Repertoire - May 22 by BOC design Inc

vol.30 no.5 • May 2022

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How Quidel Navigated COVID-19 A conversation with Quidel President and CEO Doug Bryant.

We build partnerships that matter

We know it’s been a challenging year, and it matters that we made it through together. That’s what trusted partnerships are all about. Our experienced sales and service teams are always here to help ensure your success, providing diagnostic products that deliver the highest quality results. Because for you, for us, and for your customers, every result matters. POINT-OF-CARE READER

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MAY 2022 • VOLUME 30 • ISSUE 5

How Quidel Navigated COVID-19 A conversation with Quidel President and CEO Doug Bryant. PUBLISHER’S LETTER

TRENDS

The Art of Pre-Selling........................ 2

PHYSICIAN OFFICE LAB When the POL Customer Has Stopped Testing How to safeguard your lab business by anticipating your physician office customer’s needs and challenges................... 4

Clinic vs. Clinic Retailers won’t give up their quest for primary-care market share. Neither will independent physician practices.......... 38

The Job of a Lifetime Cancer survivors are growing in numbers, and increasingly, primary care physicians are accompanying them on their lifelong cancer journey................................. 42

SUPPLY CHAIN

HEALTH NEWS Health News and Notes................... 54

MARKETING MINUTE Content Marketing Insights for Healthcare Brands.................... 55

REP CORNER A Custom Connection As dedicated sales reps, Cardinal Health’s Jeff Ledbetter and Taylor Graffeo share a common goal to connect with their customers and provide the best possible solutions.......................................... 56

Inflation and the Healthcare Supply Chain: What You Need to Know...............................................8

HIDA

IDN NEWS

Transportation Delays and Inflation Woes Persist in Medical Supply Chain..................... 59

IDNs in the News................................... 10

IDN OPPORTUNITIES

TRENDS

Collaboration for the Win Yankee Alliance President and CEO Larry Kaufman believes there’s more value for healthcare stakeholders in working together than remaining insular.................................. 14

Breaking the Rules of Healthcare: Restoring the Value of Primary Care

TRENDS

SUPPLY CHAIN Operation Warp Speed Paul Mango, Former Deputy Chief of Staff for Policy HHS, discusses the success of the public-private collaboration to deliver COVID-19 vaccines..................... 28

No Surprises Act is Flawed: Doctors They support the concept but not the proposed resolution process for payment disputes........................................... 48

If status in medicine were determined by saving lives, primary care physicians would quickly re-ascend the hierarchy....... 60

NEWS Primary Care News.............................. 63 Industry News........................................... 64

Subscribe/renew @ www.repertoiremag.com : click subscribe repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2022 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, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.

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May 2022

PUBLISHER’S LETTER

The Art of Pre-Selling “April showers bring May flowers.” I heard that quote while watching the Masters this

past Sunday and it made me think of one of the pearls of wisdom Billy Harris taught me back in my exam glove selling days. Billy always believed in the art of pre-selling everything, whether it was a new pay plan to the sales team or a new nitrile glove to a client. About three to six months before we would be asking for orders on something new, Billy would say “Time to start pre-selling.” We would come up with a game plan to casually get a ‘yes’ from whoever the target audience was. Why did we do that? Because when it came time to ask for an actual order we could say, “Remember when we talked about ‘X’ and you mentioned you’d be interested in it? Well, it’s here and we are ready to rock and roll.” This approach also allowed us to temperature check ideas before we launched them. For example, by pre-selling a pay plan change we would get feedback from the team and we could tweak the new program accordingly. There are countless benefits to pre-selling your ideas, products and services. Think of it like “April showers bring May flowers.” The next time you know something new is coming, try pre-selling it with you clients. It’s such a casual way to get an early ‘yes.’ We’ve recently been placing QR codes with end-user videos in our advertiser’s ads. This issue has one in the Symmetry Surgical ad on page 39. If you scan the QR code it will auto populate an e-mail for you, so you don’t even have to write it yourself. All you have to do is add in a client e-mail and BOOM – you’re pre-selling the Bovie® Smoke Shark® III. My challenge for you this month is to scan that code and send the video to 5 potential clients. Who knows, maybe you will sell some equipment you never planned to sell this month. Good luck, and always be closing!

Scott Adams

Dedicated to the industry, R. Scott Adams

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

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sales executive

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Keith Boivin: IMCO Home Care

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PHYSICIAN OFFICE LAB

When the POL Customer Has Stopped Testing How to safeguard your lab business by anticipating your physician office customer’s needs and challenges. One of my more questionable personal outcomes related to COVID social isolation is that I

have watched more television lately. On the positive side, I’ve noticed a clever way some programs are using “current time” and doing flashbacks. They start with a dramatic moment in current time and then flashback to the events leading up to it. Let’s see how it relates to your lab business.

By Jim Poggi

May 2022

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Your phone rings and you see it is one of your largest customer’s office managers. When you answer, you are shocked to hear, “Bill, this is Yolanda from the community group practice. The medical director has decided to stop testing immediately and is asking you to arrange removal of all the instruments. She let me know that this decision is final and not subject to negotiation.” You are in a state of shock and can only mumble “let me get back to you” before you hang up. Yolanda reminds you “we need this done ASAP.”

