership have blazed a

playbooks, and expand product work-

trail for public-private collaboration,” said

groups. The partnership also has served

Regular open dialogue is critical

Greg Burel, former SNS director who

as a model for engaging other organiza-

The SNS has hosted several workshops

retired in January 2020. “The two organi-

tions and stakeholders that have a role in

with HIDA that have led to better com-

zations meet regularly to pressure-test our

public health preparedness and response.”

munication and collaboration among

April 2020 | The Journal of Healthcare Contracting

manufacturers and distributors in

Collaborative Timeline

responding to emergencies and disas-

Full Scale Exercise

Semi Annual Meeting

ters. The open and transparent dialogue

Q4 2020 TBD

Prototype Tabletop

Workgroup Meeting October/ November

in these workshops identified market

Q2 2020 TBD

availability of ancillary supplies as related

SNS/Healthcare Supply Chain Association/ International Safety Equipment Association Tabletop

Responsive Design December 2019

to specific needs generated from an unforeseen incident such as an aerosolized

December 2017

August 2019

SNS/Healthcare Supply Chain Association Tabletop

HIDA Conference September 2018

anthrax attack.

June 2018

SNS/HIDA Tabletop II

HIDA provided executive-level subject matter experts to share commer-

George Washington University Modeling January 2018 HIDA Conference September 2017

SNS/HIDA Tabletop April 2017

cial supply chain manufacturing capacity, challenges, and industry requirements

Semi Annual Meeting

Pandemic Influenza Playbook December 2019

Ebola Response

July 2016

Influenza Pandemic 2015/2016

for ancillary supplies in the stockpile.

As product availability is compared to

Spring/Fall 2009

manufacturing surge capacity and justin-time inventories, the partnership facilitates better decision-making on what

incident. The playbook provides an

evolving changes to the strategic and

to purchase, how much to stockpile, and

overview of:

operational environment.

how best to collaborate in an effort to protect the supply chain and the public from an event.

Tangible deliverables are important SNS and its commercial partners have put

ʯ ʯ ʯ ʯ ʯ ʯ

The disease and associated symptoms Mechanisms for detection Proactive response actions

HIDA mapping tool

Medical countermeasure requirements

The HIDA mapping tool creates opportu-

Response scenario example

nity for close public and private collabora-

High-demand industry-specific

tion and coordination to respond to a pub-

medical products potentially needed

lic health event. The tool provides federal

to support a mass anthrax incident

partners at ASPR the physical locations

in many hours face-to-face to cement this

ʯ Federal response activities and

of commercial distribution partners and

partnership. While the intangible positive

actions that may be initiated to

national aggregated data for IV solution

support public health

products and more than 40 types of clini-

impact of these partnerships is great, the tangible results have been important to keep engagement high and demonstrate

ʯ Medical response efforts during an intentional anthrax emergency

value of the partnership.

cally appropriate needle/syringe product identified and validated with the SNS. Accompanying the product inventory

The playbook is designed to help

are education reports to provide additional

private partners better plan for and adjust

market insights that will assist federal part-

The anthrax playbook

their supply chain and inventory prior

ners in understanding the commercial mar-

The SNS produced the SNS Commer-

to and during a public health emergency

ket information. (Funding and support provided

cial Partner Playbook: Anthrax Re-

requiring medical countermeasures from

by the U.S. Department of Homeland Security,

sponse to provide important informa-

the SNS. This playbook is neither a docu-

National Protection and Programs Directorate, Office

tion to commercial medical supply chain

ment for procurement nor solicitation

of Infrastructure Protection, through the National

partners about anthrax and SNS medical

and is solely intended to support response

Infrastructure Protection Program Security & Resil-

countermeasure distribution operations

preparedness activities. Periodic updates

ience Challenge, which is implemented by the National

in the event of an inhalational anthrax

to this document will be made to reflect

Institute for Homeland Security (NIHS).

By Former SNS Director Greg Burel and HIDA VP of Government Affairs Linda Rouse O’Neill

The Journal of Healthcare Contracting | April 2020

41

HSCA

Group Purchasing Organizations: Supply Chain Leaders in Emergency Response

BY KHATEREH CALLEJA, J.D.

