REP Jan 2024

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vol.32 no.1 • January 2024

The Fab Four?

Primary care doctors warn patients not to get caught up in Wegovymania.


Streppy Sniff

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38 Better BP at the Point of Care CORRECT BP study finds that proper patient positioning is critical for accurate BP measurements.

42 Private Equity: Risk or Reward?

Not all PE firms are the same. That’s why physicians must approach a sale with caution.

48 Personalized Virtual Care

Leading health systems partner with consumer-focused platform for self-insured employers to expand access to patients.

The Fab Four?

50 Banding Together

Primary care doctors warn patients not to get caught up in Wegovymania.  p. 32

52 Pain Points

How a recently formed hospital alliance aims to expand access and improve outcomes – while reducing costs – in a rural setting. Recent survey reveals how healthcare providers believe supply chain disruptions are affecting clinical outcomes.



First Thoughts on 2024



Home is Where the Heart Disease is

Facts, trends and research to include in your customer conversations when speaking about testing for heart disease in the physician office lab. ` DISTRIBUTION

10 RISE to the Challenge

Henry Schein Medical has developed a resource to help ASCs educate team members on infection prevention.


12 You See What You Look For How to train your brain for more gratitude, joy, and connection.

14 From Gatekeeper to Innkeeper

Changing how you look at the gatekeeper will ultimately get you closer to the decision-maker.


18 2023 Infection Prevention Wrap-up What 2023 numbers can tell reps about the category.


20 The Dangers of Sepsis

Sepsis has a substantial impact on U.S. hospitals. How can healthcare providers better safeguard their patients?



24 Amazon’s Reach Extends to Healthcare

After many forays into the market, the e-commerce giant acknowledges it can’t do it alone.

28 Optum Broadens Coverage into Home Care

Commercial healthcare providers heavily invest in home care sector as Medicare Advantage expands, aging in place trends up.

54 Supply Chain’s Fight Against Cancer

New alignment and new projects highlight New York cancer center’s commitment to end cancer for life.


58 How to Build Brand Trust ` HIDA

59 HIDA Bill to Expedite Medical Supplies Introduced in Congress


60 Health Tips from the Experts 2024

Tips from the experts to be your healthiest self throughout 2024.


63 The Common Health Coalition

Leading healthcare partners announce system to improve public health.

64 Industry News

30 CHPs in the News

Repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 350 Town Center Ave, Ste 201, Suwanee, GA 30024-6914. Copyright 2024 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 350 Town Center Ave, Ste 201, Suwanee, GA 30024-6914. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.


January 2024

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Publisher’s Letter

First Thoughts on 2024

editorial staff editor

Mark Thill managing editor

Graham Garrison

January 2024

What will 2024 have in store for us as a country, industry, and individually? My guess is we will all be sick of the election cycle the media will put us through over the next 11 months. Hey, at least we have two 80-year-olds running for the most powerful seat in the free world, right? I’m not sure I’d let either of them do much more than play in a bingo tournament, so it should be a barnburner! OK, that’s all I’ll say from a political standpoint. Instead let’s focus on the industry we all love, and ourselves individually. From an industry perspective, I believe in being positive, and I think we are in for a strong year. The supply chain seems to have stabilized, and traditional lead times are becoming the norm again. We are seeing more and more collaboration between manufacturers and distributors to bring efficient solutions to help caregivers with labor shortages, while at the same time helping them run more profitable organizations. The combination of these factors should lead us to a strong sales year in med-surg. From an individual growth standpoint as salespeople, January is a great time to reflect on what you did last year to better yourself and then set a plan for how you will improve this year. We have seen an incredible uptick in reps going into RepConnect’s training library to learn new products. If you are unfamiliar with RepConnect, go into the app store and download it for free today. Trust me, you will thank me later. The app was designed 100% with you in mind. Each day you can read the latest industry news keeping you up to date on our everchanging market. You will have access to manufacturers’ collateral material and rep rosters, as well as a variety of educational podcasts and short 2–3-minute training videos on products you can sell every day to your accounts. These videos are a great way to give yourself something new to talk about each week while growing your business. I’d like to challenge you to try and learn one new product a week next year. This will take you no more than three minutes a week via the app. We all have three minutes to invest in ourselves. My commitment to you is the Repertoire team will continue to develop content to help you improve your skills, so that you bring the highest level of value to your clients.


Here’s to an amazing NEW YEAR. Dedicated to the Industry, R. Scott Adams Repertoire editor-in-chief, Dail-eNews

Jenna Hughes art director

Brent Cashman circulation

Laura Gantert

senior sales executive

Amy Cochran (West Coast) (800) 536.5312 x5279 sales executive

Aili Casey (East Coast) (404) 625-9156 publisher

Scott Adams (800) 536.5312 x5256 founder

Brian Taylor

Subscriptions or (800) 536-5312 x5259

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Physician Office Lab

Home is Where the Heart Disease is Facts, trends and research to include in your customer conversations when speaking about testing for heart disease in the physician office lab.

 As consultants to the clinical practices we call on, we sometimes wonder “What do I REALLY

January 2024

need to be able to communicate to be considered valuable? Is the lab and clinical information that I provide considered credible and actionable? Will my customers think I am trying to show I know more than they do? Will my consultative activities grow my business?”

As I write some of my more clinically oriented columns, I try to keep these thoughts in mind and answer the key question on your mind: “How can I effectively use this information to grow my business?”



In this column, like others in the past, my answer is that being well informed allows us to have more meaningful and deeper conversations with our customers. We are not trying to be a peer-to-peer resource, but we should show an

By Jim Poggi

point of care for the benefit of your customers and their patients.

Latest heart disease morbidity and mortality trends From 2019 to 2020, age-adjusted death rates increased for 6 of 10 leading causes of death and decreased for 2. Heart disease continues to be the leading cause of death in the United States and its rate is increasing. The rate increased 4.1% for heart disease (from 161.5 in 2019 to 168.2 in 2020). Cancer death rates declined during this time, widening the gap between heart disease as number one and

been that heart attacks and stroke spike in the winter. As a native of western New York, where long winters meant cold temperatures and lots of snow to shovel, this felt logical to me, especially with lower levels of winter exercise coupled with the exertion of shoveling snow. What I did not realize is that heart attacks also have a summer peak. CDC, NIH and numerous recent studies have clarified this data and it is becoming more well known. While not as high as the winter peak and with fewer reported heart attacks in the

While not as high as the winter peak and with fewer reported heart attacks in the summer, it is becoming clearer that managing to get through winter without a heart attack does not mean that your customers’ patients are in the clear. cancer as number two. Overall life expectancy in the U.S. has declined post-COVID and I am confident this fact is on the minds of many of your customers. As we discuss the importance of effective screening for lab tests related to heart disease, we need to be mindful of how our customers view these morbidity and mortality trends and how they are managing them. Do they feel the need for more intensive pre-diabetes screening with A1C? What about lipid testing? Has their patient counseling protocol changed? How can we help?

Heart disease seasonal risk statistics As I mentioned earlier, the conventional wisdom has

summer, it is becoming clearer that managing to get through winter without a heart attack does not mean that your customers’ patients are in the clear. The implication: all manner of preventive strategies should be year-round efforts. Counseling for lifestyle improvements, especially regarding proper exercise and weight control measures will have benefits for quality of life and prevention of premature heart attack. Glucose, hemoglobin A1c and lipid tests all factor into a proper preventive strategy along with vital signs measurements for every patient visit, particularly those who present with risk factors, including hypertension, diabetes, obesity Repertoire

January 2024

understanding and respect for the information physician offices use every day as they seek to provide the best patient care possible. I believe using this information properly allows us to have better conversation starters to discuss the value of lab. If used properly, it certainly sets us apart from those who do not know or use this information. Along the way, I learned the most useful approach to weave this information into conversation. In my rookie years, I often asked “did you know” questions using a clinical tidbit. The customer reaction was rarely positive. When I switched to “In my research on (clinical topic) to prepare for our meeting, I learned some interesting information I would like to share with you…” the reaction was uniformly more positive. It is best, when using this type of approach, to ALWAYS have your payoff in mind as you begin the conversation. As an example: “I always thought heart disease and heart attack spiked in the winter. As I researched, I learned it also has a summer peak. This leads me to wonder how this information impacts the use of our screening for diabetes, lipids, hypertension and cardiac marker assays. I would be interested in how you use this information in your practice, particularly in how you use lab tests for heart disease. (Pause to allow customer to respond).” With this context in mind, I have a few interesting facts regarding heart disease to pass along. It is my hope that you find them useful in your customer conversation and that you learn new ways to discuss the importance of having lab tests available at the


Physician Office Lab

or lipid disorders. I will present some interesting lifestyle information later. How you live makes a difference in your risk of heart attack, but I learned that where you live also has an impact.

Heart disease and where you live The incidence of heart disease varies considerably, based on where you live in the U.S. Based on scores for seven well established risk factors for heart disease, the South has the highest risk level, followed by the Midwest, Northeast and West regions respectively. The data summarized below are from largescale studies conducted by the NIH over more than 10 years. One point of caution: much of the data was collected by phone and was “self-reported” by the patient or a family member. This is likely to explain why the reported level of diabetes in this study does mirror CDC data for confirmed diabetics, but is likely not to include prediabetics. CDC estimates that in addition to 37 million diagnosed diabetics, there are 96 million more prediabetics. Early detection of the prediabetic population with urinalysis, hemoglobin A1c and lifestyle counseling would have a major impact on this data. How are your customers diagnosing prediabetics? Are they seeing an increase in the number of first-time adult diabetics diagnosed? Ask to learn more

Is it possible there is a magic bullet for diabetes, weight loss and heart disease? The data is shaping up that way so far. GLP-1 agonists (semaglutide and others) have been prescribed for diabetes control. They have also been used, sometimes off label, for weight loss and the results have been impressive. and recommend broader scale screening especially in the at-risk population: older, obese, history of heart disease, and elevated lipids.

But Exactly WHERE you live is also a factor, which was news to me The data tends to vary somewhat from one area of the country to another, but except for the West, rural populations tend to have the highest rates of heart disease. Is it about access to quality health care, more physical labor, different lifestyle choices or another factor? Discussing this information can lead to some interesting dialogue with your customers. In my area of rural Virginia, it is widely believed that access to quality health care is a big factor, along with lifestyle choices (we tend to smoke more and eat less well) than other parts of the state. No matter what the underlying cause may be, early diagnosis via proper lab and vital signs

screening methods will lead to better patient health outcomes.

Racial and ethnic makeup also makes a difference Black Americans have the highest level of heart disease incidence no matter which area of the country they live in. Non-Hispanic White Americans have the second highest rate. Asian and Hispanic Americans have the lowest rates. There are likely to be access to care, socioeconomic and other factors in play here. There is little doubt that your customers are aware of these differences and that they factor in their screening and care planning.

How you live The NIH has developed and tracks cardiac risk factors based on seven classic risk factors in their Behavioral Risk Factor Surveillance System database. These factors are: ideal blood pressure, blood glucose, lipid levels, body mass index, smoking,

Age-Adjusted Cardiovascular Mortality Across the United States: 2017 Midwest



AAMR (95% CI)

AAMR (95% CI)

AAMR (95% CI)

AAMR (95% CI)

207.3 (206.3-208.3)

227.7 (226.7-228.7)

233.0 (232.2-233.8)

197.5 (196.6-198.5)

January 2024


NOTE: AAMR is “age adjusted mortality rate”




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Physician Office Lab

Cardiovascular Risk Factors 300 250 200 150 100 50


physical activity and diet. Their data from a long-term study are summarized in the graph above. It shows what every clinician counsels their patients daily: eat right, exercise, do not smoke and be tested for risk factors like blood pressure and diabetes frequently. The data correlates well with the observed levels of heart disease in each area of the U.S. Follow your doctor’s orders, get screened annually and your risk of heart disease is reduced.

January 2024

New therapeutics: Hope around the corner? For every person who follows their doctor’s advice, there are several of us who “hope for the best” and expect a magic bullet to show up just in the nick of time. Is it possible there is a magic bullet for diabetes, weight loss and heart disease? The data is shaping up that way so far. GLP-1 agonists (semaglutide and others) have been prescribed for diabetes control. They have





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also been used, sometimes off label, for weight loss and the results have been impressive. A recent study conducted by the manufacturer of one of these medications involving over 17,000 patients without diabetes but with heart issues conducted over 5 years has shown to reduce heart problems by 20%. While these drugs are shown to reduce weight, the study showed independence of heart risk reduction from weight loss suggesting another mode of action or multiple modes of interaction. Reduction in inflammation as well as improved utilization of insulin are factors being evaluated to understand the overall mechanism of interaction. This information is worth some conversation. Do your key customers use these medications? Are they seeing a reduction in prediabetes, diabetes, and better weight control? It is likely too early for them to see changes in heart disease, but the data point in the direction of a reduction

in heart disease for patients on these medications. It’s a great conversation starter. And follow up questions could include: How does this impact your patient screening activities? Are you seeing long-term improvement? Is your use of these medications increasing? What impediments to their use are you experiencing? Note: for weight loss indications, Medicare does not pay for these medications and private insurance companies are reluctant to do so, believing that weight loss is largely a cosmetic benefit. The emerging data is very likely to change the reimbursement landscape. In summary, what you know can be useful. But, it’s more important to tailor your message so it is properly perceived to be useful and actionable. There is a lot to know here and many pathways to interesting and involving interaction. Use it wisely as you grow in your consulting skills. As your skills grow, your business will grow also.

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RISE to the Challenge Henry Schein Medical has developed a resource to help ASCs educate team members on infection prevention.

 More than half of all surgical procedures today are done in an outpatient setting such as an

January 2024

Ambulatory Surgery Center (ASC). And that volume is only projected to grow.

Yet ASC administrators typically don’t have the scope of resources that a hospital or health system does like human resources, legal, risk, materials management – even education. In order to properly train staff on important topics, administrators have to turn to outside resources and experts. Henry Schein Medical recently created the Henry Schein



RISE platform to do just that. The medical business of Henry Schein, Inc. provides resources

and education on one of the most critical topics for healthcare providers – infection prevention. Indeed, 1 in 31 U.S. patients develops a healthcare-associated infection (HAI) every day, according to the Centers for Disease Control and Prevention (CDC). Poor adherence to an infection control program could be costly – even disastrous – for an ASC.

