Rep April 21

vol.29 no.4 • April 2021

Executive Interview: NDC’s Mark Seitz Medical distribution is seeing immense change, as well as immense opportunity, says NDC’s president and CEO

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APRIL 2021 • VOLUME 29 • ISSUE 4

PUBLISHER’S LETTER Normalcy in Sight?.......................... 2

PHYSICIAN OFFICE LAB Every Step of the Way How to help your customers successfully establish, and maintain, a CLIA moderate complexity laboratory................ 4

POST-ACUTE ‘What Matters’ For providers, being ‘age-friendly’ means listening to the patient..................16

TRENDS Inpatient Hospital Care Comes to the Home......................24 Physical Health / Behavioral Health Primary care doctors draw the connection, but can they address it in their practices?.....................28

LEADERSHIP

Executive Interview: NDC’s Mark Seitz

8

Pivot with Purpose Lessons on corporate resiliency...............32

SALES IDN OPPORTUNITIES

Is Bad Strategy Worse Than No Strategy?

Building a Resilient Supply Chain This year’s Contracting Professional of the Year helped to develop and implement unique solutions to supply chain challenges brought on by the pandemic......38

Three bad habits you might need to break.........................46

HIDA GOVERNMENT AFFAIRS Red Flags to Avoid PPE Scams Distributors, manufacturers, and healthcare providers all have a role in fighting PPE fraud........50

HEALTHY REPS Health news and notes...............52

WINDSHIELD TIME Automotive-related news........58

NEWS Amanda Chawla

Industry news....................................60

Rep Corner

Hard Riding Susan Van Cleve seeks excellence working with colleagues, customers – and her horses

54

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PUBLISHER’S LETTER

Normalcy in Sight?

As I write this Publisher’s Letter, the stock market is over 32,700. Texas and Mississippi

have lifted their mask mandates. Airline stocks are on the rise, live meetings are being planned, and all is headed back to normal.

Or is it? Over the past 12 months, we’ve all done more Zoom calls than we ever thought possible. We’ve learned to sell virtually, and we’ve maintained relationships with our clients via a computer screen.

As I talk to organizations and individuals around the country, most people think virtual selling is here to stay. Let’s face it, all of us who have embraced virtual selling have become more efficient and are probably communicating as much or more with clients than ever before. So, this virtual world has its pros, especially if you use tools like video calls, selling videos, education modules, and manufacturer reps who are proficient on Zoom calls. In my opinion, virtual selling isn’t going away for the above reasons. If you haven’t embraced this fact, you really need to take a look at the reps around you that have and pick their brains on how to get good at it.

Now for a little old school Scott Adams. While this virtual selling gimmick is efficient and allows for way more communication with clients in a single day, it can never replace “RELATIONSHIPS” formed from years of face-to-face sales calls, meetings, and dinners.

So, before we get too far ahead of ourselves and think technology is the only way to reach customers, let us all remember who brought us to the dance. Ride days, sales meetings, demos, favors, making our customers look great in front of those they care about the most, and most importantly showing up when they need us the most.

Yes, virtual selling is here to stay and can help us maintain existing business, but if we want long-term growth with new clients and bigger sales, we will have to get back on the face-to-face horse and start calling on accounts again. Those who can do both are the ones who will win in the days going forward.

I look forward to seeing you on a Zoom call in the future, but I really look forward to shaking your hand, looking you in the eye and having a live conversation. Stay safe out there and keep selling!!!

Scott Adams

Dedicated to the industry, R. Scott Adams

Repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia.com; www.sharemovingmedia.com

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PHYSICIAN OFFICE LAB

Every Step of the Way How to help your customers successfully establish, and maintain, a CLIA moderate complexity laboratory.

Investing time and energy in creating best-in-class customer solutions is a top-of-mind

By Jim Poggi 4

April 2021

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activity for the experienced distribution account manager. Nowhere is this truer than guiding customers to consider establishing a laboratory. While PAMA reimbursement cuts have impacted the economic benefits of a lab somewhat, the clinical value continues to be a powerful enhancement to even the best medical practices.

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Which clinical conditions do they see most frequently that would benefit from an in-office lab? Where do you draw the line between adding tests for improved patient care and adding cost and complexity to the lab? What is the staff viewpoint on lab testing? Are they ready or reluctant? Don’t forget site readiness for power, space and water needs. Your key lab supplier will perform a site survey to alert you and the practice to site requirements for a properly functioning lab.

They can also help with assessing training and CLIA compliance issues to smooth the transition and provide sound management post installation. Finally, the best-in-class office labs consider LIS and EMR connectivity for staff and patients alike.

The classic “crawl, walk, run” approach allows the fledgling POL to grow into its laboratory at a reasonable pace, with staff and management learning along the way.

Getting the deal right

In this article, I plan to outline key steps in a sound consultative approach in establishing and maintaining a CLIA moderate complexity laboratory. Our customers are constantly on the look out for solutions that provide improved clinical outcomes, better office efficiency and financial benefits. A physician office lab provides all three while providing the tests needed to initiate or modify a patient treatment program during the office visit.

Setting the stage This key first step involves comprehensive customer discussions that identify key needs and wants of the practice.

Expectations are everything at this stage. You need to consult and provide a realistic view of time and budget considerations related to needed equipment, staff training, regulatory and space considerations and down stream management time and effort. While a test menu that rivals that of the local hospital looks impressive on paper, it is likely to lead to inefficiency, reagent waste, staff frustration and potential issues with maintaining high quality results. The classic “crawl, walk, run” approach allows the fledgling POL to grow into its laboratory at a reasonable pace, with staff and management learning along the way. A good quarterback leans heavily on their key lab suppliers and is not afraid to advise the customer to take establishing a laboratory “one step at a time.” Needs for ancillary supplies like centrifuges and lab accessories are often neglected or poorly planned. Make sure your key lab supplier is prepared to address connectivity and result availability issues for LIS and EMR. www.repertoiremag.com

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PHYSICIAN OFFICE LAB Customer satisfaction is an ongoing time investment While it may be tempting to help the customer get the lab established and then “move on to the next opportunity” neglecting proper follow-up inevitably leads to customer frustration and headaches for all over time. The savvy distribution account manager plans time to assure their customer’s on-going satisfaction with periodic structured post installation visits. It is not enough to do “fly by” visits to the lab during your routine customer visit, asking if everything is ok and heading down the hall. Meetings dedicated to spending structured time with the clinical and lab teams are critical to a properly functioning lab and meeting customer expectations. Quarterly business reviews with agreed upon agendas make all the difference. Assign someone to keep notes on action items and follow up. Be sure to focus on both “what is working well” and “what needs to be addressed or improved.” Often new testing opportunities present themselves during these business reviews. While management of the customer experience takes time, it pays big dividends down the road.

your planning activities. Be sure to take the lead in making ordering reagents and ancillary supplies easy and convenient. Standing orders for frequently needed supplies and tracking practice spend and stocking levels are necessary tools. Be sure to proactively manage these elements to avoid customer remorse and dissatisfaction. Avoid being blind sided by customer issues that seem to crop up quickly if you do not actively pay attention to customer needs and feedback post sale.

Every piece of capital equipment comes with a substantial initial customer investment. The skilled distribution account manager works with their key lab suppliers to create credible and appealing financial proposals. But, where many could improve relates to product life cycle management. Have you informed the customer of the importance of system maintenance? Do they know the supplier schedule for routine maintenance they need to perform as well as preventative visits?

Service contracts keep expectations in line and avoid surprise repair bills down the road. Every multiple year lease needs to include a service contract. Make it a part of every proposal you create. At the same time, plan for system upgrades and replacement early in the lease term. Too often customers do not plan for end-of-lease term issues until they receive a notice from the leasing company that their lease is ending and they need to decide whether to keep the equipment, upgrade it or go month to month. The best practice of skilled account managers is to begin discussing end-of-term options well before the lease is due to end.

Many account managers begin these discussions while there is still one year left on the lease. This allows the practice to plan for budget and site needs for new equipment and provides time to assure that the new equipment is up and running smoothly without disruption to the practice or patients.

A commitment to planning every step of the way from the initial recommendations to consider a lab through implementation of the exciting new solution, solving issues uncovered effectively as they occur and planning for life cycle management keeps your customers happy, avoids unpleasant surprises for all and leads to excellent, patient centric solutions.

Which clinical conditions do they see most frequently that would benefit from an in-office lab? Where do you draw the line between adding tests for improved patient care and adding cost and complexity to the lab? What is the staff viewpoint on lab testing?

Stumbling blocks that lead customers to consider closing their in-office lab includes staff frustration based on new and unfamiliar duties. Ongoing training with your key lab supplier in the lead and a commitment to management by the practice medical director are important elements to emphasize up front in the sales process and to keep in view after the laboratory is up and running.

Assume there will be staff turnover and integrate it into 6

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Executive Interview: NDC’s Mark Seitz Medical distribution is seeing immense change, as well as immense opportunity, says NDC’s president and CEO

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Mark Seitz is closing in on having two equally long careers in two very different fields. He

spent about 20 years practicing law, and now he’s in his 17th year in medical distribution as President and CEO of NDC, Inc. “It was quite a change,” he said, when asked to compare the two experiences. “While practicing law, I started as a prosecutor with the attorney general’s office, and then ended up as a corporate attorney representing NDC.” As an attorney, engagements were very compartmentalized. “You would go out, do a transaction or consult on a tax matter or something similar. There was a beginning, a middle and an end to the work that you were doing as a lawyer. And then, you would move on to your next project. Sometimes you had two or three

going at once, but it was very much compartmentalized. And you were marketing yourself and your individual capabilities and your experience as a professional.”

In medical distribution, your body of work is never over until you retire, according to Seitz.

“You start developing relationships. You build a team around you. If you’re leading a company, whether it’s a manufacturer or distributor, it’s a constant evolution of experience. So, it’s really a marathon of evolution compared to this isolated case-by-case pattern that you got into as a lawyer.”

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Executive Interview: NDC’s Mark Seitz

Regardless of what your role is in the healthcare ecosystem, you have a profound impact on the human condition, Seitz said. “That sounds a little extreme, but not really if you step back and think about it. We may get lost in the forest of what we are doing every day, but we are all connected to one mission and one goal, which is to improve the quality of care for the people in the U.S. and in some cases, throughout the world. That was a big win for me. While practicing law, there was a certain satisfaction from successfully conducting a large business deal or solving a legal crisis for a friend or client; but what I love about our industry is being part of making a difference in the quality of life for people in my community and for that matter, throughout the United States.”

In a recent conversation with Repertoire Publisher Scott Adams, Seitz discussed how the industry has changed during his tenure, how NDC as an organization has changed, leadership lessons learned, and what he anticipates for the industry’s future.

There was a whole myriad of things internally that drove NDC to make the decision to consolidate our legacy buying groups. What we suspected at the time, and seems to have proven true, was that we would not have been able to stay relevant to manufacturers if we did not consolidate.

Scott Adams: The industry has changed quite a bit during your tenure. NDC as an organization has gone through some serious change.

Talk a little bit about some of the changes you’ve seen during your tenure.

Mark Seitz: Internally at NDC, I have had a lot of talented people join the organization. Many are still here, and some have come and gone on to different opportunities. It has been quite a journey, but we are committed to changing alongside the industry to make sure that we keep the organization relevant.

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It makes me feel a little bit old-in-the-saddle to have this conversation, but there’s no denying that buying cooperatives were strongly serving a mission in my early time with the company. Mr. Jim Stover envisioned and then built an impressive business model – partnering with some of the most respected individuals within the industry, including leaders like Ted Almon. After Mr. Stover’s retirement, I had the good fortune to collaborate with industry leaders from some of the most respected companies in healthcare such as Mike Racioppi with Henry Schein and Chris Fagnani with Lynn Medical. I am personally, and professionally, grateful for their vision, hard work and shared success that was realized among the industry.

There was a whole myriad of things internally that drove NDC to make the decision to consolidate our legacy buying groups. What we suspected at the time, and seems to have proven true, was that we would not have been able to stay relevant to manufacturers if we did not consolidate.

Luckily, the entire team at NDC recognized the need to change and to continue to evolve the business and, perhaps most importantly with respect to this topic, our distributor partners gave us the chance to evolve our model.

In my opinion, the industry is at an interesting inflection point. We’ve seen healthcare reform, Obamacare, payment reform, ACOs, IDNs, value-based purchasing … pick your flavor of the day. Most of the past reforms, although impactful, were more tactical. They were very important and transformational – yet none of them really had the sweeping magnitude of change that everyone anticipated when they first surfaced.