Health crises like the coronavirus place enormous stress on the entire health-

disruptions might occur, and working

care system, including first responders, physicians, hospitals, other healthcare providers,

closely with the Department of Health

and the patients they serve. America’s healthcare providers and physicians are faced with

and Human Services’ (HHS) Strategic

a number of challenges – from obtaining necessary supplies to educating practitioners

National Stockpile (SNS), U.S. Food and

on proper response procedures – as they work tirelessly to treat and prevent the spread

Drug Administration (FDA), Congress,

of the coronavirus and preserve patient care.

the Administration and all policymakers to inform responses. HSCA and its member GPOs are also actively support-

As the sourcing and purchas-

ing policy solutions like Medical Supply

ing partners to America’s acute and

Chain Security Act, the Safeguarding

non-acute providers, healthcare group

Therapeutics Act and the MEDS Act

purchasing organizations (GPOs)

which help enhance supplier resiliency,

play an important role in helping to

safeguard the supply chain and prevent

support response efforts to emergen-

and mitigate product shortages.

cies like the coronavirus. Leveraging

GPOs take their role as the sourcing

their line of sight over the healthcare

and purchasing partners to America’s

supply chain, GPOs work with public

hospitals very seriously – a commit-

and private healthcare stakeholders to

ment that is tried and tested during

ensure healthcare providers have what

as healthcare stakeholders, and state,

emergency situations. As the United

they need to effectively and efficiently

federal, and local health and emergency

States continues to address the corona-

combat public health threats.

management agencies to ensure a coor-

virus pandemic, HSCA and its mem-

dinated, comprehensive response.

ber GPOs will continue to work with

GPOs work with healthcare providers to create preparedness plans to

In response to the coronavirus pan-

Congress, the Administration, federal

ensure uninterrupted patient care; to

demic, GPOs are taking a number of in-

agencies and all healthcare stakehold-

source alternate supplies of products in

novative steps, including tracking emer-

ers throughout the healthcare delivery

shortage and to respond nimbly to help

gency room data, surveying provider

system to protect the supply chain and

hospitals, nursing homes, and other

members to gain an accurate understand-

ensure hospitals and healthcare provid-

providers treat a surge in patients. In

ing of supplies on hand and estimate

ers are equipped to treat and prevent

the event of an epidemic, GPOs work

future needs, working with suppliers to

the spread of this disease and provide

with their provider partners as well

see where potential supply shortages and

first-class patient care.

Khatereh Calleja, J.D., is the president and CEO of Healthcare Supply Chain Association (HSCA).

42

April 2020 | The Journal of Healthcare Contracting

SUBSCRIBE TO JHC FOR YEAR-ROUND COVERAGE JHC PUBLISHES YEAR-ROUND 6 PRINTED • 6 DIGITAL To enure you are receiving every issue please email Katie Educate at keducate@sharemovingmedia.com or visit our website at www.jhconline.com

CALENDAR

Due to COVID-19 restrictions at press time some dates and locations may change.

Calendar of events Association for Health Care Resource & Materials Management (AHRMM) AHRMM20 Conference and Exhibition July 26-29, 2020 Austin, TX

IDN Summit Spring IDN Summit & Reverse Expo TBD (due to COVID-19 restrictions at press time) Fall IDN Summit & Reverse Expo August 24-26, 2020 JW Marriott Desert Ridge Resort and Spa Phoenix, AZ

Federation of American Hospitals 2021 FAH Conference and Business Exposition March 7-9, 2021 Washington Hilton Hotel Washington, DC

Spring IDN Summit & Reverse Expo April 12-14, 2021 Omni Orlando Resort at ChampionsGate Orlando, FL

Premier GHX Supply Chain Summit April 27-29, 2020 Online Virtual Summit Experience www.ghx.com/summit

Breakthroughs Conference June 23-26, 2020 Gaylord Opryland Resort & Convention Center Nashville, TN

Share Moving Media Association of National Health Connect Partners Spring ’20 Hospital Supply Chain Conference May 20 - 22, 2020 New Orleans, LA Fall ’20 Hospital Supply Chain Conference September 30 - October 2, 2020 Kansas City, MO

Account Executives (ANAE) August 11-13, 2020 ANAE Annual Conference San Diego, CA Consolidated Service Center Forum November 3, 2020 Atlanta, GA

SEND ALL UPCOMING EVENTS TO DANIEL BEAIRD, MANAGING EDITOR: DBEAIRD@SHAREMOVINGMEDIA.COM

44

April 2020 | The Journal of Healthcare Contracting

NEWS

Premier releases annual report on national drug shortage programs Premier Inc. recently released an annual report on its national drug shortage

effects of poisonings are hard to come

programs, detailing key accomplishments and successful outcomes that have been

by. Without them, first responders are

achieved in collaboration with nearly 1,600 member hospitals.

