JHC Special Edition 2020

Providing Insight, Understanding and Community

Before, During, After Supporting healthcare systems across the you, United States

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S TR O N G T OG E T H E R TO DAY. . .

S TR O N G E R T OG E T H ER TO MO R R O W The COVID-19 pandemic is our generation’s most severe healthcare challenge.

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CONTENTS »» SPECIAL ISSUE 2020 4 Publisher’s Letter: Providing support and hope during an unprecedented time 5 Unsung heroes

Why the work you are doing matters.

And why we can’t go back to normal.

16 Do we finally have a tipping point for a better healthcare supply chain?

20 AHRMM Senior Director to supply chain leaders: Review and implement CDC strategies

An enormous force for good How the private/public sector collaboration will help guide us out of these troubled times

p8

21 UHS Quality and Chief Medical Officer: Providing the best possible care during unprecedented challenges

The challenge will not wait Why the supply chain is instrumental in helping to manage, and overcome, the current crisis

p12

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Special Issue 2020 | The Journal of Healthcare Contracting

28 Leading IDNs are being judicious with supply orders “for the foreseeable future,” GPO executive says 36 Vizient: Focus on resiliency

While meeting the demands of an emergency, supply chain teams will also need to anticipate future needs

Come together Supply chain leaders met with the president at the White House as part of the COVID-19 Supply Chain Task Force

p24

40 Intalere’s Steve Kiewiet: Transparency is key 48 SMM thanks Owen & Minor and McKesson teams

Keeping healthcare facilities infection free Best practices and protocols from an infection preventionist

p44 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

Publisher John Pritchard jpritchard@sharemovingmedia.com

Managing Editor Daniel Beaird dbeaird@sharemovingmedia.com

Vice President of Sales Katie Educate keducate@sharemovingmedia.com

Art Director Brent Cashman bcashman@sharemovingmedia.com

Circulation Laura Gantert lgantert@sharemovingmedia.com

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 contributing authors.

The Journal of Healthcare Contracting | Special Issue 2020

3

PUBLISHER’S LETTER

JOHN PRITCHARD

Providing support and hope during an unprecedented time Welcome to this first-ever special edition of The Journal of Healthcare Contracting. We have been publishing for over 15 years with a front row seat to the U.S. Healthcare Supply Chain. Our community is facing an unprecedented crisis and we simply cannot sit by, so we’ve created this publication to help in the looming COVID-19 crisis.

We stand in solidarity and support of our nation’s medical suppliers in this great time of uncertainty. In an effort to inform our nation’s supply chain leaders, we have assembled this group of suppliers to communicate how they are assisting all of you supporting our hospitals and IDNs. In this magazine you will find contributions from many renowned experts who share their insights and observations to shed some light and hope during a challenging time. I’d like to thank the following people for their contributions:

ʯ ʯ ʯ ʯ

Dee Donatelli Jeromie Atkinson John Strong John Bardis

Communication is paramount to any crisis relief plan. During this COVID-19 crisis the number one request we hear from Supply Chain Leaders is that they are trying to understand when and where help is coming from.

This publication shows them exactly how suppliers are answering the call. You will see direct responses on what suppliers are doing to

We stand in solidarity and support of our nation’s medical suppliers in this great time of uncertainty.

repair the nation’s supply chain and support our healthcare providers.

The Journal of Healthcare Contracting is committed to helping Supply Chain professionals coast to coast.

Keep an eye on regular updates via our website at www.jhconline.com or through our DaileNews.

Please reach out to me if you have any questions or if I can be of service to you. Thank you for reading this special edition of The Journal of Healthcare Contracting.

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Special Issue 2020 | The Journal of Healthcare Contracting

SUPPLY CHAIN

Unsung heroes Why the work you are doing matters. And why we can’t go back to normal.

BY DEE DONATELLI

Reading each day’s headlines about how COVID-19 pandemic is affecting our

It’s the supply chain – suppliers,

hospitals and health systems, two thoughts strike me. First, the frontline caregivers are

manufacturers, supply chain profession-

obviously and appropriately being commended for their work and sacrifices. There is

als – that will be the unsung heroes of

even an appreciation now for the environmental workers, testers, support staff – anyone

this fight.

who is out having contact or could be physically touching patients

We’ll get through this. But when we do, we shouldn’t go back to normal, because normal wasn’t working all that well.

But that leads me to my second

A good friend of mine who is a supply

thought about the coverage. There are a

chain executive said the painful truth is that

lot of heroes in our health organizations.

we’ve never managed supply chain well.

Many, though, aren’t wearing scrubs.

We go to conferences and attend meeting

Whether the lack of recognition is good

after meeting and talk about the problems.

or bad remains to be seen. I’m concerned

But when are we going to start solving

that when all of the dust settles that the

them? How do we find the solutions?

supply chain will be a scapegoat in the crisis

Now that the light is shining on our

rather than recognized for the Herculean

contributions to healthcare, I don’t think

efforts of individuals and organizations

we should go back to normal. If we go

to move product to where it’s needed at

back to the way things were, we wouldn’t

unprecedented speed and volume. Will sup-

have learned any lessons from this.

ply chain be blamed that we didn’t do more,

We have to rise up and do better.

that we were ill-prepared or equipped? I

How do we have greater visibility in the

would love to believe that won’t happen,

upstream supply chain? How do work

but you can already see finger pointing and

as true partners and not just give out lip

second guessing in the news. Pointing fin-

service? How do we better understand

gers now or really ever is not in my opinion

where a vendor sources products from,

the right thing to be doing.

and how do we have greater visibility

Instead, we should look to the heroes.

strain knowing their clinical staffs are having

Supply chain teams across the nation are

to do without critical supplies and equip-

into the overall supply chain?

That’s what this is about. That’s what

working tirelessly to procure supplies from

ment. The burden and how that weighs on

sources they would never have thought

you when you are down in the basement

As unimaginable and awful as this situ-

imaginable, and didn’t even know existed

doing everything you possibly can is just

ation is, let’s not have it be for naught. Let’s

a month ago. They’re feeling unbelievable

almost unimaginable.

learn from this and let’s do better, together.

this could be about.

Dee Donatelli, RN, BSN, MBA, is vice president of professional services, TractManager, and principal of Dee Donatelli Consulting, LLC. She currently serves as chair of the Association for Healthcare Resource and Materials Management (AHRMM) board, is a 2015 Bellwether inductee and serves on the Bellwether Board. She is also past president of AHVAP.

The Journal of Healthcare Contracting | Special Issue 2020

5

We’re here for healthcare.

Throughout the fight against COVID-19 and beyond, Owens & Minor is here to empower our healthcare customers and supply partners.

Together, we’re making a difference.

Visit owens-minor.com/covid-19 to learn more.

Owens & Minor has been in the business of healthcare for over 135 years. We know that when times are hard, healthcare doesn’t stop—and neither do we. As the world battles the 2019 novel coronavirus (COVID-19) pandemic, our teammates are working around the clock to serve our mission to empower our customers to advance healthcare. Throughout the many challenges and unprecedented demand stemming from COVID-19, Owens & Minor’s goal remains the same: we’re here for healthcare. We’re here for the clinicians and the patients.

We’re here for each other.

The health and safety of our teammates, suppliers, and our customers and their patients are at the heart of everything that we do. Whether it’s implementing advanced safety protocols to protect our teammates and service providers, or taking significant action across our organization to make and deliver product as rapidly as possible, Owens & Minor is committed to protecting our healthcare customers and the patients they care for in the fight against COVID-19.

In the earliest days of the COVID-19 impact on the United States, we enacted business continuity and expedited delivery plans to ensure our ongoing capability to supply critical products to the nation’s hospitals. The majority of Owens & Minor’s Personal Protective Equipment (PPE) manufacturing is located within the US and Americas, enabling a more rapid supply chain from point of manufacture into the United States. We’ve invested heavily to further expand manufacturing capacity to supply as much critical equipment as possible during this challenging time.

We are also working closely with government agencies such as FEMA and HHS along with our supply chain partners to address the unprecedented demand for PPE so we can provide healthcare customers critical product needed to fight this crisis. COVID-19 has certainly challenged our industry and the supply chain, but Owens & Minor, leveraging our Americas manufacturing footprint, remains intensely focused on partnering with suppliers and customers to mitigate risk wherever possible.

Our leadership team is in awe of the tireless efforts of the entire healthcare community, including our customers, teammates and suppliers, in the fight against COVID-19. We are extremely proud to be part of Owens & Minor as together we work to conquer this global challenge. These are uncertain times, but I am confident in our ability to empower healthcare today, tomorrow and for years beyond this crisis, just as we’ve done for the past century and more.

Ed Pesicka President & CEO

SUPPLY CHAIN

An enormous force for good How the private/public sector collaboration will help guide us out of these troubled times

founder and former CEO of MedAssets. “I think our eyes are being opened to some

The COVID-19 pandemic has created a different kind of supply chain activity

degree across the world about that now,” he said.

“I think the supply chain profession in

The greatest risk to the human race isn’t nuclear. It’s biologic, according to John Bardis, former assistant secretary of Health and Human Services (HHS), and the

Bardis discussed this topic and more in a recent National Accounts Today podcast

8

general has adopted over the last several

with John Pritchard, publisher of The Journal of Healthcare Contracting. The following

decades just-in-time practices as an ef-

are insights gleaned from the podcast.

ficiency focus for the management of raw

Special Issue 2020 | The Journal of Healthcare Contracting

materials, all the way to finished goods

nor does it have a program to do it that

to customer,” said Bardis. “Obviously,

would cover all.”

that type of supply chain activity didn’t

So it underscores the extraordinary

contemplate or really doesn’t contemplate

value and importance of the delivery

the impact of a pandemic, particularly in

system in the United States and the role

a country that imports as America does

that it plays, but also the tragically fragile

the vast majority of its PPE.”

nature of certain elements of the supply

The supply chain and the way that

chain, in this case, PPE. “And not just

it works and the lessons that we’ll learn

PPE, but this is also quite true as it relates

from this particular event will change

to our compound formulas for the major-

the way we think about strategic sup-

ity of our pharmaceuticals,” he said.

ply chain and healthcare, said Bardis.

“Specifically, if we were outsourcing our munitions for our military and found ourselves in a conflict but short on the

John Bardis

Drawing from his experience as assistant

supply chain, we would rethink that, but obviously, we manufacture the vast majority of our own armament.

“You could even take into the similar vein the food supply in America,” he continues. “If we were importing the vast majority of our food during a crisis like this, we would have a serious problem on our hands. For some reason, largely because of lower manufacturing costs, we outsourced some portion of the commodity supply chains, specifically PPE, to Asia, and mostly China. That has really come back to bite us. In the end, yes, we have effectively reduced the price of com-

“There’s going to be a lot of hindsight analysis of how we responded and whether or not the mechanisms of government responded quickly enough to the real danger of the pandemic.”

secretary of HHS, Bardis praised the people working at institutions such as the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH) and HHS. “There’s going to be a lot of hindsight analysis of how we responded and whether or not the mechanisms of government responded quickly enough to the real danger of the pandemic,” he said. “What I’ve learned was, these organizations, these scientists, these humanitarians are amazing. America shut down the Ebola crisis in Africa.