There is something going on in the industry now that feels different to me. Again, this is just my opinion, and there are probably other people better qualified to answer this question. I call it the “verticalization of healthcare”.

You have payers, providers, and then patient populations that are employee-based, whether it’s Walmart or Target or insurance carriers. This change is being driven by the desire for efficiency, predictability and affordability.

Healthcare is being used as a tool to recruit talent to your organization. The drivers behind the vertical integration of healthcare in the U.S. is something that’s going to be very interesting and very impactful.

Adams: What are one or two things you’re most proud of NDC over this past year?

Seitz: You hear this response a lot, because it’s consistently true across so many dimensions of healthcare distribution.

The employees that work at this company and their selfless commitment and dedication during the pandemic was truly inspirational.

Today, things are relaxing with soft openings and a vaccine available. But we can all think back to a time during the pandemic where there was genuine fear. It grew into this situation where you didn’t want to touch a surface. You were afraid to get your mail out of your mailbox. You were hesitant to touch a cart in the grocery store. And people had a genuine fear that they could get this virus and didn’t know what it would do to them. Yet during that time, at the height of the pandemic, I had people beating down the door of our distribution centers to come to work and do their job, to serve our customers.

It was really something to see.

and shortages. I am proud that at NDC we tried our best to support the small businesses throughout the United States that partner with us for solutions. That was a big deal – keeping essential businesses in local communities up and running.

Adams: Shifting gears a little bit, as a leader, how do you continue to develop and grow? Are there things that you do personally around that?

Seitz: I do some of the regular stuff that you often hear about. I have a few books and podcasts that catch my attention. I try to stay literate when it comes to The New York Times and The Wall Street Journal. I try to listen carefully to the folks that grew up in our industry. The relationships I have made as a HIDA board member have been so critical.

Adams: You’re not the first CEO who’s shared a story like that. I’ve said it for the last year, how thankful everyone in the country needs to be to those people. The average American just assumes that gloves, masks, gowns and syringes somehow miraculously end up in a hospital. And you’re right, people were so scared.

Seitz: I’d have to admit that at times, I had fear about where it was going to end up when it was really peaking. We didn’t know the full cascade of consequences. It certainly turned out to be a horrific situation for the country. There’s no doubt about that. It was terrifying for people, and understandably so, but they still showed up to work in all types of essential businesses.

For us, we had another mission too. Besides just supporting healthcare, our model supports many small businesses, and they all have employees and families and customers that depend on them to stay open. So, it was gratifying for us to fulfill our duty to the best of our ability under all the circumstances, including allocations www.repertoiremag.com

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Executive Interview: NDC’s Mark Seitz

I do all the regular things people do, but I also try to look at my experience capital differently. Just going through the pandemic and having to make real-time decisions in unknown territory has shown me how much I depend on my team. NDC team members come from diverse backgrounds and diverse professional experiences. I’ve got all this experience capital from all these wonderful people that I’ve had a chance to work with at NDC and in the industry. So, I make sure that I don’t ever get in a place where I think I know the answer to anything or everything. I wake up every day determined to listen.

Adams: Within your organization, how do you generate great ideas?

Seitz: One of the biggest challenges I’ve had with COVID and with how large we’ve gotten with being multisite – ten distribution centers and four corporate offices – is that I’ve lost my nexus with everybody in the company. I still have it to some degree, but not like I want to.

Yet during that time, at the height of the pandemic, I had people beating down the door of our distribution centers to come to work and do their job, to serve our customers. It was really something to see.

But, thankfully, I am not the source of great ideas at NDC. My teams are interfacing with customers. People are getting products out to customers, along with all the things that are mission critical for what we do. In the business, the ideas come from the folks that are executing on those responsibilities. They might not always know the answer, but they know the problem. Once you can appreciate the problem, then you are on your way to finding a solution.

Strategic planning is an essential part of bringing the right ideas to the business, and you must commit to it. I call it “reinventing the business”, whether it’s a rebranding exercise or moving forward in a market like we did with Preferred Medical. You must have a strategy and be committed to executing. Making sure that you take the 12

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time to think about the business long-term – and what it will look like in a couple of years. In my mind, it is a mistake to try to do too many things at the same time.

Adams: NDC has obviously grown up in front of the entire industry, from a co-op to private equity. How do you manage the cultural change?

Seitz: It’s a collective effort. Somebody must be the leader, but it’s a very collaborative effort to achieve success in business. And anybody that’s had success understands that and appreciates it.

The cultural change is interesting. You cannot have a good culture unless you’re successful. You cannot be successful unless you have a good culture. For me, it is the way that we treat people and build relationships every day.

It’s integrity and consistency. Whenever I interview someone, I tell them that the biggest way to get on my bad side is not to speak to our receptionist when you are in our lobby. When you get off the elevator in the morning, you know, there’s a person sitting there. And if I see somebody get off our elevator and not speak to that person, I’m going to have a problem. I know that sounds a little self-righteous, but it’s a metaphor for what’s important to me. It’s about mutual respect.

Once you develop that culture, you have to remember to live it – you must hire and fire by your culture. Unfortunately, I have sometimes fallen short of my own expectations. Nonetheless, you must treat your partners consistent with your culture, while also making sure that the culture contributes to financial success. Ultimately, the responsibility of any leader of a business is to create jobs, support families, and support the trading partners that count on them. I am proud that we have a culture that’s well-respected in the industry. I think people feel appreciated and respected here, and when people feel appreciated and respected, they’ll run through a wall to take care of their customers.

As we have changed ownership in the company, we have been able to make sure that all of our partners appreciated that our culture is an essential ingredient to financial success.

Adams: One last question, and this might be the hardest: What’s your forecast for the future of distribution, and more importantly, the future of independent distribution?

Seitz: As a function in healthcare, the opportunities for distribution are immense from a macro level.

Executive Interview: NDC’s Mark Seitz

Regardless of advances in techNDC team members distribution businesses – they’re not nology and changes in care settings, just independent distributors. come from diverse wherever care is provided, a product If you look at our customer backgrounds and must arrive so that the caregiver can base that is independently owned, provide a service. So, distribution is diverse professional they all have carved out a spesafe and secure. It’s about how you cialty, niche, delivery model innovaexperiences. adapt to best position your distribution, or marketing capability that’s I’ve got all this tion business to stay relevant. truly unique. It used to be sort of experience capital Looking at macro trending, if cookie cutter, independent distribuyou just did a market study, which tors serving an alternate site market. from all these we’ve done a couple recently, you’d That’s not the case anymore. Maybe wonderful people see that the market’s expanding. The they’re specializing in dermatology. that I’ve had a population is expanding. There’s Maybe they’re specialized in cardigoing to be more insured lives than chance to work with ology. Maybe they’re specializing in there ever has been before. Unfortuorthopedics, all these markets that at NDC and nately, there’s more chronic disease haven’t been consolidated because in the industry. states. There is an aging baby boomer they’re great markets to serve. They population. Taken collectively, these developed the capabilities to be macro trends make this time the best able to serve those markets. There’s ever to be in healthcare. immense opportunity with independently owned speLet’s talk about independent distribution for a cialty distribution models. little bit. I think “independent distributor” is a tired I want to close by highlighting that, for me, it is a privilabel. I think they’re independently owned specialty lege and honor to be part of such a wonderful industry.

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POST-ACUTE

‘What Matters’ For providers, being ‘age-friendly’ means listening to the patient “What’s bothering you today?” or “How do you feel?” are common openers for physicians, nurses and other

caregivers when they meet a patient. What often follows are a quick diagnosis and treatment plan. But some providers are rethinking the process. They’re taking a step back and asking their patients a fundamental question: “What matters to you insofar as your health and life are concerned?”

For some patients, it might be gaining enough strength to walk a block, or controlling pain, or living independently as long as possible. For those with an advanced illness, it could be, “I want to live long enough to see my daughter’s baby,” “or “I’ve always wanted to travel, and now is the time to do it.”

The Age-Friendly Health Systems movement is an initiative to align “what matters” to the patient and their family caregivers at every care interaction. Launched in 2017, Age-Friendly is an initiative of The John A. Hartford Foundation and Institute for Healthcare Improvement (IHI) in partnership with the American Hospital 16

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Association and the Catholic Health Association of the United States. Until now, it has focused primarily on older adults in the ambulatory or acute-care setting, but proponents believe its strength lies in its application across the care continuum, including long-term and post-acute care.

The 4Ms Close to 2,000 providers are formally recognized as being “Age-Friendly” by the Institute for Healthcare Improvement, says Alice Bonner, PhD, RN, senior advisor for aging at the IHI. The number of nursing homes and other congregate care settings is growing.

POST-ACUTE In order to become recognized as age-friendly, the provider must demonstrate a set of four evidence-based elements of high-quality care, known as the 4Ms: What Matters, Medication, Mentation, and Mobility. Some organizations include a fifth – Medical Complexity.

What Matters: Knowing and aligning care with the older adult’s specific health outcome goals and care preferences, including, but not limited to, end-of-life care, and across settings of care.

Medication: Using age-friendly medication that does not interfere with What Matters to the older adult, Mobility or Mentation.

Mentation: Identifying, treating and managing dementia and depression.

Mobility: Ensuring that each older adult moves safely every day to main function and do What Matters to them.

Age-Friendly is effective only if the 4Ms are delivered as a set, according to proponents. Still, “What Matters” is the central tenet from which the others spring. Finding out what matters to the person and developing an integrated system to address it can lower inpatient utilization (54% decrease) and ICU stays (80% decrease), while increasing hospice use (47.2%) and patient satisfaction, according to

“4Ms” Framwork of an Age-Friend Health System

the Health Resources & Services Administration of the U.S. Department of Health and Human Services.

A framework for care The 4Ms are a framework to work within, not rigid rules, says Bonner. Healthcare providers have been practicing many of them already, though perhaps not all of them, with all residents, all the time. “But this is about implementing them as a set in hospitals, ambulatory care settings, nursing homes and other settings,” she says.

“ Our goal is for everyone who works at the Cancer Institute to understand the special needs of older adults.”

By implementing the 4Ms across the care continuum, patients can achieve higher functionality and avoid acute care costs, says Donald Jurivich, D.O., chief of geriatrics at the University of North Dakota and program director of Dakota Geriatrics, which partners with skilled nursing facilities and assisted living facilities in North and South Dakota to implement Age-Friendly.

“In ‘What Matters,’ we want to understand the health goals of the older adult,” he says. “We’ve been focused on such things as advanced directives and, in North Dakota, the Physician Orders for Life-Sustaining Treatment, or POLST. But these are end-of-life issues, and we don’t really know the goals of the older adult. Is it to take care of grandchildren? To travel? To do hobbies? We don’t know these things, nor do we document them in the medical record. The point is, once we learn the goals of the patient, it would be well for us to align their care with them.”

An ‘aha’ moment In September 2020, the Hartford HealthCare Cancer Institute was designated an Age-Friendly Health System. The designation recognized the Cancer Institute’s Comprehensive Oncology and Aging Care at Hartford (COACH) program.

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A C LO S E R LO O K AT A FI N I O N™ 2 A N A LY Z E R The Afinion™ 2 Analyzer enables fast and easy quantitative determinations of hemoglobin A1c (HbA1c) and albumin-creatinine ratio (ACR). With its compact size and short test times, the Afinion™ 2 System is ideal for any of your customers that are managing patients with diabetes.

FACTORY CALIBRATED Each Afinion 2 Analyzer is carefully calibrated during manufacturing and a self-check is automatically performed when the instrument is turned on.

No calibration check devices or cumbersome and costly operator calibration is required.

GUIDED TEST PROCEDURE The analyzer’s simple, 3-step procedure includes a touch display with icons and short messages that guide the operator.

NO MAINTENANCE The analyzer has no parts requiring periodic replacement.

Recent studies comparing the Afinion™ HbA1c assay to routine and reference laboratory methods have consistently shown a bias close to zero and a coefficient of variation (CV) below 2% (NGSP units).1-5 Test results can be printed or transferred to electronic medical records.

1. Nathan DM, Griffin A, Perez FM, et al. Accuracy of a Point-of-Care Hemoglobin A1c Assay. J Diabetes Sci Technol. 2019;13(6):1149-1153. https://journals.sagepub.com/doi/abs/10.1177/1932296819836101.