forced to wastes precious time during a medical emergency administering drugs using vials or turning to substitutes. In

Premier said its approach to ad-

that lead to drug shortages, Premier

response, ProvideGx partnered with

dressing drug shortages includes part-

has a successful record of remediating

Amphastar Pharmaceuticals to increase

nerships with 25 leading manufacturers

the flaws in the generic drug economic

the supply of seven front-line drugs clini-

to reliably supply its members with

model, most recently with the creation

cians routinely use in emergency depart-

nearly 150 shortage drugs by National

of its ProvideGx program in 2019.”

ment crash carts. With creative financing

Drug Code (NDC). Annually, Premier’s

ProvideGx’s mission is to ensure

programs ship approximately 11.4 mil-

health systems have continuous and af-

created a remedy to the emergency sy-

lion units of shortage drugs to facilities

fordable access to shortage medications,

ringe shortage problem.

across the nation.

as well as those in categories that lack

“Our ability to take action and al-

and group purchasing options, ProvideGx

competition. In 2019 alone, ProvideGx

Ensuring availability before, during

leviate shortages of lifesaving drugs

added 18 new drugs to its portfolio,

and after pandemic events. Between

speaks to the core strengths of Premier

almost all of which were on the shortage

80-90% of all raw ingredients used for

and the differentiated value provided

list at the time of launch, Premier said,

U.S. drugs are in China. Given the recent

by our group purchasing organization,”

including metoprolol; cysteine hydro-

outbreak of the coronavirus in China,

said Premier President Michael J. Alkire

chloride; sodium bicarbonate; diphen-

closures of seaports or restrictions on ex-

in a release. “Guided by our member

hydramine; hydromorphone; lidocaine;

ports could compromise supply and lead

health systems, Premier’s multi-faceted

morphine; thiamine; phytonadione

to shortages. To address this, ProvideGx

approach is eliminating drug shortages

injection; vincristine; and emergency,

requires that manufacturers disclose plant

with both short- and long-term solu-

pre-filled syringes of calcium chloride,

locations, as well as the country of origin

tions that are increasing competition

epinephrine, sodium bicarbonate, atro-

for all active pharmaceutical ingredients.

and improving the economic health of

pine sulfate, dextrose and lidocaine.

Manufacturers with an undue concentra-

the market.”

tion of facilities in a single region are Other key accomplishments highlighted

passed over in favor of those that source

in the report include:

from multiple countries or continents.

ProvideGx

Speeding emergency response times.

None of the drugs currently on Provide-

Premier said it identifies safe, high-

Pre-filled syringes are the standard for

Gx contracts contain ingredients sourced

quality supply sources for drugs that are

emergency care because they offer the

from China, and all have diverse supply

or may be at risk of being added to the

precise adult dose in a ready-to-use

chains to ensure a continuous supply of

national drug shortage list. “In doing

formulation, speeding response times

life-saving products before, during and

so, Premier protects its members from

and minimizing the potential for dosing

after an outbreak.

supply fluctuations that may affect the

errors. Unfortunately, across the country,

market at large,” the organization said in

emergency syringes used to treat allergic

To view the report, visit: https://explore.

a release. “Recognizing the varied issues

reactions, manage trauma and reverse the

premierinc.com/providegx-dev.

The Journal of Healthcare Contracting | April 2020

45

NEWS

Contracting News & Notes Recent headlines and trends to keep an eye on

services provider specializing in protect-

Premier Inc. (Charlotte, NC) recently

tacks. The group purchasing contract also

issued a statement to CMS to recommend

benefits members of Provista, Vizient's

that, in light of its success, the Next

supply chain partner serving the non-acute

Generation Accountable Care Organiza-

market. Under the terms of the agreement,

tion (NGACO) program be extended or

CI Security will offer its Critical Insight

adapted. The NGACO model requires

Managed Detection and Response solution

participants to take the greatest level of

to Vizient and Provista members via their

financial risk of any ACO model, Premier

group purchasing portfolio to provide criti-

said. And yet, the organization recently

cal insight into the health of their security

announced that NGACOs reduced

posture and the ability to lower the impact

Medicare spending by $242 million in in

of cyberattacks through real-time threat

HealthTrust, Community Hospital Corporation renew exclusive supply chain relationship

2018, achieving nearly $221 million in

detection, investigation, and response.