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You flash back to your typical customer visit. You quickly dodge past the lab where two techs are apparently working hard on chemistry and hematology systems. You wave hello but head to the relative safety of the business office to check in. No real pressing issues, but you have a couple of new products to share and a back order or two to manage. Besides, the lab SEEMED OK, busy but OK. When business is done, you skirt past the lab, hoping not to get engaged in a technical discussion. You made it and with a sign of relief, settle into your car to get to the next customer visit.

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PHYSICIAN OFFICE LAB What you do not know is that the lab staff is struggling with technical issues on two chemistry tests and has not been able to resolve them on the phone. You also did not know that one of the techs quit in frustration and they are down to two techs, rather than the three that normally staff the lab. The techs have been “hoping for the best” on the technical issues and have not alerted the management or medical staff yet. That ugly moment happens when they fail a proficiency test on their chemistry system six weeks later. Oh, and there was that recall letter you filed, assuming that the vendor would contact them and come to the rescue.

Keep your finger on the pulse Moral of the story? Every important element of your business needs to be actively managed, including the lab business. After all, it is only an asset if the customer is satisfied, confident, well trained and receives meaningful meetings with you. As the account manager and quarterback, you do not have to be the technical resource, but you need to keep your finger on the pulse of the personnel running the lab. Your commitment to follow up and desire to assure the satisfaction of the customer will help you to have a satisfied customer, a safe and secure lab business and the possibility of future referrals to other prospects.

Every important element of your business needs to be actively managed, including the lab business. After all, it is only an asset if the customer is satisfied, confident, well trained and receives meaningful meetings with you. Let’s step back in time and try to change the past to improve the future. Back then, you actively call on the lab and learn from the lab manager “Barb is just not getting chemistry. We have worked closely with her but can’t seem to get her on track.” You ask a few questions and learn she is not confident in herself and the new lipid tests she has recently begun performing. You suggest an onsite vendor training visit. The vendor’s technical representative can identify issues and coach a willing tech on how to resolve them and move on. As her confidence grows, she will be more 6

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able to take on new tests and more able to consistently turn out high quality results. Her ability to troubleshoot will also improve. As a significant additional benefit, she will also be more willing to reach out to technical service with questions in the future. Training takes place and makes the expected improvements in Barb’s performance and confidence level. Barb stays on the job and performs well. Two weeks later you learn of a recall on two lots of quality control material. You check in with your vendor and learn there are new lots now available to replace the recalled product. You immediately call the customer and ask them to provide you with the lot numbers of QC material they’re using. They also got the recall letter and confirm they have one of the recalled lots in the lab refrigerator. You arrange a replacement of the recalled product and then personally deliver new QC material with the vendor. You assure the customer that the new product will perform properly and ask them to set up a run to test the performance of the new material before switching to it. Your vendor assigns a technical specialist to follow up. As a result, the next QC run performs properly, the customer has data to assure themselves and any inspector that their tests are performing correctly and knows their patient results will be accurate and consistent. A potential crisis is averted and customer confidence is restored. The medical director has the office manager call you to let you know “Bill, we were really concerned about the QC recall since we never had one before. You and the manufacturer stepped in, helped us manage a concerning situation, and the medical director asked me to thank you on behalf of the staff and our patients. We appreciate you and all you do.” Of course, these situations do not occur frequently and do not always have the same happy endings I have proposed. But, I can assure you of one thing: if you do not hold meaningful lab meetings and pay careful attention to the satisfaction of the lab staff and management you may be setting yourself up for the kind of unfortunate outcome Bill experienced when Yolanda called to deliver the bad news that they had decided to stop testing and move on. Secure your customer’s satisfaction, work along with your key manufacturer to assess the overall performance of the lab and make sure your business is safe. Check in early and often. Ask questions. Probe for issues before they get out of hand and continue to focus on the benefits of in office testing and even expansion of needed testing. Ten minutes on every visit will pay dividends for you and your customer. Check in and check up on your customer and business. Your customers perform check ups every day. So should you.

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SUPPLY CHAIN

Inflation and the Healthcare Supply Chain: What You Need to Know

There’s no getting around it. Inflation has permeated every aspect of the economy – including the healthcare

supply chain. Raw materials, energy, labor and logistics have all been affected, said Margaret Steele, Vizient senior vice president, med/surg.

Indeed, over the 12 months from February 2021 to February 2022, the Consumer Price Index, which measures the average prices of consumer goods and services, increased 7.9% to a four-decade high. Labor costs rose 4% to 8% with manufacturers and freight companies struggling to attract workers and drivers. In the healthcare sector, escalating labor costs have been particularly painful. In its February National Hospital Flash Report, Kaufman Hall found that from December to Janu8

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ary labor expense per adjusted discharge climbed 14.6%. Through the last year and a half (since fall 2020) energy, resins, cotton and most metals have all surged in excess of 30%. “With the recent upturn of oil prices, the rate of inflation will continue this upward trend,” Steele said. “These levels of inflation are impacting manufacturers and service providers significantly and they have begun raising prices on the supplies, equipment, and services they deliver to hospitals.”