2. Arnold WD, Kupfer K, Little RR, et al. Accuracy and Precision of a Point-of-Care HbA1c Test. J Diabetes Sci Technol. March 10, 2019. https://journals.sagepub.com/doi/pdf/10.1177/1932296819831292.

3. Arnold WD, Kupfer K, Swensen MH, et al. Fingerstick Precision and Total Error of a Point-of-Care HbA1c Test. J Diabetes Sci Technol. March 6, 2019. https://journals.sagepub.com/doi/ pdf/10.1177/1932296819831273.

4. Lenters-Westra E, English E. Evaluation of Four HbA1c Point-of-Care Devices Using International Quality Targets: Are They Fit for the Purpose? J Diabetes Sci Technol. 2018;12(4):762-770. https://journals.sagepub.com/doi/pdf/10.1177/1932296818785612.

5. Sobolesky PM, Smith BE, Saenger AK, et al. Multicenter assessment of a hemoglobin A1c point-of-care device for diagnosis of diabetes mellitus. Clin Biochem. 2018;61(4):18-22. https://www.sciencedirect.com/journal/clinical-biochemistry/vol/61/suppl/C. © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. Any photos displayed are for illustrative purposes only.

10005910-01 08/20

POST-ACUTE “We have been blessed with very active geriatric programs at Hartford HealthCare for many years,” says Christine Waszynski, APRN, coordinator of Hartford’s Inpatient Geriatric Services and NICHE (Nurses Improving Care for Healthsystem Elders) program. In fact, Hartford Hospital became a NICHE site in 2003 in order to achieve systematic change to benefit hospitalized older patients. “Age-Friendly isn’t a new concept, but it fits into our mission and core values,” she says. “The 4Ms make it easy to digest, and they are very tangible to our geriatric population.”

“Our goal is for everyone who works at the Cancer Institute to understand the special needs of older adults,” says Mary Kate Eanniello, DN, RN, OCN, director of oncology education and professional development. “AgeFriendly is the perfect tool to help us achieve that.” The key to its implementation has been Rawad Elias, M.D., who came to the Cancer Institute three years ago to serve as its medical director of geriatric oncology, she says.

“ Once we learn the goals of the patient, it would be well for us to align their care with them.”

about geriatric oncology. “I interviewed at Hartford Cancer Institute and found they were just as excited about it as I was,” he says. He joined the Cancer Institute in 2018 and later helped launch COACH. In January 2021, he took on his current position as medical director of geriatric oncology.

COACH features a team of providers who work with each other and the referring oncologist to help older patients achieve what they wish following a cancer diagnosis and treatment. Following the patient’s initial assessment, they might offer psychosocial support, nutritional advice, physical and occupational therapy, guidance from a pharmacist, even help managing household bills.

“We can’t tell the oncologist what to do,” says Elias.

But by engaging with oncologists and surgeons, those involved with COACH focus not just on treatment, but on the patient and their quality of life after treatment.

“My big message is, ‘Treat the patient, not the cancer,’” he says. “If you focus on the cancer, you link it to the treatment. But when you focus on the patient, you work on what makes sense to them.”

“The most important thing for the Cancer Institute and our patients is that we have a validated tool to use for the initial assessment,” says Eanniello. “If a patient is vulnerable or frail, we tell them. But if they want to live to see their daughter get married, we will be proactive in helping them reach that goal. Nobody wants to do harm to a patient. But without proper tools, like the assessment, it’s difficult to put a workable plan in place.”

Incorporating Age-Friendly Elias always had an interest in oncology, but his “aha moment” came about 10 years ago when he read a book on geriatric oncology, he says. His passion for the subject grew through a fellowship and exposure to the late Arti Hurria, M.D., a nationally recognized expert and advocate for elderly patients with cancer, who led the Center for Cancer and Aging at the City of Hope in Los Angeles.

At the Center, Hurria and her team developed a comprehensive assessment of patients to determine a more tailored approach to cancer care, one that could help the patient and provider predict that person’s risk for chemotherapy’s side effects, the impact of treatment on their medications, and their preference regarding treatment, taking into account its impact on the person’s ability to act independently.

Elias looked for a practice setting that would enable him to bring to patients the insights he had gained 20

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One of the little-known facts about being Age-Friendly is that it actually can save the provider time and money, says Bonner. “It’s not about cutting corners. It’s about redesigning the care processes in a way that eliminates extra steps and unnecessary workflow. That might mean eliminating meds that people don’t need, or parts of the care plan that the person doesn’t want. So it’s not adding work for the staff. It’s redesigning how the staff works.”

And in most cases, people are far more satisfied with their treatment.

“We put a lot of passion and energy into this, but passion isn’t enough,” says Elias. A formal structure or framework is needed, such as the COACH assessment tool. “That’s what’s important for sustainability.”

“We have integrated the 4Ms into our standard workflow and with staff who come to us,” says Waszynski.

“Our motto is, ‘This isn’t extra work. It’s our work.’”

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The Science of Soap Formulation

Prior to publication of the 2002 Centers for Disease Control and Prevention (CDC) hand hygiene guidelines,

soap was the predominant hand hygiene product. While alcohol-based hand rub (ABHR) is the primary pillar of hand hygiene today, washing hands with soap and water is recommended primarily when hands are visibly soiled or contaminated with blood or other bodily fluids and when there are outbreaks of Clostridium difficile or norovirus.1 Soap is still a critical part of hand hygiene in healthcare settings and is often not always given as much consideration as it deserves. Soap can have an impact on healthcare workers’ (HCW) skin health. That’s why it’s important to understand how soap works and how choosing a properly formulated soap can make all the difference in helping to maintain proper skin health and giving safer patient care.

Choosing a soap The general mechanism of action is lifting and suspending oil, dirt, and other organic substances from hands so they can be rinsed down the drain, much like cleaning a dirty dish. Soaps are classified as surfactants (surface active agents) that possess both polar (ionic/hydrophilic) and non-polar (long hydrocarbon/hydrophobic) groups.

A soap molecule has a polar head that is water-loving and

a non-polar tail that is oil-loving. When water is added, the soap molecules aggregate into tiny formed clusters called micelles. When this happens all the non-polar (oil-loving) tails line up on the inside, excluding the water and attracting the oil and dirt to the inside of the micelle and suspending it there. The polar heads align on the outside of the micelles where the water is and allow the suspended dirt and oil to be washed down the drain. As a result, www.repertoiremag.com

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soaps are capable of cleaning skin and other substrates by removing both water soluble and water-insoluble dirt from the substrates and suspending them in aqueous, or water-like, solutions.

When choosing between a plain or non-antimicrobial and antimicrobial soap it is important to understand the key differences. With non-antimicrobial soaps, organic substances and some germs are removed by simply using friction from rubbing hands together. This action helps loosen up the bacteria and soils on the hands, allowing them to be rinsed down the drain. With an antimicrobial soap, the same physical mechanism of action for removing germs and soils happens, and any bacteria or germs present are exposed to the antimicrobial active ingredient which attaches to the germs and kills them. The CDC hand hygiene guidelines allow the use of either an antimicrobial or a non-antimicrobial soap. One is not recommended over the other in healthcare.

Not all soaps are created equal and poorly formulated soaps can be very harsh on the skin, setting up a vicious dry skin cycle that worsens with each soap handwash.

Understanding the anatomy of skin To understand how hand hygiene products affect the skin, it is important to understand a little about the anatomy of skin. The top layer of skin, known as the stratum corneum, is made up of mostly dead skin cells, lipids, oils and corneocytes. This paper-thin structure serves as the primary barrier between the body and the environment.

Its primary function is to protect the body and to prevent loss of water. The stratum corneum has a brick-andmortar structure that is tightly packed together to form your skin barrier. When washing your hands with soap the micelles attract oils and lipids, as previously mentioned, but they are also attracting and removing the oils and

Key points It’s important to understand the key differences between a plain or non-antimicrobial and antimicrobial soap: ʯ With non-antimicrobial soaps, organic substances and some germs are removed by simply using friction from rubbing hands together. This action helps loosen up the bacteria and soils on the hands, allowing them to be rinsed down the drain.

ʯ With an antimicrobial soap, the same physi-

cal mechanism of action for removing germs and soils happens, and any bacteria or germs present are exposed to the antimicrobial active ingredient which attaches to the germs and kills them.

lipids from this top layer of your skin. As these lipids are removed from your skin, they can leave gaps in the brickand-mortar structure through which allergens and germs can to enter. This interruption of the skin’s barrier happens when a HCW over-uses soap and water to clean their hands, and can happen faster if warm or hot water is used when washing. Think of washing butter (similar to the skin’s “mortar”) off of a dinner plate at home. Therefore, it is also important to use cool or lukewarm water when washing hands with soap and water.

Given the impact of soap on the skin, it is critical for healthcare facilities to choose a soap that has been formulated for high in-use settings. Not all soaps are created equal and poorly formulated soaps can be very harsh on the skin, setting up a vicious dry skin cycle that worsens with each soap handwash. In the past, antimicrobial soaps have been less mild to skin than non-antimicrobial soaps; however, the latest generation of antimicrobial soaps can provide both antimicrobial efficacy and improved skin mildness. While there is not specific guidance on the use of either an antimicrobial or a non-anti-microbial soap, it is critical to choose a well-formulated soap with low potential for irritation to help mitigate skin health issues.

Selecting the right soap may not be easy, but being wellinformed about the options and key selection factors can help make the process easier.

1. D ubberke ER, Carling P, Carrico R, et al; Society for Healthcare Epidemiology of America. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update.

Infect Control Hosp Epidemiol. 2014;35(6):628-645.

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TRENDS

Inpatient Hospital Care Comes to the Home

Medicare believes that treatment for more than 60 different acute conditions can be treated appropriately and safely in home settings with proper monitoring and treatment protocols 24

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Medicare has given a boost to a home-based program that’s closer

to inpatient acute care than to traditional home care. In fact, it is acute care, reimbursable at inpatient rates – but it is administered to patients in their homes. And even though the agency’s recent actions are intended to last only for the duration of the COVID public health emergency, proponents of “hospital at home” programs – often referred to as HaH – are hopeful that its impact will be longer-lasting.

In November, the Centers for Medicare & Medicaid Services expanded its previously announced “Hospitals Without Walls” initiative with its Acute Hospital Care At Home program, providing eligible hospitals with more regulatory flexibilities to treat eligible patients in their homes. The agency believes that treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD) care, can be treated appropriately and safely in home settings with proper monitoring and treatment protocols.

Participating hospitals must ensure that a registered nurse evaluate each patient once daily, either in-person or remotely. Two in-person visits by either registered nurses or mobile integrated health paramedics must be made daily. (Prior to the November announcement, hospital-at-home programs were required to provide onsite nursing services 24 hours a day, 7 days a week, and the immediate availability of a registered nurse for care of any patient.)

Participating hospitals must have appropriate screening protocols before care at home begins, to assess both medical and non-medical factors, including working utilities, assessment of physical barriers and screening for domestic violence concerns. Beneficiaries can only be admitted from emergency departments and inpatient hospital beds, and an in-person physician evaluation is required prior to starting care at home.

Remote monitoring can be continuous or intermittent, and the intensity should be appropriate to each patient’s management needs. All patients must have at least two sets of vital signs obtained daily, in-person by clinical team staff.

Hospital-at-home programs have flourished in countries with single-payer health systems, but their use in the U.S. has been limited, according to the Commonwealth Fund. In Victoria, Australia, for example, every metropolitan and regional hospital has a hospitalat-home program, and roughly 6% of all hospital beddays are provided that way. Nearly 60% of all patients with deep venous thrombosis were treated at home in 2008, as were 25% of all hospital patients admitted for acute cellulitis.

A hospital-at-home pioneer in the United States – Johns Hopkins – reports that compared to similar hospitalized patients, HaH patients experience lower rates of mortality, delirium sedative medication use and restraints. In addition, HaH programs result in:

ʯ Cost savings of 19% to 30% compared to traditional inpatient care. ʯ Lower average lengths of stay. ʯ Fewer lab and diagnostic tests compared with similar patients in acute hospital care.

Which patients can benefit most?

As of late January, 38 health systems with 92 hospitals in 24 states were enrolled in CMS’ program. Two of them were Presbyterian Healthcare Services in Albuquerque, New Mexico, and Mount Sinai Health System in New York. Elizabeth De Pirro, M.D., medical director, Presbyterian Medical Group; and Pamela Saenger, M.D., MPH, lead provider at Mount Sinai Hospitalization at Home, spoke at a recent webinar about patient selection, sponsored by the Hospital at Home Users Group.