HealthTrust (Nashville, TN) and Commu-

ing networks of healthcare organizations and critical infrastructure from cyberat-

Henry Schein Lilly MetroHealth Premier Inc Kaiser Permanente Kimberly-Clark UPMC Vizient Inc

net shared savings. NGACOs that are

nity Hospital Corporation (CHC) (Plano,

organized in Premier’s data-driven col-

TX) have signed a long-term partnership agreement to strengthen the operating

of $63 million in shared savings. The

IDNs, GPOs, and healthcare suppliers and distributors named to 2020 list of World's Most Ethical Companies

NGACO model is scheduled to sunset at

Ethisphere has announced its 2020 list of

or advises more than 100 acute care and

the end of this year. Premier has called on

the world’s “Most Ethical Companies.”

post-acute hospitals and healthcare facili-

CMS to build on these successes by either

This years list recognized 132 companies

ties. The contract renewal with Health-

extending the NGACO program or bet-

“for setting the global standards of busi-

Trust preserves the support structure and

ter adapting the new Direct Contracting

ness integrity and corporate citizenship.”

resources these community hospitals and

laborative realized nearly 30% of these savings, reducing total spending by more than $70 million and earning in excess

between models for NGACOs.

CI Security awarded contract with Vizient, Inc. to provide managed detection and response services CI Security (Seattle, WA) was awarded a group purchasing contract with Vizient, Inc. (Irving, TX). CI Security is a Managed Detection and Response (MDR)

performance of community-based hospitals. CHC is a nonprofit organization that owns, manages, consults with and/

non-acute providers have come to depend

Model to provide a stepwise progression

46

ʯ ʯ ʯ ʯ ʯ ʯ ʯ ʯ

Premier recommends modifications to Medicare Direct Contracting Model

The list includes 15 healthcare related

on to manage the escalating costs of

companies, including:

healthcare delivery, the company said.

ʯ ʯ ʯ ʯ ʯ ʯ ʯ ʯ

3M Baptist Health South Florida

Colgate-Palmolive Company

HCA reverses decision to close Plantation General Hospital when it opens new 200-bed facility next year

Covenant Health

HCA Healthcare (Nashville, TN) an-

HCSC (Health Care Service

nounced it no longer plans to close

Corporation)

Plantation General Hospital (Plantation,

blue California CareFirst Cleveland Clinic

April 2020 | The Journal of Healthcare Contracting

FL) when it completes a new hospital in

of Sears Holding Corporation. As Cardinal

COVID-19. Allocations are typically set

Davie, Florida. After failing to win state

Health CFO, Hollar will lead financial

to match the customer’s historic purchase

Certificate of Need approval to build a

activities across the enterprise, includ-

volume in order to prevent unnecessary

hospital in Davie, HCA announced plans

ing financial strategy, capital deployment,

hoarding. A downside of this is that, while

in 2016 to transfer Plantation General

treasury, tax, investor relations, account-

well intentioned, it may limit healthcare

Hospital's license to Nova Southeastern

ing and reporting. He will succeed Dave

providers in the amounts they can buy,

University's campus in Davie. Under the

Evans, who has been serving as interim

even if they have legitimate reasons for

plan, Plantation General Hospital would

CFO. Evans will continue to serve as CFO

new, larger orders. This particularly may

have shut down services, except for a

of Cardinal Health through May 11.

affect senior living facilities. For most hos-

standalone emergency department, after

pitals’ and health systems’ facilities, PPE

the license transfer. In 2019, the Florida

orders are common, as these goods are

Intalere cancels Elevate 2020 member conference

required to perform a range of activities,

most hospitals, paving the way for HCA to be able to build a hospital in Davie and

Intalere (St. Louis, MO) announced it has

tion prevention. However, most senior

keep Plantation General Hospital open.

cancelled Elevate 2020, Intalere’s Member

living facilities don’t perform critical care

HCA expects to open the new 200-bed

Conference, May 11-13 (Nashville, TN)

functions, and thus purchase almost no

hospital on Nova Southeastern Univer-

The company said it made the decision

PPE at all.

sity's campus in Davie in early 2021.