America has stemmed the tide with the

modities within the American healthcare

AIDS and HIV crisis in Africa through

delivery system, but we continue to operate under a very expensive model called

Government can, and should, play a critical role

Should a pandemic hit again, it is not

the PEPFAR program, which was initi-

the federal government who is going to

ated under Bush 43. Essentially, it was a

be able to solve these crises by stockpil-

coordination between USAID, the state

ing, he said. “Now we do stockpile all

department, the CDC, and the NIH. Dr.

The U.S. supply chain will change as a result of this pandemic

over the United States for critical events

Deborah Birx, who was the ambassador

like biological warfare or a radiological

for South Africa and came back to lead

Some of the ways that the supply chain

event, potentially nuclear event, that kind

the President’s work here with COVID,

will change would be equally obvious to

of thing. But as it relates to the broad

led that effort. Today, there are 15 to 18

us all, said Bardis. “One, we cannot de-

general population, a pandemic that

million citizens in Sub-Saharan Africa

pend on a foreign nation for something as

could affect over 300 million people,

who get antivirals every day to prevent

critical to our delivery system as personal

the federal government doesn’t have the

the spread of HIV and ultimately AIDS.

protective equipment.”

capacity to stockpile enough product,

America does that.”

fee-for-service.”

The Journal of Healthcare Contracting | Special Issue 2020

9

SUPPLY CHAIN

However, America doesn’t get credit for that kind of thing, Bardis said. “It doesn’t make the headlines; it doesn’t make the news, but we do it every day.

When the Ebola crisis hit, it was us who put the Commission Corps on the ground in Liberia and other African countries. We buried the dead, we built the hospitals, we had the handheld technology that unraveled the DNA of Ebola and sent that back to Dr. Anthony Fauci at the NIH, and within nine months we had a vaccine for Ebola.”

“I think that what will likely come out of this is good old American ingenuity backed by a government that’s willing to support private/ public sector partnerships to get it done.”

Bardis said that while we don’t always move as rapidly in some areas like the supply chain as we might hope, “this country is an enormous force for good, particularly in its health assets throughout the world. You won’t find India, Russia, or China on the ground in these hot zones. You’ll find America on the ground and officers of the Commissioned Corps, the CDC, and then the scientists behind the scenes who worked tirelessly to solve these kinds of problems.”

Collaboration between the private/public sectors will get us out of this crisis If you’re looking for quickness and speed, the government isn’t your dance partner, Bardis said, “but if you’re looking for power and getting it ultimately right with remarkable force, the government with industry combined is really rather remarkable.

I suspect out of this lesson we’re going to get that.”

Industry isn’t going to want to see the country return to this kind of problem again, where the economy gets shut down and people can’t work. “I think that what will likely come out of this is good old American ingenuity backed by a government that’s willing to support private/public sector partnerships to get it done. I think what will come out of it is remarkable, but it doesn’t mean that we’re out of the pain, if that makes any sense.”

To listen to the full National Accounts Today podcast, visit www.nationalaccountexecutives.com/ category/podcast.

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Special Issue 2020 | The Journal of Healthcare Contracting

More than providing care.

Making a difference.

Thank you.

We know healthcare providers are working harder than ever to keep our communities safe. That’s why our dedicated teams, especially our delivery and distribution professionals, are working hard to support you with the products you need. From all of us at McKesson, thank you. ©2020 McKesson Medical-Surgical Inc.

SUPPLY CHAIN

BY JEROMIE ATKINSON

The challenge will not wait Why the supply chain is instrumental in helping to manage, and overcome, the current crisis

Novel approaches to fighting a novel virus In my conversations with my healthcare supply chain colleagues around the country over the past couple of weeks, the discussions are typically focused on the emergent need – personal protective equipment (PPE), ventilators, available beds – and the worry about our caregiver colleagues, those who are the last line of defense for the sickest patients. However, I have also been encouraged by the resilience of our healthcare supply chain leaders across the country. When faced “When we least expect it, life sets us a challenge to test our courage and

with this ‘novel’ virus, they are taking

willingness to change; at such a moment, there is no point in pretending that nothing has happened

novel approaches to responding to the

or in saying that we are not yet ready. The challenge will not wait. Life does not look back.”

immediate concerns, while not losing site

– Paulo Coelho

of our supply chain mantra, that we never become the weakest link in the overall healthcare value chain.

When faced with a crisis, we natu-

are becoming unemployed as industries at-

There are many lessons to be learned

solutions. Leaders are present in all forms

tempt to adjust to an uncertain future.

from this event, and we could likely fill an

around us; our workplace organization

While all that may feel overwhelming,

entire textbook of things that we should

leaders, our community or religious leaders,

the immediate crisis is the one faced by

do different going forward, but the below

and of course our leaders at the local, state

health systems across the country as they

are four high-level observations:

and federal levels. When leaders are at their

attempt to understand a virus that trans-

best, they are a steadying force during times

mits very efficiently, is much more severe

have been, and rightfully so, heavily

of uncertainty in taking charge of the im-

than the annual flu, and is often transmit-

tilted toward cost saving outcomes.

mediate crisis, while learning and planning

ted by those who are asymptomatic all

While driving cost out of the system

for the future so that the same kind of

while managing a patient load that is taxing

remains an element of high impor-

crisis will never catch us unaware again.

their resources beyond anything in recent

tance, what has been uncovered of

1. Supply chains around the country

memory. I don’t know when the time is

equal importance is the assurance of

foundations of life as we knew it. Millions

appropriate to look for a bright side, but

supply and the importance of having

across the country are in self quarantine in

when we do have some time to reflect, the

multiple avenues to diversify our

their homes, the retail, entertainment, hos-

supply chain of healthcare will have an op-

spend portfolio and minimize risk

pitality, and restaurant industries are reeling,

portunity to really look in the mirror and

on our critical care items. After all,

the stock market is reflecting the uncertainty

diagnose where we could have been better.

it doesn’t matter what the cost of an

COVID-19 has completely shaken the

12

of the global market, and millions of people

rally defer to looking to our leaders for

Special Issue 2020 | The Journal of Healthcare Contracting

item is if you cannot get the item in

information as there are companies

ended with the other parties’ eyes roll-

the first place.

in the healthcare supply chain. I read

ing back in their head as I explained. I

optimistic reports that we are close

love the profession of supply chain, but

silos. While our collaboration as an

to turning the corner and pessimistic

let’s be honest: It has never been a sexy

industry has never been higher, we

reports that we should prepare for

industry and I doubt 1 in 10 people had

often tackle challenges on a premise

the worst still to come and many

any idea how supply chains make their

that “this is my problem to solve”

sources that just present the data for

entire worlds work, from the technol-

vs. “this is something we can more

the reader to interpret and make de-

ogy that they use on a daily basis to the

effectively solve when we work with

cisions based on. Having a source of

clothes that they wear, to the foods they

an extended network of partners.”

truth is a challenge with the volume

eat. Today, I suspect nearly everyone

We often fail in the healthcare sup-

of content to sort through.

in the country knows what the sup-

ply chain to consider all sources of

4. The need for an industry utility

ply chain is and has an opinion on it

2. We are still solving many problems in

contribution. While there are pockets

focused on supply resilience and

formed over the last 60 days. Of course

of working across systems, inclusive

continuity might be more visible

we should be instrumental in helping

of our supplier partners, it is not

than ever before. While we have

to manage this crisis, and most of our

nearly as widespread as it could be in

resources like the Strategic National

supply chain colleagues are currently

the crowdsourcing of ideas and the

Stockpile, we do not have resources

working around the clock to help man-

sharing of capabilities. It is incum-

dedicated to coordinating supply

age this emergent needs.

bent upon us as an industry group

chain efforts across the industry

to process how we got here and how

that is led by healthcare supply chain

is to ensure we prepare our organizations

we might address these challenges

experts. Tremendous efforts are be-

and industry for the next time something

cohesively as a group for the next

ing exerted by the industry profes-

like this happens. This is our time as

event. It is only a matter of when

sional organizations, by GPOs, by

supply chain leaders to lead with strategy

before another event, not a matter

leading progressive health systems,

and insights, to create forward looking

of if, and using the lessons of CO-

and many others, but we are often

plans, to be agile and to create sustainable

VID-19 to inform our future should

building duplicative versions of the

operations supported by a strong supply

be a platform for us all.

same solutions. It might be time to

chain backbone and resilience.

However, the other half of leadership

3. Sorting through the ‘noise’ to find

consider a unified vision for supply

Our organizations, our colleagues –

clear and concise information is a

continuity of our most critical sup-

and most importantly our patients – need

challenge. While many organizations

plies, funded by our industry and

us to be the best versions of ourselves

are doing admirable work in trying

managed by our industry.

in the future. Now is our time to have

to collect content to put in an easily

the willingness and courage to adapt and

accessible online repository, there are almost as many repositories of

When telling someone what I did for a living a year ago, it inevitably

change, and show with our actions that we are ready.

Jeromie Atkinson, Supply Chain Leader and Essentialist, Supply Chain Sherpas. Leveraging 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, Jeromie 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.

The Journal of Healthcare Contracting | Special Issue 2020

13

SUPPLY CHAIN

BY JOHN STRONG

Do we finally have a tipping point for a better healthcare supply chain?

This past Sunday afternoon, I was sheltering at home due to COVID-19 after

The second is the Food Safety and

walking our dogs about as far as either they or I could go and turned on the TV. ESPN8

Modernization Act of 2011, enacted after

was replaying the 2006 Johnsonville Brat Eating World Championship from Sheboygan,

the September 11 terrorist attacks on the

Wisconsin. It was an MLE (Major League Eating) event, with an $8,000 cash prize for

U. S. This Act applies to everyone in the

the winner with Sonja “the Black Widow” Thomas trying to best her previous record of

food supply chain, from farmers to large

eating 35 brats in just 10 minutes.

manufacturers, and it mandates that all facilities in the food supply chain have a proper food safety system that includes

How does protection of the U. S. food production system mirror healthcare’s current requirements?

2002 which required processed food man-

All this sports action and the daily brief-

history of their products. That history

ing from the White House missing any

needs to include where the ingredients

Why can I find a can of Spam, but not N95 respirator masks?

details about what products were available

have been, where they are at the cur-

The Bioterrorism Act and the FSMA Act

in the healthcare manufacturing sup-

rent time and where they are consigned

have been used – and are instructive to

ply chain and where they were located

for delivery. The Act gives the Food and

healthcare. In May of 2018, the Hormel

reminded me that the federal government

Drug Administration the authority to

Company recalled more than 220,000

had put in place two important pieces of

recall food if they have evidence that it

pounds of their Spam meat product

legislation to protect America’s food sup-

poses serious health threats to humans

because they found metal contamination

ply some years ago.

and animals.

from batches produced in February. As

The first is the Bioterrorism Act of

traceability of all products.

ufacturers to show the entire movement

1

a result, no consumers were seriously harmed. Only the recalled batches came back, and the cost was lower than a general recall would have been.