Daily operations must be fast, responsive and efficient, and patient flow from acute to community must be seamless.

Presbyterian established its program – Presbyterian Hospital at Home – for its own health plan and Medicare Advantage in 2008, explained De Pirro. The program provides hospital-level care at home for six different diagnoses, and serves patients 18 years old and above, who live within a 25-mile radius of a Presbyterian hospital.

She cited a 30-day readmission rate of 5.6%, and a 90-day readmission rate of 6.4%.

Mount Sinai launched its Hospitalization at Home program in 2014 and began admitting COVID-19 patients in May 2020. To date, the HaH team has treated more than 1,100 patients, ages 18 and over. Over 95% of referrals come from the ED or inpatient floor, with a smaller number from the home or clinic. The 30-day readmission rate in the first three quarters of 2020 was 6.3%.

Selecting suitable patients for HaH is a critical first step in the program’s success, said De Pirro and Saenger.

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TRENDS touch with their referral sources, to educate them on the program, they said.

Return on investment Mass General Brigham in Boston has nearly five years’ experience providing home hospital care. Over the course of the past two to three years, it has offered such care to over 1,000 patients, most often those who present to the ED for acute illnesses that require hospitalization,

including infections, heart failure, asthma and other acute conditions.

In December 2019, physicians within Mass General Brigham reported the results of a randomized controlled study of hospital-level care at home for acutely ill adults.

The study found that the cost of care was nearly 40% lower for home patients than control patients. Home hospital patients had fewer lab orders, used less imaging and had fewer consultations. The team also found that home

Are your customers ready?

Hospital-at-Home programs call for a great deal of time and commitment. At a recent webinar sponsored by the Hospital at Home Users Group, Elizabeth De Pirro, M.D., medical director, Presbyterian Medical Group in Albuquerque, New Mexico; and Pamela Saenger, M.D., MPH, lead provider at Mount Sinai Hospitalization at Home, New York, listed some of the questions any health system interested in HaH must ask itself:

How intensive is our patient monitoring? ʯ Can we provide telemetry, continuous vital signs monitoring? ʯ What is the frequency of touchpoints? In-person vs. telehealth? ʯ How about after-hours availability – community paramedicine, urgent RN/provider visits?

What are our diagnostic capabilities? ʯ Which labs can/can’t we perform? How long to result? How frequently can we monitor? ʯ How quickly can we get new meds to the home? ʯ Do we have the capability to do EKGs? X-ray? Ultrasound/dopplers? Line placement? ʯ Are specialist consults possible?

What clinical capabilities and ancillary services can we provide? ʯ Foleys, wound vacs, tubes & drains, IV pumps, midlines/PICCs? ʯ Can we deploy physical therapy, occupational therapy, speech/swallow therapy? ʯ Which DME can we get to the home – and how quickly? ʯ Who will provide food delivery for patients with access issues? ʯ Home health aides?

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How about social and safety considerations? ʯ Does the home have any infestations? ʯ Access to electricity, water and food? ʯ Substance abuse? ʯ Are there weapons in the house?

ʯ If there are pets, are they a threat to strangers?

ʯ Can IVs and other equipment be kept clean and safe?

ʯ How about special popula-

tions, such as people who are homeless, or who live in a group home or assisted living?

hospital patients spent a smaller portion of their day sedentary or lying down, and had 70% lower readmission rates within 30 days than control patients.

Huntsman at Home™ a program of the Huntsman Cancer Institute at the University of Utah, was launched in 2018. Patients who have been referred by their oncologist and who live within a 20-mile radius of the flagship hospital in Salt Lake City may participate. (In July 2020, Huntsman expanded its program into rural Utah, including Carbon, Emery and Grand counties.)

The HaH team is led by Huntsman Cancer Institute nurse practitioners working in conjunction with HCI oncologists, and is operated in partnership with Community Nursing Services, a home health and hospice agency that provides registered nurses. Other cancer care specialists such as social workers and physical therapists contribute to patient care.

In May 2020, Huntsman at Home reported the results of a 14-month study comparing outcomes for 169 cancer patients who participated in the program, and 198 who did not, as they lived outside the service area. During the first 30 days of enrollment, Huntsman at Home patients were 58% less likely to be admitted for an unplanned hospital stay, and those who were admitted to the hospital had a shorter length of stay. Huntsman at Home patients had 48% fewer emergency department visits. They also had 48% lower cumulative charges for clinical services when compared to controls.

Results over 90 days were similarly robust.

Speaking at a user group’s webinar about logistics and operations issues in February, Karen Titchener, MS, director of strategic management for Huntsman at Home™, said such programs are “a machine that has to keep flowing.”

Daily operations must be fast, responsive and efficient, and patient flow from acute to community must be seamless.

There must be good communication within the team, and with staff, patients, oncologists, patient and family, she said.

In addition to the clinical team, HaH programs demand that a day-to-day manager oversee logistics.

Huntsman has four cars in the field, each with equipment and supplies for EKGs, bladder scans and IV access, as well as first-dose pharmacy bags. Titchener has found that staff can be expected to make three to five visits in an eight-hour day; four to six visits in a 10-hour day; and six to eight visits in a 12-hour day.

The key to success in the hospital-at-home program lies in flexibility, she said. “Your program will evolve.

Don’t write anything in stone. And don’t be afraid to change. You learn from something that didn’t work, and you adapt and move forward.”

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TRENDS

Physical Health / Behavioral Health Primary care doctors draw the connection, but can they address it in their practices?

Mind or body. Traditionally, if primary care physicians had to focus on one or the other when diagnosing and

treating a patient, they’d go for “body.” But that may be changing.

In 2020, the American Medical Association and seven other physician organizations, including the American Academy of Pediatrics, American College of Obstetrics and Gynecology, and the American Academy of Family Physicians – joined forces to form the Behavioral Health Integration (BHI) Collaborative. Its mission is to enable physicians to sustain a “holistic and equitable approach to physical and behavioral healthcare in their practices.”

The need to gather and act on “biopsychosocial” data has been recognized in the medical community for years.

In 1996, for example, an Institute of Medicine report on primary care cautioned that mental health and primary care are inseparable, and that avoiding one or the other usually leads to inferior care. And in 2011, the Robert Wood Johnson Foundation noted that “having a mental disorder is a risk factor for developing a chronic condition, and having a chronic condition is a risk factor for developing a mental disorder. When mental and medical 28

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conditions co-occur, the combination is associated with elevated symptom burden, functional impairment, decreased length and quality of life, and increased healthcare costs.”

As many as 40% of all patients seen in primary care settings have a mental illness, and given that mental and physical health problems are often interwoven, as many as 70% of primary care visits stem from psychosocial issues, concludes the National Center of Excellence for Integrated Health Solutions. While patients may initially present with a physical health complaint, data suggests that underlying behavioral health issues often trigger these visits.

And in a study in the June 2020 issue of the Annals of Internal Medicine, researchers said that 68% of persons with a mental health problem also have medical conditions, and persons with chronic illness are twice as likely to have mental illness.

Despite all these statistics, integrating behavioral and physical health is still uncommon among U.S. physician practices, the researchers said. And the reasons are no surprise. “Philosophically, behavioral health integration is not meant to succeed in fee-for-service,” noted one primary care practice leader cited in the study. “The traditional [financial accounting] measures don’t apply.”

For four years, the Centers for Medicare & Medicaid Services has made separate payments to physicians and non-physician practitioners for BHI services. As of

January 1, 2018, these services were to be reported using new CPT codes. Although the agency has not taken any significant additional steps to explicitly incentivize behavioral health integration (BHI), many of its population-health or value-based care efforts indirectly work to incorporate and encourage such efforts, says Patrice A. Harris, M.D., AMA immediate past president and an Atlanta-based psychiatrist. That said, “utilization of the medical reporting codes for BHI is significantly less than the unmet need for behavioral healthcare services,” she adds.

What it looks like Most approaches to behavioral health integration fall on a continuum between two “archetypes,” according to the Annals researchers. On one end is a “co-located model,” in which behavioral health clinicians are onsite with primary care physicians. On the other is a “collaborative care model,” in which offsite behavioral health clinicians (usually psychiatrists) supervise onsite care managers who help primary care providers meet patients’ behavioral health needs.

“An integrated approach to delivering behavioral health care is not a one-size-fits-all solution,” says Harris. “A consistent feature of practices that have adopted BHI is that medical and behavioral health clinicians work together as a team to identify and address the individual patient’s behavioral and medical health concerns. By comparison, practices without BHI may be unable to offer as many options or respond as quickly when new behavioral health needs are identified, and access to treatment may be limited due to significant wait times. Once an integrated approach is in place, it can be activated when and for people who need it, and it does not have to be established anew for each and every patient.

“With BHI, primary care practices frequently maintain contact with the patient and provide brief interventions – if deemed appropriate – while facilitating a handoff to a behavioral health clinician when warranted,” she says. Additionally, integration makes diagnosis and medication management much easier, since the primary care physician can consult with a behavioral health specialist about complex patients, such as someone who is not responding to therapy.

Behavioral care manager In an integrated model, a “behavioral healthcare manager” coordinates the care of the patient and ensures effective communication among team members, says Harris. The

manager – who frequently has a master’s level education or specialized training in nursing, psychology or counseling – ensures implementation of treatment plans, provides brief psychotherapy consistent with their training and licensure, supports medication management, alerts the primary care physician when a patient is not responding to treatment, and communicates with the psychiatric consultant regarding treatment changes.

In many instances, the salary of the behavioral health care manager is paid by the practice or health system if they are a full or nearly-full-time member of the staff,” she says. In some practices, and depending on an individual’s qualifications and licensure, a behavioral health manager may bill independently for their services. Some practices or health systems have received grants that cover or partially cover the salary of the care manager; however, this financial support may be limited to the term of the grant. “Ultimately, who pays for their salary depends on how the integration model is structured.

‘Any steps taken toward integration – no matter how small – can have a significant impact on patients.’

“As for the consulting psychiatrist, their salary is typically paid for by the practice or health system, since they are providing ad hoc consultation to the practice or health system and do not see the patients or prescribe medications, except in rare circumstances.”

Financial sustainability A 2020 AMA-RAND study noted that financial sustainability is a pervasive and continuing concern for practices that have implemented BHI, says Harris. “Some practices are confident that they can achieve financial sustainability via fee-for-service payments negotiated with commercial payers and using the Medicare billing codes. Many other practices, however, continue to struggle when estimating the specific impact of BHI on revenue and expenses. More assistance is needed to help practices analyze the full cost of integration activities and assessing their financial viability. www.repertoiremag.com

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TRENDS “Adoption of alternative payment models may increase long-term sustainability of integrated behavioral healthcare through return of shared savings and improved care quality,” she says. “There may not be a direct benefit seen in the office expenses, and realizing real financial returns may take several years, so it is important to take a comprehensive view of whole patient care.” Calculations of the return on investment should account for improvements in patient satisfaction, chronic disease outcomes, medication adherence, and the frequency of emergency room visits and hospitalizations.

There is no one way to accomplish behavioral health integration, says Harris. “Primary care physicians can customize their approach to fit the circumstances of their practice, including how it is structured, resources available locally, specific patient population needs, etc. The better the fit to the practice culture and available resources, the better the outcome.

“At the same time, primary care physicians should not let the number of available choices discourage them from acting. Any steps taken toward integration – no matter how small – can have a significant impact on their patients.”

A new take on the H&P When asked to predict the future of behavioral health integration, Patrice A. Harris, M.D., American Medical Association immediate past president and an Atlanta-based psychiatrist, says, “Ideally, in 10 years we won’t even be talking about ‘integration’ per se. We’ll be talking about total patient care, because all care – physical, mental and behavioral – is seamlessly integrated into physician practice.” Some medical schools are already steering their students in that direction.

A pilot project funded by a grant from the AMA Accelerating Change in Medical Education initiative is training students at four U.S. medical schools to incorporate a new history and physical (H&P) model – the H&P 360 – to collect biopsychosocial data, better manage chronic disease and address social determinants of health. The four schools are the University of Michigan, Eastern Virginia Medical School, Florida International University and the University of Chicago.