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Global events hit home Steele said the healthcare supply chain has been significantly impacted over the last several years due to many factors including world events. As a result, timely and accurate information is critical to minimize impact and determine risk mitigation strategies. “Supply chain leaders use various tools, such as budget impact projection reports, market supply updates and category specific insights, to understand the impact of changes affecting raw materials, labor and logistics as they look to understand cost and risk for supply disruption,” Steele said. Now, supply chain leaders are utilizing these same sources to monitor the impact of the recent events that also have an impact on raw materials, manufacturing and transportation. Steele projects the most impactful and of most interest will likely be oil as so many products contain some form of plastic or resin (a derivative of oil). In mid-March, resin prices remained higher than preCOVID levels and were expected to remain so as long as oil remains near or above $80 per barrel and producers continue struggling to get resins moved through the supply chain. Both issues are anticipated to remain through most of 2023. Oil price fluctuation, trucker shortages and port backups will also impact the costs for transporting products to the provider locations. “Many products have not yet been impacted as the situation is affecting raw materials,” Steele said. “That said, impact mitigation strategies vary by location and provider type. Providers are sharing conservation strategies in efforts to reduce usage as appropriate, pre-qualifying alternative products in the event of a disruption, increasing product on hand (or at a distributor/partner location) and ensuring product is sourced from a variety of locations. Several suppliers have medical teams that will work with the providers directly to discuss alternative uses. And, many are also participating in commitment programs, wherein suppliers and providers agree on a longer, committed supply and in some cases pricing.” While GPO and self-negotiated contracts are keeping prices fairly stable at the moment, supply chain leaders fully expect to see significant price increases in the next series of contracts, said Mike Schiller, senior director of supply chain at the Association for Health Care Resource & Materials Management (AHRMM) of the American Hospital Association (AHA). “Many are anticipating high single to low double digit price increases and have begun to include these into their budgetary considerations.”

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IDN NEWS

IDNs in the News

1 North: UPMC launches first tele-emergency department in Pennsylvania UPMC is leveraging its clinical expertise and innovative technology to launch the first tele-Emergency Department (Tele-ED) in Pennsylvania at UPMC Kane in McKean County. In line with the Pennsylvania Department of Health guidelines announced on March 2 to increase patient access to care through innovative delivery models, UPMC created a first-of-its kind in Pennsylvania rural health care approach that will allow access to excellent emergency medical care at UPMC Kane. UPMC Kane is partnering with UPMC Hamot in Erie to create 10

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an emergency medicine collaboration using advanced telemedicine technology. Board-certified emergency medicine physicians located at UPMC Hamot, 94 miles away in Erie, partner with on-site, trained advanced practice providers (APPs) at UPMC Kane, 24 hours a day, seven days a week, to provide the best care for all who seek it. “Bedside care is delivered by physician assistants (PAs) and certified registered nurse practitioners (CRNPs) at UPMC Kane using advanced video, audio and examination technology to connect patients seamlessly and quickly with board-certified emergency medicine physicians at UPMC Hamot,” said Mark Papalia, UPMC

Kane president. “Together, the APP and physician diagnose and care for the patient.” UPMC Kane is an acute care hospital located in a remote, rural community with an average daily inpatient census of five to six hospitalized patients and approximately 6,000 total emergency department visits each year. UPMC Hamot is the advanced tertiary care regional hub for UPMC in northwest Pennsylvania and southwest New York caring for nearly 70,000 patients in the emergency department annually. UPMC Hamot provides high-level specialized care and is a Level II trauma center, the only accredited trauma center in the Erie region.

ʯ ʯ

Cleveland Clinic Hillcrest Hospital – 125 Cleveland Clinic Avon Hospital – 312

The rankings are based on three data sources: online surveys of more than 80,0000 medical experts from around the world; results from publicly available patient experience surveys; and medical key performance indicators, including patient safety, infection prevention measures, and doctor-to-patient ratios.

3 South: Baptist Health South Florida launches startup

2 Midwest: Cleveland Clinic ranked number two hospital in the world Cleveland Clinic is ranked as the number two hospital in the world again by Newsweek’s World’s Best Hospitals 2022 list. Cleveland Clinic Abu Dhabi, Cleveland Clinic Fairview Hospital and Cleveland Clinic Florida are also recognized among the Top 250 hospitals in the world. The rankings are based on surveys and data from more than 2,200 hospitals in 27 countries. “(W)hat has set the world’s leading hospitals apart is their continued ability to deliver the highest-quality patient care and conduct critical med-

ical research even as they focused on battling COVID,” said Newsweek Global Editor in Chief Nancy Cooper. “Indeed, as the fourth annual ranking of the World’s Best Hospitals by Newsweek and Statista shows, consistency in excellence is the hallmark of these institutions …” Newsweek also ranked six Cleveland Clinic locations among the best hospitals in the United States: ʯ Cleveland Clinic – 2 ʯ Cleveland Clinic Fairview Hospital – 38 ʯ Cleveland Clinic Florida-Weston – 45 ʯ Cleveland Clinic Akron General Hospital – 86