Despite more than 50 years of trying, the healthcare industry has never been able to accomplish this feat, even though the barcodes and technology already exist for this purpose. For example, GS1 has already set standards for healthcare products2. For years both manufacturers of healthcare products and healthcare providers have pointed to each other and said “you need to go first” with the adoption of these standards. As a result,

16

Special Issue 2020 | The Journal of Healthcare Contracting

there has been a stalemate of epic pro-

that can help ‘balance’ the healthcare

downsides but not overpowering ones –

portions for tracking many commoditized

supply chain and avoid factors such

either for healthcare providers or health-

healthcare items where absolutely noth-

as the “Bullwhip Effect”4.

care product manufacturers. Yes, there

ing has happened. (Think N95 masks, disposable gowns, and gloves.)

is a higher maintenance cost than simply

ʯ Real time location(s) of products.

Nice to have – right now.

doing nothing5 and it does involve more government regulation. It also requires staff to manage the process and more

Advantages and disadvantages of a medical product tracking system

ʯ Proper documentation of products.

difficult data analysis. Facilities must pay

This will put the so-called grey

a $500 annual registration fee to the FDA

market at rest and ensure that

… which in the scope of this health crisis

Now that we are coping with supply

products will perform as specified

seems like a modest amount.

shortages of key medical products due to

and not endanger providers on the

the COVID-19 health crisis, the advantag-

front lines of healthcare.

Conclusion

es cited by both those advocating for the use of these barcodes, and those in the food supply chain seem almost prophetic.

ʯ Access and manage inventory more

ʯ Response preparedness. The

The United States is blessed to have the

healthcare supply chain is still

most innovative and productive develop-

largely reactive, and more needs

ment capacity for new medical devices

effectively across various storage

to be considered to help it become

and pharmaceuticals of anyone around

locations . Many folks are flying blind,

more proactive during events

the globe. At the same time, we still

and just know they need more product

like COVID-19.

haven’t engaged the technology neces-

3

to get them through the next few weeks.

sary to make the healthcare supply chain

ʯ Transparency and honesty. Been ʯ Make products more available

far more transparent and useful in times

approached by folks with high cost

of crisis. This pandemic should be a

when needed and avoid and

supplies? One of my contacts reported

reminder to everyone working along the

mitigate out-of-stock scenarios by

more than 50 calls from folks hawking

supply chain that we can and need to do

identifying an alternative source.

hard to find medical products.

better before the next pandemic.

FEMA is moving their stockpiled goods to so-called “hot spots”

Let’s use this lesson to better pre-

ʯ Ease of corrective action. Having

pare the healthcare supply chain for the

around the country. Wouldn’t it be

more information about the location

next pandemic. Even professional eaters

nice for large healthcare systems to

and types of medical supplies will

prepare by stretching their stomachs

have the same capability?

allow healthcare providers without

for weeks. Unfortunately, though, the

federal intervention to allocate their

“Black Widow” was upended in her

ʯ Undertake more effective hospital

supplies in a more efficient fashion,

bid to eat more than 35 brats in the

inventory planning projections.

and share with others, if necessary.

2006 World Championship by Takeru

While impossible to project the demand for something like the COVID-19 crisis, this is a key feature

Kobayashi, who was able to consume Lessons from food traceability indicate that there are some significant

58 sausages in just 10 minutes. That’s roughly 10 pounds.

www.getsweet.com/blog/posts/importance-of-effective-food-traceability-system See GS1.org/healthcare 3 GS1.org/healthcare 4 The bullwhip effect on the supply chain occurs when changes in consumer demand causes the companies in a supply chain to order more goods to meet the new demand. The bullwhip effect usually flows up the supply chain, starting with the retailer, wholesaler, distributor, manufacturer and then the raw materials supplier. This effect can be observed through most supply chains across several industries; it occurs because the demand for goods is based on demand forecasts from companies, rather than actual consumer demand. (www.cbpp.uaa.alaska.edu/afefbullwhip_effect_in_supply_ch.htm) 5 Op.Cit., www.getsweet.com.

1 2

The Journal of Healthcare Contracting | Special Issue 2020

17

There are a lot of unknowns in the world right now. But one thing is certain‌ we are here for you.

Now more than ever, we can all appreciate the importance of coming together during times of crisis. As we are all altering our lives to limit the advancement of COVID-19 to keep our families, teammates and customers safe, we also recognize that Midmark has a vital role to play in our country’s response.

Midmark provides essential equipment, technology and services that our customers need to diagnose and treat patients. To manage this safely, Midmark created a dedicated COVID-19 task force to monitor developments of facilities, supply chains and required guidelines.

In supporting these guidelines Midmark has developed a plan that allows a high percentage of teammates to work remotely. This is something new for most of our teammates, but we are staying connected and supporting one another every day.

With this, Midmark is considered an essential business for the medical, dental and animal health industries and will have an operational presence in mission-critical locations that provide the products needed in healthcare facilities.

Our priorities revolve around the well-being of our teammates and to safely serve our customers during this time of need. Within our offices and production areas that remain operational, we are taking the necessary precautions to practice social distancing, disinfection practices, the monitoring of teammate temperatures and providing clinical education to minimize the risk of COVID-19 exposure.

Today, our healthcare customers are strained and Midmark is here for them. As we follow state and national guidelines, we will provide support for essential products and services in emergency situations. Please understand that we could have limited availability for nonessential services during this time.

Midmark is dedicated to maintaining production in this fight and we will do our very best to serve our customers and channel partners through this difficult time. I have never been prouder to be a part of Midmark as our teammates are working tirelessly to take care of each other and our customers. We are in this together.

Designing better care.TM

John Baumann President and CEO Midmark Corporation Learn more at: midmark.com/cometogether

There are a lot of unknowns in the world right now. But one thing is certain... we are here for you.

As we find ourselves in the midst of unprecedented circumstances in healthcare, we’d like to take the time to make sure you know just how much we appreciate what you do. We see the sacrifices you’re making as you work tirelessly to help keep our communities safe and healthy. From the bottom of our hearts, thank you.

See what we’re doing to help at: midmark.com/cometogether

© 2020 Midmark Corporation, Miamisburg, Ohio USA

INDUSTRY RESPONSE

AHRMM Senior Director to supply chain leaders:

Review and implement CDC strategies To help answer questions on how the COVID-19 pandemic is affecting the U.S.

associations, suppliers, and distributors

healthcare supply chain, The Journal of Healthcare Contracting reached out to Michael Schil-

from across the health care field, sharing

ler, CMRP, senior director, Association for Health Care Resource & Materials Manage-

information and solutions around resource

ment (AHRMM), a professional membership group of the American Hospital Associa-

allocation conservation, supply continuity

tion (AHA). The following were his responses from the early spring.

and availability.

JHC: What do supply chain leaders need

Healthcare organizations are encour-

The Journal of Healthcare Contracting:

to know about the supply and distri-

Can you provide us with some insights

aged to work with their suppliers, under-

bution of the coronavirus test kits?

into what is going on at a national level

stand product shortages and allocations

Schiller: Supply chain leaders should

in the U.S. healthcare supply chain?

they may be facing or expect to face, and

work closely with their laboratory depart-

Michael Schiller: The FDA issued an

identifying and implementing conservation

ment and staff on the procurement and

Emergency Use Authorization for use of

measures, as well as work with their State

inventory levels, and management of the

NIOSH approved N95 masks to supplement

and Local emergency management agencies.

COVID-19 test kits.

the CDC has issued strategies for optimizing

JHC: How is the government

JHC: How are you advising hospitals

the supply of N95 respirators. A checklist

coordinating with providers, GPOs,

and health systems to navigate any

for healthcare facilities and utilization

associations, etc.? What are the

supply disruptions?

of N95 masks beyond the manufacturer

conversations like?

Schiller: First and foremost we recom-

designated shelf life can be found at

Schiller: AHA has coordinated a number

mend healthcare organizations visit the

www.cdc.gov/coronavirus/2019-ncov/hcp/

of calls with healthcare executives, regula-

CDC COVID-19 website (www.cdc.gov/

respirators-strategy/index.html.

tory agencies, State, Local and Metropoli-

coronavirus/2019-nCoV/index.html) to ac-

healthcare organizations’ mask inventory, and

The CDC has also

tan Hospital Associations.

cess the resources and information they

stated that based on local

All conversations have been

have compiled. We are encouraging supply

and regional situational

extremely collaborative,

chain professionals to review and imple-

analysis of PPE supplies,

focused and engaging.

ment the CDC strategies for the extended

facemasks are an accept-

use and limited reuse of N95 filtering face

able alternative when the

JHC: What product

piece respirators in the healthcare setting

supply chain of respirators

categories are most

and, review the surgical N95 masks that

cannot meet the demand.

affected by COVID-19?

have been approved for use. For a com-

More information regard-

Schiller: Personal protective

prehensive listing of the NIOSH approved

equipment (PPE) including

masks visit www.cdc.gov/niosh/npptl/topics/

gowns, gloves, and respirator

respirators/disp_part/respsource3surgi-

gov/coronavirus/2019-

masks, and blood supplies

caln95.html. Lastly we encourage reviewing

ncov/infection-control/

are the most affected catego-

the CDC’s strategies for optimizing the

ing these recommendations can be found at www.cdc.

20

Michael Schiller

control-recommendations.html?CDC_

ries. It has been projected that there are over

supply of N95 respirators; crisis and alter-

AA_refVal=https%3A%2F%2Fwww.

1,900 medical/surgical items and pharma-

nate strategies by visiting www.cdc.gov/

cdc.gov%2Fcoronavirus%2F2019-

ceutical items on allocation. AHRMM is

coronavirus/2019-ncov/hcp/respirators-

ncov%2Fhcp%2Finfection-control.html.

actively working with healthcare leaders,

strategy/crisis-alternate-strategies.html.

Special Issue 2020 | The Journal of Healthcare Contracting

UHS Quality and Chief Medical Officer:

Providing the best possible care during unprecedented challenges Editor’s note: In the following letter, Paul Stefanacci, MD, FACS, MBA, vice president, quality and chief medical officer, acute care division, Universal Health Services, Inc., shared with The Journal of Healthcare Contracting what UHS was doing at press time to leverage its resources and collaborate with federal, state and local health authorities.

As healthcare providers, we fulfill a

ʯ Alternate, external

of patients, as we

critical mission in society. And as the

screening locations

mitigate the risks of

novel coronavirus creates unprecedented

for the Coronavirus

community spread.

challenges nationwide, we are continuing

have been set up away

to provide the best possible healthcare

from the main EDs

Our Supply Chain

across our served communities. Our

to ensure the safety

team is continuing to

hospitals are collaborating with each other

of patients, staff and

source for necessary

for best-practice sharing and leveraging

visitors and allow for

the resources we share as an organization.

patient access for other

supplies and equipment, Paul Stefanacci

emergency conditions.

We are working closely with the Centers

including actively seeking alternate supplier channels. UHS Supply Chain is

ʯ We have suspended visitation,

working daily with customers, distribu-

and with local health authorities. We are

with limited exceptions. We

tors, and manufacturers to manage our

actively taking precautions to protect the

are screening all individuals

supply needs across the organization.

health and safety of our patients and staff

upon entering the facility. We

We have established tracking, reporting

members, and to help reduce the spread of

are monitoring patients for any

and have daily calls with our internal

the virus in our regions. Specifically:

symptoms and implementing

customers to ensure their needs are be-

isolation protocols, if needed.

ing met. We are redeploying supplies to

for Disease Control and Prevention (CDC)

ʯ We are in daily communication with all clinical workers to share updated guidelines/protocols. Providing updated training to ensure we can

facilities who are experiencing unusually

ʯ We are scaling telehealth to continue to provide care.

ramp up quickly.

ing our hospitals of the importance of conservation of supplies, especially

ʯ All volunteers have been asked ʯ Taking temperatures daily; reporting

high spikes in volumes. We are remind-

PPE. We are utilizing corporate re-

to temporarily suspend their

sources across the enterprise to manage

symptoms, as appropriate. Using

scheduled times at the hospital,

consistency and information flow dur-

isolation, when warranted.

for their own safety as well as that

ing this evolving situation.