“Medical practice is necessarily undergoing a paradigm shift, and the new paradigm has to do with accounting for social determinants and behavioral health,” says Brent Williams, MD, MPH, director of the Global Health and Disparities Path of Excellence at University of Michigan Medical School. Early pilot results show that students trained in H&P 360 are more likely to recognize patient needs and to suggest appropriate resources.

The idea behind the H&P 360 is that by including in the routine history at least a few questions in each of the following six domains, physicians’ care of patients will improve: 1. Patients’ perceptions of health, goals and values.

2. M ental health conditions, including mood, thought patterns, pertinent social issues.

3. B ehavioral health, e.g., health behaviors, medication

management/adherence, nutritional behaviors, physical activity, personality disorders, substance abuse.

4. Social support, including primary relationships, social support, caregiver availability, abuse/violence, community relationships.

5. Environmental or physical resources, such as food security, housing stability, financial resources, access to transportation.

6. Functional status, including affect, social and occupational functioning, satisfaction with life, activities of daily living.

Clinicians are not expected to collect the entire range of biopsychosocial data from their patients in a single encounter. Rather, specific information can be elicited over time as appropriate to individual patients, rather than an exhaustive generic checklist.

Editor’s note: The sample questions that the AMA suggests for each of the six domains makes for interesting reading.

Go to https://cdn-links.lww.com/permalink/acadmed/a/acadmed_2020_07_24_kirley_acadmed-d-20-02813_sdc1.pdf

Editor’s note: For your physician customers who want to learn more about behavioral health integration, steer them to the online Behavioral Health Integration Compendium, © 2020 American Medical Association. In 30 pages, the guide covers the basics and background of behavioral health integration, with guidance on how to get started and implement BHI. 30

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BD, the BD Logo and Veritor are trademarks of Becton, Dickinson and Company or its affiliates. © 2020 BD. All rights reserved. December 2020

LEADERSHIP

Pivot with Purpose Lessons on corporate resiliency

By Lisa Earle McLeod

If your sole purpose in business is to make money, when an economic crisis hits, you’re going to flounder.

In a time of economic volatility, the firms who define themselves by their earnings alone will be hard pressed to rally their teams or innovate on behalf of their customers.

Contrast firms whose single North Star is money with organizations who have a customer-focused purpose bigger than money. A team aligned to improve life for customers has somewhere positive to look during a crisis. They’re less likely to panic because customers still need their help. Clarity of purpose improves resilience.

For example, the hotel industry was amongst the hardest hit by the COVID crisis. The revenue impact was immediate, and likely long lasting. But one chain in particular found themselves turning to a noble purpose to weather the storm.

When Hilton Founder, Conrad Hilton said, “It has been, and continues to be, our responsibility to fill the earth with the light and warmth of hospitality,” he had no way of knowing that 100 years later, the employees of Hilton worldwide would draw upon that single sentence to chart their course during a global pandemic of 2020.

As many industries face devastating economic impacts and an uncertain future, Hilton’s response to the crisis provides some lessons for other firms that have been hard hit.

Leaning on their sense of purpose – to fill the earth with the light and warmth of hospitality – Hilton was able to rally their employees and start innovating for the future. When I recently spoke with Danny Hughes, Hilton’s President Americas about Hilton’s response, three key strategies emerged that can be used by other leaders facing similar challenges:

No. 1: Find a noble purpose you can rally around Before the crisis, did you have a higher purpose, if so what was it? Now is the time to double down on it. If you didn’t have an explicit purpose, what was your implicit purpose? How did you make a difference to customers?

That should be your starting point going forward.

When the crisis hit, Hughes says, the Hilton Executive team knew, “We lead with hospitality, we are ultimately in the business of serving people.” This gave them a framework for making fast decisions. Hilton decided to partner with American Express to give away a million free rooms to medical professionals. Hughes reflects on the Executive Team’s conversation, “Our President and CEO (Christopher Nassetta) knew immediately, there was going to be a need. We all looked at him and said go for it.” Free rooms came as welcome relief to frontline medical staff who needed a place to sleep, recharge or isolate, and who might have otherwise had to spend their own money.

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LEADERSHIP The leadership lesson here goes beyond simply being generous. Clarity of purpose before the crisis enabled Hilton employees of every level to respond quickly. If you don’t have that clarity of purpose today, think about the impact you want to have on your customers, and use that as a starting point. When you frame decisions around your highest aspirations for your customers, your team can come up with bolder ideas. While every team can’t give away their product, leaders can find ways to step up for customers who need them.

No. 2: Innovate for the long term (sorry amygdala) When you’re trying to recapture lost revenue, your team is going to be inclined to simply try to do more of what they did in the past. And they’ll probably do it in more frantic ways. This is unlikely to work because circumstances have changed. Even if things aren’t monumentally different in your industry, your customer’s mindset has changed dramatically. Instead of being reactive, think about what the world will look like for your customers a year from now. They may be trapped in today’s problems, but if you and your team can imagine what your customer will be trying to achieve in the future, you can be ahead of the market.

As Henry Ford famously said, “If I had asked people what they wanted, they would have said faster horses.”

An organization thinking about the impact they want to have on customers in the future has a big advantage over an organization who is simply trying to recapture lost revenue.

In a hospitality world, big meetings were cancelled when COVID hit. While they were handling the immediate crisis, Hilton also began thinking about what meeting planners would want when they start to reschedule things. Clarity about their purpose, and thinking about their customers’ and owners’ future needs, prompted Hilton to launch EventReady with CleanStay, a program that includes new cleanliness protocols, greater flexibility in contracting (to enable meeting planners to schedule well in advance without fear of cancelling) along with distancing plans for meetings and utilizing outdoor space.

Your firm’s version of future thinking will be different. Put yourself in your customer’s shoes one year from now. What will be going through their minds? What do they care about? What do they worry about?

No. 3: Prioritize humanity For many leaders the first (and natural) thought in a crisis is, what impact will this have on our financials? Preserving economic viability is crucial, but it’s not the full story.

How you respond on a human level is what will drive the good will of your staff and customers for years to come.

Hughes describes a situation that revealed how deeply Hilton staff cared about their people and their customers.

One of Hughes’ first trips after reopening was to the McLean Hilton, near Hilton headquarters outside Washington, DC. Sitting in the lobby, Hughes observes, “This lady comes in with two jugs of milk through the revolving door.” She was Kinko Hamilton, wife of McLean property General Manager Scott Hamilton. She didn’t work at the hotel, yet despite having just made a cross-country move, and with two kids at home doing remote schoolwork, she’d gone out to get milk so the hotel’s Team Members could have milk with their cereal. Hughes says, “A small act of humanity and hospitality makes a difference to the staff. In all the tragedy that we’re going through, those small acts remind us of our humanity.”

You know your employees care deeply when even their spouses pitch in. Leaders who pull shared humanity front and center and are more likely to have a team that will go the extra mile. On the flip side, when leaders double down on logistics or finances, they miss an important opportunity to unlock the power of compassion and caring with their team. At the end of the day, the firms who rebound from adversity will be those whose employees cared enough to give it their all.

There’s a popular Chinese proverb, “The best time to plant a tree was 20 years ago. The second-best time is now.”

Maybe your firm had a founder like Conrad Hilton who planted a sense of purpose, hospitality and humanity into the organization over 100 years ago. If so, it’s time to lean on that purpose and leverage it to help you pivot towards the future.

If you didn’t plant your tree 20 years ago, you have a chance to do it now. Some of the strongest teams are born in crisis. You and your team can use this challenging time as an opportunity to decide what you’re made of and what you stand for. When you claim a purpose bigger than money, your organization takes on new life.

You build more confidence for the future. If you’re trying to build resilience, give your people a purpose, then, unleash to do their best work.

Lisa Earle McLeod is a leading authority on sales leadership and the author of four provocative books including the bestseller, Selling with Noble Purpose. Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purpose-driven sales organization. Her NSP is to help leaders drive revenue and do work that makes them proud.

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Building a Resilient Supply Chain This year’s Contracting Professional of the Year helped to develop and implement unique solutions to supply chain challenges brought on by the pandemic.

Amanda Chawla, Chief Supply Chain Officer, VP at Stanford Health Care, Stanford Children’s Health & Stanford-Valley Care

In 2020, collaboration was top of mind for Amanda Chawla, chief supply chain officer/ vice president, Stanford

Health Care, Stanford Children’s Health and Stanford Health Care – ValleyCare. For instance, at the time of Federation of American Hospitals Conference last February, as Chawla watched the coronavirus developments overseas, she tried to plan for what was coming, not only for Stanford Medicine, but for the local community and industry in general. “I probably didn’t imagine the pandemic to the degree that it is today,” she said. “I was thinking about what was happening abroad at the time of Federation, the potential impact, and what were ways I could collaborate with my colleagues should COVID become prevalent in the United States? How could we work together to secure the Supply Chain?”

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Chawla, this year’s The Jounral of Health Contracting’s Professional of the Year, answered those initial questions with ideas that helped Stanford Medicine navigate the COVID-19 pandemic, and benefited neighboring health systems as well.

Stanford Medicine tenets Stanford Medicine is an academic medical center (AMC) focused on education, research and clinical care. The primary organizations are comprised of: ʯ Stanford University School of Medicine ʯ Stanford Health Care ʯ Stanford Health Care – ValleyCare ʯ Stanford Children’s Health All told, Stanford Medicine’s clinical facilities includes approximately 146 operating/procedure rooms and over 1,200 beds. Stanford Medicine has about 3 million outpatient encounters a year with a non-labor spend of $1.5 billion.

Supply chain is a shared corporate service across Stanford Health Care, Stanford Children’s Health and Stanford Health Care – ValleyCare. “Supply Chain is a strategic, operational, and executive function that impacts every single non-labor resource and every function in any organization.

Healthcare Supply Chain requires a patient-centric approach and a dyadic clinical partnership that incorporates value (value = cost, quality, efficiency & outcomes) in every aspect of the business. Supply Chain is about executing board functions from planning, procurement to operations of logistics by keeping the patient at the heart of the equation – we provide the right item at the right time to healing hands that provide care to our patients. Supply Chain is really the supportive arm and sits across the entities.”

There are three tenants that bring those entities together, Chawla said.

“One is our drive to be digitally driven,” she said. “The second is to be value focused, and value as defined by quality, safety cost, experience, whether it involves patients or stakeholders. The third is to be uniquely Stanford, which is the cutting-edge medicine component of changing the way we do things through innovations, education, and research. Having the privilege to lead in an AMC, I have the opportunity to collaborate with professionals across the health system and university and access to resources that assist with the advancement of our profession.”

for the labs needed for COVID-19 testing. “Our lab and procurement team partnered with the School to pull raw materials used in research to make our own media for testing in house,” Chawla said. Stanford Medicine has been making its own media for COVID-19 testing ever since.

Another product shortage involved testing swabs. Supply was limited and, across the industry, supply chain departments were up against the same barriers. Stanford Medicine partnered with several companies in the Bay Area, such as 3D printing organizations and engineers, to try to solve its own supply chain problems.

“ We were able to solve some supply chain problems not only through direct international strategic sourcing, but leveraging collaborations and through the activations of an Innovations Task Force.”

– Amanda Chawla

Innovations and Innovation Task Force Internally, Stanford Medicine leveraged resources, knowledge and the skillsets of its professionals to help propel the health system’s COVID19 response and solve problems that couldn’t have been solved through strategic procurement. The organization created an Innovation Task Force.

Because the global supply chain was being stretched to the limit, Stanford Medicine leaders asked themselves, ‘What solutions could the organization come up with internally?’

As it turned out, plenty. For example, Stanford Medicine was short on media

Through these partnerships, Stanford Medicine was able to produce 3D-printed swabs. Another example of innovation was with PPE and disposables being short on the market, Stanford utilized 3D printing to solve the market limitations with standard face-shields, equipment parts, and CAPR/PAPR shields.

“We were able to solve some supply chain problems not only through direct international strategic sourcing, but leveraging collaborations and through the activations of an Innovations Task Force,” Chawla said.

In early March, as the pandemic worsened and shortages of critical www.repertoiremag.com

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IDN OPPORTUNITIES supplies surfaced, Chawla approached the CEO of an AI technology organization about creating a supply exchange for local healthcare providers. “When you’re in an urgent situation where traditional sourcing channels are limited, the idea is to be able to reach out to your colleagues across our industry and trade product. We know that not all purchasing is equal,” she said. “We have to come together as a healthcare provider industry supporting not only our systems and our community but support one another as healthcare supply providers. While this solution is intended for emergent needs, we still need to evolve and develop data sharing and intelligence that leads to a resilient Supply Chain. We are data-rich but intelligence poor – we

must solve and address the gaps that will allow for visibility in the ‘Supply Chain’ linking raw materials to utilization to demand forecasting.