Baptist Health South Florida announced an agreement with Rehab Boost, a pioneer in artificial intelligence (AI) to develop an innovative platform to diagnose movement abnormalities. The body motion recognition technology being developed under the name Gait Boost, LLC is a first-of-its-kind platform, which also marks Baptist Health Innovations’ first startup company. Gait Boost, will focus on a person’s gait, better known as a person’s manner of walking. Abnormalities in movement may provide early indicators of severe sicknesses or medical conditions. “Gait Boost is intended to work at the intersection of technology and medical knowledge, ultimately offering a new way to identify abnormalities,” said Mark Coticchia, Corporate Vice President, Baptist Health Innovations. “The opportunity and ability to diagnose patients sooner than currently available with new medical approaches, advancements and innovation is precisely why Baptist Health Innovations was created – to commercialize novel ideas for patient benefit.” www.repertoiremag.com

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May 2022

SPONSORED

ORASURE

It’s Time to End the HCV Epidemic The story of hepatitis c (HCV) in America has traditionally been a generational one.

The Baby Boomer generation (1946-1964) was the first to be affected by HCV following its emergence in the 1940s, and initial discovery in the 1970s. The Boomer generation was also the first to be stigmatized by the virus. Not unlike the HIV epidemic, HCV has often been culturally associated with “risky behavior.” Many of the Boomers diagnosed with HCV were unfairly maligned at the time by societal impulses to blame their diagnosis on their own behaviors. This stereotype ensured that HCV would proliferate hidden by stigma, remaining undetected and untreated for many. Spread of HCV in the Boomer generation can also be attributed to other factors such as unsafe medical practices related to blood screening during organ transplant or blood transfusion procedures prior to 1992.1 The enduring stigma of HCV has had disastrous effects on all generations. In fact, current growth in HCV prevalence is primarily experienced in younger generations, despite advancements in screening and treatment which can result in cure. Most recent data from 2018 indicates that Millennials (most adults in their 20s and 30s) make up 36.5% of newly reported chronic hepatitis C infections,

the highest rate of prevalence ahead of Baby Boomers with 36.3% and Generation X (adults in their late 30s to early 50s) with 23.1%. More than half of the 2.4 million americans living with HCV don’t know they have the virus.2 In response to this growing epidemic, the CDC updated its HCV screening guidelines in April 2020, recommending one-time HCV testing of all adults (18 years and older) and all pregnant women during every pregnancy. The CDC also recommends people with risk factors, including people who inject drugs, be tested regularly. In addition, The

United States Preventive Services Task Force (USPSTF) recommends that clinicians consider HCV screening high-risk patients younger than 18 and older than 79, as well as younger pregnant patients.3 Detection is the first step to prevention, and the best way to stop the spread of HCV is early diagnosis. Our OraQuick® HCV Rapid Antibody Test is the only CLIA-waived point-of-care HCV test on the market today. It detects HCV antibodies in fingerstick and venipuncture whole blood in individuals 15 years and older with three easy steps (collect, insert, read*), and provides results in 20 minutes. A crucial tool in the fight against HCV, the OraQuick® HCV Rapid Antibody Test helps health care providers reach more people where they are, anytime, anywhere. If we are to see an end to this HCV epidemic, it is important that all generations routinely be screened for HCV. Undetected HCV can become chronic, and if left untreated can lead to serious health impacts such as cirrhosis of the liver and liver cancer. It’s time to end the HCV epidemic and ensure that future generations know a world without HCV. For more information about the OraQuick HCV Test and how it can help healthcare providers fight the HCV epidemic, please contact us at endtheepidemics@orasure.com.

https://www.health.harvard.edu/blog/baby-boomers-and-hepatitis-c-whats-the-connection-2019050116532 https://www.cdc.gov/nchhstp/newsroom/2020/hepatitis-c-impacting-multiple-generations-press-release.html 3 https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm *For complete testing instructions, please refer to package insert. 1 2

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Help end the epidemic in 3 easy steps*

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TRENDS ʯ

CVS: MinuteClinic® clinics are in 1,100 CVS Pharmacy and Target stores. In 2021 CVS announced it would convert as many as one thousand existing stores into HealthHUBs, offering treatment for common illnesses, chronic care management, telehealth, pharmaceutical consultation and medical products.

Dollar General: Established a partnership in 2020 with London-based Babylon, a telehealth provider which, in March 2021 acquired Fresno, California-based FirstChoice Medical Group, with 180 primary care and 1,000 specialty providers. In July 2021 Dollar General hired its first chief medical officer, Albert Wu, M.D.

Walgreens: In October 2021 agreed to invest $5.3 billion in VillageMD to accelerate the opening of at least 600 Village Medical primary care locations – staffed by primary care physicians and pharmacists – in more than 30 U.S. markets by 2025. (VillageMD remains independent, but Walgreens has a 63% ownership stake.)