Paul Stefanacci, MD, FACS, MBA is Vice President, Quality and Chief Medical Officer for the Acute Care Division of Universal Health Services, Inc. Dr. Stefanacci provides UHS with the clinical leadership to face the challenges of the rapidly evolving healthcare environment and advance an ambitious quality and performance improvement agenda.

The Journal of Healthcare Contracting | Special Issue 2020

21

To those on the front lines, As the COVID-19 pandemic continues to affect people and communities around the world, I appreciate the unimaginable minute-by-minute demands placed upon you and your teams. BD fully understands the sacrifice and commitment from all of the frontline healthcare workers who are risking their own health to help others. It is nothing short of heroic.

I want you to know that helping our longstanding partners respond to the COVID-19 crisis is BD’s sole focus right now. Because patients depend on you, BD teams around the world are working to fulfill our shared obligation to serve patients and society during this unprecedented time.

BD has deployed our capabilities, expertise and scale to address critical health needs related to coronavirus – from our diagnostic offerings to identify COVID-19, to real-time informatics and electronic surveillance technology, to essential medical devices to support patient care. We are committed to doing our part, and we’ve ramped up production and activated our business continuity plans, so we can make every effort to ensure you have the medical technologies you need to respond.

With the first reports of COVID-19 in January, BD took immediate action to prepare by activating our global crisis management team, and we wanted to provide you with an update on our efforts to ensure BD products and solutions are there to support you – and your patients.

Prioritizing the access to BD products – BD manufactures and sources products from multiple locations around the world. Each of our manufacturing and distribution centers that are critical to responding to COVID-19 are operational and have enacted business continuity plans to minimize the risk of disruption to you. In response to very high demand for our critical medical devices, we have ramped up production to the highest degree possible under the current circumstances, and we are closely monitoring inventory and customer ordering to ensure supply continuity. We are continuing to update the list of products on manual inventory allocation on a new website at bd.com/allocation.

Collaborating with government and industry – Consistent with BD’s long tradition of public-private partnerships, we’re proud to be working with government and industry partners to expand access to testing and bring new innovations to the market to aid in the identification, diagnosis and treatment of COVID-19. In addition to working with the FDA on new diagnostic tests that will increase the potential capacity to test for COVID-19 using the BD Max™ platform, we’re also exploring the development of a rapid point-of-care test for coronavirus by leveraging the BD Veritor™ system. At the same time, we are collaborating with peers from across the industry, HHS, FDA and private partners to identify and validate additional swab types as well as transport medium options in order to expand capacity and alternative collection methods.

Ensuring we’re there when you need us – Our sales and clinical associates have tools to support you remotely, including FaceTime and Microsoft Teams among others. Where our on-site support is needed to ensure immediate patient care, such as technology installation/service and clinical support, we will be there at your request. We are taking precautions to protect our associates, customers and patients by following guidance from the World Health Organization, U.S. Centers for Disease Control, and each of our customers’ guidelines on access to their facilities.

Protecting our employees – As part of our preventative actions, we have taken a number of steps to ensure the health and safety of our team. In our manufacturing facilities and distribution centers, we have increased our deep cleaning protocols, implemented temperature screening for on-site employees, and are changing work practices where possible to facilitate social distancing. Around the world, we are regularly educating employees about good hygiene and health practices, including social distancing, self-quarantining and handwashing.

Supporting response efforts – BD is deploying more than $1 million in cash and product donations to seven non-profit organizations – Direct Relief, the International Medical Corps, Americares, the World Health Organization-United Nations Foundation COVID-19 Solidarity Response Fund, Project HOPE, the CDC Foundation and the Wuhan Red Cross – to advance their work to contain COVID-19, support healthcare workers and treat patients in countries throughout the world.

We will continue to communicate regularly on our website — bd.com/COVID-19 — to keep you informed as we move forward.

On behalf of the 65,000 employees at BD, I want to express our deep appreciation to you and the hundreds of thousands of healthcare providers across the country who have answered the call to respond to this truly unprecedented situation. We consider it a privilege to support you as a trusted partner.

Sincerely, Tom Polen, CEO and President BD

For the tireless, the selfless, the brave

You mean the world Whether you are working on the frontlines or are the last line of defense in the fight against COVID-19, you are making a world of difference for so many. Thank you.

bd.com/COVID-19 BD and the BD Logo are trademarks of Becton, Dickinson and Company.

All other trademarks are the property of their respective owners. Š 2020 BD. All rights reserved. 4644

INDUSTRY RESPONSE

Come together Supply chain leaders met with the president at the White House as part of the COVID-19 Supply Chain Task Force

President Trump held a meeting at the White House on Sunday, March 29,

Schein on a number of collaborative

with the leaders of several supply chain distributors and shipping companies as part of

fronts. “No. 1, we’ve all talked about PPE

the COVID-19 Supply Chain Task Force.

products – that’s critical, and it’s not just to the hospitals,” Connett said. “It’s a

Med/surg supply chain leaders who participated were:

ʯ ʯ ʯ ʯ ʯ

must to the hospitals, but it’s really to all

Brad Connett, president, U.S. Medical Group, Henry Schein

healthcare providers that are working on

Mike Kaufmann, CEO of Cardinal Health

the front line. Our commitment is to get

Charlie Mills, CEO of Medline Industries Inc.

it to the hot spots, and get it to the care

Ed Pesicka, president and CEO of Owens & Minor

providers who are taking care of those

Brian Tyler, CEO of McKesson

patients. It’s absolutely key.”

Second, Connett said the task force talked about the importance of buying

“We’re waging a war against an invisible enemy,” said Trump. “We are grateful

American-made products, and getting

med/surg leaders at the press conference.

manufacturing and resources back in

for your tremendous partnership – it’s

America. “It’s a lesson to be learned from

been incredible – and the work you’ve

where we are.”

done so far.”

Each supply chain representative was given an opportunity to provide an update.

24

The following were comments made by the

Henry Schein

Connett also spoke about the im-

Connett thanked President Trump and his

portance of more rapid tests to detect

administration for working with Henry

COVID-19. As of press time, Henry

Special Issue 2020 | The Journal of Healthcare Contracting

Schein helped bring two products into

The 51 flights the president referenced,

masks a week is now using 200,000 to

the market. The first is an antibody

we’re excited about. We look to build

300,000 masks a week. So you multiply

rapid blood test, known as Standard

upon that. So, I would echo my thanks for

that times the entire U.S., let alone the

Q COVID-19 IgM/IgG Rapid Test,

your leadership, and certainly to the staffs

same demand outside of the U.S., and

intended to be administered at the point

for the terrific partnership and the com-

that’s part of the issue we are running

of care. According to the healthcare

mitment to protect the people we think

into. Even with a significant ramp up

company, the test delivers results within

about most often, which are the people

in supply, there is still a demand that is

15 minutes from a pinprick with no

on the front lines providing care.”

much greater.”

instrumentation required.

Henry Schein will also serve as the exclusive distributor in the United States of a second point-of-care rapid test kit that can detect antibodies associated with COVID-19 in as few as 15 minutes.

“ The supply chain is working, it’s resilient, and though supply is a challenge, we’re tackling that.”

– Brian Tyler, CEO of McKesson

Working with BD (Becton, Dickinson and Company) and BioMedomics, a North Carolina-based clinical diagnostics company, Henry Schein will make the test kits

Tyler also offered a word of thanks

Cardinal Health

available to health care professionals as

on behalf of all the CEOs present at the

Kaufmann thanked the president for his

part of the company’s broad offering of

task force meeting to the teams of each

leadership. “Because of that leadership,

point-of-care rapid tests.

organization “that continue to show up in

we’ve seen the government agencies

warehouses across the country, in pharma-

working with industry like no time be-

cies across the country, and do their jobs

fore,” Kaufmann said. “We’ve seen HHS,

McKesson

to keep the supply chain going. The supply

FEMA, and the CDC work effectively

Tyler said collaboration between the

chain is working, it’s resilient, and though

with all of the distributors. And all of the

government agencies and medical sup-

supply is a challenge, we’re tackling that.”

distributors are working together for the

pliers has been key. “I’d certainly like to

good of the people. All of us have been

echo my colleagues’ comments that the

so focused on making sure we take care

collaboration amongst many of the gov-

Owens & Minor

of our customers because our customers

ernment agencies and the private market,

Pesicka said Owens & Minor is leveraging

are the ones taking care of the patients

including the distributors represented

its manufacturing capabilities in America,

every day. We need to do everything we

here today, has been incredible, and has

specifically in North Carolina, to ramp up

can to make things good for them.”

been increasing and ramping up over the

production. “We did hear the challenge,

past few weeks.”

and starting in January we’ve ramped up our production in the Americas, including

Medline Industries

an innovative public-private partnership

our facility in North Carolina where we

In his remarks at the press conference,

called Project Airbridge, where FEMA

are now manufacturing an additional 40

Mills said the demand for supplies has

and other government agencies will

to 50 million masks per month to get into

skyrocketed. “We’re doing a lot of things

coordinate 50-plus air cargo flights in a

the U.S. healthcare system.”

to bring in more masks and other protec-

During his remarks, Tyler referenced

span of two to three weeks. Each flight

Pesicka said the task force talked

tive apparel,” he said. “We are involved in

will bring tons of medical supplies to the

about the massive demand increase in

reprocessing masks. We’ve already started

U.S., directly to the cities where it is most

PPE supplies. “I used an anecdotal ex-

reprocessing about 100,000 masks per

needed. “Today the first delivery of Proj-

ample of one hospital in New York that

day. We hope to expand from there, so

ect Airbridge is evidence that it’s working.

traditional uses roughly 10,000 to 20,000

we’re quite optimistic about it.”

The Journal of Healthcare Contracting | Special Issue 2020

25

A Message from MedPro Associates: To Our Distributor and Manufacturer Partners, The past several weeks have certainly tested us all. As we continue to monitor ongoing developments related to the coronavirus (COVID-19), please know that MedPro will not compromise our commitment to you and the customers we collectively serve. We will always be here when you need us most, and you can count on us to continue providing the same high level of service you have come to expect.