RISE (Resources, Infectious Prevention, Solutions and Support, and Education) was built to help ASCs educate their staff around infection prevention. Providers can log onto henryscheinRISE. com and create a free account. Some of the features offered on the platform include:

` Latest News and Develop-

ments. Current information

from the Ambulatory Surgery Center Association, Association of Perioperative Registered Nurses, CDC, and other organizations is featured on the site. For instance, if a state is experiencing a tuberculosis outbreak, that information would be posted so providers would know which cities or counties are affected. ` Specialized Guidance. Users can focus on a certain area of care for their research or training – pre-op, post-op, OR, sterile processing, facility hygiene, etc.

` Continued Education and Train-

ing. Henry Schein Medical offers

access to third-party continuing education (CE). The Company has partnered with suppliers who specialize in infection prevention and have already created free CE courses. Users can click on a link that goes straight to the supplier’s CE site. They can fill out the information, and take the course, with the supplier providing the CE credits.

` Infection Prevention Informa-

tion and Clinical Studies. This section includes surveys, case studies, worksheets and more. ` Featured Products. Information on products for ASCs from world-class suppliers are highlighted.

` Consult and Expert. Users can

request for a Henry Schein Medical specialist or supplier to visit and discuss certain topics in-person. Users can even search for a Henry Schein Surgical Solutions Specialist by state on the website. ` Podcasts. The site also features podcasts, including Beyond Clean and First Case, which provide infection prevention-related topics from experts in the space.

facility hygiene. Each one has their own specialty, and together they contribute to the entire continuum of infection prevention.” The platform pulls all those best-in-class companies together by providing users access to their education resources. “Otherwise, the ASC would have to go to all of these different companies with different expertise levels to accomplish what Henry Schein RISE does, all available on one platform,” Jackson said.

“ Henry Schein RISE is one way we can show our customers that Henry Schein Medical is more than a distributor. We truly care about what goes on in our customers’ facilities,” she said. “Customers can rely on us to deliver solutions that can help them continue to deliver quality care.” -- Erica Smith, Surgical Solutions Manager, Henry Schein.

“Henry Schein RISE is one way we can show our customers that Henry Schein Medical is more than a distributor,” said Erica Smith, Surgical Solutions Manager, Henry Schein. “We truly care about what goes on in our customers’ facilities,” she said. “Customers can rely on us to deliver solutions that can help them continue to deliver quality care.” Henry Schein RISE is a very holistic approach to infection prevention, said Scott Jackson, Vice President of Surgical Solutions at Henry Schein. “If you look at the names of some of the companies already on board, they’re all top tier. One might have something for skin prep, one might have something for

Indeed, the more companies that Henry Schein Medical can bring into the program with their educational resources, the more impactful the program becomes. The Henry Schein RISE platform is built to eventually cover more than infection prevention. Other critical areas can be added in the future. “We feel we’ve got a very good strong start with the companies that are part of this and what they bring,” Jackson said. “We don’t want to have a lot of overlap. But we are looking for other manufacturers that bring different areas of infection prevention expertise that complements the current portfolio of companies that contributing today.” Repertoire

January 2024

How it works



You See What You Look For How to train your brain for more gratitude, joy, and connection. By Lisa Earle McLeod

 Have you ever decided to buy a certain type of car? Let’s say you want a blue sedan. As you mull

January 2024

over your decision, you notice blue sedans everywhere. Did everyone get a blue sedan overnight? Probably not.

When you become more aware of something, you start seeing it more often. This brain pattern can be annoying if you haven’t intentionally put some guardrails on your mind.



Fighting with your spouse about dirty clothes on the floor? If you walk into your bedroom and there’s a ‘not quite dirty sweatshirt’ randomly sitting on the floor, it will be all you see. Making a proactive

effort to eat healthier? You may have never noticed the huge array of chips at your mother-in-law’s house, but now it haunts you. We (consciously or unconsciously) train our brains on

Gratitude I was working with an IT team at a major bank. We were talking

about how they make a difference to their organization. One of the guys said, “No one ever notices us until something goes wrong.” It’s not just IT. It’s everything. Our brains gloss over all the times our takeout order is correct, all the days we wake up without a stuffy nose or every person who uses their turn signal on the road. Training your brain to notice how often things are going ‘right’ helps the rough patches feel more insignificant. Statistically speaking, they are.

Joy When do you feel the space between your eyebrows soften and the corners of your mouth lift up? Is it when you take that

Training your brain to notice how often things are going ‘right’ helps the rough patches feel more insignificant. Statistically speaking, they are.

first sip of coffee, hear a throwback song, or take off your shoes at the end of the day? Pay attention to it. Notice the joy in other people. A child at the store, a dog being let off the leash in the dog park, or your team laughing at a cheesy joke on Zoom. After a few hours, the world will appear more joyful. It was always there, now you’re noticing it.

Connection Did someone hold the door for you? Send you a funny meme? Even just give you a passing smile? These moments can be fleeting without a proactive effort to internalize them. You don’t need to spend minutes basking in the fact someone smiled at you; you’re likely way too busy for that. Just spend one second, as if you’re mentally checking off an item on your mental ‘to-do’ list. This will feel awkward for the first couple of hours. Without an established lens, you’ll likely need to put forth some mental horsepower to tease out what you’re looking for. By the end of one day, it will become easier. You’ll start to naturally notice things in the moment they happen, instead of consciously reminding yourself to look. We see what we look for. If you’re searching for evidence that your boss is a jerk, your spouse is rude, or your career is off track … you’ll find it. If you’re searching for things to be grateful for, small moments of joy, and opportunities for connection, you’ll find those, too. Choose wisely, friend.

Lisa McLeod is the global expert on purpose-driven business. She is the author of five books, including her bestseller: Selling with Noble Purpose: How to Drive Revenue and Do Work That Makes You Proud. Repertoire

January 2024

what to look for and what to ignore. Our mental framework determines how much attention we pay to particular pieces of the world. Think back to the hypothetical blue sedan. What if instead of being particularly conscious of blue sedans, you chose to be particularly conscious of moments of gratitude, joy, and connection? When you make a proactive effort to notice these things, you’ll see more of them. For the rest of today, pick one of these categories to pay attention to:



From Gatekeeper to Innkeeper Changing how you look at the gatekeeper will ultimately get you closer to the decision-maker. By Brian Sullivan

 I was recently traveling with a salesperson spending a day cold prospecting in the field. My job

January 2024

was to sit back, watch the rep do his thing, then give him some tips on what he could do better. Because I am a master sales strategist and expert sales coach, my innate abilities allowed me to pick on something very nuanced that was preventing him from being successful. My keen eye noticed … HE WAS TREATING THE GATEKEEPERS LIKE CRAP! (Brilliant, right?)

What is it with the generations-old relationships between gatekeepers and salespeople? Why do salespeople fear gatekeepers, and why do gatekeepers loath salespeople? While I don’t have a scientific answer backed by data, I believe that BOTH are to blame. But guess what, we don’t have control over the attitude of the gatekeepers towards us. Maybe they act that



way because countless salespeople (like the guy I was traveling with) look at these humans … as gatekeepers. If that’s you, stop looking at them that way. Instead, look at them as the Innkeeper. Be nice, and they will let you IN! At our company, PRECISE Selling, we use software to record the calls of many of our clients’ (as well as our own) outbound

sales teams. This helps us better coach them as we can deliver specific tips to salespeople on what to say and how to say it. Many of the unsuccessful calls we listen to often start with the salesperson saying something like this once the phone is picked up: “Hello, I’m trying to get in contact with Dr. Joe Smith. Is he in today?”

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This sales rep might as well say, “Hello, I know you aren’t very important, so I have no reason to be nice to you. Do me a favor and get me over to somebody who actually has the power to make my commission check fatter.” Treat the gatekeeper like dirt and you can be assured they won’t be helping you. Instead, begin your call/visit by asking the gatekeeper for help. With a subtle tweak, you will be a lot more successful. Instead say something like: Hello, my name is ________ with ________ and I was hoping you could help me?

January 2024

We have found that it is hard for gatekeepers (or any human for that matter) to be a jerk to somebody who warmly asks for help. Also, be conscientious of the tone of your voice and don’t forget to smile when asking. People will do more to help you based on your attitude and enthusiasm than anything else. If the gatekeeper doesn’t understand who you are, who you should talk to, or why the target prospect will want to talk to you, take a step back and educate the gatekeeper by sharing either a little bit about the value you provide, the pain that your company solves or some examples of other named clients you serve. But don’t launch into a full-blown sales presentation.


Below are some examples of things you can say after your initial greeting: Value you provide

Let me take a step back and let you know why I am calling/visiting. The reason for my call is that we help clinics like yours to: ` Value Point 1 ` Value Point 2 ` Value Point 3 I don’t know if you all want to improve those areas and that is why I am calling. Do you know if Dr. Joe is the right person to speak with or would you recommend somebody else here at the clinic?

for my call is that we worked with (Name-Drop Client) and helped them to (Technical Improvement). This ultimately helped them to (Business Improvement). I don’t know if we can help you in the same way, and that is why I was calling/visiting. Do you know if Dr. Joe is the right person to speak with or would you recommend somebody else here at the clinic? Another way to effectively engage a gatekeeper and maximize your time is by asking the same types of questions you would pose when speaking with a target prospect. This could

Treat the gatekeeper as the Innkeeper, and as great as you would treat the ultimate decision-makers. Pain points

Let me take a step back and let you know why I am calling/visiting. The reason for my call is that we work with a lot of clinics, and they often have issue with: ` Pain Point 1 ` Pain Point 2 ` Pain Point 3 I don’t know if you all are facing some of those same issues, and that is why I am calling/visiting. Do you know if Dr. Joe is the right person to speak with or would you recommend somebody else here at the clinic? Name drop

Let me take a step back and let you know why I am calling. The reason

include inquiries related to their current environment, challenges they’re facing or pain points that need resolving. Doing so allows you to start building rapport right away while demonstrating your knowledge in the field. Final point

Change how you look at the gatekeeper by changing your perspective. Look at them as an ally to get you closer to being able to serve the client … and NOT as an obstacle. Treat the gatekeeper as the Innkeeper, and as great as you would treat the ultimate decision-makers. And who knows, you just may make a friend who is happy when you call/visit.

As Founder of PRECISE Selling, Brian Sullivan, CSP helps improve sales, customer service, negotiations, leadership, and presentation skills through seminars and Internet training programs. Go to and subscribe to his weekly video tips that will help you become your company’s Top Sales Performer. Repertoire

Infection Prevention

2023 Infection Prevention Wrap-up What 2023 numbers can tell reps about the category. By Paul Girouard

January 2024

 If you have a Spotify account, December was the month to receive “Your 2023 Wrapped” list. They


ask and answer a lot of great questions that cover your music interests throughout the year. There are questions like, how many genres did you listen to, what area of the world has similar musical tastes, how many songs did you play, who was the top song and artist, and how long did you listen? If you are a data geek like me, you probably found the metrics very interesting.


Vaccine manufacturers estimate that they will supply the U.S. with as many as 170 million doses of influenza vaccines for the 2023-2024 season. This is tracking to be a very busy season, so get vaccinated if you haven’t already. Although demand spiked and has come down significantly from the pandemic, hand sanitizer usage remains up 2 to 3 times pre-pandemic, and hand soap is at 1.5 times pre-pandemic levels. Although the pandemic was painful, the silver lining is that


January 2024

So, if we took Spotify’s concept and wrapped up the infection prevention category from 2023, what would it look like? According to the CDC, 81.4% of the U.S. population has received at least one dose of the COVID-19 vaccine, 69.5% has completed the primary series of the vaccine, and 11.0% have received the updated vaccine for the ’23-24 season. The percentage of nursing home residents that are up to date with COVID-19 vaccinations is 27%

it promoted better hand hygiene and that behavior has held steady. Sales of surface disinfectant wipes have grown 10% overall, and 12.5% in acute care. Liquid disinfectants that were predominant during the pandemic have declined 6.5% overall. Surface wipes with hydrogen peroxide formulations were launched and are growing quickly. Sterilants used in instrument disinfection/sterilization have declined 11.1% overall. It should be noted that a significant part of this decline is due to a market leading brand/supplier changing their distribution strategy and no longer going through the healthcare distribution channel. It’s estimated that there were 48 billion gloves sold into the healthcare market in 2023. The glove product category is a meaningful piece of infection prevention and overall distribution business. It’s ranked the fourth largest category in the physician market segment, and second in the long-term care segment. There has been an excess of exam glove inventory in the market. Due to this, average selling prices for exam gloves are at prepandemic levels. On the positive side, there is an opportunity with surgical gloves due to increased patient volume and procedures in the ASC market segment. Take a moment to review how you performed with your infection prevention business in 2023. Who were the top suppliers to help you grow? What were the top items that contributed to success? Where did you underperform compared to the market? What are the new products that will help you hit your goals this year? If you set up metrics like Spotify did, it will help you drive and improve performance for the category in 2024. Get busy. Wash your hands!



The Dangers of Sepsis Sepsis has a substantial impact on U.S. hospitals. How can healthcare providers better safeguard their patients?

 The body’s extreme response to infection, including sepsis, are life-threatening medical emergencies.

Yet, despite the seriousness of sepsis, large numbers of patients develop it within hospitals. At least 1.7 million adults in America develop a sepsis infection each year, and nearly 350,000 adults die from sepsis yearly, according to the Centers for Disease Control and Prevention (CDC). Sepsis occurs when almost any infection that a patient already has (such as influenza, COVID-19, pneumonia, etc.) triggers a further reaction in the body.