Walmart: As of September 2021, provides healthcare services (including primary care, x-rays, labs, wellness classes) in 20 health centers, called Walmart Care Clinics, in Arkansas, Georgia and Illinois. Walmart Health is building seven primary care clinics in Northeast Florida.

Clinic vs. Clinic Retailers won’t give up their quest for primary-care market share. Neither will independent physician practices. Not long ago, big health systems appeared to be the biggest challenge for

independent physician practices. And truth be told, they probably still are. A December 2021 study published in Health Affairs showed that from 2014 to 2018, hospital and health system ownership of physician practices increased by 89%, from 24% to 46%. But increasingly, health systems are competing for the physician market with health insurers, drugstore chains and other retailers.

They’re not new to the game. They’ve tried many approaches before. But they’re persistent. Here’s a rundown on what’s happening among some of the big retail players.

Amazon Care: Works with Care Medical, an independent practice based in Seattle, to deliver healthcare to Amazon Care members, and plans to expand the program across the United States. The company provides telehealth as well as “mobile care RNs” (the latter in a handful of locations). Best Buy: Acquired Current Health for $400 million in

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November 2021. According to Best Buy, Current Health “integrates patientreported data with data from biosensors – including their own continuous monitoring wearable device – to provide healthcare organizations with actionable, real-time insights into the patient’s condition.” Meanwhile, Best Buy’s Geek Squad installs personal emergency response systems, medication management devices, remote patient monitoring, and “Senior Living Safety Systems” in the home.

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TRENDS Along with these retailers add UnitedHealth’s Optum unit, which Bloomberg says has more than 60,000 employed or “aligned” physicians, about half in primary care; and Humana, which is reported to be bringing its primary-care footprint to about 250 locations in 2022.

Austin Regional Clinic All that said, independent practices, such as Austin Regional Clinic, based in Austin, Texas, remain strong. “Our advantage is being local,” says CEO Anas Daghestani, M.D. “Healthcare is still local, and there are pieces you can solve by providing a digital experience or applying [artificial intelligence]. But at the end of the day, patients seek the relationship, local access and market knowledge.” Austin Regional Clinic is a 42-year-old multispecialty group with 380 physicians, nurse practitioners and physician assistants. The Clinic cares for 580,000 patients in 33 locations in the Austin and Central Texas area. It represents 19 specialties, but 65% of its physicians and advanced practice providers focus on primary care. It’s true that independent practices lack the scale and access to the infrastructure or financial solutions that national companies enjoy, says Dr. Daghestani. “But we respond by investing in the future and looking for strategic partnerships, whether with large organizations or with local and regional ones.” Another advantage that independent practices have over many retailer-based clinics is their ability and desire to solve for total care, not pieces of it, he says. “People need a quarterback to guide their care, and we can be that quarterback.” Chief Medical Officer Manish Naik, M.D., says, “One of the biggest challenges companies such as 40

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Amazon, Walmart and the others face is that they’re addressing one piece of the puzzle, such as an urgent care issue or something from a menu of common minor ambulatory conditions.” That approach exacerbates the fragmentation of healthcare, he says. “You may address the sore throat, but you haven’t addressed things like blood pressure or blood sugar. You’re not caring for the whole patient. An organization like Austin Regional Clinic supports patients in managing all aspects of care, and if we do a good job of that, the total cost of care is less.”

doctors aren’t the only ones who are mastering these skills at Austin Regional Clinic. “Some of our most senior doctors have contributed significantly to the progress we’ve made with cutting-edge digital solutions.”

‘Unfair advantages’ Retailers and insurers are trying to solve for the same issues that all physician practices are, including access, patient satisfaction, and recruitment and retention of patients, says Dr. Daghestani. And they have significant and impressive tools to address those issues. But the challenge they

‘ People need a quarterback to guide their care, and we can be that quarterback.’ Conventional wisdom has it that young people prefer the perceived simplicity and speed of dealing with a retail clinic rather than a family physician or practice. “It may be harder to attract [young people], but it’s doable,” says Dr. Naik. “You have to provide a digital front door, whether it’s a patient portal, telemedicine or digital access, like online scheduling and text reminders, and we’ve had success doing that. “Still, there’s a limit to what you can accomplish digitally. AI or a patient portal are tools like any other tools. But how do you connect that digital care with in-person care?” After all, AI is only as good as the input fed into it, and that should be based on feedback from clinicians taking care of patients in their offices, he says. Young doctors coming into practice today were brought up in the digital world and find it easy to adjust to electronic medical records and patient portals, says Dr. Naik. But young

face is that they are fragmented from the larger healthcare ecosystem. If retailers are to maintain a presence in the healthcare market, they would be well-advised to partner with local practices, such as Austin Regional Clinic, he says. Insofar as competition from bigger players goes, Dr. Daghestani sees “unfair advantages” every which way. “Yes, national companies have access to capital and technology, and they have a new way of looking at things, because healthcare is new to them. But our unfair advantage at Austin Regional Clinic is this: We think of ourselves as organized medicine. We are local, we have relationships with patients and employers, and for us, healthcare is a career, not a project. “If we can figure out how to channel our respective ‘unfair advantages’ so that independent practices and national companies can both be successful, that’s where the magic can happen. And if we can’t figure that out, we risk further fragmentation.”