As COVID-19 continues to impact our customers and supply chain needs, we are committed to doing A Message from MedPro Associates: what is best for our customers, our reps and the public. We have been closely monitoring the situation and making changes along the way. Based on customer requests and CDC recommendations, we have To Our Distributor and Manufacturer Partners, implemented social distancing sales protocols, but continue to actively communicate via phone, webinar The past several weeks have certainly tested us all. As we continue to monitor ongoin and Zoom technology, both with our distribution channel and healthcare providers to support your related to the coronavirus (COVID-19), please know that MedPro will not compromise customers for product in-services, demos, and other needs. Furthermore, we have heightened our sales to you and the customers we collectively serve. We will always be here when you nee and product training to stay sharp and be prepared to be stronger than ever when the crisis is under you can count on us to continue providing the same high level of service you have com control, while keeping active and prospective sales moving forward. We take our responsibility very seriously and will continue to do our part as representatives of our distributor and manufacturer As COVID-19 continues to impact our customers and supply chain needs, we are comm partners, as well as the customers we serve. what is best for our customers, our reps and the public. We have been closely monito and making changes along the way. Based on customer requests and CDC recommend MedPro has not taken a pass during this healthcare fight against COVID 19. We are operational and implemented social distancing sales protocols, but continue to actively communicate v available. Please do not hesitate to reach out to our management team and your local reps. There can and Zoom technology, both with our distribution channel and healthcare providers to never be enough communication during this time when our customers need us most. customers for product in-services, demos, and other needs. Furthermore, we have he and product training to stay sharp and be prepared to be stronger than ever when the As always, we appreciate our business partnership and your confidence in MedPro. control, while keeping active and prospective sales moving forward. We take our resp seriously and will continue to do our part as representatives of our distributor and ma Sincerely, partners, as well as the customers we serve.

Bill Sparks, CEO Manny Losada, President MedPro has not taken a pass during this healthcare fight against COVID 19. We are op & our entire Executive Management Team available. Please do not hesitate to reach out to our management team and your loca never be enough communication during this time when our customers need us most.

As always, we appreciate our business partnership and your confidence in MedPro. Sincerely, Bill Sparks, CEO Manny Losada, President & our entire Executive Management Team

WE’RE HERE FOR YOU. Committed to the well-being of our customers, reps, and the public, through our continued support of distribution.

CALL AND LET US HELP.

800-778-4718 ext. 114 info@mproassociates.com www.mproassociates.com

GPO RESPONSE

Leading IDNs are being judicious with supply orders “for the foreseeable future,” GPO executive says Editor’s note: As the coronavirus pandemic has evolved, JHC has reached out to several healthcare supply chain organizations to help assess the situation for our readers to try and make sense of what is going on. The following are responses from Chaun Powell, MBA, group vice president, strategic supplier engagement, Premier, originally posted on JHC’s blog in late March.

The Journal of Healthcare Contract-

caregivers at these facilities are working

Over the next five weeks we tracked the

ing (JHC): How are you working with

around the clock to promote the safety of

progress of the virus and the impact to

member organizations to identify

their patients and clinicians, and we must

the global supply chain, yet the impact on

and mitigate potential impacts or

do all we can as a country to support

the U.S. was minimal. Less than a month

supply disruptions?

them. Above all, we would

ago, there were still only three states with

Chaun Powell: This is an

like to thank our caregivers

fewer than 10 confirmed patients do-

incredibly challenging and

for everything they’re doing

mestically. Now we are serving providers

fluid situation with variables

to provide critical care to

across 49 states dealing with more than

that are in constant flux. As

our communities.

3,500 confirmed cases. In order to be ef-

a member-driven organiza-

fective, we have had to pivot our internal

insight on the speed at

processes significantly to make sure that

behalf of nearly 4,000

which this is escalating, the

our clinicians are able to deliver uninter-

acute care hospitals and

Premier Disaster Prepared-

rupted care. In addition to the work that

health systems and 175,000

ness and Response Team

we are doing with members, we are also

activated on January 24.

partnering with government agencies, the

non-acute providers. The

28

To provide some

tion, we are working on

Chaun Powell

Special Issue 2020 | The Journal of Healthcare Contracting

Administration, suppliers and distributors

joined India, Taiwan, Thailand, South

COVID-19 patients. However, a respira-

in the private sector to create both short-

Korea and China in halting exports of

tor, ex N95, is only required during high-

term and long-term solutions grounded

personal protective equipment (PPE).

risk procedures. Industrial N95 masks

in data created as a result of our primary

We recently released results of a sur-

research with the ultimate goal of inform-

vey of non-acute care providers, who

ing public understanding.

are experiencing supply chain strain

We collaborated with the White

that are NIOSH-approved and certain expired N95s are also allowed.

To go along with the CDC’s revised

in accessing PPE. This follows up our

stance, CMS has temporarily waived

House Administration’s COVID-19 sup-

survey released at the end of February,

annual fit testing for respirators, which

ply chain task force to share our data-

which asked acute care providers about

will avoid wasting masks used in the

driven perspective about the current state

their inventory levels related to PPE.

annual validation.

of health system preparedness and potential actions that could be taken to ensure a more reliable supply chain. Premier presented unique insights and data on the 2,000 unique items that are currently on national allocation and in shortage, and key recommendations to protect the integrity of our acute, non-acute and pharmaceutical supply chain.

Since activating over seven weeks ago, we’ve been sending daily updates to our

Coronavirus illuminates a critical message that we’ve been communicating for a very long time. We, as a nation, need to be more intentional with our supply chain.

field team and members, and maintaining near real-time updates on our internal Disaster Preparedness Response Com-

JHC: What are some best practices of

munity. There, we’ve been equipping our

leading IDNs, health systems and hos-

with supply orders for the foreseeable

members with updates including links to

pitals that have disaster and disruption

future. This is true for both the PPE

the CDC’s latest guidance, appropriate

plans in place? How are they trying to

supply chain as well as the pharmaceutical

use guidelines for PPE and response to

stay ahead of any potential issues?

supply chain. By avoiding panicked order-

many of the questions we’ve gotten from

Powell: We continue to advise all

ing, providers prevent straining the supply

our members. We also have the Premier

members to follow CDC-recommended

chain at large.

Safety Institute, a public-facing site where

conservation protocols for PPE.

Obviously, we all need to follow the

we provide the most up-to-date scientific

Currently, there are roughly 2,000

CDC’s general health guidelines here, par-

documents, resources and tools primarily

unique stock keeping units (SKUs)

ticularly healthcare workers: wash hands

focused on clinical information.

that have been placed on allocation

regularly; cover a cough or sneeze, avoid

from distributors. This means that in

touching our eyes, nose and mouth; avoid

JHC: What product categories

most cases, supply ordering is limited

close contact with people who are sick;

are seeing the most strain?

to historic levels. This underscores the

and stay home when sick.

Powell: Currently, the categories where

importance of all providers following

members are experiencing the most difficul-

rigorous conservation protocols.

ty accessing supplies include N95 masks, ear

As of March 11, the CDC has

Leading IDNs are being judicious

One additional area of interest for many industry stakeholders should be the increase in gray market activity. We’re

loops, hand sanitizers, COVID-19 testing

revised its guidance on masks and res-

cautioning our members to be careful

swabs and reagents, PAPRs and gowns.

pirators. Personnel should continue to

about anyone approaching them outside

wear facemasks and eye protection while

of their normal supply chain chan-

providing care to known or suspected

nels purporting to have access to PPE,

Further compounding this issue is the fact that Russia and the entire EU have

The Journal of Healthcare Contracting | Special Issue 2020

29

THANK YOU FOR YOUR DEDICATED COURAGE AND LEADERSHIP We’re proud to support the front lines of health care.

To Our Health Care Leaders and Providers:

More information on Henry Schein’s key efforts:

First, we would like to thank all of the health care providers across the country for your dedicated courage and leadership as we combat the coronavirus disease, which continues to take its toll on our communities. We salute all health care workers and first responders for your bravery, compassion, and diligence.

COVID-19 TESTING

Henry Schein takes seriously the promise we make to our customers – Rely on Us – and that promise is especially meaningful in challenging times. Among our many efforts, we’ve announced our distribution of two point-of-care antibody rapid tests, shared information on the benefits of virtual care with Medpod, our Telemedicine Solution for health care professionals, and developed a Coronavirus (COVID-19) Resource Center.

Additionally, Henry Schein is a participant in the White House’s COVID-19 Supply Chain Task Force, and has worked with the U.S. government to ship personal protective equipment (PPE) from the Strategic National Stockpile to testing sites in support of front-line health care professionals. The Company is also working with the Federal Emergency Management Agency (FEMA) to source and deliver critical supplies quickly, in accordance with directions from the U.S. government.

We thank you for your service, and we applaud your personal sacrifice to stop the spread of the coronavirus and to keep our local communities healthy under these extraordinary circumstances.

Sincerely,

Bradford C. Connett President, U.S. Medical Group Henry Schein Medical Group

Bradford C. Connett

In collaboration with our diagnostic partners, we introduced a wide array of diagnostics specific to COVID-19. Our new point-of-care antibody tests can deliver test results within 15 minutes from a pinprick with no instrumentation required.

Our portfolio allows health care professionals to use the results with a patient’s medical history, symptoms, and results of other relevant testing, to make informed decisions about patient treatment and care. Our ultimate goal is to help get Americans back to work.

MEDPOD FOR TELEMEDICINE Medpod, Henry Schein’s telemedicine platform, comes in highly versatile configurations including a cloudbased version without devices and complete units deployed in a suitcase, stand-alone cart, or a mobile facility.

To learn more about the benefits of virtual health care, please visit www.henryschein.com/medpod.

RESOURCE AND EDUCATION CENTER Henry Schein’s Coronavirus (COVID-19) Resource Center and Coronavirus (COVID-19) Education Center on our website delivers frequently updated information and offers educational resources to help customers with the wide range of issues presented by the outbreak.

THE CATALYST ADVANCING HEALTH CARE Henry Schein has partnered with Medpod, a software solution that transforms health care delivery.

By transforming telemedicine with the most comprehensive scalable telediagnostics platform, Medpod connects groundbreaking software and medical devices, optimizes health care delivery and maximizes patient management throughout the continuum of care.

Medpod elevates the medical standard for higher quality care between remote provider and patient, regardless of their physical location — maximizing flexibility and opportunity for your practice.

Are you ready to navigate the future of telemedicine?

Let Henry Schein Medical and Medpod lead the way.

1.800.P.SCHEIN HenrySchein.com/Medpod DISCLAIMER: All product and company names are trademarks™ or registered® trademarks of their respective holders. The Medpod logo may not be reproduced by any means or in any form whatsoever without Medpod Inc.’s written permission. The Henry Schein logo is a registered trademark of HS TM, LLC, a Henry Schein subsidiary. The Henry Schein logo may not be reproduced by any means or in any form whatsoever without HS TM, LLC ‘s written permission. All rights reserved 2016-2019. © 2019 Medpod Inc. All Rights Reserved.

GPO RESPONSE

pharmaceuticals and other healthcare

This becomes problematic as suppliers,

are not made aware of a shortage until it

supplies, and to work with their GPO to

in an effort to remain cost-competitive,

has already been declared. The late notice

identify the authenticity of these goods.

have moved more manufacturing offshore.

leads to hoarding, as healthcare systems

We now find ourselves relying on Asian

react to protect their patient populations.