Sepsis is not a contagious disease and can’t be transmitted to other patients. Instead, infections that lead to sepsis often start in the lungs, urinary and gastrointestinal tract, and skin, according to the CDC. Symptoms of sepsis include a heightened high heart rate, confusion, extreme pain and discomfort, fever, shortness of breath, clammy skin, and more. Anyone can develop sepsis, but risk factors such as being 65 or older, being a child under the age of one, having a weakened immune system, having chronic medical conditions including diabetes or kidney disease, or having recently been hospitalized, make the chances of developing it much higher according to the World Health Organization (WHO).

January 2024

Sepsis within U.S. hospitals According to the CDC, one in three people that die in the hospital had sepsis during the hospitalization. Many infections can resolve on their own, but for some individuals with a severe infection, that is not the case, and they go on to develop sepsis. “When a patient develops a worsening infection, whether the initial infection is viral or bacterial,



or starts in the skin, lung, urinary tract, or anywhere else, the patient may continue growing sicker, and ultimately develop sepsis,” said Akin Demehin, Senior Director of Quality and Patient Safety, American Hospital Association. Sepsis acquired in healthcare settings is a frequent adverse event during care delivery, affecting

hundreds of millions of patients worldwide every year, according to the WHO. Sepsis is also a burden on the U.S. healthcare system, as the condition often leads to hospital readmissions and longer hospital stays, according to statistical brief (#168) from The Healthcare Cost and Utilization Project1.

CDC’s sepsis response The CDC launched the Hospital Sepsis Program Core Elements program to support U.S. hospitals in ensuring that effective resources are in place to identify sepsis quickly and accurately. The resource allows staff to identify routine practices and leadership structures that assist in managing sepsis rates in hospitals. The CDC recommends that hospitals integrate a multi-disciplinary system within their sepsis programs to monitor and improve the outcomes of patients with sepsis. According to the CDC, the key elements of the sepsis control program include leadership commitment, which dedicates the necessary human, financial, and IT resources toward sepsis management; accountability, or appointing a leader responsible for setting program goals; multi-professional expertise, which engages key partners in the organization; action, which implements processes to identify, manage, and help patients recover from sepsis. The next steps of the program include monitoring sepsis to reduce disease incidence. This includes close tracking, which

measures sepsis epidemiology, progress toward goals; reporting, which provides usable information on sepsis treatment and outcomes to relative partners; and finally, education, which provides crucial sepsis information to healthcare professionals during onboarding and annually. “The CDC’s Hospital Sepsis Program Core Elements effort is a resource that helps providers identify sepsis more quickly, and provides tools to implement, monitor, and help optimize their sepsis programs,” said Craig.

treating, and measuring it. That is one reason why the CDC’s new Sepsis Core Elements offer a broad, evidence-based foundation of practices. From this scaffolding, hospitals and healthcare professionals can build the program they need to best support their own, unique communities,” said Demehin. For hospitals that are just beginning their sepsis program with limited resources, they should first identify a sepsis program leader or co-leader, secure support from hospital leadership, conduct a needs analysis

Hospital-specific programs may focus on sepsis only, or they could be part of a broader initiative that addresses multiple areas of quality improvement throughout the hospital. The CDC framework is beneficial because hospital systems can use it as a guide, tailoring the program in a way that works best for their healthcare procedures. Hospital-specific programs may focus on sepsis only, or they could be part of a broader initiative that addresses multiple areas of quality improvement throughout the hospital. The program’s goals may be specific to a single hospital or span entire healthcare systems. These core elements guide hospitals in structuring a sepsis program that rapidly identifies effective care for patients with sepsis. The CDC Sepsis Core Elements are designed to guide medical leaders in organizing staff and help with increasing sepsis-related survival rates. “Sepsis is a complex disease and there is no one-size-fits-all approach to preventing, identifying,

to order sets and supplies, be aware of any regulations, and obtain necessary data to begin establishing the initial goals for a successful sepsis program.

Physicians play a role For hospital patients that have been diagnosed with sepsis, it is important to recognize that physicians and healthcare providers play a critical role in monitoring fluids and treatment as patients transition between care. Physicians should act quickly and know how to identify the signs of sepsis, as it can make a significant difference in the survival of a patient. “One essential step in sepsis monitoring is to bring together relevant experts inside a hospital to provide a multi-disciplinary approach to the rapid identification Repertoire

January 2024

“In addition to its impact on patients, sepsis is an important health focus because the condition is also a burden to healthcare systems,” said Angela Craig, Medical Science Liaison and Clinical Nurse Specialist in Critical Care, Baxter. “Sepsis is the number one cause of hospital readmissions2, sepsis patients usually have a longer hospital stay3, and sepsis is the most expensive reason for hospitalization, costing more than $53 billion annually in the U.S.4, 5”



and treatment of sepsis. Leadership commitment to supporting that team’s work also helps encourage implementation of the standard processes and protocols used to rapidly identify and treat patients at risk for sepsis,” said Demehin. Following the CDC’s guidelines, and establishing a clear leader in infection prevention efforts, can assist a hospital in properly managing each patient’s sepsis infection. “Patients hospitalized with sepsis often receive IV fluids, and proper fluid management may improve a patient’s clinical outcomes. Increasing awareness among healthcare teams of early detection of the condition and appropriate fluid management tools that provide accurate and precise data such as the Starling Fluid Management Monitoring System can help make an important impact,” said Craig.

Future of sepsis care

Many studies are currently underway to find more effective methods to identify patients who have sepsis, how the disease impacts each individual, and possible biomarkers that could identify the disease, according to the Society of Critical Care Medicine. Said Craig, “At Baxter, our mission is to save and sustain lives.

“ Artificial intelligence can be used in hospital settings to review digital records in real-time to help doctors, nurses and advanced practice providers identify patients at risk of sepsis even earlier.” “Everything we know about sepsis tells us that early diagnosis and appropriate rapid treatment with antibiotics saves lives. But sepsis may present very differently in different populations. For example, the early signs of sepsis in a premature newborn can look very different than those of a trauma patient coming out of surgery or an elderly patient being transferred from a nursing home,” said Demehin. “Moreover, for people struggling to cope with multiple chronic conditions, the early symptoms of sepsis can mimic those of any number of other conditions. As a result, hospitals frequently implement programs that focus on the rapid identification and treatment of sepsis.”

For sepsis, that comes to life by helping to bring awareness to the condition, early detection, and treatment including the critical role that fluid management can play.” “We are fortunate to live in an age of technological transformation with real-time analytics, machine learning and natural language processing that are helpful tools for clinicians in predicting, identifying and responding to sepsis. Artificial intelligence can be used in hospital settings to review digital records in realtime to help doctors, nurses and advanced practice providers identify patients at risk of sepsis even earlier,” said Demehin. “We must continue to resource these kinds of innovative approaches as we strive to stamp out sepsis.”

January 2024

The overall impact of sepsis in hospitals became more evident during the hospital admittance surges during the COVID-19 pandemic, according to a study titled “Sepsis: New Challenges and Future Perspectives for an Evolving Disease” from the National Library of Medicine. A notable challenge in treating sepsis is the variety of reactions to treatment experienced on a patient-by-patient basis. Sepsis can be a full-body reaction to a

previous illness, requiring external support such as ventilators, dialysis, maintenance of blood pressure, and more, according to the Society of Critical Care and Medicine. Many patients who do survive experience ongoing complications after a sepsis infection, such as physical and cognitive issues that linger.

Sources: 1 2 Chang DW, Tseng CH, Shapiro MF. Rehospitalizations following sepsis: common and costly. Crit Care Med. 2015;43(10):2085-2093. 3 Latham HE, Bengtson CD, Satterwhite L, et al. Stroke volume guided resuscitation in severe sepsis and septic shock improves outcomes. J Crit Care. 2017;42:42-46 4 Buchman, T. G., Simpson, S. Q., Sciarretta, K. L., Finne, K. P., Sowers, N., Collier, M., ... & Wax, M. (2020b). Sepsis Among Medicare Beneficiaries: 3. The Methods, Models, and Forecasts of Sepsis, 2012–2018. Critical Care Medicine, 48(3), 302. 5 Torio, C. M., & Moore, B. J. (2016). National inpatient hospital costs: the most expensive conditions by payer, 2013: statistical brief# 204. Healthcare cost and utilization project (HCUP) statistical briefs, 2006-2016.



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Commercial Healthcare Providers

Amazon’s Reach Extends to Healthcare After many forays into the market, the e-commerce giant acknowledges it can’t do it alone. By Daniel Beaird

January 2024

 Amazon has tried different avenues in its quest to tap into the healthcare market in recent years.


It acquired online pharmacy PillPack in 2018 and launched Amazon Care in 2019 as a primary care service for its employees that blended telehealth with in-person medical services. It unveiled Amazon Pharmacy in 2020 offering discounts to Prime members and free delivery. In 2021, Amazon Care expanded to outside employers and added in-person care options in multiple cities, but it shut down last August after struggling to get insurers on board and after Amazon’s acquisition of primary care provider One Medical for $3.9 billion.


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Amazon Clinic was launched last November, which is available to people 18 to 64 years of age in all 50 states and Washington, D.C. Customers can use messaging to consult a clinician about common conditions like acne, migraine headaches and hair loss, among other conditions. It uses thirdparty vendors and does not accept health insurance, instead charging a flat fee, and customers can see their medical cost before their visit.

Launched in 2007, it had 836,000 members by the end of 2022. Senior Vice President of Amazon Health Services Neil Lindsay said Amazon is on a mission to make it dramatically easier for people to find, choose, afford and engage with the services, products and professionals they need to get and stay healthy. “Coming together with One Medical is a big step on that journey,” he said in a press release announcing the

The new Prime membership benefit is available to Prime members for just $9 a month (or $99 annually – up to $100 off the standard One Medical membership fee This January, Amazon introduced RxPass for $5 per month for Prime members to get all their eligible generic prescriptions through the e-commerce giant as companies are seeking to drive down the cost of generics by removing pharmacy benefit managers (PBMs) from the supply chain or manufacturing the drugs on their own.

January 2024

Amazon partnerships Amazon’s Chief Medical Officer Sunita Mishra told Yahoo Finance that the company will be flexible with its healthcare strategy and won’t go it alone. Its acquisition of San Francisco-based One Medical last July points to Amazon just gearing up in the healthcare sector. One Medical is a membership-based primary care practice offering comprehensive care in 19 major U.S. markets and 24/7 access to virtual care. It also works with over 8,500 companies to provide One Medical health benefits to their employees.



acquisition. “One Medical has set the bar for what a quality, convenient and affordable primary care experience should be like. We’re inspired by their human-centered, technology-forward approach and excited to help them continue to grow and serve more patients.”

What’s next for Amazon and One Medical Amazon is a behemoth with nearly $540 billion in revenue during the past 12 months. Healthcare has seemingly been its white whale in recent years. Is another healthcare acquisition next? Amazon’s attraction to One Medical’s humancentered, technology-forward approach could hint at further likeminded additions. Amazon was rumored to be in talks with home healthcare company Signify Health before CVS Health acquired Signify for $8 billion in March. “Together (with One Medical), we believe we can make the healthcare experience easier,

faster, more personal and more convenient for everyone,” said Amazon CEO Andy Jassy. One Medical offers: ` Around-the-clock access through the One Medical app. ` On-demand virtual care services like 24/7 video chats and in-app messaging. ` Same and next day in-office or remote visits. ` Walk-in availability for on-site laboratory services. In November, Amazon announced a membership benefit to its Prime members involving One Medical. The new One Medical membership covers unlimited access to 24/7 on-demand virtual care, including video chats with licensed providers within minutes and an in-app “Treat Me Now” feature that lets members get fast care for common concerns such as cold and flu, skin issues, allergies, urinary tract infections, and more. The new Prime membership benefit is available to Prime members for just $9 a month (or $99 annually – up to $100 off the standard One Medical membership fee). Prime members can add up to five additional memberships, each costing just $6 a month (or $66 annually – up to $133 off the standard fee). “When it is easier for people to get the care they need, they engage more in their health, and realize better health outcomes,” said Neil Lindsay, senior vice president, Amazon Health Services. “That’s why we are bringing One Medical’s exceptional experience to Prime members – it’s health care that makes it dramatically easier to get and stay healthy.”

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Commercial Healthcare Providers

Optum Broadens Coverage into Home Care Commercial healthcare providers heavily invest in home care sector as Medicare Advantage expands, aging in place trends up. By Daniel Beaird

 UnitedHealth Group reported a $5.8 billion profit in the third quarter as its Optum medical provider

business and its health insurance plans grew by double-digit percentages. Revenue increased 14% to $92.4 billion thanks to its third quarter growth. Optum’s third quarter revenues rose 22% to $56.7 billion and operating earnings grew to $3.9 billion. Optum businesses include healthcare services like surgery centers, clinics, doctor’s offices and pharmacy benefit manager (PBM) OptumRx. “Optum’s been the leader in showing how a managed care organization with an ambulatory care delivery platform and a pharmacy benefit manager all in house can lower or maintain and bend cost trend and then drive better market share gains in their health insurance business,” Ana Gupte, managing director of healthcare services at Leerink Partners, told Healthcare Dive.

Optum brokers deal with home care provider Amedisys This year, Optum agreed to combine with Baton Rouge, La.-based Amedisys, a provider of home health, hospice and high-acuity care, with the acquisition of Amedisys’ outstanding common stock in an all-cash transaction for $101 per share. It outbid competitor Option Care Health, which offered an all-stock deal in May. Optum’s deal values Amedisys at approximately $3.7 billion. The deal met shareholder approval in September, and it creates a massive combination of postacute care services with over 16,500 employees and over 670 care centers in 46 states. And it followed Optum’s earlier $5.4 billion merger with home health provider LHC Group, which was folded into Optum.

Concern from industry stakeholders January 2024

But American Pharmacy Cooperative, Inc. (APCI) sent a letter to the U.S. Department of Justice (DOJ) in October opposing the Optum-Amedisys deal and requested it be scrutinized closely pursuant to DOJ and Federal Trade Commission’s (FTC) draft merger



guidelines. The APCI letter calls the acquisition “a further descent into an already vertically integrated healthcare supply chain in which the largest insurers and their affiliated pharmacy benefit managers are able to profit off conflicts of interest and misaligned incentives.” APCI is a member-owned cooperative made up of over 1,800 independent pharmacies in 23 states. It offers members group purchasing power and frontend merchandising services among other benefits.