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TRENDS

The Job of a Lifetime Cancer survivors are growing in numbers, and increasingly, primary care physicians are accompanying them on their lifelong cancer journey.

As of January 2019, there were 16.9 million cancer survivors in the United States. That’s 5% of the population.

The number was projected to increase to 22.2 million, by 2030, and to 26.1 million by 2040. The number of people expected to live five or more years after their cancer diagnosis was projected to increase 33%, to 15.1 million. In 2019, 64% of survivors were age 65 or older, and it was estimated that by 2040, 73% of cancer survivors in the United States would be age 65 or older. 42

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TRENDS Five-year and 10-year survival rates for those with childhood cancer now exceed 80%. In 2020, there were an estimated 500,000 survivors of childhood cancer in the United States. It’s all good news. But being a survivor doesn’t mean patients or their healthcare providers can leave cancer behind. Patients with a history of cancer live with the threat of recurrence and late effects of treatment. Both they and their primary care doctors need to keep an eye out for treatment-related effects and cancer-related medical issues and comorbidities, even years after the cancer occurrence.

tor, Cancer Survivorship Section and co-leader, Cancer Control & Survivorship Program, St. Jude Children’s Research Hospital, Memphis, Tennessee. “Cancer treatment also plays a large role, and toxicities are related to specific modality, dose, and therapy combinations.” Dr. Hudson is part of The Children’s Oncology Group (COG), a National Cancer Institute-supported clinical trials group, and she is co-author of “Long-term Followup-Care for Childhood, Adolescent, and Young Adult Cancer Survivors,” a September 2021 clinical report from the American Academy of Pediatrics. The report

‘ Every healthcare professional – primary care physicians, orthopedists, dermatologists and others – will have cancer survivors in their panel.’ There are approximately 18 million cancer survivors in the United States, says Lidia Schapira, M.D., FASCO, professor of medicine at Stanford University School of Medicine, and director of Cancer Survivorship at the Stanford Comprehensive Cancer Center and Cancer Institute, Stanford, California. “When you look at it like that, you can see that every healthcare professional – primary care physicians, orthopedists, dermatologists and others – will have cancer survivors in their panel.”

Risk People with a history of cancer can experience impairment in function due to organ loss (i.e., surgical removal) or infiltration with cancer, says Melissa Hudson, M.D., direc44

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is based on care guidelines developed by the COG. “Health behaviors and genetics play an important role, and understanding mechanisms that make a survivor more or less vulnerable represent a focus of ongoing research,” she adds. “Comorbid health conditions can increase vulnerability, and social determinants of health – which can determine a survivor’s access to care – can impact outcomes.”

Burden of late effects In general, cancers that typically require intensive multimodality therapy (e.g., radiation and chemotherapy) carry a higher burden of late effects, says Dr. Hudson. Examples include brain tumor survivors, high risk/advanced stage solid malignancies (e.g., sarcomas),

Hodgkin’s lymphoma, and solid and hematological malignancies treated with hematopoietic cell transplantation. “The prevalence of health conditions increases with aging and with increasing time from cancer diagnosis and treatment. Multimorbidity is common.” In many ways, primary care physicians approach their patients who have had cancer similarly to those who have not, says George Abraham, M.D., MPH,, MACP, FIDSA, president of the American College of Physicians and chief of medicine at Saint Vincent Hospital, Worcester, Massachusetts. “We watch lipid counts, diabetes risk and risk of infection, much as we do with any of our patients,” says Dr. Abraham, who is professor of medicine at University of Massachusetts T.H. Chan School of Medicine. But there are differences. For example, people with premenopausal breast cancer may be at risk for early heart failure depending on the type of chemotherapy used, and those with a history of breast cancer are strongly encouraged to get annual mammograms. Peripheral neuropathy – numbness of the feet – can be a sign of chemotherapyinduced nerve injury. Similarly, liver dysfunction could be related to radiation-induced lung toxicity. Promoting overall wellness – e.g., healthy eating, plenty of exercise – is particularly important for patients with a history of cancer, as it can reduce the risk of recurring cancer and secondary infections, says Dr. Abraham. “We are especially mindful of making sure cancer patients give up potential risk factors. Someone who had lung cancer is encouraged not to smoke; someone who had liver cancer shouldn’t drink.”

Comorbidity Adult cancer survivors are especially susceptible to comorbid illnesses, according to the American Cancer Society. People who are treated for cancer, even those treated in childhood, tend to have a higher prevalence of chronic illness later in life. Age-related health conditions appear earlier and with greater severity than might otherwise be expected. Using 2002-2018 National Health Interview Survey data, among 30,728 cancer survivors, increasing trends were observed in the prevalence of hypertension, diabetes, kidney disease, liver disease and morbid obesity. Cancer survivors with multiple chronic conditions increased from 4.7 million in 2002 to 8.1 million in 2018. The increase was more pronounced among survivors aged 18 to 44 years. Among adults without a cancer history, the prevalence of multiple chronic conditions also increased, but more slowly than among survivors.