JHC: How do we as an industry pre-

manufacturing for large portions of our

The downstream impact is amplified

vent shortages that may occur due

supply chain. This became apparent dur-

when the supply chain is overseas and

to hoarding and panic buying?

ing the Ebola crises, but our memories

not easily within our control. In sum-

Powell: Coronavirus illuminates a critical

faded about the risks of reliance on other

mary, increasing visibility to the upstream

message that we’ve been communicat-

countries to support our product needs

supply chain, increasing regulation around

ing for a very long time. We, as a nation,

until January.

notification periods for disruptions, and

need to be more intentional with our

In order to regain a competitive edge

bringing product manufacturing back

supply chain. Over the past several years

in the healthcare supply chain, we must

to the U.S. will allow us, as a healthcare

of a bull economy, there has been much

collaborate across private and public

ecosystem, to be more proactive and less

focus on profitability as most healthcare

sectors to improve visibility to upstream

relegated to reactivity.

systems only materialize a 2% profit. With

stakeholders including the locations of

decreasing reimbursements, in order to

raw materials, contract manufacturers and

JHC: Are you seeing lessons learned

maintain their ability to offer patient care

distributors. We must also increase the

from previous disasters being imple-

and other community benefits, healthcare

regulatory obligation of suppliers to pro-

mented? If so, how have we gotten

providers have tasked their supply chain

vide advanced notice of disruptions. In

better at handling situations like this?

professionals to help reduce expenses, and

today’s supply chain environment for de-

Powell: Given Premier’s unique posi-

they in turn typically turn to commodities.

vices and medical consumables, we often

tion in the supply chain as an extension of America’s healthcare providers, we understand firsthand the impact to patient care when hospitals and health systems do not have access to the drugs and medical supplies needed to treat patients. We also know that during shortages, prices tend to skyrocket and clinicians are removed from patient care as they are called on to help source alternative therapies. During outbreaks such as H1N1, Ebola and COVID-19, access to these drugs and medical supplies can determine whether our ability to practice modern medicine is threatened. Therefore, it’s critical that we proactively address these known supply chain vulnerabilities now.

In order to truly address these supply chain vulnerabilities, we need additional transparency to understand true risk.

We also need to create incentives to encourage domestic manufacturing of drugs and medical supplies. These are

32

Special Issue 2020 | The Journal of Healthcare Contracting

common-sense, market-based, holistic and sustainable solutions that Congress can act on. Congressional action is imperative to ensure the United States healthcare supply chain in prepared for the next COVID-19.

For drugs, Premier supports S. 2723 – The Mitigating Emergency Drug Shortages (MEDS) Act introduced by Senators Susan Collins (R-ME) and Tina Smith (D-MN). Supported by over 75 provider organizations and health

In order to regain a competitive edge in the healthcare supply chain, we must collaborate across private and public sectors to improve visibility to upstream stakeholders including the locations of raw materials, contract manufacturers and distributors.

systems, the MEDS Act builds upon the prior work of Congress to provide ad-

regarding where critical drugs are

API manufacturers do not have

ditional authority to the Food and Drug

manufactured, the source of API,

to report supply disruptions to

Administration (FDA) to help mitigate

and redundancy plans. To overcome

the FDA. The MEDS Act would

drug shortages and develop market-

these lessons learned, the MEDS

expand FDASIA Title X reporting

based incentives to help ensure a stable

Act requires manufacturers to report

requirements to API manufacturers

supply of medications critical for patient

to the FDA the exact location of

and require reporting of potential

care. Specifically, the following scenarios

manufacturing for these critical

supply disruptions to the FDA,

exemplify the need for enactment of the

drugs, the exact source of all raw

creating an early warning system

MEDS Act:

materials, and redundancy and

that would allow the FDA upstream

ʯ A major concern with the

contingency plans to ensure a stable

visibility to appropriately assess

COVID-19 outbreak in China is the

supply. In the case of COVID-19,

risk and rapidly work to identify

overreliance on a single nation for

this type of information would be

alternative sources of supply.

a significant portion of the United

critical to understand exactly what

States’ drug supply. The MEDS Act

is being manufactured in China,

helps address this overreliance by

exactly what proportion of API and

we need to arm the FDA with similar

requiring the Secretary of Health

raw materials are manufactured in

authority to act for supply disruptions

and Human Services (HHS) to

China, and what a manufacturers’

and shortages as they do in the drug

develop a report to Congress with

contingency plans are should

space. As FDA articulated in their FY

recommendations to incentivize

manufacturing in China no longer

2020 budget request, no law requires

the domestic manufacturing of

be feasible. This is all critical

medical device manufacturers to notify

finished dose formulations and active

information to understand the true

FDA when they become aware of a

pharmaceutical ingredients (API).

risk to the supply chain and potential

circumstance that could lead to a device

The MEDS Act also examines the

drug shortages due to pandemics

shortage. By creating such a requirement,

risk to national security.

such as COVID-19.

as currently exists for drug manufactur-

ʯ We also support the Preventing Drug Shortages

For devices and medical supplies,

ers, it would ensure FDA has timely and

ʯ Another major unknown currently

accurate information about likely or

Act, a similar bill in the House

is the downstream impact of any

confirmed national shortages of essen-

of Representatives.

potential API shortages as a large

tial devices to enable FDA to take steps

portion of the world’s API is

to promote the continued availability of

manufactured in China. Currently,

devices of public health importance.

ʯ A lesson learned from Hurricane Maria is the lack of transparency

The Journal of Healthcare Contracting | Special Issue 2020

33

To our valued partners, It is difficult to fathom all of the change that the globe has experienced since we first heard the word “coronavirus.� At the OraSure family of companies, we see the enormous impact the COVID-19 pandemic is having on our customers, our communities and our families. At this time it is critical for organizations to rally and innovate to bring new solutions to a common challenge that is impacting everyone on the planet.

We want to thank all of the frontline health workers, our trusted partners, and everyone in the healthcare community who is working tirelessly day in and day out to combat the COVID-19 pandemic.

During these challenging times we offer our support and pledge our continued commitment to providing innovative, easy-to-use and scalable point-of-care diagnostic tools to help detect infectious diseases including HIV and HCV. We are working closely with public health to uncover new modalities to safely bring in-home HIV testing to those who are at extra risk during this time.

And we are proud to bring our expertise to the fight against COVID-19 with the development of diagnostic solutions squarely aimed at improving access to reliable testing. We recently announced a contract from the U.S. Department of Health and Human Services’ Biomedical Advanced Research and Development Authority (BARDA), to develop a pan-SARS-coronavirus antigen rapid self-test that uses oral fluid samples to enable in-home testing.

We are also developing an ELISA-based antibody test for Laboratory use.

As a life-sustaining business, we remain engaged, ready, and committed to supporting our customers and partners.

We wish you all safety and health, and sincerely thank you for your ongoing support of OraSure Technologies.

Sincerely, Stephen Tang, CEO And our entire OraSure family of companies

We want to thank all the frontline health workers, our partners, and everyone in the healthcare community working tirelessly day in and day out to combat the COVID-19 pandemic.

During these challenging times we offer our support and pledge our continued commitment to providing innovative, easy-to-use and scalable point-of-care diagnostic tools to help detect infectious diseases including HIV and HCV. We are proud to bring our expertise to the fight against COVID-19 with the development of a Rapid Oral Fluid Antigen Self-Test for In-Home use and the development of an ELISA-based antibody test for Laboratory use.

We’re here to help – reach out to us at

orasure.com/smm for more information.

OraQuick® and OraQuick ADVANCE® are registered trademarks of OraSure Technologies, Inc. © 2020 OraSure Technologies, Inc. OQA0568 rev. 04/20

GPO RESPONSE

Vizient: Focus on resiliency While meeting the demands of an emergency, supply chain teams will also need to anticipate future needs

The Journal of Healthcare Contracting asked Vizient for insights into how the

Steve Downey: Most of the conversa-

organization and its members are responding to the COVID-19 pandemic. Respond-

tions are centered on supplies, especially

ing to JHC ’s questions were Steve Downey, group senior vice president, supply chain

critical ones – how many days on hand

operations, Vizient, Inc.; and Julie Cerese, group senior vice president, performance

do they have for masks, gowns, ventila-

management and national networks, Vizient, Inc.

tor parts, etc. Supply chain teams are trying to get ahead of what materials they need as their hospitals ramp up to

The Journal of Healthcare

provide care and how they’ll get those

Contracting: Can you pro-

in these times of short supply. They are

vide us with some insights

reviewing what practices clinicians are

of what is going on at hos-

implementing to conserve supply and

pitals and health systems

vetting suppliers that seemingly come

as it relates to their supply

out of the woodwork. They’re working

chain teams? What con-

to confirm deliveries, as some locations are right on the edge of stock outs and

versations are they having right now?

36

Steve Downey

Julie Cerese

arrival times matter. We are also seeing

Special Issue 2020 | The Journal of Healthcare Contracting

members and local sites setting up

JHC: How should supply chain teams

to convert those areas to needed patient

emergency operations and increasing bed

be planning long-term?

care areas. Hospitals have also worked

capacity quickly. Those emergency sites

Downey: Supply chain teams should

with local, state and federal health au-

need supplies, logistics and labor and

make their plans with a focus on resiliency

thorities to develop regional approaches

their unique requirements put pressure

because it ensures supply continuity for

to care that can support patient surges.

on the supply chain.

the long term. Vizient will soon roll out a

Some Vizient members have repurposed

new platform to members that will create

their ambulatory practices to serve as

JHC: How are you advising hospitals

a “two-sided� marketplace for healthcare

COVID-19 testing and treatment sites,

and health systems to navigate any

organizations and suppliers to map supply

helping to preserve hospital capacity for

supply disruptions?

sources, risk points and create transparency

the sickest patients.

Downey: We are advising supply chain teams at member hospitals to conserve where they can and to check our Disaster Preparedness page regularly for the latest updates and information. Vizient continues to explore alternative supply resources and make that information available to members as soon as possible. In addition, we are encouraging members to keep

Working with clinical teams, they should set up conservation practices on scarce supplies. When they have challenges, they can rely on Vizient contacts and resources such as webinars and newsletters, for key information.

forward-looking in order to project what stock they will have and what stock they will need so that suppliers can react to

through the supplier and provider chain.

their best abilities.

The platform will help supply chain leaders

ed to this crisis, they have made major

As healthcare providers have respond-

at hospitals recognize areas where supply

progress in improving access to health-

JHC: What are a few things that ev-

may be constrained, at risk because of

care for patients. When restrictions were

ery supply chain team should being

single geographic origination or with a ven-

lifted to make telehealth more available,

doing today as a result of COVID-19?

dor having fill-rate challenges, so they can

many providers made it the first stop of

Downey: Clear communication with

make the necessary adjustments for supply

the triage process, stopping patients from

key stakeholders is a major factor in

chain resiliency within their organization.

arriving and overwhelming the emergency

successfully working through a disaster.

department. This has helped providers

Every supply chain team should know

JHC: In what ways do you think

and patients to become more familiar

what supplies are critical to the care of

COVID-19 is transforming how

with telehealth as a future option for their

their hospital’s COVID patients and

healthcare is provided?

health care needs.

stay on top of the days-on-hand of

Julie Cerese: To prepare for COVID-19

those materials. Working with clinical

patients, healthcare providers quickly can-

ages of PPE, healthcare providers have

teams, they should set up conservation

celled elective surgeries and procedures to

quickly stood up new and innovative

practices on scarce supplies. When they

marshal resources for the coming surge.

processes to ensure PPE is available for

have challenges, they can rely on Vizient

They quickly began to assess, train and re-

front-line caregivers. This has included

contacts and resources such as webinars

deploy staff to support critical areas such

developing new sanitation processes, or

and newsletters, for key information.

as emergency departments and ICUs.

cohorting patients in a way that enables

Most importantly, they should take

Organizations quickly moved to

In addition because of critical short-

PPE to be used longer by staff. Vizient has

every step possible to keep their clinical

assess the facilities they own, such as

held weekly webinars and has been collect-

teams safe and healthy, as these are

closed inpatient areas, operating rooms

ing practices from its members in order to

difficult times.

and conference rooms and develop plans

improve knowledge transfer in this area.