As home-based care gains popularity and the Medicare Advantage population expands, companies like UnitedHealth Group and other commercial healthcare providers continue to eye a larger footprint in post-acute care. But Optum says no single participant in the home care market has more than a single-digit percentage share and Optum is confident about its combination with Amedisys. As home-based care gains popularity and the Medicare Advantage population expands, companies like UnitedHealth Group and other commercial healthcare providers continue to eye a larger footprint in post-acute care.


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Commercial healthcare providers ramp up investment in home care sector CVS Health and Walgreens Boots Alliance both acquired home care companies as services moving into the home were accelerated by the COVID-19 pandemic and older Americans seeking to age in place. Optum says even with numerous home care providers, demand far exceeds available supply, creating the need for substantial investment in the sector to serve patients and their families more fully with high-quality care in their homes. “Amedisys’ commitment to quality and care innovation within the home, and the patient-first culture of its people, combined with Optum’s deep value-based care expertise can drive meaningful improvement in the health outcomes and experiences of more patients at lower costs, leading to continued growth,” Patrick Conway, M.D., chief executive of Optum Care Solutions, said in a statement about the deal.

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Commercial Healthcare Providers

CHPs in the News Sixty VillageMD clinics to close in 2024

January 2024

Before Walgreens Boots Alliance (WBA) named Tim Wentworth as Walgreens’ new CEO in October, it announced plans to close 60 VillageMD clinics in five markets in a $1 billion cost reduction strategy. “Our performance this year has not reflected WBA’s strong assets, brand legacy or our commitment to our customers and patients,” said Ginger Graham, interim CEO, in a statement. “We have taken a number of steps to align our cost structure with our business performance, including planned cost reductions of at least $1 billion, and lowered capital expenditures by approximately $600 million.” During the fourth quarter earnings call, Wentworth said he sees the opportunities to build on Walgreens’ pharmacy strength and its trusted brand to evolve healthcare and the customer experience.



“I know WBA. I have worked with Walgreens as a customer, partner, competitor, investor and family member. There is a reservoir of goodwill for this company across communities and a substantial opportunity to return value to our customers, employees and shareholders,” he said.

Walgreens to launch direct virtual care to consumers Retailers entering the world of healthcare has continued with Commercial Healthcare Provider (CHP) Walgreens entering the virtual health service scene. Walgreens Virtual Healthcare (WVH) will tie together virtual consultations with healthcare providers and prescription services, available to consumers through their phone, tablet, or computer. In late October, the virtual program began in nine states including California, Florida, Georgia, Illinois, Michigan,

Nevada, North Carolina, Ohio, and Texas. Patients currently in the eligible states will be able to access WVH at There are plans by the company in place to expand the program to more states over time. WVH offers treatment for common health needs such as seasonal allergies, medication refills, urgent care (COVID-19 and flu related), women’s health, men’s health, hair loss and skin health, and more.

Oak Street Health opens first primary care center in Scranton, Pennsylvania Oak Street Health announced in early November it was welcoming patients at a new Scranton, Pennsylvania center. This is the first center for Oak Street Health in Scranton and the 15th in the state of Pennsylvania coming on the heels of the Lancaster and Allentown centers that opened in September, according to a release. Oak Street Health delivers personalized, preventive primary care through a model that was created to meet the unique needs of older adults. The integrated model incorporates behavioral healthcare and social determinants support and is easily accessible through a mix of in-center, in-home and telehealth appointments, as well as a 24 ⁄ 7 patient support line. The Company has reduced patient hospital admissions by approximately 51% compared to Medicare benchmarks, and driven a 42% reduction in 30-day readmission rates and a 51% reduction in emergency department visits.

The Fab Four? Primary care doctors warn patients not to get caught up in Wegovymania.


January 2024


he American public is jazzed about Wegovy, Ozempic, Mounjaro and Zepbound for their potential for weight loss. Their primary care physicians? Not so much. Drugs such as these are not miracle cures for obesity, clinicians say. They often come with intolerable side effects, they cost a lot of money, and when people stop using them (which many do), they will likely gain back the weight they lost. Perhaps most important, these drugs deliver best results only when accompanied by increased physical activity and a reduced-calorie diet.


The Fab Four?

In a recent Harvard publication, Walter Willett, professor of nutrition at the Harvard T. H. Chan School of Public Health, laid out two pathways ahead. “On one, the new drugs help people with severe obesity lose meaningful amounts of weight, which then increases chances of success of lifestyle-based approaches. On the other, people don’t improve their diet, don’t increase exercise, and use the drugs to counter unhealthy habits they maintain and that may have contributed to the problem. On this path, people’s health would still be poor because good lifestyles contribute to well-being in many ways unrelated to weight control.” “Patients do come in after seeing TV and magazine ads and talking with neighbors and friends about Wegovy and Ozempic,” says Karen Smith, M.D., FAAFP, a family physician in Raeford, North Carolina, and a board member of the American Academy of Family Physicians. “They want to lose weight, and they believe this new miracle drug will help. We have a discussion with them and ask, ‘What else have you done about weight?’” Given that approximately 70% of American adults have obesity or are overweight, conversations such as these between primary care physicians and their patients are likely to multiply. Some Wall Street analysts predict a potential $150 billion to $200 billion opportunity for the makers of these drugs.

January 2024

The red carpet The key component of many weight-loss drugs – semaglutide – belongs to a class of medications known as glucagon-like peptide-1 (GLP-1) receptor agonists, according to the FDA. It mimics the GLP-1 hormone that is released in the gastrointestinal tract in response to eating. One role of GLP-1 is to prompt the body to produce more insulin, which reduces blood glucose. In higher amounts, GLP-1 also interacts with the parts of the brain that reduce appetite and signal a feeling of fullness. Ozempic injection and Rybelsus tablets are approved by the FDA to lower blood sugar levels in adults with type 2 diabetes mellitus, in addition to diet and exercise. Ozempic is also approved to reduce the risk of heart attack, stroke, or death in adults with type 2 diabetes mellitus and known heart disease. Wegovy injection was approved for weight loss in 2021 and is simply a higher dose of semaglutide than Ozempic. The newest entrant in the weight-loss derby is another injectable – Zepbound from Eli Lilly



and Co. Zepbound was approved by the FDA in November for chronic weight management in adults with obesity (body mass index of 30 or greater) or overweight (body mass index of 27 or greater) with at least one weight-related condition (such as high blood pressure, type 2 diabetes or high cholesterol), in addition to a reduced calorie diet and increased physical activity. Tirzepatide, the active ingredient in Zepbound, had previously been FDAapproved under the trade name Mounjaro to help improve blood sugar in adults with type 2 diabetes.

Do they work? Overall these compounds have shown to help patients shed 10% to 22% of body weight in their

‘ We know Ozempic by itself won’t affect any of these stressors. So there are things that have to be addressed before we rely on semaglutide.’ 958 patients who received once-weekly placebo injections. In both trials, patients who received Zepbound at all three dose levels experienced a statistically significant reduction in body weight compared to those who received placebo. In addition to weight loss, these drugs have been shown to offer other health benefits. For Repertoire

January 2024

first year of use, according to Harvard nutrition expert Willett. In its January 2021 approval of Wegovy, the FDA reported that its manufacturer, Novo Nordisk, demonstrated in a study that people who received Wegovy lost an average of 12.4% of their initial body weight compared to individuals who received placebo. Another trial enrolled adults with type 2 diabetes, whose average age was 55, average body weight 220 pounds and average BMI 36. In this trial, individuals who received Wegovy lost 6.2% of their initial body weight compared to those who received placebo. In trials of Zepbound, Eli Lilly measured weight reduction after 72 weeks in a total of 2,519 patients who received either 5mg, 10mg or 15mg of Zepbound once weekly and a total of


The Fab Four?

example, in November, Novo Nordisk reported that semaglutide 2.4mg (Wegovy) delivered a statistically significant 20% risk reduction in major adverse cardiovascular events (MACE) across age, gender, ethnicity and starting body mass index. The risk reductions in MACE were evident soon after initiation, suggesting an effect of semaglutide 2.4mg beyond weight loss alone, according to the data presented at the American Heart Association Scientific Sessions and published simultaneously in New England Journal of Medicine.

Primary care perspective Family physicians have a unique perspective when talking to their patients about overweight, obesity and weight-loss drugs, says Dr. Smith. “We have cared for many of our patients since before 2008, which is how far back our EHR goes. We review their records and try to match their BMI to life events that might have occurred through the years.”

‘ They want to lose weight, and they believe this new miracle drug will help.’ As patients get older, for example, they might not be exercising regularly or going to the gym or taking the walks they used to take. “We try to find out if their routine has changed in any way. Perhaps they are too busy taking care of young children to the point where they’re not paying attention to themselves. Was there a job change? Has their income level shifted? Have the kids left but now they must take care of their elderly mom or dad? “We know Ozempic by itself won’t affect any of these stressors. So there are things that have to be addressed before we rely on semaglutide.”

January 2024

Yellow light All has not been smooth sailing for the blockbuster drugs. Given their popularity, availability has been spotty, says Dr. Smith. “Some pharmacies have it, others don’t.” Prior authorization has proven to be a hassle as well, she says. “We might have to demonstrate lifestyle changes, the existence of comorbid conditions, the fact that the patient is considering bariatric surgery, a one-on-one nutritionist



consultation. And despite all that, the claim may still be denied. Or the patient may say, ‘I’ll pay the $600 out-of-pocket for a prescription,’ but lack the money to get refills. And we have had patients who were successful in losing a percentage of body weight but don’t make the necessary lifestyle changes. Wegovy isn’t set up for lifelong management of obesity.” Due to negative side effects, a good proportion of people discontinue use of semaglutide, cancelling out its long-term effectiveness for weight loss. For example, Eli Lilly reports that Zepbound use may be associated with gastrointestinal adverse reactions, sometimes severe. The most commonly reported adverse events were nausea, diarrhea, vomiting, constipation, abdominal pain, dyspepsia, injection-site reactions, fatigue, hypersensitivity reactions, eructation, hair loss and gastroesophageal reflux disease. What’s more, birth control pills may lose their effectiveness for people on Zepbound. Then there’s the cost. Zepbound, whose active ingredient is tirzepatide, costs about 20% less than semaglutide, according to Eli Lilly, but still comes with a list price of $1,060 per month. In July, pharmacy benefit manager Prime Therapeutics reported that among individuals who initiated GLP-1a drugs for weight loss, the total cost of care at a one-year follow-up came to $7,727 per person. Adherence to these drugs was also poor, with just 27% of individuals taking GLP-1a drugs after one year. “GLP-1a drugs and their use for weight loss have taken the health care industry by storm, but several issues must be resolved, including how to ensure that those who may benefit most have access while maintaining overall pharmacy benefit affordability,” said David Lassen, PharmD, chief clinical officer at Prime, in a statement. “While we hope to see additional data to refine our guidance, health plans should consider programs to help adherence to avoid medication waste and comprehensive therapy plans – which include diet and exercise – to help people on their weight loss journey.”

What’s next? Estimates of the percentage of the U.S. population who are overweight or obese range from 30% to 70%. Whatever the real number is, most healthcare providers believe it’s too high. Now, is there any way

to put a positive spin on it? Can the weight-loss drugs help? Is the U.S. losing the battle against obesity? “At least we have data on obesity today,” says Dr. Smith. “We have identified the problem, we have mapped it out. Now it’s a question of, how do we take that information and apply it to our individual patients who are at risk of obesity and other compromising conditions?

“It’s a sensitive topic, an emotional topic. What we can do is bring it home to our patients. We tell them, ‘Here’s the data. I am here to advise you, counsel you, be compassionate about this disorder that’s all around us, and help prevent you from being in the same state of suffering you see others experiencing. “’Let’s work together in a compassionate and understanding manner. Let’s help you get through it.’”

Bariatric surgery:

Repertoire: Analysts have predicted that sales of weight-loss medications such as Wegovy could reach $100 billion by 2030. One analyst predicted that by 2030, around 15 million adults in the U.S. will be treated with an anti-obesity medication. Do you expect that the popularity and reported effectiveness of semaglutide as a weightloss tool will have an impact on bariatric surgery? Marina Kurian, M.D.: We believe greater adoption of the new antiobesity medications will lead to increasing demand for metabolic and bariatric surgery. Many patients may start with medications but then turn to surgery due to compliance or cost issues or for even more robust weight loss results and improvements or remission in diseases including diabetes, heart disease and sleep apnea. Metabolic/bariatric surgery has been

shown to be the most effective and durable treatment for severe obesity yet least utilized treatment in medicine. About 1% of eligible patients undergo the surgery in any given year thus far. It’s also one of the safest operations in America, with a safety profile comparable to appendectomy, hip replacement and gallbladder surgery. Studies show that:

` Bariatric surgery may reduce a patient’s risk of premature death by 30-50%. ` Patients may lose as much as 60% of excess weight six months after surgery, and 77% of excess weight as early as 12 months after surgery. ` On average, five years after surgery, patients maintain 50% of their excess weight loss. ` Most bariatric surgery patients with diabetes, dyslipidemia, hypertension, and obstructive sleep apnea experience remission of these obesity-related diseases. The bottom line is, obesity is a disease that must be treated and cannot be ignored. Our hope is more people will seek the treatment for them without facing barriers.

Repertoire: The Centers for Disease Control and Prevention says that obesity prevalence was 42% from 2017 to 2020. Is there any way to look at this statistic in a positive way? Dr. Kurian: Obesity is a serious disease, and it is not at all positive that it continues to increase. Obesity is linked to diabetes, heart disease, stroke, scores of other diseases and shorter lifespans. It would be a very positive development if we could decrease its prevalence, which in turn would lead to less other disease and people living longer, healthier lives.

Repertoire: Anything to add about treatment for people with obesity considering the popularity of Wegovy and Ozempic? Dr. Kurian: Clearly, patients should seek advice from their own doctors. However, in general terms, neither drug therapy nor metabolic and bariatric surgery should be delayed until more severe disease occurs. Patients should not be forced to wait until their diabetes or obesity becomes worse or have a heart attack or stroke before they can have metabolic and bariatric surgery or other effective treatments.