“because of the uncertainty surrounding

legislature eliminated the CON law for

including surgeries, ICU care and infec-

ʯ About 43% of the senior living

the COVID-19 situation and keeping the

facilities responding to the survey

safety and security of members, suppliers,

don’t have a consistent ordering

Cleveland Clinic named No. 2 Hospital in the World by Newsweek

and employees as a priority.” According to

history for PPE

Intalere’s Chief Executive Officer Julius

ʯ Of respondents that have a consistent

Newsweek has ranked Cleveland Clinic

Heil, it was cancelled in accordance with

purchasing history of PPE products,

the No. 2 hospital in the world, as part of

the CDC recommendations on restrict-

87% are not receiving the full quantity

its World’s Best Hospitals 2020 analysis.

ing large group gatherings over the next

of products ordered. effectively leaving

In the U.S., Cleveland Clinic again earned

several weeks and, “our commitment to

them without a legitimate channel

the No. 2 ranking, while four other

our members, staff and suppliers, and the

for purchasing supplies that may be

Cleveland Clinic hospitals also were listed

need to keep them focused on care deliv-

necessary to protect workers and elderly

among the best hospitals nationwide:

ery and the needs of the community.”

ʯ ʯ ʯ ʯ

Cleveland Clinic Florida-Weston Cleveland Clinic Akron General Cleveland Clinic Hillcrest Hospital

residents in senior living facilities

ʯ About 30% of senior living

Cleveland Clinic Fairview Hospital

respondents reported no inventory

Senior living facilities unable to access PPE needed for COVID-19 containment plans, Premier says

ʯ 68% said they had limited to no

Premier Inc. (Charlotte, NC) released

ʯ Nearly 60% of respondents also

of N95 masks ability to access additional masks

Cardinal Health names Jason Hollar as new Chief Financial Officer

survey results finding that more than two-

Cardinal Health (Dublin, OH) announced

face shields and other personal protec-

to no ability to obtain disinfecting

that its board of directors elected Jason

tive equipment (PPE) that may be needed

products such as wipes, spray and

Hollar as CFO, effective May 12. Hollar

to care for current or suspected cases of

hand sanitizer

most recently was the CFO of Tenneco

COVID-19. Healthcare distributors have

ʯ 70% reported limited to no ability to

Inc., a global automotive products and

placed more than 700 unique PPE stock-

acquire face shields and other facial

services company, and previously was CFO

keeping units (SKUs) on allocation due to

protective equipment.

thirds of senior living facilities in the U.S. cannot obtain the necessary N95 masks,

The Journal of Healthcare Contracting | April 2020

indicated limited to no ability to access gowns

ʯ Approximately 65% have limited

47

EDITOR’S NOTE

Graham Garrison

A Fluid Situation As of press time, we were still not out of the woods when it comes to the global spread of COVID-19. Not by a long shot. While nations such as China and South Korea were expressing optimism that they had gotten things under control, Italy and Israel were on lockdown, and here in the United States testing for the disease was just beginning to ramp up.

And even when we do get a handle on containing the disease, there will be plenty of long-term implications, including the supply of products and services in healthcare. For instance: ʯ Supplies of PPE. In early March Premier released results of a survey finding that 86% of U.S. hospitals and health systems are concerned about their supply of face masks and other personal protective equipment (PPE) as the global spread of the COVID-19 coronavirus strains the supply chain. According to Premier’s purchasing data, hospitals and health systems across the United States typically buy 22 million N95 face masks a year. However, during the months of January and February, demand for N95s surged, up 400% and 585%, respectively, largely fueled by a heavy flu season and forward buying in anticipation of a coronavirus outbreak in the United States. The levels of demand suggest a minimum consumption rate of 56 million masks in 2020, nearly a three-fold increase in demand when compared to a typical year.

The levels of demand suggest a minimum consumption rate of 56 million masks in 2020, nearly a threefold increase in demand when compared to a typical year.

ʯ Pharmaceuticals. Modern Healthcare reported in early March that the Indian government may hold 26 pharmaceutical ingredients and drugs made from them amid supply concerns stemming from the coronavirus, stretching an already fragile pharmaceutical supply chain. Much of the world’s supply of generic drugs comes from India, which relies heavily on China for their active pharmaceutical ingredients, according to the report.

What does this mean for supply chain departments across the nation? In the event of possible disruptions and shortages, communication and collaboration with suppliers has never been more important. Do IDNs and health systems have a good grasp on their inventory levels? If supplies are low, what are some viable alternatives? Is there a plan in place for disaster response? These are just some of the many questions we’ll be looking at in the weeks and months to come.

48

April 2020 | The Journal of Healthcare Contracting

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