The Journal of Healthcare Contracting | Special Issue 2020

37

DUKAL Strong This year – 2020 – started out as any other year. I spent a week in Shanghai, China, in mid-January to celebrate the Chinese New Year with DUKAL’s China team when we heard there was a virus in Wuhan, China, but thought nothing of it. However, Wuhan is an economic development city and billions of dollars have been invested there by foreign countries in manufacturing, led by the U.S. With visitors from all over the world traveling in and out of Wuhan daily, coupled with a virus that is a killer, it wasn’t long before we had the beginnings of a global mess on our hands.

Healthcare suppliers in the U.S. have handled pandemics before, but never one that hit so close to home and disrupted our supply chain while immobilizing our citizens. Wuhan and its surrounding cities were all quarantined before the end of the Chinese New Year holiday, and unable to resume their normal production. With a high concentration of PPE production coming out of Wuhan, and COVID-19 spreading in Europe and the U.S., the dramatically increased demand exceeded the production capacity of the region.

By early March, COVID-19 had come into the New York region and broadened our focus beyond just the need to maintain our supply chain. The continued well-being of our employees and their families became an urgent concern as well.

The continuity of the business hinges on our essential employees and for them to be able to complete their jobs efficiently. As an essential supplier, and one very involved in PPE, we knew DUKAL had to remain fully functional. Our Disaster Recovery Plan was enhanced to address both the pandemic and our employees’ well-being. The DUKAL main office in Ronkonkoma, New York, went fully remote on Monday, March 16 with over 50 people able to work at home. Phones rang, emails flowed, and the office become fully functional from 50 locations! That day the reality of the severity of what was happening

from buyers around the world and demand drives up pricing.

Additionally, raw material shortages and hoarding also contributes to rapid and continued increases.

Look at the Raw Material Pricing Index from January to April 13 to get an idea of the magnitude of the jump:

set in. As a person who believes in “New York Strong” I had not felt so empowered since the region started to recover from the tragedy of 9/11.

• Polypropylene the raw

As we work through the realities of meeting our customers’ increased demand, coupled with China still trying to normalize production post-virus, the industry is faced with rapidly increasing prices, especially for the PPE products. DUKAL is now competing for scarce products

• Spunbonded Polypropylene

material to make the SPP fabric: January RMB: 5,000 ton; April 13: 50,000 ton

fabric (SPP): January RMB: 8,000 ton; April 13: 120,000 ton

• Labor in China has increased five times since the beginning of the year

• China factories now require a 30-40% deposit upon order and full payment on shipping The current normal in the industry is that prices increase weekly and as of mid-April there is no timetable for stabilizing. It is very difficult to run a business during uncertain times and that is where the quality of a company’s management team is critical.

Gerard LoDuca president and founder

For the past 30 years, DUKAL has been able to drive redundant costs out of healthcare through smarter manufacturing practices. This past month, it has been disheartening to see 30 years of work be erased as these pandemic-related price increases wipe away a lifetime of work. However, in customary fashion we will move forward, continue to find innovative ways to bring healthcare products to market and put our customers first. Wherever that journey takes us, our team remains dedicated to being the best we can be and DUKAL STRONG!

We want to thank you, everyday warriors.

As DUKAL employees work to ensure essential medical and PPE products are reaching healthcare workers on the frontlines of COVID-19, we want to take a moment to recognize and thank the essential workers who are committing tireless hours to keep our nation going.

While it can feel like the world is standing still, everyone at DUKAL would like to acknowledge the postal workers - the grocery and restaurant workers - the farmers - the service worker - the not for profit staff - the truckers - the pharmacists - the police officers - the firefighters - the nurses, doctors, therapists and patient care aides from the medical industry, know your selflessness and dedication is so appreciated.

Follow @dukalcorp to hear DUKAL employees share their thanks.

www.dukal.com

GPO RESPONSE

Intalere’s Steve Kiewiet: Transparency is key To help answer questions on how the COVID-19 pandemic is affecting the U.S.

JHC: Are you seeing lessons learned

healthcare supply chain, The Journal of Healthcare Contracting reached out to Steve Kiewiet,

from previous disasters being imple-

Chief Commercial Officer, Intalere. He offered the following comments.

mented? If so, how have we gotten better at handling situations like this?

Kiewiet: I think individual systems have

JHC: What are some best practices of

chain visibility and transparency. We

gotten better and individual manufactur-

leading IDNs, health systems and hos-

should be able to track and trace every

ers have gotten better. I don’t believe the

pitals that have disaster and disruption

product necessary for the delivery of

industry has improved at all. Every dis-

plans in place? How are they trying to

care from raw materials to the use in

ruption becomes a case study in the same

stay ahead of any potential issues?

delivery of care. Inventory levels should

lessons learned from the last disruption.

Steve Kiewiet: I think some systems do a great job in communicating with everyone in their system about the impacts when disruptions occur. They manage their inventory and utilization effectively and engage their clinical community in ways to maintain care

Steve Kiewiet

Transparency can help prevent overstock and understock issues. It can ensure all necessary products for care are in the right place at the right time for the right patient.

while reducing the use of impacted products or finding alternative products for the

be transparent to every link in the

Yet, as an industry we don’t take those

delivery of care. Emergency operations

chain. Each stakeholder should be held

learnings beyond the local or individual

and crisis management are executed

accountable to use that transparency

stakeholder level. We don’t come together

well by many systems. The shortfall is

to ensure the complete supply chain is

as an industry and make the changes

we don’t work together to make this

optimized versus the optimization of

necessary to remove the risks and bring

best practices, common practice for

one link over another. Transparency

end-to-end resiliency to the supply chain.

everyone in the industry.

40

can help prevent overstock and under-

Healthcare isn’t consumer goods; we can’t

stock issues. It can ensure all necessary

keep living in reaction mode and playing

JHC: How do we as an industry pre-

products for care are in the right place

the role of hero firefighter. We need to

vent shortages that may occur due

at the right time for the right patient. We

be fanatic about fire prevention. It would

to hoarding and panic buying?

need to take all of the “lessons learned”

be great if I never had to watch another

Kiewiet: Transparency is the key. We

from every previous supply disruption

presentation, read a case study or attend a

must, as an industry, commit to enabling

and implement the change necessary for

seminar on the lessons learned from the

and participating in end-to-end supply

every link in the chain.

latest disruption.

Special Issue 2020 | The Journal of Healthcare Contracting

Whatever is takes and however long it takes Optimal is fully operational The team at Optimal is committed to working the necessary hours to get med-surg products out to people on the front lines.

www.optimalmax.com

Dear Healthcare Colleagues,

During this unprecedented, challenging time of the COVID-19 pandemic, it is more important than ever to honor and support the healthcare workers that are making a difference every day. It is the first responders, doctors and nurses, and all of those behind the scenes in hospitals, including cleaning and maintenance staff, who deserve our utmost thanks and appreciation for their unrelenting strength and resilience.

With the number of COVID-19 cases continuing to rise, the focus on infection prevention and enhanced safety within hospitals is crucial. As my colleague, Caitlin Stowe, clinical research manager at PDI Healthcare, explains in this informative piece, there are key company-wide best practices to follow to ensure hospitals are properly protected. This includes establishing comprehensive cleaning and disinfecting protocols, utilizing proper equipment and products, and maintaining adequate supplies.

As we have all witnessed, the most critical and valuable ingredient in infection prevention is the human element. Hospitals and healthcare facilities need to support their entire healthcare team.

This crisis is not going away quickly, and we need to sustain these frontline heroes. Make sure they are physically and mentally healthy, and above all, keep them protected and safe.

Now is the time for hospitals and healthcare facilities to focus on a layered approach to infection prevention, including hand hygiene and personal protection equipment, as well as implementing rigorous surface and equipment disinfecting processes. Managing the supply chain and having honest discussions with distribution partners is also a key element to ensure adequate supply of critical products, such as masks, cleaning supplies and life-saving equipment, during this time of heightened demand.

We are all in this together. With a focus on best practices for infection prevention to protect patients and our healthcare professionals, we can safeguard our communities. Our thoughts and gratitude remain with all of those on the frontlines as we all forge ahead.

Stay safe and healthy, Sean Gallimore Senior Vice President and General Manager PDI Healthcare

Infection risks are everywhere.

So are we.

Innovation against infection.

Sani-Cloth® Prime Wipes, Sani-Prime® Spray, Sani-24® Spray, Sani-HyPerCide™ Spray, Super Sani-Cloth® Wipes, Sani-Cloth® Bleach Wipes, and Sani-Cloth® AF3 Wipes are on EPA's List N1 for the emerging viral pathogen claim and are recommended by the CDC for surface disinfection to help prevent the spread of COVID-19.

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For more info go to pdihc.com/tracking-2019-novel-coronavirus-2019-ncov/ 1 https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 ©2020 PDI PDI03202074

BE THE DIFFERENCE®

RESOURCES

Keeping healthcare facilities infection free Best practices and protocols from an infection preventionist

Introduction

as safe and healthy as possible so they can

at a cancer center, and worked her way up

The response to the COVID-19 pan-

be on the front lines saving as many lives

through various care settings. Stowe was

demic from medical caregivers has been

as possible.”

a system director for a couple of years

heroic, said Caitlin Stowe, clinical affairs

before she made the jump to industry

The Journal of Healthcare Contracting and

back in 2016. She has a master’s degree

highlighted the everyday work that nurses

Repertoire Magazine, asked Stowe for her

in public health and global communi-

and physicians do. Everybody in the hos-

insights into how best to keep those

cable disease and a certificate in infection

pital plays a key role in the prevention of

healthcare workers safe amid the risks

control. Stowe is currently working on her

infections, and I think it just goes to show

associated with the coronavirus.

PhD in health science and she is certified

that healthcare workers are the heroes right now. We have to keep our caregivers

44

Share Moving Media, publisher of

research manager at PDI Healthcare. “It’s

Stowe has been an infection preventionist since 2009. She started her career

in infection control, health care quality, public health and vascular access.

Special Issue 2020 | The Journal of Healthcare Contracting

In the following article, Stowe high-

protective equipment to help our team

Stowe said supply chain teams must

lighted the infection prevention products

members and staff care for patients,

work with their infection prevention team

that will be key to healthcare facilities’

but also making sure we have enough

and their nursing leadership to estimate

efforts, short-term challenges providers

disinfectant to appropriately wipe down

usage. “And with the situation so fluid it’s

will need to navigate, and the long-term

the surfaces, because we don’t want that

obviously subject to change,” she said.

planning that will be needed to maintain

to perpetuate the spread of this in the

“But in a worst case scenario, what’s the

an adequate supply.

healthcare setting. We need to ensure

par level or what’s the daily supply that

that we’re also doing really good surface

you’re going to need in order to take care

and equipment disinfection.”

of your patients safely?”