We must address the simple dayto-day operations such as removing the ‘hunting and gathering’ of par management in logistics. Building an intelligent supply chain that allows us to have a push system, automated information, leading to reliability, performance, transparency, and value, is a must. Can we create a cultural change in our industry that forces transparency and collaboration? When we face the next global pandemic together, we’ve got to be able to collaborate, have solutions in place that protect not only our institutions and communities, but each other across the industry.”

The exchange would prove to be of immediate value for Stanford Medicine and other hospitals as supply shortages varied. Stanford Medicine did a number of exchanges where it had surplus of certain PPE size or item with another system who may have had another PPE size or item. Stanford Medicine traded products such as N95s, cleaning and disinfectant wipes and masks with other systems through the pandemic.

Keeping people at the center When the pandemic hit, Stanford Medicine had to move towards a distributed workforce model almost overnight. Its category management, master data management, and purchasing teams all went off site. They’ve been working from home ever since,

Stanford Medicine

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IDN OPPORTUNITIES amid conditions that require tight coordination, communication, connection and collaboration.

The infrastructure component was critical. Stanford hospital leaders discussed how they could have their command center set up within supply chain so coordination could be maintained from leadership to frontline staff. To do this, they invested heavily in how communications occurred in addition to the structure itself. “We’ve always had monthly newsletters,” Chawla said. “We revamped those for use in our daily huddle structure and enhanced communications and connects through a myriad of different tools from daily cascading of huddles to podcasts to bi-monthly newsletters and increasing frequency of all hands leadership meetings.”

The podcasts have been a hit as they shine light on the frontline team members and present an opportunity for leaders to provide a personal touch to the messaging and organizational communications broken down in a meaningful way.

2020 has been an unprecedent year of disruption, angst and of change. Stanford Medicine navigated through the first supply disruption of the Cardinal packs and gowns to the pandemic to social justice to California fires to the election unrest.

With the amount of disruption the nation has faced it has brought forward economic hardships, loss of homes, illness, job loss, unreliable childcare and much more.

“It’s not just one thing,” Chawla said. “Recognizing the impact of the disruptions, we have focused on well-being, health, the team and support. As a leadership team we have ensured that we’re keeping people at the center of what we do. Part of that for me, is empathy, respect, recognition and the communication, 42

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Taking a moment to step back and reflect on the past year, Chawla said it is important that we recognize the Supply Chain responded and performed in the way that it was designed to, with lean principles. collaboration, and transparency – reaching out. Because at the end of the day, we’re all people, and we’re all in a human business.”

Resiliency Taking a moment to step back and reflect on the past year, Chawla said it is important that we recognize the Supply Chain responded and performed in the way that it was

designed to, with lean principles.

Pre-COVID-19, the key tenants of supplier/provider relationships were efficiency and cost.

The silver lining that the pandemic has brought forward is an opportunity to change or double down on a perspective and approach.

“I do not see cost or price of products and services being removed from the conversation – that is still going to

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IDN OPPORTUNITIES be part of the compensation for economic viability,” Chawla said. “But I would propose the conversation will shift in a more accelerated manner towards total value and reliability.”

Stanford Medicine made two major decisions in the midst of the pandemic to focus on risk, resiliency, transparency and diversification. The resiliency part of the conversation was probably one of the most important elements that is being embedded within contracts with transparency and data as part of contractual language.

“Outside of contracting, it is important that in part of that evolving relationship with suppliers there are more in-depth conversations to build trust and understanding principles. The conversations may go something like, ‘I can’t do X for you; however, an area where we may be able to collaborate or provide support towards the problem or solution is on Z.’ It’s that trust and that knowledge of whether the supplier is a company you can rely on. Do they have safety stock? How do I ensure that my organization is going to be protected and that we are not going to impact patient care? How do we know what the supply is in terms of availability and demand? Importantly, how do we come together?”

Moving forward, there will be a greater demand for further insight into quality and control on inventory.

Providers will want the right and intelligent information and visibility upstream Supply Chain, all the way to raw materials that leads to reliability and resiliency.

Indeed, conversations on visibility are happening all around the industry, Chawla said. There are questions to work through, such as what platform to use, data systems integrity and standards around the data.

“There’s a lot that goes into it. And 44

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Chawla said COVID-19 has accelerated the need to further invest in the Supply Chain on things that we should be doing and have needed to do. right now, as I see what we’re doing at Stanford, and what my colleagues are doing, a lot of it is the focus on resiliency. We’ve invested very heavily in a resiliency program and model.”

Data integrity and transparency are integral. Not just understanding what’s in the pipeline, but what the raw materials are, where they come in during the manufacturing process, how the product is transported, and what is the location of the distribution centers where the inventory is stored before it actually reaches hospitals and health systems. Understanding the current inventory on hand at any given moment to the consumption’s trends and demand fluctuations.

“I believe more organizations will take pause and re-assess their just-intime inventory model differently,” Chawla said. “Because if you think

about it, most hospitals designed their Supply Chain to be a lean Supply Chain, to be Just-in-Time and to only keep a certain amount of inventory on hand. When the pandemic hit, our Supply Chain responded in the way that it was designed. It was not designed around resiliency. It was not designed around pandemics.”

Stanford Medicine did a risk stratification analysis of all the different types of disruptions that can occur from daily manufacturer back orders to a recall to situations that are specific to the Northern California region, like earthquakes or wildfires.

The Supply Chain team then broke the stratification out into four quadrants, and discussed what was most likely to occur, the potential impact, and the hospital’s preparedness and response capabilities.

Based on that grid, the Supply Chain team came up with a number of different factors to examine and resolve as they built their resiliency program. This included data access, data management, analytics, processes across the intra-Supply Chain, and standard work. Another element was the investment of a resiliency program that supports business continuity and manages towards a resilient Supply Chain including risk mitigation scenarios and planning. Facilities also factored in. “We have invested capital into a resiliency warehouse in which we’re keeping certain amounts of supplies and operationalizing a hybrid model between just-in-time with our distributor, direct order management, and the resiliency warehouse.”

Supplier diversification was an important consideration. “Another important element our item management and assessment is using the 80/20 rule. How do we accelerate clinical equivalence substitutes, so

when we have a product disruption with product X, we know what’s clinically acceptable as an alternative?”

The road ahead Chawla said COVID-19 has accelerated the need to further invest in the Supply Chain on things that we should be doing and have needed to do. “It has brought the awareness to our organization as a lifeline – without the medical supplies to our care providers we are handcuffed on the core mission of providing patient care and that is the case for all healthcare institutions.”

Obtaining funding, support, clinical partnership, and investment for Supply Chain has been important. Stanford Medicine’s Supply Chain is clinically integrated and supported. “So we’re fortunate in that sense,” Chawla said. “But it’s brought that to a heightened awareness. We have forged stronger relationships with our clinical providers, leadership across the organizations

and systems, improved some of our business processes that has provided greater visibility in our inventory, and are improving relationships with our strategic suppliers and collaborators.”

Chawla said that the next six to 12 months will be about adjusting to the next normal. “It’s going to involve recognition of what’s gone on in 2020, and how that changed our lives,” she said. “I think we’ve been in the stage of adapting to the new normal, but now it’s about living in that new normal. And it’s about transforming our leadership, business practices for enhancement and optimization for in the next normal of our future.”

Supply Chain and the U.S. healthcare system as a whole must utilize 2020 as a catalyst to lead and change. “Is COVID going away?

Probably not. But how we respond, engage and operate can be different.

We should utilize 2020 as a silver lining to design the next future.”

Doing the right thing Chawla was born in India, but grew up in the suburbs of Seattle, Washington.

Her family relocated to the United States primarily because of an aunt, who was a nurse. Chawla’s aunt passed away due to a medical error. While Chawla was very young when it happened, her aunt’s death was a pivotal event. “It had an impact on my family and in my personal life. As a result, I think about processes, structure, assuming good intent and as a leader my responsibility to provide support

and care to people at the heart and center of leadership,” she said. “How do we create processes and infrastructures that eliminate the potential human errors in our processes? People intend to do the right thing and are good in their desire, but we are human, we do make mistakes. So how do we create an infrastructure that’s around processes and systems and leverage that in the work?”

Chawla got an early start to a career in healthcare as a medical assistant.

While in high school and through college, she worked at a psychiatric hospital performing a myriad of functions from intake, admission, to providing direct patient care across pediatrics to adults. She also worked for a private practice, a group of physicians who wanted to start clinical trials. Chawla would end up opening their clinical trial site operations, establishing the operating procedures to marketing and recruitment. “Some of

the things that the physician owners and leaders taught me was really how we lead and connect with people, whether it was on the frontline taking care of a patient, or whether it was running the office to speaking engagements.

I learned early on that it was really about people.

You can learn the technical aspects of the job, but you have to have the behavioral components and the leadership attributes to bring and lead people.”

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SALES

Is Bad Strategy Worse Than No Strategy?

Three bad habits you might need to break.

By Sandler Training

Your prospect interaction strategies, or lack thereof, have a greater impact on your chance of closing a sale than

the actual features, pricing and benefits of your products and services. Good strategy should become a habit. But bad strategies, or not having a strategy at all, can also easily become habits! We’ve recognized three “bad habits” that are common but also breakable and replaceable with practice!

No. 1: Explaining “what” rather than finding out “why” Many salespeople, those without an end strategy in mind, begin by talking about their company’s capabilities, their experience in the prospect’s industry, their length of time in business. They continue with a listing of their products and services, along with the accompanying features, benefits, functions, advantages, etc.

What’s wrong with that, you might ask? It wastes time – yours and theirs – if the salesperson isn’t coming from a place of first finding out what the prospect truly needs, 46

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if anything, from those long, wordy lists of products and services, features and benefits.

These salespeople are afraid that if they give away too much information, the prospect, fully armed with knowledge, will have the ammunition to fix the problems themselves without the salesperson’s product or service, OR will take the information to a competitor who will inevitably undercut their price.

What these salespeople fail to recognize is that there’s an important difference between discussing solutions and

revealing the specifics of implementing them. It’s necessary to discuss concepts, especially if it helps prospects reveal new perspectives on their challenges; prospects have to “buy” into the true need for the solution before they’ll “buy” the product or service to address it.

Prospects don’t just want to know how much you can DO, but how well you can FIX their pain. You must be absolutely clear about how your solution meets their need. Without making a clear connection between your “what” and their “why” you’ll lose the opportunity to a salesperson who does.

No. 2: Not asking enough questions or the right questions Therefore, the key to closing more sales is uncovering pain, or a level of discomfort on the prospect’s part that’s enough to inspire action. You’re not creating the discomfort, you’re shining a spotlight on something that already exists and letting them tell you about it.

A simple and effective way to uncover a prospect’s pain is “reversing,” or answering a question with a question, with a strategy in mind. Your goal is to dig deeper, mining for the prospect’s pain. Reversing actually helps you find out if they actually have pain or not!

Let’s say a doctor is thinking of adding a lab to his practice and asks you for products, equipment and services you would recommend for a start-up lab. Many reps would instantly jump at the chance to list all the lab equipment, assays, tests, cabinetry, disposables and addon products they carry. But we recommend you respond with something like, “That’s a good question. We carry a wide variety of lab products, and it would take a great deal of time to go over all of it. Can you tell me more about why you’re thinking of adding a lab?”

The doctor explains that he previously offered some lab services that just didn’t make sense for the practice.

Would you be tempted at this point to explain the intricacies of billing, which tests are profitable, which are the

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SALES most performed? Instead, reverse again with a question of your own.

“I’m sorry if you experienced a loss of any kind.

Would you be comfortable enough to tell me a little bit more about it?” After a couple reverses, the doc starts to share a personal experience. The story involves giving up an exam room to have the space to create a lab. It also created changes in personnel, in hours and in time spent seeing patients.

Now that you have a little more information, keep digging and pose questions like, “How did that impact you?” or “What did the personnel changes look like?” or “How did seeing fewer patients make you feel?

Some salespeople will over complicate their offers.

They believe that they must present complex solutions in order to establish value.

That is, they think the more elements and layers in the offer, the more the prospect will perceive the value and effectiveness of it.