January 2024

New anti-obesity drugs will not replace bariatric surgery. In fact, they may drive more surgical procedures, says Marina Kurian, M.D., president of the American Society for Metabolic and Bariatric Surgery. Repertoire asked Dr. Kurian about weight-loss drugs and bariatric surgery.



Better BP at the Point of Care January 2024

CORRECT BP study finds that proper patient positioning is critical for accurate BP measurements.


 Blood pressure (BP) is a vital sign taken at nearly every doctor’s visit, and millions of patients have their BP measured each day. Properly taken, BP measurements are critical for doctors to improve the accuracy of disease diagnosis.


Association (AHA) guidelines for proper patient positioning. The authors of the study are Bruce S. Alpert, Joseph E. Schwartz, Mira Shapiro and Randell K. Wexler. Results of the CORRECT BP study confirm AHA-recommended patient positioning affects BP measurements and show that improper positioning can result in higher BP measurements. The authors and Midmark believe it is important for healthcare systems to

understand the results for more effective care of their patients.

The impact of correct BP measurement Something as seemingly minor as improper patient positioning can negatively affect BP measurements. As shown by the CORRECT BP study, AHA-recommended patient positioning can decrease BP measurements by 7.0 millimeters of mercury (mmHg) for systolic Repertoire

January 2024

“Midmark Corporation researches important healthcare issues through its Better BP program to offer medical products designed to help improve clinical care,” said Dr. Tom Schwieterman, Chief Medical Officer and Vice President of Clinical Affairs for Midmark. Midmark funded a study conducted by The Ohio State University (OSU) Department of Family and Community Medicine to test current American Heart



BP (top number) and 4.5 mmHg for diastolic BP (bottom number). The 7.0/4.5 difference was statistically significant and clinically important. Improper positioning (a patient sitting on a chair or fixed-height table with their arm and feet unsupported) leads to incorrect BP results that could impact the clinical decisions of physicians. It is likely there are millions of people throughout the country that are not having their BP measured correctly. Midmark has worked diligently to inform clinicians of the importance of Better BP and the results of the CORRECT BP study.

escalations, and the morbidity of the U.S. patient population. “As a clinical team, through the CORRECT BP study, we found that once we dove into the past research on the topic, there were many studies on every individual aspect of blood pressure positioning, such as that the patient’s back needs to be supported, or a patient’s feet must be on the floor, or their arms must be supported with an armrest, or the cuff has to be at the right level,” said Dr. Schwieterman. For instance, the 2015 SPRINT study published in The New England Journal of Medicine reported that reducing the BP

January 2024

BP is one of the most important vital signs because it is such an important contributing factor to many chronic diseases and is also a risk factor for cognitive disorders. With BP, there is a real opportunity to reduce current trends, cost escalations, and the morbidity of the U.S. patient population. “What we’re finding is that the Better BP concept resonates with clinicians and others who understand that blood pressure is a critical part of the care chain. Midmark has been researching this concept for some time and we feel we’re creating real value in the marketplace,” said Dr. Schwieterman. BP is one of the most important vital signs because it is such an important contributing factor to many chronic diseases and is also a risk factor for cognitive disorders. With BP, there is a real opportunity to reduce current trends, cost



treatment threshold from 140/90 to 130/80 was estimated to reduce cardiovascular events by more than 25%. The researchers for the study were selective and focused on specific patient preparation aspects – such as patient positioning, avoiding caffeine prior to measurement, and making sure that patients had a rest period and that they were comfortable before having their BP measured. The information reported in the 2015 study was impactful, and if widely followed, had the potential to prevent one in every four heart attacks,

strokes, and other vascular disorders. Once the SPRINT study was published, guidelines for how BP should be taken were revised across the nation. In 2017, AHA published new guidelines for in-clinic BP measurement that largely mirrored the highly specific protocol for BP measurement defined in the study published in the New England Journal of Medicine. Many of the known causes for avoidable variation in point of care measurement were taken into account in the protocol, except for the known impact of white coat hypertension. Individual aspects of proper BP measurement had been studied previously, but to see the affect on resting BP measurement when the most common causes of error were evaluated at the same time, rather than individually, Midmark supported further research the topic. The CORRECT BP study was designed to determine the effects of poor positioning that occur when BP is taken with the patient sitting on a typical clinical exam room fixed-height table, where the feet are not flat on the floor, the back is not supported and the arm is not supported with the BP cuff at heart level. The results of this study support AHA-recommended guidelines for patient positioning when doing BP measurements.

Better BP and distributor reps Midmark funded the CORRECT BP study to be conducted at OSU by Dr. Randy Wexler as the principal investigator. Dr. Wexler has a longstanding professional interest in BP management and is

an experienced clinical researcher within the OSU Department of Family and Community Medicine. “We were confident Dr. Wexler and the other authors would ensure the study findings were unbiased and could be trusted by the medical professional community,” said Dr. Schwieterman. “As a peer-reviewed study published by a well-respected medical journal, we feel the CORRECT BP study is likely to be well received by clinicians who distributor reps share it with.” Whenever a distributor rep is selling to a doctor, they have different categories that the product could fall into, said Dr. Schwieterman. “These can include equipment or supplies, infrastructure, or appealing to the deep-seated, if not emotional, focus a clinician places on how these products impact care and drive better population health results,” he said. “What Midmark has done is create a package that says to physicians when they set

Distributor reps can assure their customers that they are not only getting the best aesthetic, design, workflow, and barrier-free engagement with patients through Better BP practices and equipment, but also clinical results that are trustworthy and reliable. up an ecosystem with all these correct environmental needs, you’re also setting up the patient for success with their clinical care and clinical outcome which maps directly toward value-based care.” Distributor reps can assure their customers that they are not only getting the best aesthetic, design, workflow, and barrierfree engagement with patients through Better BP practices and equipment, but also clinical results that are trustworthy and reliable. Focusing on those attributes, and the fact that Better BP ensures BP measurements can be better at the point of care, allows distributor reps to sell Better BP to physicians.

Midmark has resources for sales reps to assist them in conveying to doctors in the selling process how many people this study could impact if they implement Better BP practices. Stated Dr. Schwieterman, “Millions of patients get their blood pressure measured at doctors’ visits every day, and the thought that Midmark could help increase the accuracy of this very important vital sign is very exciting. It impacts dealer reps that are calling on point of care practices on a daily basis.” Editor’s note: Repertoire would

like to thank Midmark for their assistance with this article.

Key findings of the CORRECT BP study include:

ing resulted in substantially lower BP values when compared to those readings obtained within routine clinical care where AHA-recommended positioning procedures for BP attainment were not followed.

` BP readings taken on a fixedheight exam table where the proper AHA protocol could not be achieved were significantly higher than readings taken

using the proper technique with the patient seated in an exam chair with adjustable positioning options.

` Pooled systolic/diastolic BP readings taken on the exam table with incorrect positioning were markedly higher by 7.0/4.5 mmHg (both p<0.0001) than those taken in the exam chair.

` These significantly higher readings could result in

misclassifying a patient as having hypertension

` The observed benefit of proper positioning is sufficient to change the classification of BP disorders for millions of patients from hypertensive to normal.

` The results support estimates that as many as 30 million or more Americans may be incorrectly classified as having hypertension.


January 2024

` AHA-recommended position-



Private Equity: Risk or Reward? Not all PE firms are the same. That’s why physicians must approach a sale with caution.

 Who hasn’t heard the story about a private equity deal gone bad? It usually goes like this: PE firm

January 2024

acquires old and beloved business, then slashes overhead and sells off bits and pieces of it, leaving a carcass and bad feelings.



Why now? Two years ago, Physician Growth Partners, a Chicago-based firm that represents independent physician groups in transactions with private equity, reported that much of private equity’s interest in healthcare was fueled by record-low interest rates, a prolonged bull market, and all-time-high levels of uninvested capital, or “dry powder.” Dental consolidation has been privy to private equity investment for over 20 years, while dermatology, eye care and pain management have been consolidating for over five years, according to the firm. More recently, specialties including orthopedics, gastroenterology, urology, podiatry, ENT and women’s health have begun to consolidate as well. A private equity partner that is both an optimal cultural fit and offers a cohesive growth strategy enables a physician practice platform to scale significantly more rapidly than it could independently,

according to Physician Growth Partners. Healthcare private equity groups typically look to scale physician practice platforms over a five-to-sevenyear investment cycle before evaluating an exit. These investors continue to be attracted to physician specialties that benefit from growth in the aging population, supply and demand imbalance, and the growing incidence of chronic conditions. Healthcare private equity firms often employ a “platform-based” strategy, says the company. They make a large initial investment with a regionally dominant practice that serves as an anchor, then invest in smaller practices to establish multistate and regional dominance. Another strategy is to acquire strong, clinically driven practices across multiple geographies, establishing a brand known for exceptional patient outcomes.

‘ Sellers are expecting to receive the same sort of value that their colleagues may have received in the prior 12 to 24 months, but buyers today can’t pay as much as they historically have.’ Are we OK with this? Many physicians worry that private equity will interfere with patient experience. However, given the right fit, PE firms “provide scale to allow independent practice groups to survive and maintain their autonomy,” says Michael Kroin, founder and chief executive of Physician Growth Partners. But not everyone regards PE firms favorably. Prices for physician services increase 1.5 to 3 times in markets that are highly penetrated by private equity, according to the American Antitrust Institute. This is true for key areas of medicine, including gastroenterology, dermatology and obstetrics & gynecology. In October 2021, the USC-Brookings Schaeffer Initiative for Health Policy published a report titled “Private equity investment as a divining rod for market failure,” in which authors blamed PE-backed physician staffing companies and air ambulance operators for exacerbating out-of-network surprise medical billing.

January 2024

That’s not how it has to be, says Gary Wayne Stewart, MD, FAAOS, a foot and ankle specialist at Resurgens Orthopaedics in metropolitan Atlanta, a successful practice that partnered with private equity firm Welsh, Carson, Anderson & Stowe (Welsh Carson) in December 2021. “Instead of becoming stagnant, our plan was to offer the next generation of care,” he says. The plan seems to be working out. Private equity firms have been busy acquiring physician practices across several physician specialties since 2012, increasing from 75 deals in 2012 to 484 deals in 2021, according to a study from the American Antitrust Institute. At the local level, these firms are acquiring significant shares of physician practice markets. In 28% of metropolitan statistical areas (MSAs), a single PE firm has more than 30% market share in terms of fulltime-equivalent physicians, and in 13% of MSAs, the largest PE firm’s market share exceeds 50%. Case in point: Gastro Health, a gastroenterology medical group in Miami, Florida, which in 2021 was purchased by a private equity arm of a Canadian pension fund. Today the practice has a presence in seven states – Florida, Alabama, Washington, Virginia, Ohio, Maryland and Massachusetts – with over 375 physicians and 150 medical offices, infusion centers, imaging services and specialty pharmacies. Additionally, Gastro Health owns and operates endoscopy centers in five states and operates pathology and anesthesia services as well.




The AAI report identified three ways that private equity’s growing healthcare involvement could harm consumers and physicians:

market failures and payment loopholes than other potential acquirers, which could result in higher healthcare spending and patient and taxpayer costs.

Their warnings notwithstanding, the AAI report’s authors add this disclaimer: “[It] is unclear whether private equity investment is itself a problem or whether, in the absence of private equity, other sources of capital – such as public equity, venture capital, health systems and insurers – would similarly exploit existing market failures and legal loopholes in the health care system.”

2. PE’s growing investment in physician practices may

GI Alliance

1. Private equity may more aggressively exploit

accelerate horizontal consolidation in certain specialties, which could lead to increasing prices and/or poorer quality of care.

3. Driven by tax and regulatory advantages, private

equity might “distort the organizational form of physician practices away from physician ownership,” which could adversely affect patient care.

In 1978, Lawrence Kosinski, M.D., founded the Illinois Gastroenterology Group, now the largest such group in Illinois. In 2018, its partners started exploring a relationship with private equity. In 2019 they sold the practice to the PE-backed GI Alliance, which today is the largest PE-owned gastroenterological practice in the country, with 900 gastroenterologists in multiple states.

January 2024

‘Doctors just want to be doctors and put the management of their practice into the hands of somebody who will have their best interests in mind.’



“One of the most important things that has happened – and this is across the physician spectrum – is the growth in the knowledge that must be mastered to practice medicine effectively,” says Dr. Kosinski. “Doctors just want to be doctors and put the management of their practice into the hands of somebody who will have their best interests in mind, such as a private equity firm.” In many PE deals, physicians continue to control the medical side of the practice while a management services organization – owned predominantly by the PE firm – takes care of the business side (e.g., HR, contracting, billing, etc.), he says. In such deals, physicians maintain revenue earned from patient care but then give the MSO a portion of their earnings – usually annually – to fund its operations. “What’s intoxicating about private equity is the money involved,” says Dr. Kosinski, who prior to his retirement from the GI group founded SonarMD, a firm that offers care plans for physicians treating patients with complex chronic diseases. Upfront payments are enticing, but doctors need to carefully examine the terms of any deal to ensure they and their patients will benefit from it long-term, he says. “The best thing that can happen is, less upfront money is distributed to the doctors and more is put back into the practice so a deep clinical infrastructure can be built.” “There’s obviously risk in any deal,” says Kroin. “The question is, how do you mitigate it? How much control will the physicians maintain after the transaction is completed? Will they be able to practice medicine as they have historically and make decisions at the local level? There’s a reason a practice is successful for 30 or 40 years. You want to maintain that culture and DNA, and make sure it is written into the governance documents. “Understand that not all private equity groups are created equal,” he adds. “Each one comes with its own opportunities and risks. Some PE firms want to maintain full control, but others leave control to the local entity. That’s why it’s so important to navigate through the noise.”