The long-term plan Primary care providers – pediatricians, family practitioners, internists, practitioners trained in internal medicine and pediatrics, and advanced practice providers – are likely to have an increasingly vital role in caring for this rapidly growing population, according to The Childhood Cancer Survivor Study, the largest and most extensively characterized cohort of five-year survivors of childhood cancer in North America. But there are hurdles to jump. “We consistently hear about longterm consequences of treatment that aren’t well managed by the care team,” says Shelley Fuld Nasso, CEO of the National Coalition for Cancer Survivorship, which conducts an annual cancer survivorship survey.

While receiving treatment, the cancer patient is closely monitored by a team of oncologists, she says. But when treatment ends, patients may feel they’ve been left on their own to deal with the fatigue, depression and anxiety, which are common. That’s not to mention longer-term effects, such as cardiotoxicity or heart damage due to chemotherapy, or monitoring for recurrent or additional primary cancers.

and primary care, with potentially harmful results for the patient. “I’ll confirm the disconnect, and I’ll confirm it’s not good for the patient,” says Dr. Schapira. Survivorship care plans have been recommended for almost 20 years, but implementation by medical professionals remains uneven, she says. “The problem is, the early versions of care plans were long, laborious, and not helpful to primary

Patients who have been treated for cancer need more than a piece of paper or PDF to guide themselves and their physicians through long-term care plans. Cancer survivors often need special help during the first year after treatment, she continues. “You may be seeing your care team daily, then you’re told, ‘Your treatment is done; come see us in three months.’ But their lives don’t necessarily go back to the way they were before their diagnosis. Survivors are dealing with collateral damage, and they lack regular support and communication. It’s emotionally challenging.” Survivorship care plans – which spell out diagnosis, therapy, potential late effects and long-term surveillance guidelines – can help the patient and primary care doctor navigate survivorship. “Part of what we do is empower survivors to be advocates,” she says. “But not everyone can or will be able to advocate for themselves. And they shouldn’t have to. Having a cancer diagnosis is hard enough.”

The disconnect Advocates for cancer survivors speak of a disconnect between oncology

care doctors.” Furthermore, they were paper-based and difficult for care providers to access and share with colleagues. But today, clinical specialists and generalists have access to easy-to-complete forms, such as those available online from the American Society of Clinical Oncology and other groups. Dr. Abraham says that because large healthcare systems and multispecialty practices share common electronic platforms, secure messaging among providers is more doable today. “There’s less of a disconnect than what we saw with paper-based systems, which relied on dictated notes and passing paper.” Technology is not the only barrier to effective communication between oncology and primary care, according to experts. Putting together individualized treatment summaries and care plans isn’t easy, says Fuld Nasso. It calls for cooperation among medical oncologists, surgical oncologists, radiological oncologists and others. Nor is there www.repertoiremag.com

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TRENDS adequate reimbursement for their time spent doing so. “As one expert said, ‘If it were easy, it would be done all the time,’” she says. What’s more, studies show that patients who have been treated for cancer need more than a piece of paper or PDF to guide themselves and their physicians through longterm care plans. “It’s about communication and discussion,” she says. “It’s helping people use the care plan, share it with physicians, see that it is updated over time, and make sure it remains tailored to the individual.” “Care planning is a process where individuals involved in the care of the patient anticipate their healthcare needs and surveillance, and make plans to coordinate ongoing care, share responsibilities about education and risk mitigation, and help the survivor gain access to the care they need,” says Dr. Hudson. “Hospitalized patients routinely get a discharge summary upon discharge, but cancer patients don’t necessarily get a survivor care plan. “It just makes good sense that they do.”

before. They want a concise plan with all their treatment information. “At St. Jude, we strive to educate our patients and families about why the care plan is so important. Some people embrace it; others don’t so much. Some of it is cultural, some relates to health literacy. But we need them to understand how their cancer history during childhood can affect long-term health.” Similarly, primary care physicians need to appreciate that they are caring for a cancer survivor who may have unique health risks.

Ownership Dr. Schapira’s research has focused on improving communication between

The prevalence of health conditions increases with aging and with increasing time from cancer diagnosis and treatment. Furthermore, the mere existence of a care plan doesn’t mean the survivor or their provider knows what to do with it, she continues. People who were treated for cancer in their youth might have forgotten they even received such a plan. “Years after their treatment, they may develop breast cancer or a heart problem,” she says. “They can request their records, but they don’t need information on what their blood counts were 20 years 46