The doctor might share personal impacts such as having to let go of a staff member to afford a lab tech, getting up earlier and missing gym time to accommodate lab hours, or feeling disconnected from the community by seeing fewer patients.

Do you see the strategy in this type of questioning?

To relieve pain, you must get the prospect to reveal pain, and to relive it on a personal level. Now you can ask good questions about the prospect’s budget and other

time and personnel resources, and providing answers on the solutions you have to fit their needs.

No. 3: Being uncomfortable talking about budget (and that’s not just money) Some salespeople will over complicate their offers. They believe that they must present complex solutions in order to establish value. That is, they think the more elements and layers in the offer, the more the prospect will perceive the value and effectiveness of it.

Other salespeople over complicate the offer as an attempt to justify the “price tag.” They include a number of “value added” elements that aren’t essential to what the prospect said they need; they’re included to artificially up the perceived value of the offer.

The truth is that prospects appreciate simple and concise solutions and presentations. Simplicity makes it easy for prospects to connect your solution to their needs. The easier you make it for them to see that connection, the more likely you are to make the sale.

Costing out the problem (COP) is an advanced sales technique in which you use facts and numbers and questions to help prospects discover exactly what their issue is costing them, in hard dollars, then using that expense to leverage into action their emotional pain with the current situation.

When prospects see their challenge in terms of how much it’s costing and will continue to cost them, that annoys them. Annoyance is a negative emotion. Negative emotions are in the category of pain. Pain compels people to buy.

So if you find that your strategy is that you’re engaging in one or more of these “common” habits, consider this: common habits are for common salespeople who are satisfied with common results. If disappointing results have become a habit, perhaps it’s time to change them!

Interested in building better habits both professionally and personally? To schedule a complimentary 30-minute advisory session on questioning techniques, goal-setting for success, or other sales or sales management challenge, send your request and contact information to SalesTips@repertoiremag.com with “Free Consultation” in the subject line.

Sandler Training: With over 250 local training centers around the globe, Sandler is the worldwide leader for sales, management, and customer service training. We help individuals and teams from Fortune 500 companies to independent producers dramatically improve sales, while reducing operational and leadership friction. © 2021 Sandler Systems, Inc. All rights reserved.

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HIDA GOVERNMENT AFFAIRS

Red Flags to Avoid PPE Scams Distributors, manufacturers, and healthcare providers all have a role in fighting PPE fraud A year into the pandemic, the problem of counterfeit

personal protective equipment persists, engineered by opportunistic vendors and profiteers taking advantage of the lengthy spike in demand. HIDA recently hosted a webinar, “Working with Your Supply Chain Partners to Avoid PPE Scams” to identify how distributors, manufacturers, and providers can all work together to combat fraud.

The presenters from 3M Healthcare, Medline Industries, and Sri Trang USA emphasized the importance of working with authorized, established distributors and original equipment manufacturers to ensure FDAapproved, quality medical products flow through the supply chain for optimum patient care. If the offer seems too good to be true, it is too good to be true.

Short-term ʯ Reaching out to distributors to understand current challenges ʯ Reducing supply chain complexity (such as modifying a product so that it ships easier) ʯ Reducing niche products (do you really need that grape-flavored glove?) ʯ Suggest alternatives (innovative or nascent products)

Here are key takeaways.

Long-term ʯ Expanding or modernizing facilities ʯ Diversifying raw material sources ʯ Educating and raising awareness (seminars, social media campaigns) ʯ Engaging with regulators and standards organizations

How distributors help

How providers help

Distributors have been deluged with offers from unfamiliar brokers and vendors. In response, they have been using every tool available to meet the increased need. ʯ Identifying appropriate product substitutions when available ʯ Expediting shipping and delivery to hot spots ʯ Coordinating with current suppliers to ramp up production ʯ Vetting and onboarding new suppliers ʯ Using allocation systems to conserve inventory and maximize product ʯ Maintaining stockpiles

Healthcare providers can keep an open line of communication with their trusted distributor partners to help identify and solve pressing challenges created by COVID19. The panelists recommended ways providers can be a positive part of a resilient supply chain. ʯ Being flexible ʯ Being open to evaluating product alternatives (For example, a new generation of latex gloves as a substitute for nitrile) ʯ Focusing on critical product requirements ʯ Recognizing the downsides of large stockpiles (puts products needed on the front lines onto back shelves)

How manufacturers help They manage supply and provide alternatives through short- and long-term strategic planning.

The full webinar recording is available in the Events + Education section of HIDA’s website, HIDA.org.

Unfamiliar sources may not offer vetted product

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Unfamiliar Suppliers

Distributors

Price

One-time deals for the highest price

Prices based on long-term relationships and contracts with manufacturers and healthcare providers

Safety

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Sourced from vetted and FDA-approved manufacturers

Quality

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Take possession and ownership of products and deliver to healthcare provider

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HEALTHY REPS

Health news and notes Read up! Eat up!

The foods and beverages that you consume have a profound impact on your health, says the U.S. Department of Agriculture and the U.S. Department of Health and Human Services in its recently published Dietary Guidelines for Americans, 2020-2025, 9th Edition. The scientific connection between food and health has been well documented for many decades, with substantial and increasingly robust evidence showing that a healthy lifestyle – including following a healthy dietary pattern – can help people achieve and maintain good health and reduce the risk of chronic diseases throughout all stages of the lifespan. The new edition of Dietary Guidelines is 150 pages long, but full of easy-to-understand verbiage and graphics.

Breast density best measured at age 40 High breast density not only has a masking effect on mammogram reading, it also increases the risk of breast cancer. However, most women do not know their breast 52

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density classification until after their first mammogram at age 50. A recent study in the Annals of Internal Medicine suggests that a mammography screening strategy based on a baseline breast density measure at age 40 may be the most effective and cost-effective way to reduce breast cancer mortality. (Current breast cancer screening guidelines recommend that mammography begins at age 50 for women at average risk.) The Breast Density Notification Act requires providers to inform women who have a mammogram whether they have dense breasts.

Cognitive aging can be slowed down or even reversed Aging and inflammation go hand in hand. Overactive inflammatory responses lead to conditions more common in people over 65 – atherosclerosis, metabolic syndrome, cancer, and frailty. In the brain, inflammation is also tied to cognitive decline. Myeloid cells that should clear debris no longer do so, but instead go into inflammatory overdrive

that contributes to neurodegeneration. The newsletter Stat reports that a new study in the journal Nature of aging mice and older human cells shows that treating myeloid cells with a drug that suppresses a pro-inflammatory signaling molecule corrected glucose metabolism, controlled inflammation, and restored cognition – as measured by tests of mouse memory and spatial navigation. “Our study suggests that cognitive aging is not a static or irrevocable condition but can be reversed,” the authors write.

Folic acid helps prevent major birth defects Folic acid is an important part of planning for a healthy pregnancy, says the Centers for Disease Control and Prevention. CDC urges all women of reproductive age to consume 400 mcg of folic acid each day, in addition to consuming food with folate from a varied diet, to help prevent major birth defects of the baby’s brain (known as neural tube defects). The two most common types of neural tube defects are anencephaly and spina bifida. Anencephaly is a birth defect in which parts of a baby’s brain and skull

do not form correctly. Babies born with anencephaly cannot survive. Spina bifida is a serious birth defect in which a baby’s spine does not develop correctly and can result in some severe physical disabilities. All women, but especially those who might become pregnant, need 400 mcg of folic acid every day.

Two arms … two different BP readings?

Generally, a small difference in blood pressure readings between arms isn’t a health concern, according to Mayo Clinic. However, a difference of more than 10 millimeters of mercury (mm Hg) for either your top number (systolic pressure) or bottom number (diastolic) may be a sign of blocked arteries in the arms, diabetes or other health problem. People who repeatedly have an interarm blood pressure difference of 10 to 15 mm Hg for systolic pressure are more likely to have vascular disease. They also have a greater risk of developing cardiovascular disease and related complications during the next 13 years. If you have a large difference in blood pressure readings between arms, talk to your doctor.

MAR-117 (Rev 1)

REP CORNER

Hard Riding Susan Van Cleve seeks excellence working with colleagues, customers – and her horses Susan Van Cleve was born into one of the original South Texas ranching families. The Van Cleve Picosa Ranch was

founded in 1888 by her great grandfather, who passed along his love of ranching to her grandfather and father … and to Susan.

She maintains her passion for riding and showing horses today, and finds it a welcome balance to her job as senior account manager for McKesson Medical-Surgical, Home Care – HME/DME sales, for the Dallas/Fort Worth Metroplex, Central Texas and El Paso. It’s a passion that has also given her a community of friends, who have helped her through good times and bad.

Breaking into sales

Susan Van Cleve

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Van Cleve was born and raised in Cypress, Texas. Her father, Delbert W. Van Cleve, owned a family business specializing in the design, installation and maintenance of commercial and residential water treatment plants. He passed away in August 2019. Her mother, Diane E. Van Cleve, continues to maintain accounting and administrative responsibilities for the business.

She graduated with a registered nursing degree, in addition to a bachelor’s degree with a business emphasis, from Tarleton State University in Stephenville, Texas. She had an interest in the business aspect of healthcare and looked to her father for some career guidance. “He asked me, ‘Have you ever thought about sales? Why don’t you use what you’re good at – meeting people, making friends?’ He was right. I’ve never met a stranger.”

She found out that the road to medical sales isn’t always a smooth

one, particularly for someone lacking sales experience, even for someone with a nursing degree. But she was committed to entering the field and decided if she couldn’t enter through the front door, she’d go through the back. So, she searched for an outside sales position and found one with Waste Management, known for its renowned sales training program, to gain the sales experience needed to ultimately secure her dream job in medical sales.

‘Life is short, and we are not promised tomorrow.’

For three years, she called on strip malls, independent businesses and other commercial customers that generated large volumes of waste. “The job taught me how to present a value prop and the reasons someone should choose our company over another,” she says. “It is a very competitively priced market, and there were a lot of ‘no’s before ‘yes’s.

So I had to be very knowledgeable about what set us apart, instead of running a race to the bottom on price.”

After three years at WM, she had the opportunity to move into healthcare sales with a manufacturer of biohazard bags, and then, to First Quality.

A chance to help people “First Quality was an opportunity for me to make a difference by representing a product line that truly helped people. I had struggled with incontinence during my youth prior to corrective surgery, and First Quality was a way to give back to others because I had actually ‘walked in their shoes.’

“I was passionate about the educational side of my sales role – assisting caregivers in proper application and utilization of the products for their loved ones and clients. I was known by my distribution partners for being one of the only reps who would perform an in-service for the nursing staff with a personal demonstration of how to properly apply the briefs. Hence, I wore dress pants to work most days.”

At First Quality, she was responsible for the relationship with McKesson Medical-Surgical reps in Texas, Oklahoma, Arkansas and Louisiana, one of whom was Ken Stansberger. “Together, we had significantly grown

the First Quality business through McKesson,” she says.

After he had been promoted to a management role, one of his tenured reps retired, and Van Cleve applied for the position.

“I was very happy at First Quality, but I had also spent many years as a ‘road warrior,’ covering multiple states. The opportunity to have a local territory was very appealing, especially when it came to work/life balance.”

Serving on both sides of the desk – first as a manufacturer, then a distributor – has enabled her to provide guidance to her customers on navigating contracts, GPOs and formularies, she says. “It also lends itself to stronger distributor/manufacturer partnerships, which ultimately benefit the customer. I will forever be grateful to Ken Stansberger and Jeff Bowman for believing in me and offering me a position on the home care team.” While Stansberger has continued to rise through the leadership ranks with McKesson, Van Cleve considers herself very fortunate to now have the support of her current region manager, Ryan Partridge.

A chance to heal “I have always taken great pride in being a top performer professionally, and strive to overachieve in all aspects of my life,” she says. And what goes for sales goes for riding as well.

‘Cow sense’ Susan Van Cleve’s show horse, Rigby, is considered a ranch horse, that is, one that is well suited for working with livestock, particularly cattle. Ranch horses are characterized by agility, alertness, stamina and powerful hindquarters, she says. They are noted for their intelligence, willing attitude, enthusiasm and “cow sense,” that is, an instinctive understanding of how to respond to the movement of cattle so as to move livestock in a desired manner with

minimal or no guidance from their rider.

These horses are used both as working animals on livestock ranches, and in competition, where they are evaluated on their ability to perform ranchtype activities. Coupled with their understanding of how to respond to movement of cattle with little guidance, ranch horses in shows perform gait transitions and maneuvers based on non-visual cues of leg/ seat pressure, along with the rider’s verbal cues.