Resurgens “PE-backed groups shouldn’t practice medicine differently than any others,” says Dr. Stewart at Resurgens Orthopaedics. “Patients shouldn’t notice any differences at all, except for positive things,


like improved access, innovation, ease of service – things that any well-functioning practice should offer. But people get scared. They seldom hear of successful deals but are almost certain to hear about the bad ones.” Resurgens and Welsh Carson formed their venture – United Musculoskeletal Partners – in December 2021. Today UM Partners has 400 providers in 56 locations, primarily in the Atlanta and Dallas metropolitan areas. “We were the most successful orthopedic practice in the Atlanta metro area,” says Dr. Stewart. “We had 95 physician partners and a strong leadership structure in place. We were doing well. But it would be disingenuous to say we weren’t feeling headwinds. We were feeling pressure from hospitalbased practices, market consolidation, unfavorable regulatory developments, and a gradual move toward value-based payment from fee-for-service. We knew we would need capital to stay competitive.”

Initially the group’s doctors were skeptical about private equity. Would a PE partner support growth? After all, some PE firms had built their reputation primarily around cost-cutting. “But we felt that Welsh Carson – which is well known in healthcare – could offer something different. They have deep experience in operations, reimbursement, the revenue cycle. We wanted to continue to change, to invest in state-of-the-art care, to be on the cutting edge. We made it clear we wanted a true partner, and we felt Welsh Carson could be one. “Our physicians maintain complete autonomy over clinical decisions,” he says. “We have been able to offload many business functions, which only increases the amount of time we spend with our patients. We have established a physician leadership board, which oversees governance and quality of patient care. We have made sure there is a place for young physicians and that all specialties are treated the same. This is about partnership,

‘Understand that not all private equity groups are created equal. Each one comes with its own opportunities and risks.’ medical innovation, patient care and finding a way to maintain physician autonomy in the clinical arena. We’re two years in. The idea and the goal was to get better, to not stand pat.”

What’s next?

January 2024

Despite their growth, private equity firms face challenges in healthcare, including scrutiny from the federal government. In June 2023, for example, the House Energy and Commerce Committee recommended a bill (H.R. 3561) that would require entities, including physician practices with more than 25 physicians, to report annually to the U.S. Department of Health and Human Services their business structure, mergers and acquisitions, and changes in ownership. In September, the Federal Trade Commission sued U.S. Anesthesia Partners, Inc., the dominant provider of anesthesia services in Texas, and private equity firm Welsh, Carson, Anderson & Stowe, alleging the two executed a multiyear anticompetitive scheme to consolidate anesthesiology practices in Texas, drive up the price of anesthesia services provided to Texas patients, and boost their own profits.



In addition to the political headwinds, PE firms are facing some economic challenges as well. Last fall, Politico reported that “a wall of debt” is coming due for private-equity-owned hospitals and nursing homes. “Cheap and flexible financing that helped big Wall Street buyout firms snap up health centers, long-term-care facilities and provider networks in recent years has evaporated. Higher borrowing costs are chipping away at margins. And bankruptcies at private-equity-owned businesses are on track to reach decade highs, which could result in job cutbacks.” Physician Growth Partners’ Michael Kroin says rising interest rates and capital costs have already slowed down the pace of PE acquisitions and have created an imbalance between the expectations of sellers and buyers. “Sellers are expecting to receive the same sort of value that their colleagues may have received in the prior 12 to 24 months, but buyers today can’t pay as much as they historically have.”

There’s no doubt PE-backed groups will continue to make acquisitions, but they are modifying their approach, says Kroin. “In the past couple of years, a lot of these PE groups have built density within the same specialty. To keep growing, some are bringing together specialties that are adjacent to or that complement each other.” He cites Unio Health Partners, a Triton Pacific Capital Partners portfolio company, which built a urology practice but has since added gastroenterology and radiation oncology. Dr. Kosinski advises physicians in PE-owned groups to consider what might happen to their practice when the firm decides to sell it. “The bottom line is, being a good doctor has become much more intensive given the demands of the profession, and doctors will continue to be employed by some entity,” he says. “The question is, who will be the consolidator? Hospitals look like they have an edge on that, but insurance companies are becoming major players. Whoever bears the risk of the cost of care will be the ultimate convener.”

Antitrust and private equity

The FTC’s complaint, filed in federal district court, alleges that USAP and Welsh Carson: ` Executed a roll-up scheme, systematically buying up nearly every large anesthesia practice in Texas to create a single dominant provider with the power to demand higher prices. ` Further drove up anesthesia prices through price-setting agreements with remaining independent practices. ` Sidelined a significant competitor by striking a deal to keep it out of USAP’s territory.

The FTC alleges that USAP’s multi-pronged anticompetitive strategy and resulting dominance has cost Texans tens of millions of dollars more each year in anesthesia services than before USAP was created. USAP denies the FTC’s charges. In a statement, Dr. Derek Schoppa, a practicing USAP physician in Texas and a USAP Board member, said, “The FTC’s intended outcome threatens to disrupt and restrict patients’ equitable access to quality anesthesia care in Texas and will negatively impact the Texas hospitals and

health systems that provide care in underserved communities.” Dr. J. Scott Holliday, another USAP physician in Texas and a USAP Board member, called the FTC’s actions “especially concerning given this moment in time when the healthcare infrastructure in the United States is facing multiple headwinds such as provider shortages, clinician burnout and turnover, and health disparities. While we fight the FTC’s overreach and misguided allegations, we will remain true to our mission of providing highquality anesthesia care in the communities we proudly serve.”


January 2024

In September the Federal Trade Commission sued U.S. Anesthesia Partners, Inc. (USAP), the dominant provider of anesthesia services in Texas, and private equity firm Welsh, Carson, Anderson & Stowe, alleging they “executed a multiyear anticompetitive scheme to consolidate anesthesiology practices in Texas, drive up the price of anesthesia services provided to Texas patients, and boost their own profits.”



Personalized Virtual Care Leading health systems partner with consumer-focused platform for self-insured employers to expand access to patients.

 The healthcare industry continues to develop and innovate to meet consumer preferences and

January 2024

needs. The pandemic led to wider access to virtual care services, and technology has enabled new entrants into the healthcare industry to profit.

One of those companies, Transcarent, has partnered with 10 health systems across the nation to form a virtual provider ecosystem. Transcarent is a consumer-directed healthcare platform for self-insured employers. With an ecosystem of virtual point solutions, care professionals, and local healthcare facilities, Transcarent aims to make it easier for patients to have access to healthcare right from their phone or laptop. Employers using Transcarent as their companies’ healthcare provider receive competitive pricing previously only reserved for narrow networks. For the first time, members can access virtual care that works together with complex care services delivered locally at hospitals, according to Transcarent. The brand connects consumers with healthcare information, allowing them to get care on demand, find in-network providers, locate prescription savings, explore care benefits, view lab results, and access educational content. Transcarent offers resources that support patients with everyday care, surgery, at-home physical therapy,



Transcarent announced the National Independent Provider Ecosystem that includes health systems such as: ` Advocate Health ` Atrium Health ` Baylor Scott & White Health ` Corewell Health ` Hackensack Meridian Health ` Intermountain Healthcare

` Mass General Brigham ` Memorial Hermann

Health System ` Mount Sinai Health System ` Virginia Mason Franciscan Health “We are proud to be collaborating with Transcarent as we accelerate the innovation of care delivery models that are transforming health care,” says Ketul J. Patel, CEO of Virginia Mason Franciscan Health and president of the Pacific

Northwest division of CommonSpirit Health. “This alignment expands our commitment to serving our communities by further integrating care across our continuum, in part, by pioneering a range of digital experiences that will make health care easier to navigate, more affordable and more easily accessible for patients across our region.” Transcarent’s comprehensive care model will offer employers and their employees a personalized care experience in the virtual platform in collaboration with each health system. Consumers will also have access to expert clinical opinions, virtual physical therapy, orthopedic consultations, a pharmacy marketplace, access to immediate care quickly (or at home); and a cost effective same-day payment feature unique to Transcarent. Payment works through a direct-to-employer system that pays providers on the same day care is delivered. Value-based incentives allow employers receive competitive pricing previously reserved only for narrow networks, while maintaining access for members. Employees benefit from waived co-pays and co-insurance for making better decisions about care. “We are excited to partner with Transcarent to provide employers across our region with better, more convenient access to high-quality, value-based care options for their employees,” said David L. Callender, MD, President & CEO for Memorial Hermann Health System. “We know that business leaders are a catalyst for improved outcomes in health care, and by collaborating to enhance their employees’ wellness, we can work to improve the health of our communities together.” Repertoire

January 2024

comprehensive case reviews, support for oncology care, behavioral healthcare, pharmacy, and more.



Banding Together How a recently formed hospital alliance aims to expand access and improve outcomes – while reducing costs – in a rural setting. By Jenna Hughes

 Value-based care is a highly sought after goal – yet often an elusive one – for healthcare providers of

January 2024

all shapes and sizes. No where is this more evident than the rural setting, where large geographic distances, reduced access to services, rising costs and lack of scale all come into play for providers.

To tackle those challenges, an alliance of 23 rural hospitals in North Dakota recently announced the formation of the Rough Rider High-Value Network, The network, based in Cando, N.D., was formed to strengthen rural healthcare for providers and patients throughout the state. The network announced its formation at the end of 2023 as a collaboration between individual and independent critical access hospitals that all collaborate to address rural health challenges and enhance community health. The hospitals work together on clinical and operational initiatives to strengthen the availability, affordability, and quality of care in communities across the state of North Dakota. “The Rough Rider Network consists of 23 hospitals that came together to capitalize on the economies of scale that they all represent in unison. The goal is a triple aim of improving access to care, quality of care, and reducing the cost of healthcare,” said Alfred Sams, president, Rough Rider HighValue Network. “Those goals rely on being able to tackle all of the barriers in being an independent hospital, but also coming together and being able to pool



resources with other hospitals while maintaining independence.” The Rough Rider Network is committed to enhancing the sustainability of rural healthcare throughout North Dakota. Uniting a network of critical access hospitals and clinics, the alliance aims to combine resources while remaining independent. “Independence is an important aspect for all of our members,” said Nathan White, CEO, Rough Rider High-Value Network. “Members, however, also must focus on surviving in

their current environment, both clinically and financially. The alliance offers two benefits to members, investment in services, and then, on the clinical integration side of things, each individual hospital being able to take advantage of the pooling of their resources. The ability to dive into value-based healthcare and reduce the risks from a collective perspective is critical.”

The rural setting For hospitals and health systems in rural areas, focusing foremost

Benefits of a health alliance Through the Rough Rider Network’s clinically integrated network (CIN), member hospitals will collaborate to support new specialty programs including surgery, ophthalmology, obstetrics, and mental health, which would be difficult for individual hospitals to support on their own. The CIN also aims to reduce administrative burdens and streamline measuring quality, according to The Rough Rider High-Value Network. Additionally, the Clinical Integration Committee (CIC), with a medical provider on the committee from each member hospital, will oversee clinical and quality initiatives within the alliance. The Rought Rider CIN will collaborate with payers on value-based insurance products that will enable patients, providers, and payers to succeed by enhancing the patient and provider experience. “Managed IT solutions, aggregated accounting solutions, mobile radiology, imaging reads, and more, are all services that can be integrated through the alliance that enhance ability to focus on patients and provide better care,” according to Sams. The Business Integration Committee, with operations leaders from each of the joined hospitals, will oversee the development and operation of shared service offerings. The committee also provides a forum for leaders to discuss business challenges and develop solutions. “Within our network, every facility has a clinical representative on the clinical integration committee. Each hospital puts forth a member and they come together and discuss pertinent topics, quality measures, best practices, and

help the system take on a unified approach to patient care and best practices,” according to Sams.

Future The Rough Rider Network received state funding of $3.5 million to assist with facilitating its goals, and to support North Dakota patients and hospitals in the value-based care transition, according to The Rough Rider High-Value Network. “We tackle the challenges that are the hospital’s most demonstrated needs,” White said. “If the majority of our members are interested in a particular shared service, we will try to negotiate that for our members. If 70% of the members are interested in a different solution, we will move forward with that change.” The Rough Rider High-Value Network plans to integrate a menu of shared services between hospitals that will promote more efficient operations going forward. These shared services would include pharmacy, laboratory, telehealth, information technology, health information exchange, clinical staffing, supply chain, and more. “The reality is that many payers are moving their financial incentives toward value-based care arrangements. That is happening with Medicaid expansion in North Dakota, too. So, we knew at Rough Rider that there was a lot of financial and clinical gain from moving towards value-based care models,” said White. “By coming together, hospitals are aggregating the base of their covered lives while also investing in shared solutions to manage challenges and improve population health.” Repertoire

January 2024

on local cases and community health is critical. An alliance allows rural hospitals to broaden their resource availability and more effectively deliver healthcare to communities by investing in medical advances, controlling the rising costs of providing care, and enhancing care coordination, according to the network. “The geographic isolation in the North Dakota area presents challenges for hospitals, especially during inclement weather,” said Sams. “It is often frozen here for five months with ice and snow, and so we have a geographic boundary that isolates some of our facilities. We also have hurdles in attracting and maintaining our work staff such as doctors, specialists, and nurses.” White adds: “Access inequities can present a tremendous challenge for independent rural hospitals. Older populations have disparities in health outcomes, and independent hospitals lack scale and suffer from price disadvantages and service disadvantages.” Expanded healthcare capabilities are necessary for rural and independent providers, such as systems for controlling the rising costs of healthcare and enhancing care coordination. These goals are often difficult to achieve as an independent provider alone. “Interdependence drives independence,” said Ben Bucher, CEO of Towner County Medical Center in Cando, N.D., and chair of the Rough Rider HVN board. “The Rough Rider High-Value Network is built on the principle that independent rural hospitals can come together to meet these challenges and emerge stronger while remaining independent.”



Pain Points Recent survey reveals how healthcare providers believe supply chain disruptions are affecting clinical outcomes. By Jenna Hughes

 Shortages within the healthcare industry have had deep impacts to the delivery of patient care,

January 2024

according to a recent survey of healthcare providers.