Infection prevention products hardest hit There are a lot of hard decisions that healthcare facilities are having to make in regards to supplies, Stowe said. The biggest one is the use of personal protective equipment (PPE).

How much protective equipment does each provider have for its staff to adequately protect the healthcare workers and patients? “The supply chain has a really hard job right now working with their distributor partners and having open communication with their

Once teams have an adequate supply for the organization’s day-today needs, Stowe said the focus should turn to proper maintenance of that supply.

leadership in infection prevention to ensure that they are maintaining adequate supply levels.”

Indeed, cleaning personnel play an

To help with this, the Centers for

Another supply category that supply

important role when it comes to prevent-

Disease Control & Prevention (CDC) has

chain teams need to be concerned about

ing any kind of infection. “The No. 1 way

issued some guidelines for reuse of PPE,

is surface and equipment disinfectants.

to prevent infection is hand hygiene,” she

for alternative PPE to ensure that people

“Do healthcare facilities have an EPA-

said. “The No. 2 way, in my opinion, is

are still being protected. (Visit www.cdc.gov/

registered disinfectant on list N, which

adequate surface and equipment disinfec-

coronavirus/2019-ncov/index.html)

means that it has an emerging pathogens

tion, because 80% of infectious diseases

claim? This way we can feel comfort-

are spread by touch.”

the coronavirus.” The coronavirus is an

fied, if healthcare facilities don’t have

Short-term challenges and long-term planning

enveloped virus, on the lowest level of

adequate supply levels, or supplies are

Staffing will be a major short-term chal-

the hierarchy of pathogens, so it’s fairly

back ordered, is there a contingency plan

lenge for providers, which makes keeping

easy to kill.

in place? “Providers need to work with

caregivers safe and their work environ-

able in knowing the disinfectant is killing

Once the needed supplies are identi-

their infection prevention leadership,

ment infection free critical. “We have to

I’ve been reading says it lasts in aerosol

their nursing leadership, and the C suite

make sure that we’re protecting our staff,

form for a couple of hours, and can

in general to ensure that there’s not going

because if they are exposed they have to

last on a surface for two to three days.

to be a delay or a gap in care because they

self-quarantine – usually a minimum of

So it’s really important that not only are

don’t have the equipment and/or supplies

14 days if they have high risk exposure.

we making sure that we have enough

needed to do their job safely.”

The CDC has changed their guidance on

“Some of the latest research that

The Journal of Healthcare Contracting | Special Issue 2020

45

this a few times, but right now if you have a high risk exposure, meaning you were not wearing the right PPE when you were caring for a confirmed patient, you cannot work for 14 days minimum,” Stowe said.

Once supply in teams have an adequate supply for the organization’s day-to-day needs, Stowe said the focus should turn to proper maintenance of that supply. “Not a stockpile of that supply, because that’s not going to do anybody any good, but building up a day or two extra worth of their supplies to ensure that there’s not going to be a break,” she said.

Also, there is the human element to

“ Have really frank discussions with your distributor partners and say ‘This is what we need. Do you think you’ll be able to fulfill it? If not, help me find somewhere that can give me the supplies that I need.’”

think about. Supply chain teams should check in with their staff. Is their staff

46

mentally and physically doing okay? “Ev-

all those other public health measures

Visitor restrictions. The visitor

erybody’s stressed,” Stowe said. “Ensuring

we’re trying to implement now, it may go

restrictions that a lot of facilities have

that you’re supporting your team mem-

through 2021.”

been implementing are necessary, Stowe

bers through this long-term marathon

said. To that end, hospitals and health

is important. It’s not a sprint. This is a

systems can check that policies and

pandemic that’s going to go on at least for

Protocols to follow

procedures related to the appropriate

the next few months at a high level. And

Stowe recommended the following proto-

use of PPE are in place, that they are

I’ve seen forecasts from the CDC where

cols as they relate to infection prevention

being educated to and communicated,

if we don’t do the social distancing and

for healthcare facilities:

and that there are spot checks to ensure

Special Issue 2020 | The Journal of Healthcare Contracting

that their staff are doing the right thing.

supplies, or building stockpiles because

health services for years so from a public

“Everybody must know when they

that doesn’t benefit anybody. One rea-

health standpoint, we’re so strapped for

need to wear a mask, when they need to

son is because the expiration dates of

resources that maybe they weren’t as

wear a N95, and when equipment and

disinfectants are fairly short. So if you

effective as they could have been in the

surfaces need to be cleaned.”

stockpile hundreds and hundreds of cases

initial stages because we really just, we

and then you don’t use them, that’s just

didn’t have the staff or the resources.”

Cleaning. Every multi-care patient use

product that’s going to expire.” Stowe

Stowe said like a lot of infection

equipment should be cleaned in between

likens the situation to a Seesaw, “a little

prevention suppliers, PDI Healthcare is

each patient, Stowe said. The equipment

give and take on what’s the appropriate

working hand in hand with its infec-

should also be cleaned at regular intervals.

amount to use and extra to keep in stock.

tion preventionists and hospital supply

“How often is a patient room getting

But also we don’t want to hoard because

chain departments. “We’d never want

cleaned, or the high touch surfaces getting

other providers will need these supplies.

care to be delayed or not given because

wiped down on a regular basis?” Doing

We don’t want them to expire before you

of a failure or a lack of supplies when

those enhanced cleaning procedures will

can use them.”

it comes to PDI, and like I said, surface

definitely help reduce the bioburden of

disinfection of equipment and areas

this virus in the environment.

are some of the most important things

What we can learn from the COVID-19 response?

you can do after hand hygiene. We are

A supply chain team checklist

As a public health professional, Stowe

to ensure that we’re addressing all their

First and foremost, Stowe recommended

said the COVID-19 pandemic highlights

questions and concerns and making sure

that supply chain teams maintain an open

the need for more public health funding.

that they feel as comfortable as they can

dialogue and good relationship with their

“We’ve been cutting funding to public

with the current situation.”

working hand in hand with our partners

organization’s infection prevention team.

“The infection prevention team has the most up-to-date guidance from the CDC, the WHO, their local health departments and they really are the subject matter experts that can help the supply chain prioritize what they need,” she said.

Stowe said open lines of communication – and “frank” discussions – will be needed with their industry and distributor partners. “Have really frank discussions with your distributor partners and say ‘This is what we need. Do you think you’ll be able to fulfill it? If not, help me find somewhere that can give me the supplies that I need.’”

Providers and suppliers alike are working day and night to ensure that we have adequate supply for the facilities so that the supply chain isn’t disrupted.

“However, it works both ways,” Stowe said. “Facilities should not be hoarding

The Journal of Healthcare Contracting | Special Issue 2020

47

DISTRIBUTION

To the Owens & Minor Team from all of us at Share Moving Media and the industry, thank you for taking care of America's healthcare providers. The work you’re doing is more important now than ever before.

48

Special Issue 2020 | The Journal of Healthcare Contracting

To the McKesson Team from all of us at Share Moving Media and the industry, thank you for taking care of America's healthcare providers. The work you’re doing is more important now than ever before.

The Journal of Healthcare Contracting | Special Issue 2020

49

NEWS

CDC: Here’s how to keep you, your staff and your patients safe Editor’s note: The Centers for Disease Control and Prevention issued Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. Though some of the recommendations are pointed toward the inpatient setting, physician practices should adhere to others. Here are CDC’s PPE recommendations for the care of patients with known or suspected COVID-19.

ʯ Based on local and regional situational

ʯ Eye protection, gown, and gloves

analysis of PPE supplies, facemasks

continue to be recommended.

are an acceptable alternative when the

Rooms (AIIRs) should be reserved for patients undergoing aerosolgenerating procedures.

supply chain of respirators cannot meet

ʯ If there are shortages of gowns,

the demand. During this time, available

they should be prioritized for

respirators should be prioritized for

aerosol-generating procedures,

background is based on currently

procedures that are likely to generate

care activities where splashes and

available information about

respiratory aerosols, which would

sprays are anticipated, and high-

COVID-19 and the current situation

pose the highest exposure risk to

contact patient care activities that

in the United States, which includes

healthcare personnel (HCP).

provide opportunities for transfer of

reports of cases of community

pathogens to the hands and clothing

transmission, infections identified

of HCP.

in healthcare personnel (HCP),

ʯ Facemasks protect the wearer from splashes and sprays.

and shortages of facemasks, N95

ʯ Included are considerations for ʯ Respirators, which filter inspired air, offer respiratory protection.

ʯ Updated information in the

filtering facepiece respirators

designating entire units within the

(FFRs) (commonly known as N95

facility, with dedicated HCP, to care

respirators), and gowns.

for known or suspected COVID-19

ʯ When the supply chain is restored,

patients and options for extended

ʯ Increased emphasis on early

facilities with a respiratory protection

use of respirators, facemasks,

identification and implementation

program should return to use

and eye protection on such units.

of source control (i.e., putting a

of respirators for patients with

Updated recommendations regarding

facemask on patients presenting with

known or suspected COVID-19.

need for an airborne infection

symptoms of respiratory infection).

Facilities that do not currently have

isolation room (AIIR).

a respiratory protection program, but care for patients infected with

50

ʯ Patients with known or suspected

pathogens for which a respirator is

COVID-19 should be cared for in

recommended, should implement a

a single-person room with the door

respiratory protection program.

closed. Airborne Infection Isolation

Special Issue 2020 | The Journal of Healthcare Contracting

Consortium aims to bring scalable solutions to the pandemic

A consortium of life sciences companies announced on March 25 a collaboration

Companies participating in the collabora-

to accelerate the development, manufacture, and delivery of vaccines, diagnostics, and treat-

tion include:

ments for COVID-19, according to a release from the Bill & Melinda Gates Foundation.

“The life sciences industry brings a

three continents, Vas Narasimhan, chief

range of assets, resources, and expertise

executive officer of Novartis, said, “We

needed to identify effective and scal-

feel a deep shared responsibility to see if

able solutions to the pandemic, which is

there are specific areas where collaboration

affecting billions worldwide,” the release

across the life sciences industry and the Bill

said. “The impact on health systems,

& Melinda Gates Foundation can acceler-

economies, and livelihoods is profound,

ate solutions to this pandemic. In addition

and an effective response requires an un-

to the individual contributions companies

precedented collaboration across govern-

are already making, collective action is criti-

ments, academia, the private sector, and

cal to ensure any promising studies into

the philanthropic community.”

vaccines, drugs, and diagnostics are quickly

As co-chair of a consortium life science companies headquartered across

scaled to people around the world who are affected by this pandemic.”

ʯ ʯ ʯ ʯ ʯ ʯ ʯ ʯ ʯ ʯ

BD bioMérieux Boehringer Ingelheim Bristol-Myers Squibb Eisai Eli Lilly Gilead GSK Johnson & Johnson Merck (known as MSD outside the U.S. and Canada),

ʯ ʯ ʯ ʯ

Merck KGaA Novartis Pfizer Sanofi

From the care givers to the medical distribution employees, the team here at Share Moving Media would like to say thank you to every frontline human being that has done their part to take care of America.

We are forever in your debt!