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REP CORNER Her father, Delbert, was a “real cowboy.” He spent many years rodeo competing in bareback bronc riding.

In fact, that passion during his college years at Texas A&M University afforded him the opportunity to double for actor Paul Newman in the 1963 Western “Hud.” He also shared his love of horses and riding with his daughter from the time she was little. When he passed away from cancer in August 2019, Van Cleve made a promise to herself to make a concerted effort to achieve more work/life balance. “Life is short, and we are not promised tomorrow.”

In December 2019, she purchased Rigby, a four-yearold American Quarter Horse, through Bud Lyon of Bud Lyon Performance Horses in Tioga, Texas. She had actually visited Lyon with the intention of buying another horse, but he suggested she try Rigby. The two hit it off immediately. “Rigby’s sort of like an old soul,” she says.

“He tries really hard to make sure he’s doing what I ask him to do.” In rider’s parlance, Rigby is “good-minded.”

Purchasing Rigby and meeting some of the people through that purchase – including Lyon and his wife, Kim, and assistant trainer Jenna Seal, as well as Rigby’s previous owner/breeder, Brooke Wharton of WT Waggoner Estate -- helped Van Cleve heal following the loss of her father. “Keeping my mind focused that whole year of my Dad’s illness and passing made 2019 probably the toughest year I’ve had. Rigby, and the wonderful people I have met through him, have been a blessing that lifted my spirits. I know my Dad would be so happy for me.”

“Having a spouse that encourages your dreams while doing all he can to help you achieve them is a true gift.”

Thanks to Lyon and Seal’s training, and her own hard work, Rigby took the Amateur SPB American Paint Horse World Championship in Ranch Rail Pleasure and the Reserve World Championship in Amateur SPB Ranch Trail in September 2020, as well as the Open Level World Championship, receiving a Gold Globe in Jr. Ranch Riding, at the American Quarter Horse World Championship Show in November 2020.

“My personal American Paint Horse World Championship Show wins on Rigby as an Amateur are a dream come true for me,” she says. “This was actually my first World Championship Show as a competitor, and also the first major show for Rigby and me as a team, which made the wins even sweeter.

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Horse World Championship Show, is the pinnacle of achievement that many competitors and their horses work years and years for, but never reach. For Bud Lyon and Rigby, reaching this milestone together on their first attempt, while outperforming 75 horses, was truly an amazing feat.”

Face to face “I use all of the lessons I have learned from owning and showing horses – responsibility, compassion, empathy, attention to detail, patience, competitiveness, work ethic and relationshipbuilding – daily in my interactions with customers,” she says. And she looks forward to those interactions occurring face-to-face following the COVID-19 shutdown.

“When you’re sitting down in front of [customers], you can bring something valuable to them. Can I convey that over the phone? Sure.

But in conversation, things come up that might not come up on the phone.

This is consultative selling – sharing news of the industry, processing updates/changes, in-services, truly listening to your customer’s needs.”

Her husband, Nick Jung, is extremely supportive of his wife’s career and horses, “although he prefers golf as his hobby,” she says.

“Having a spouse that encourages your dreams while doing all he can to help you achieve them is a true gift.”

She has a 13-year-old stepson, and the family lives on 13 acres in the Texas Hill Country town of Fredericksburg.

“I may be conducting business on a PTO day, but I don’t mind at all, because I know that once I have assisted the customer, I can return to the joy I receive from my partnership with my horses. These partnerships have provided new meaning to work/life balance for me.” www.repertoiremag.com

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WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.

Automotive-related news

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Finding charging spots

Batteries are in demand

Electric vehicles with Google Maps built in are getting a few more features that should make it easier to plan trips around charging stops, reports Engadget. Google is using graph theory in its latest routing algorithms to help you determine the best way to get to your destination. If your journey requires more than one charging stop, Maps will look at thousands of public charging stations to figure out the most efficient route in under ten seconds, Google says. The app will note how long it’ll take to juice up your EV at each stop, as well as your total trip time including recharging. For shorter trips that only require one stop, Maps will display a list of charging stations. You can pick a spot where you can recharge your EV the fastest or one where you have a membership. You’ll be able to see what amenities are close by in case you want to pick up groceries or a coffee while you wait.

Energy research and consulting firm Wood Mackenzie estimates that electric vehicles will make up 18% of new car sales by 2030, reports The New York Times. That would increase the demand for batteries by about eight times as much as factories can currently produce. And that is a conservative estimate. Long considered one of the least interesting car components, batteries may now be one of the most exciting parts of the auto industry.

Car manufacturing hasn’t fundamentally changed in 50 years and is barely profitable, but the battery industry is still ripe for innovation. Technology is evolving at a pace that is reminiscent of the early days of personal computers, mobile phones or even automobiles.

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Chip shortage hurts car production A chip shortage that started as consumers stocked up on personal computers and other electronics during the

COVID-19 pandemic now threatens to snarl car production around the world, reports CNBC. In early February, GM said that it would extend production cuts in the U.S., Canada, and Mexico until the middle of March. They join a long list of major automakers, including Ford, Honda and Fiat Chrysler, that have warned investors or slowed vehicle production because of the chip shortage. But it’s not just the automotive industry that’s struggling to get enough semiconductors to build their products. AMD and Qualcomm, which sell chips to most of the top electronics firms, have noted the shortage in recent weeks. Sony blamed the chip shortage for why it’s so hard to get a PlayStation 5 game console.

Driver assistance … as you like it Some people love the lane-keeping assist feature in their new vehicle, but others hate it, because it reacts in a way they don’t understand. “To get these people motivated, personalization is key,” explained Bernhard Pirkl, vice president of advanced driver-assistance systems (ADAS) for Samsung-owned Harman, in an interview with Digital Trends. “This, for me, will be the major breakthrough – identifying who is behind the steering wheel and providing personalized application of the different features via the cloud.” He envisions a near future where drivers can customize their various electronic driving aids (like lane-keeping assist and automatic emergency braking).

You’ll be able to adjust them to suit your driving style, from loose and occasional interventions to aggressive and frequent take-overs. Better yet, these systems will gain the ability to adjust automatically after you save your preferences, like a memory function for electronics.

‘Unforgettable adventures’ OWDR and Subaru of America, Inc. announced earlier this year an extension of a longstanding partnership to provide POWDR mountain resort guests and Subaru owners with unforgettable adventures. The partnership expansion also makes Subaru Moto sports USA the official partner of Woodward.

The Subaru and POWDR partnership will bring more amenities to mountain experiences and connect adventure-seekers everywhere, according to a release.

During the 2020/2021 season, the POWDR and Subaru partnership includes the Subaru sponsorship of Snowbird, Copper Mountain and Mt. Bachelor’s avalanche rescue dog programs, which includes training and certification support for dogs and handlers, supplies and specialized equipment. And, to contribute to the overall guest experience while supporting safe, COVID-related

operating protocols, Subaru has designed and deployed custom outdoor chalet structures, called Subie Shacks, at various POWDR locations – offering guest amenities and Subaru owner perks such as pre-packaged menu items, snacks and Subaru prizing.

For more than six years, Subaru and POWDR have joined together to enhance experiences for resort guests and Subaru owners alike. Exclusive resort benefits such as Subaru VIP parking, Subaru concierge and shuttle vehicles, as well as ‘pop-up’ surprises and activations throughout the season, are designed specifically to celebrate and inspire adventurous Subaru owners. Additionally, through POWDR’s corporate responsibility Play Forever commitment, and the Subaru Loves the Earth initiative, the partnership has implemented green event practices that expand recycling collection and waste reduction with TerraCycle®, as well as outdoor environmental ethics education with Leave No Trace.

During the 2020/2021 season, the POWDR and Subaru partnership includes the Subaru sponsorship of Snowbird, Copper Mountain and Mt. Bachelor’s avalanche rescue dog programs, which includes training and certification support for dogs and handlers, supplies and specialized equipment.

Helicopters are faster United Airlines in February said it would buy up to 200 small electric air taxis to help customers in urban areas get to the airport, reports WTTW in Chicago, United’s hometown. The airline said it will help electric-aircraft startup Archer develop an aircraft capable of helicopter-style, vertical takeoffs and landings. Archer hopes to deliver its first aircraft in 2024, if it wins certification from the Federal Aviation Administration. United said once the aircraft are flying, it and partner Mesa Airlines will acquire up to 200 that would be operated by another company. According to an Archer presentation to investors, the orders are worth $1 billion with an option for $500 million more. www.repertoiremag.com

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NEWS

Industry News McKesson begins distributing Johnson & Johnson’s COVID-19 vaccine On March 1, McKesson began distributing the COVID19 vaccine received from Janssen Pharmaceuticals, Inc., a part of Johnson & Johnson.

The Janssen vaccine received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) on Feb. 27 and is the first one-shot COVID19 vaccine to be authorized for use in the U.S. McKesson was selected by the U.S. government in August 2020 to operate as the centralized distributor for frozen and refrigerated COVID-19 vaccines and ancillary supply kits needed to administer them.

In December 2020, McKesson began distributing the ancillary supply kits for Pfizer BioNTech’s COVID-19 vaccine. Later that month, the company began distributing Moderna’s COVID-19 vaccine and ancillary supply kits. McKesson has established four dedicated distribution centers which will be specifically used to distribute the Johnson & Johnson COVID-19 vaccine and future refrigerated vaccines. The U.S. government makes all program administration decisions, including where, when and how many vaccine doses McKesson will distribute.

B. Braun Medical names new CFO B. Braun Medical Inc. announced that James Allen has joined the company’s Executive Leadership Team and will assume the role of SVP and CFO following a transition period.

In this position, Allen will lead all financial operations of the B. Braun group of companies in James Allen North America. Allen will replace Bruce Heugel, who last summer announced his decision 60

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to retire from B. Braun after more than twenty years of service. Heugel will transition responsibilities to Allen over the next several months, until he retires in May 2021.

Allen brings more than 30 years of finance and management experience across a range of industries and financial disciplines. He comes to B. Braun after serving for 6 years as an operating company CFO with Steel Partners, where he led the implementation of multiple successful growth initiatives. His previous experience includes 15 years at Johnson & Johnson in a variety of business development and financial leadership roles. He began his career at Amoco Corporation.

Cardinal Health collaborates with HIMSS Analytics as Certified Organization of new CISOM maturity model Cardinal Health WaveMark Supply Management & Workflow Solutions has announced a collaboration with HIMSS Analytics as a Certified Organization of the Clinically Integrated Supply Outcomes Model (CISOM).nThe CISOM is an eight stage (0-7) model that provides a strategic pathway to track processes and products used in care by mobilizing data to create real-world evidence of impact and outcomes for patient populations.

The company says that the value WaveMark brings to CISOM is ensuring accurate visibility to “at risk” product inventory to help prevent “never events,” including expired or recalled product used on a patient. “A clinically integrated supply chain starts with WaveMark,” said Christina Tosto, VP of Operations at WaveMark. “We can help the clinical and supply chain teams in a health system to enhance the patient experience, ensure accurate clinical documentation of products used in patient care, and improve enterprise visibility to critical inventory and waste. The result is simply better care delivered more efficiently and at a lower cost.”

Care Happens in Many Places In today’s healthcare environments, caregivers are oftentimes required to move from room to room and patient to patient rapidly.

Midmark® Mobile Procedure Carts are designed to provide sturdy room-to-room maneuverability while supporting an ergonomically correct working position for standing procedure work and prep.

To learn more, visit: midmark.com/mobileprocedure

*Accessories sold separately.

© 2021 Midmark Corporation, Miamisburg, Ohio USA

Don’t Be Fooled

By Imitators

Don’t let imitators fool you in the new year, ensure you have authentic infection prevention products.

Increasing global demand for gloves and PPE created a tidal wave of inexperienced and unreliable entrepreneurs entering the marketplace, sourcing and marketing products without provenance, quality or proven compliance in the US. times like these you must protect yourself and your customers by ensuring “Inthey have the authentic, reliable infection prevention products needed. ” Ventyv® is the premier brand of Sri Trang USA, Inc., a member of the Sri Trang Group.

Sri Trang is a proven glove producer that has been protecting the world against infection since 1991.

If you aren’t talking to us it’s not Sri Trang.

Visit ventyv.com/rep or sritrangusa.com/rep for more information.