Through a survey titled “Medication, Supply, Equipment Shortages are Harming Patients,” completed in July 2023 by The Emergency Care Research Institute (ECRI), and its affiliate, The Institute of Safe Medication Practices (ISMP), found that many providers believe ongoing national medication, medical supply, and medical equipment shortages have been harming patients. Survey respondents included pharmacists, pharmacy technicians, procurement specialists, physicians, and nurses working in community, teaching, pediatric, cancer care, and other healthcare professions. Over 60% of respondents reported shortages of certain medications, supplies, and medical devices, according to ECRI. Many physicians stated



that care quality has been widely and overwhelmingly impacted by the shortages. “Many of the shortages are a direct result of supply chain disruptions. Supply chains have been disrupted due to raw material shortages, labor shortages, geopolitical issues, environmental factors, shipping and transport delays, and increased demand,” said Tim Browne, Vice President of Global Supply Chain Solutions at ECRI.

Patient care impact A significant number of survey respondents reported that supply and equipment shortages have impacted their ability to provide the best patient care. More than half said that shortages have delayed

treatments, and one-third reported that they were unable to provide patients with optimally recommended drugs or treatments. A quarter responded that they were aware of at least one error related to a drug or supply shortage, ECRI noted. “Survey results showed that shortages of drugs, single-use supplies, and durable medical equipment have greatly impacted the following care areas: surgery/anesthesia, emergency care, pain management, cardiology, hematology/oncology, infectious disease, and obstetrics/gynecology,” said Browne. According to survey results, 74% of respondents said that surgery and anesthetics, emergency care (64%), pain management (52%), cardiology (45%), infectious diseases (39%), and more primary and specialty care categories have been impacted by the ongoing shortages. “Practitioners may be unable to provide patients with the recommended drug or treatment for their condition due to shortages, which can lead to delays in care or patients receiving a less effective drug,” said Browne. “Healthcare organizations have reported interrupted, modified, or delayed chemotherapy regimens, and needing to reschedule, postpone, or cancel surgical cases due to lack of supplies needed for procedures. Shortages have also contributed to medical and medication errors.” Physicians stated that specific examples of the impact of shortages included an interruption or delays in chemotherapy, administration of more opioid analgesia due to lidocaine shortages, dissemination of incorrect medication dosage instructions to patients, cancellation and postponement of surgeries, and more. Physicians and hospital systems often triage supplies in the face of shortages short-term, but it is necessary to have long-term and nationally coordinated solutions in place in order to solve the persistent shortages that physicians have been experiencing, according to ECRI. “Preparation, standardization, communication, and monitoring are critical to safely managing drug, supply, and equipment shortages,” said Browne. “This involves updating systems, educating staff, and fielding questions on how to prescribe, prepare, administer unfamiliar alternative products and keeping meticulous count of inventory. Hospitals and healthcare organizations are spending a substantial amount of effort planning for and managing shortages.”

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IDN Insights

Supply Chain’s Fight Against Cancer New alignment and new projects highlight New York cancer center’s commitment to end cancer for life.

 Kreg Koford joined Memorial Sloan Kettering Cancer Center in 2018 as Senior Vice President of

January 2024

Supply Chain and Hospital Operations. After being responsible for $2.2 billion of non-labor spend at Intermountain Healthcare in Salt Lake City, he was tasked with bringing a bold vision and developing new opportunities in existing relationships to transform how the cancer center buys, distributes, and uses resources.



Founded in 1884 and located in the heart of New York City, Memorial Sloan Kettering’s (MSK) mission is to end cancer for life. That focuses its strategy and its three pillars of education, clinical care, and research to create the best possible outcome for the patient, according to Koford. He’s been building out teams, processes, and technology over the past five years, and COVID-19 hit just after onboarding his leadership team in 2019. “We’ve been on a journey with a pandemic right in the middle of it,” he said.

Leadership team When Koford first arrived at MSK, he retained Lisa Lieberman, the interim supply chain leader, as the Senior Director Operations, to maintain and learn from her 25-years’ experience in working within the MSK organization. Lieberman drove the supply chain operational planning and goal setting efforts, as well as leading the supply chain transformation. Koford enlisted Aaron Tappan as Senior Director of

Kreg Koford

Jamie Green

Lisa Lieberman

Mohamed Guiro

Materials Management. Tappan previously worked at Bloomberg for over 20 years in New York City and understood the density of distribution and the complexities of a city environment. “We brought Aaron on intentionally from outside of the industry to revamp our materials management group,” Koford said. “He had the right leadership skills to build a team around.” Koford then recruited another key hire, Mohamed Guiro from Intermountain, as Director

of Strategic Sourcing with a background in pharmacy. MSK estimates about $1.5 billion of its $2.5 billion spend is in pharmaceuticals. “Mohamed managed the Pharmacy portfolio at Intermountain and has a background in supply chain expertise to understand the rigor and the alignment needed in all clinical and non-clinical areas of sourcing and contracting,” Koford said. After Lieberman transitioned to a critical internal position, a vital leadership role needed to be Repertoire

January 2024

Aaron Tappan


IDN Insights

filled. In stepped Jamie Green at a pivotal time in the supply chain’s transformation, taking over as Senior Director of Operations for informatics, purchasing, and supplier diversity. Green came from CommonSpirit Health and was recruited through a national search. “We’re really at a time where we have depth and breadth of experience, and seasoned leaders to help us mature every aspect of the supply chain,” Koford concluded about his team. The pandemic has improved supply chain’s impact within health systems. Today, it’s viewed as more strategic by healthcare executives and is recognized for being essential in the day-to-day functioning of a health system. Supply chain stands to assume an even more strategic role going forward for many health systems, including at MSK.

to think differently about shared services, including: ` The areas being centralized or integrated. ` How the teams align and how to ensure a comprehensive change management approach. ` How the teams demonstrate value and support business development. ` Development of succession plans and career paths that will drive personal and professional growth opportunities throughout the organization. “It hadn’t really existed in the organization before. We used to run a lot of these things vertically resulting in redundancies, but there was an institutional push to codify shared services,” Koford explained. “It drives efficiency, standardization, and team mobility across all areas.”

Chemotherapeutic treatments and oncology medications drive the high cost of pharmaceutical supply chains for cancer centers, but the total pharmaceutical supply cost is negotiated between IDNs, GPOs, suppliers, and payer reimbursement rates.

January 2024

Shared services


Koford says they recently finished an 18-month project that centralized all of MSK’s logistics associates to its materials management group. “It’s complete and it has impacted the operating model for nonclinical, ambulatory care, and hospital sites,” he said. During the course of the project, he asked MSK executives Repertoire

MSK’s fight against cancer and its specialized pharmaceutical supply chain MSK’s fight against cancer is highly dependent on specialized drugs. Koford estimates close to 95% of its pharmaceutical portfolio is sole source, or drugs that don’t have alternatives. “Because of that, we work very closely with our distributors and manufacturers to understand the market and what’s going on,” he said.

“Then, we make sure we secure the right products and understand the supply chain and availability through the supply chain.” The cancer center offers unique treatments from a pharmaceutical perspective, and MSK must ensure it can access drugs like ones used in investigational drug services, because it runs over 900 investigational studies per year. Chemotherapeutic treatments and oncology medications drive the high cost of pharmaceutical supply chains for cancer centers, but the total pharmaceutical supply cost is negotiated between IDNs, GPOs, suppliers, and payer reimbursement rates. “Our informatics team is helping design the inventory management processes for pharmacy and trying to manage a point of distribution all the way up to our suppliers to really understand those complexities,” he said. “Similar to other organizations, we have to know what the manufacturers are doing and about the disruptions in the industry, and then respond and be creative. Our doctors are doing that.”

Physician engagement Dr. Selwyn M. Vickers arrived in September 2022 as the new President and CEO of MSK. An internationally recognized pancreatic cancer surgeon, researcher and pioneer in health disparities, Dr. Vickers most recently served as CEO of the UAB Health System and CEO of the UAB/Ascension St. Vincent’s Alliance, while retaining his role as dean of the UAB Heersink School of Medicine. “He’s been very supportive of the organizational change

Designs on a new CSC Koford is reviewing designs for a consolidated service center (CSC) to help optimize MSK’s physician cycles and to serve its ambulatory surgery sites. “We’re in the process of vetting it out,” he said. “But that activity would move outside of the city. The circumstances in which we work are hyperdense in Manhattan. So, when we think of our network, we think about transportation, logistics, routes and all of those things that Aaron (Tappan) and his team have been trying to analyze and optimize.” Koford says they’re working on inventory levels, technology integration, and automation in their replenishment system. “All

process simplification and simply reducing the number of trucks coming into the Upper East Side of Manhattan.

Supplier Diversity Program According to Koford, MSK has set a target of $100 million in diversity spend over the next five years. “We’re about a third of the way there today before we fully roll out this program,” he said. “There’s a tremendous amount of opportunity to connect with our community and help our suppliers better reflect our patients, while providing opportunities for growing and investing in these businesses.” Koford says there’s huge support for it within the organization.

Patient care is a top priority at MSK, and this collaborative approach gives supply chain credibility and support throughout the organization in its alignment with nursing staff in decision making. of those have work streams and will be rolled out as a big project over the next 18 months,” he said. “Our central lab is a sixstory building that has embedded materials management and we’ve brought in an ASC that’s down the street. It’s a staged approach to bring all of these groups into reporting to one central entity.” Tappan’s team expertise in materials management, logistics, and dock management lends it credibility and it’s a part of the steering committees created by MSK. These support identifying opportunities for efficiency, technological advancement,

MSK is dedicated to equality, diversity, and inclusion. It has pledged an institutional commitment to become a more inclusive and diverse institution, and it believes this is fundamental to driving innovation and to achieving its mission of saving and extending lives. Building a diverse and inclusive culture is essential to providing high-quality care to all of its patients. “Our next phase of the supplier diversity program was recently pitched to our senior leadership team,” Koford said. “We think it will yield a lot of opportunities.” Repertoire

January 2024

and alignment with supply chain,” Koford said. “We’ve also redesigned our direct report structure, and I have a direct line to the chief administrative officer and one to the president for accountability to make sure we’re delivering our services.” Koford and the Supply Chain team collaborate with MSK executive leadership across the organization to ensure alignment and prioritization. Patient care is a top priority at MSK, and this collaborative approach gives supply chain credibility and support throughout the organization in its alignment with nursing staff in decision making. “We continue to build on those capabilities to help the clinicians work at the top of their license and help bring them the information and opportunities around clinical product decision and potentially switching or saving costs,” Koford said.


Marketing Minute

How to Build Brand Trust  Marketing has a major role to play in the rate of growth of companies within the healthcare

industry. Companies that create successful marketing campaigns have the potential to gain more brand exposure and increase their recognition from influential supply chain executives.

Brand trust within the supply chain industry is a large part of what makes a company stand out and excel at marketing. Brand trust is defined as the confidence and loyalty that customers have in a brand. Customers that have high brand trust believe that a company will deliver on promises conveyed in their marketing efforts. Content creation and marketing campaigns can be a great way to start introducing brand information and positive rhetoric about your company that increases consumer trust in your brand. The following are four tips to increase brand trust:

1. Consistent Content Creation

January 2024

Content that informs and persuades audiences is very influential in the healthcare industry, as it helps foster continuing brand trust. Highlighting a company’s products and services through content creation, blogs, podcasts,



webinars, and other marketing efforts allows potential customers to gain positive exposure to a company. Consistent exposure to a brand’s marketing content also helps solidify a company as a knowledgeable leader in the medical supply chain industry. 2. Speak to Industry Needs

A successful brand has a knowledge of industry trends, challenges, and solutions. Using their expertise through marketing a brand can convey to customers that they are the most knowledgeable source to navigate industry challenges. Informative marketing content allows supply chain execs to be more aware of potential solutions to any challenges they may face within the industry that your brand can solve. 3. Accessibility

Marketing content should be accessible to gain consumer’s

trust – meaning that a brand should maintain regular interaction with customers through marketing efforts. This can be achieved through being available to customers, answering any questions, and frequently engaging in interactions with customers over social media, email, etc., according to Entrepreneur. 4. Transparency

Brands that are honest and transparent with consumers have the potential to gain an industry-wide trust and following. Brands should be open and honest about their strengths, challenges, and outcomes to gain the trust of industry execs. Brands that are honest are oftentimes more likely to have a consistent consumer following than their competitors that omit important information in marketing. Garnering widespread brand trust can improve marketing outcomes and potentially increase the rate of growth for brands in the medical supply chain industry. If your brand could benefit from assistance with the creation of a marketing campaign that fosters long-term brand trust within the industry, contact Scott Adams at Schedule a time to meet today to learn about the steps your brand can take to successfully market and build brand trust within the supply chain industry.


HIDA Bill to Expedite Medical Supplies Introduced in Congress  Transportation is a healthcare issue. Over the last several years, we’ve seen one supply chain bottleneck

By Wyeth Ruthven, Director of Congressional and Public Relations, Health Industry Distributors Association

That is why we are pleased to announce that a key HIDA legislative priority took a big step forward with the recent introduction of bipartisan Fast Pass legislation to expedite the flow of medical supplies through U.S. ports. HR 6140 – the Facilitate Access to Swiftly Transport Goods during a Publicly Announced State of Emergency Situation (FAST PASS) Act would direct the Secretary of Transportation to conduct a study of efforts to expedite the movement of critical cargo across all modes of transportation during emergencies. This bipartisan legislation has been introduced by Representatives Mike Ezell (R-MS) and John Garamendi (D-CA). “When America faces emergencies like Hurricane Katrina or the COVID-19 pandemic, our supply chains must be ready to respond. That’s why we’re introducing the FAST PASS Act, which will help get critical supplies across the country quickly and efficiently,” said Congressman Ezell. “I’m grateful to have Congressman Garamendi’s help leading this bipartisan bill so our transportation system is better prepared for future emergencies.” “As the COVID-19 pandemic revealed, congestion and supply chain crunches at American ports for medical supplies and other critical cargo can be a matter of life and death,” Congressman Garamendi said. “I am pleased to co-author this important bill with Congressman Ezell to ensure the U.S. Department of Transportation can expedite delivery of critical cargo at our

nation’s ports when American jobs and, even more importantly, lives are on the line.” HIDA is grateful to Representatives Ezell and Garamendi for introducing this important legislation and for their leadership on transportation issues impacting our healthcare system. The FAST PASS Act will take steps towards expediting medical supplies at ports and marine terminals on to rail and truck transport during emergencies like COVID. During public health emergencies, essential medical supply shipments need to be prioritized. Fast Pass has worked before. When the Ports of Los Angeles and Long Beach implemented a Fast Pass pilot program, they saw an improvement in the flow of medical products. Patrick Halloran, Director of Global Trade Logistics for Cardinal Health, credited the Port, shipping lines, terminal operators, dockworkers, and truckers with pitching in to reduce the time of delivery of the much-needed medical supplies. “It was great to see this come together as we all moved quickly to prioritize getting products where they were needed,” Halloran said. The best time to fix bottlenecks in the medical supply chain is when that supply chain is NOT straining under the weight of a pandemic. We owe it to providers and patients to ensure the smooth flow of medical products. Now is the time to adopt Fast Pass. We urge all stakeholders in the medical supply chain to support passage of HR 6140. Repertoire

January 2024

after another. Cargo delays on the West Coast. Threats of labor strife and work stoppages at ports, railyards, and parcel delivery. Even drought along the Panama Canal has caused backups of container ships.


Healthy Reps

Health Tips from the Experts 2024 Tips from the experts to be your healthiest self throughout 2024. By Jenna Hughes

 The new year is a time to reset and focus on goals and resolutions. For many people, that includes

wanting to improve their health and wellness. As you start the new year, Repertoire collected nine health tips from experts:

No. 1: Healthy aging

Healthy aging includes maintaining a consistent healthy lifestyle, according to the Mayo Clinic on adult aging beyond 50. To prevent chronic disease and maintain a healthy weight, eating a variety of nutritious foods, regularly engaging in physical activity, and monitoring any health or wellbeing changes closely can all promote good health as you age. Be careful of widely marketed anti-aging therapies, supplements, and treatments, as these may be harmful to long-term health, and remember that there is no quick fix to healthy aging besides maintaining an overall healthy lifestyle.

January 2024

No. 2: Vitamin D supplements and heart disease prevention

Some observational studies have boasted that individuals with high levels of vitamin D had lower rates of heart disease. Before following the trend and taking a large dose of the supplement, Dr. Steven Nissen of Cleveland Clinic recommends considering the risks that are associated with excessive vitamin D intake. Vitamin D is a nutrient that can help your body absorb calcium, boost bone health, support the immune system, and reduce



lifestyle habits to keep your heart healthy and consulting a doctor before taking new supplements. No. 3: Can superfood powders really boost health?

Green superfood health powders and supplements are a widely circulating health trend on social media. But how effective are these health supplements in contributing to better health? Green health

powders can be found advertised by many brands to be used as an additive to water, smoothies, and in baking and cooking. Green supplements may include probiotics, herbs, digestive enzymes, and more, and many companies promote that these products are healthy and help meet nutritional goals. According to Rachel Sproat, a registered dietitian at UPMC Western Maryland, these superfood powders should not be a substitute for whole fruits and vegetables. There is little solid research on the benefits of green powder supplements, according to UPMC, and the multivitamins in them may include much more than your body needs. Be sure to maintain a proper diet in addition to taking green powdered supplements. No. 4: Non-Exercise Activity Thermogenesis and weight management

N.E.A.T, or non-exercise activity thermogenesis, is the creation of heat through movement that is not related to exercise. N.E.A.T is an important part of weight tracking and management, according to Intermountain Health. A calorie is a unit of heat, and the number of calories burned per day is part of the weight management equation. Each time we move or complete physical activity, we create heat and calories are burned. N.E.A.T can be accomplished through day-to-day activities such as walking, gardening, taking the stairs, or even fidgeting. N.E.A.T makes up two-thirds of an individual’s total calorie expenditure throughout the day. To increase N.E.A.T for weight management or better health outcomes, engage in behavior such as walking while Repertoire

January 2024

inflammation in the body. However, a study released in 2017 in the Journal of the American Medical Association shows that taking high doses of vitamin D does nothing to prevent cardiovascular disease. Excess vitamin D can even result in too much calcium in the blood, increasing the risk for coronary artery disease (CAD). Cleveland Clinic instead recommends building healthy


Healthy Reps

talking on the phone, parking further away from your destination, or washing dishes by hand. No. 5: Women’s heart disease prevention

According to Emory’s Women’s Heart Center, heart attack risk is on the rise in younger women age 35-54. However, with certain lifestyle changes, heart disease is preventable by up to 90%. It is important to know your individual risk factors and find a cardiologist that specializes in women’s heart health, because the risk factors for women are different than those for men. Heart disease risk factors for women include diabetes, autoimmune diseases (such as lupus and arthritis), obesity, menopause, hypertension, polycystic ovary syndrome (PCOS), and pregnancy complications. Talk to your primary care provider about reducing risk factors, managing existing conditions, and addressing lifestyle habits that are potentially impacting your heart health.

decrease dehydration and reduce unwanted sugar and glucose spikes. Also, preventing and maintaining health with diabetes includes carb awareness and being mindful of your diet. Reducing carbohydrates such as high-sugar starches including milk and bread, and tuning into feelings of hunger and fullness, can help individuals in preventing and managing diabetes. No. 7: Mindfulness routine for mental health

Therapists and psychiatrists use the practice of mindfulness to ground patients and contribute to individual’s journey in improving and managing mental health,

January 2024

For those that have newly been diagnosed with diabetes, or those wishing to take better steps to prevent developing diabetes, it is important to know how and where to start. According to John Hopkins Medicine, making healthy drink choices such as water, unsweetened coffee and tea, vegetable juice, or milk can



No. 8: Children and getting through the flu

To differentiate between the signs of a common cold and the flu in children, look for a sudden onset of symptoms, a fever, body aches, chills, and a headache as signs of the flu. A stuffy nose, sneezing, and sore throat are more likely to be the common cold, according to Providence Health. Children that have the flu usually feel much sicker than those with a cold. Children with the flu need lots of rest, fluids, and to stay home from school while recovering. No. 9: Lifestyle changes and reducing Alzheimer’s disease

When you are feeling stressed, overwhelmed, or anxious, taking inventory of where you are is important to focus on to improve overall mental well-being. No. 6: Diet and diabetes awareness

statistics in the U.S. are staggering, with one in five adults living with a mental illness, according to Sanford Health. Research has shown that mindfulness practices, such as breathing practices, meditation, guided imagery, and more can increase gray brain matter, increase ability to focus, and contribute to reduced stress.

according to experts at Sanford Health. Mindfulness is described as a state of mind and being, not necessarily a particular set of behaviors or actions, that get an individual to focus on the present moment. When you are feeling stressed, overwhelmed, or anxious, taking inventory of where you are is important to focus on in order to improve overall mental well-being. Mental health

Certain lifestyle changes, such as participating in aerobic exercise, quitting smoking, staying social, maintaining a healthy diet, getting quality sleep and getting mental exercise can all reduce the risk of Alzheimer’s disease, according to Mercy Health. There is no one guaranteed way to reduce Alzheimer’s disease, but lifestyle changes can improve an individual’s overall health and wellbeing. Older adults can participate in physical activities such as walking or swimming, connecting with other people, and eating a diet rich in antioxidants, omega-3 fatty acids, and healthy fats to maintain a healthy lifestyle and prevent aging-related diseases.


The Common Health Coalition Leading healthcare partners announce system to improve public health.

 The collective approach toward public health efforts significantly changed as a result of the

COVID-19 pandemic. The impacts of the pandemic saw new and unconventional partnerships form between health systems and public health organizations, with the organizations working together toward improved health outcomes during the pandemic, according to The Common Health Coalition. Public health leader chairs also include Dr. Georges C. Benjamin, Executive Director of the American Public Health Association, and Dr. J. Nadine Gracia, President and CEO of Trust for America’s Health.

Structure of The Coalition The Coalition’s recommendations are informed by technical advisory groups of subject matter experts and public health leaders. Dr. Dave A. Chokshi, Former New York City Commissioner of Health, is the head chair of the Common Health Coalition. Dr. Chokshi is a practicing physician at Bellevue Hospital and most recently served as the 43rd Health Commissioner of New York City. Additionally, Chelsea Cipriano, the Coalition’s managing director, most recently held leadership roles at the NYC Department of Health and Mental Hygiene and the NYC Mayor’s Office, and previously served within the federal government at the US Centers for Disease Control and Prevention and the US Department of Health and Human Services.

Public health recommendations The Coalition and its’ partners are committed to “making healthcare accessible and affordable for everyone,” according to AHIP, and, according to the Alliance of Community Health Plans, “we understand we are all stronger when we collaborate and work together.” The Coalition’s approach to accomplishing its goals include being transparent in regard to its clearly delineated goals, roles, responsibilities, and deliverables; and among partners and public health agencies, maintaining a reliable infrastructure during crisis, addressing health disparities, and interoperability across healthcare sectors. ChangeLab Solutions, a nonprofit advancing health equity through law and policy, serves as the host of The Coalition and facilitates the development of recommendations. Repertoire

January 2024

The Common Health Coalition: Together for Public Health, was formed in March of 2023 and announced on November 9, 2023 as a joint commitment to public health by five founding member organizations including the American Hospital Association, America’s Health Insurance Plans (AHIP), the Alliance of Community Health Plans, the American Medical Association, and Kaiser Permanente. The Coalition aims to translate the lessons and successes of the COVID-19 pandemic into strategies that will strengthen partnerships with public health systems. To outline actionable strategies to further public health, The Coalition will publish four recommendations in early 2024 that focus on spearheading greater coordination between public health and healthcare systems, building shared emergency preparedness plans, establishing national standards for healthcare data that help identify health disparities, and modernizing infectious disease detection, according to The Common Health Coalition.



Industry News

January 2024

BD names Dr. Ron Silverman as Chief Medical Officer BD (Becton, Dickinson and Company) announced that Ronald (Ron) Silverman, Dr. Ron Silverman MD, FACS, has been named executive vice president and chief medical officer of BD, effective Dec. 4, 2023. Dr. Silverman will be responsible for leading the company’s Medical Affairs organization, which includes end-to-end medical affairs across BD’s business units, regions and central team. In this role, he will use medical insights and expertise to advance BD’s pipeline of clinically relevant, innovative solutions that align with evolving patient needs, while also contributing to the safety and compliance of BD’s in-market portfolio of products. Dr. Silverman will report to Beth McCombs, executive vice president and chief technology officer for BD, and serve as a member of the BD Executive Leadership Team. Dr. Silverman replaces Dr. William Sigmund, who has been chief medical officer for BD since January 2018 and announced his intent to retire from the company in June 2023. Dr. Silverman joins BD from 3M Health Care, where he most recently served as senior vice president and chief medical officer since 2021. He previously led Medical and Clinical Affairs teams for multiple business units within 3M – first for KCI Corporation, followed by Acelity



Corporation, and then 3M Health Care Medical Solutions Division. Prior to that, he was chief of plastic surgery at the University of Maryland Medical Center and continues to hold academic appointments at both the University of Maryland and Johns Hopkins schools of medicine. Dr. Silverman earned a Bachelor of Arts degree and a Doctor of Medicine degree from the University of Maryland and trained in surgery and plastic surgery with Harvard’s Massachusetts General Hospital. He is certified by The American Board of Plastic Surgery, is on the advisory board for the University of Maryland Fischell Department of Bioengineering at the Clark School of Engineering and holds membership with 7 professional organizations. Dr. Silverman holds two patents, has authored more than 80 journal publications and contributed to several textbooks.

Owens & Minor launches Life Takes Care™ Owens & Minor, Inc. has unveiled its new purpose, Life Takes Care. More than a motto or tagline, Life Takes Care captures the company’s unique approach to caring for both the business and the humanity at the heart of healthcare. The past few years have brought about historic shifts affecting not only Owens & Minor, but also the healthcare industry as a whole, accelerating trends in where, when and how care is delivered. Research shows that purpose-driven companies experience approximately 14% greater revenue growth,

are nearly two times as likely to have above average returns, and have +8% reduced turnover; have +12% fewer safety incidents; and +4% increased profitability. Additionally, a study of high-growth companies found company purpose to be one of four key growth drivers. Life Takes Care was uncovered and developed using teammate perspectives as well as strategic insights from company leadership. This statement of purpose encompasses the entirety of Owens & Minor’s global business: the Products & Healthcare Services and Patient Direct business segments as well as its affiliated brands, Apria®, Byram® and HALYARD*. Life Takes Care was first unveiled on December 6, 2023 and will be celebrated throughout its inaugural year in 2024.

Baxter International Foundation and UNICEF partner to expand safe water access The Baxter International Foundation, the philanthropic arm of Baxter International Inc., and UNICEF, announced a partnership to improve access to safe drinking water and sanitation in five waterchallenged regions in Egypt. The sanitation effort is supported by a $2.5 million grant from the Foundation, this threeyear initiative aims to implement climate-smart water, sanitation and hygiene (WASH) programming for thousands of people in Upper Egypt’s governorates of Aswan, Assiut, Quena, Minya and Luxor through community engagement, education and rehabilitation of primary health units.

Improving Patient Health Better BP ®

Did you know high systolic blood pressure (BP) is a leading modifiable risk factor for death worldwide?1 Proper patient positioning alone can lower resting blood pressure (BP) measurements by 7 mmHg systolic and 4.5 mmHg diastolic.2 That’s why, Midmark designed the first and only fully integrated point of care ecosystem that has been clinically validated to achieve improved accuracy for a resting BP. 01 Low-height exam chair helps patients keep their back supported and feet flat on the floor


02 Articulating arm rail supports the patient’s arm and cuff at heart height


03 Automated vital signs promote consistency and data accuracy 04 EMR connectivity improves workflow efficiency and reduces errors

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Scan to explore the latest study reporting the cumulative effect of poor positioning that occurs when BP is taken with the patient sitting on a typical clinical exam room table.

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