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patients and physicians. The Stanford team has opened a faculty-embedded primary care practice specifically for cancer survivors and offers a free online CME course on the care of patients with a history of cancer. “It’s a great resource for primary care doctors and nurses,” she says. Last fall, CRC Press published “Essentials of Cancer Survivorship: Guide for Medical Professionals,” edited by Dr. Schapira, for cancer

clinicians as well as generalists and specialists who meet cancer survivors in their practices. “A 25-year-old software engineer, who was treated for leukemia when she was four, moves to Silicon Valley and looks for a primary care doctor. But she is not a typical healthy 25-year-old, and we need her primary care doctor to assess her health risks to make sure she gets good advice and care. A 75-year-old man treated with radiation for early-stage prostate cancer when he was 65 may develop a urethral stricture at age 75 and come to his primary care doctor with symptoms of urinary frequency. A woman treated with radiation to the chest as a college student is at risk for developing breast cancer, and we recommend screening with mammograms and MRIs, if possible, eight to 10 years after treatment. And the cardiac health of someone whose treatment included exposure to cardiotoxic drugs may be affected.” Cancer survivors need to understand their risks and what they need to do to stay healthy. “If they were treated as a child, they may need to learn enough about the disease and treatment to ‘own’ their history,” says Dr. Schapira. Similarly, primary care doctors need to understand the protocol those patients underwent years before and how the exposures to cancer treatments can affect the health of the patients in their office. “It’s about co-managing,” she says. “How can we include the patient in their continuing health in a way that is empowering but not overly burdensome?” Several organizations and associations, including the National Coalition for Cancer Survivorship, have developed care guidelines for patients and primary care physicians. “The whole idea is to become more proactive with these tools.”

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TRENDS

No Surprises Act is Flawed: Doctors They support the concept but not the proposed resolution process for payment disputes. The No Surprises Act of 2020 has gotten off to a rocky start since it went into effect on January 1. Few people op-

pose the concept, that is, protecting patients from receiving bigger-than-anticipated bills from their provider following a procedure, or totally unanticipated bills from out-of-network providers (e.g., emergency room physicians, orthopedists, radiologists) who participated in their care.

Rather, the primary point of contention has been the process by which payment disputes between out-ofnetwork providers and commercial payers will be resolved regarding claims filed on behalf of people covered by group and individual health plans. The No Surprises Act protects people covered under group and individual health plans from receiving surprise medical bills when they receive most emergency services, non-emergency services from out-of-network providers 48

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at in-network facilities, and services from out-of-network air ambulance service providers. (People covered by Medicare and Medicaid already have these protections.) It establishes an independent dispute resolution (IDR) process for payment disputes between plans and providers. It also provides dispute resolution opportunities for uninsured and self-pay individuals when they receive a medical bill that is substantially greater than the “good faith estimate” they receive from their provider.

Before the No Surprises Act, people with health insurance who received care from an out-of-network provider or an out-of-network facility, even unknowingly, would often be on the hook for the difference between the billed charge and the amount paid by their health plan. (This practice, called “balance billing,” is banned in some states.) An unexpected balance bill from an out-of-network provider is now considered a surprise medical bill. For people without insurance or who self-pay, the No Surprises Act assures they will get a good faith estimate of how much their care will cost prior to delivery of the service. For services provided in 2022, patients can dispute a medical bill if final charges are at least $400 higher than the good faith estimate, but they must file a dispute claim within 120 days of the date on their bill. Enforcement of the “good faith estimate” requirement will expand over time, according to legal firm Reed Smith. In the current first phase, providers must provide such an estimate inclusive of their own charges. Effective Jan. 1, 2023, however, they will have to include co-provider estimates, such as out-of-network emergency services. In “Phase 3,” whose effective date has yet to be determined, good faith estimates – including provider and co-provider estimates – will be required for all patients regardless of their insurance status.

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Doctors object Under the law, once a patient with insurance initiates a dispute over payment, the matter is paused pending resolution. Generally, the IDR process will follow a “baseball-style” approach, following these steps, according to the American College of Emergency Physicians:

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3. If that fails, either party can take the dispute to IDR using an online portal. They select an arbiter from a pre-vetted list of IDR entities. Both parties must pay the IDR fee upfront – $200 to $500 for one claim; $268 to $670 for “batched” claims of

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TRENDS similar services with the same insurer. (The “winner” of the dispute will be refunded its fee.) 4. Each party submits offer for reasonable payment within 10 days. Those offers must include the Qualified Payment Amount (calculated as the median innetwork rate), information on the physician’s training and experience, and a description of the complexity of the procedure or the medical decision-making associated with it. 5. The impartial reviewer evaluates submissions from provider and insurer, then chooses one of the two payment amounts within 30 business days. 6. The “loser” makes the other side whole and pays for the IDR fee within 30 calendar days.

“ Physicians will have little to no leverage to negotiate contracts above whatever an insurer calls the ‘median,’ which itself is subject to manipulation by the insurers.” The regulations as implemented allow arbiters to assume that the correct amount for an insurer to pay the doctor is the median amount usually paid for that service in that geographic area. Doctors’ groups argue that the text of the law precludes such a presumption and that other factors must be given equal weight, including the provider’s training, quality of outcomes, patient acuity or complexity of services provided, and teaching status and case mix of the facility where services were provided. In February 2021, a federal judge in Texas ruled in favor of the Texas Medical Association, deciding that the No Surprises Act implementation did indeed give unequal weight to the Qualified Payment Amount (QPA), tilting the process unreasonably in favor of insurance companies. While a relief to doctors’ groups, several are still jittery.

Physicians’ stance Repertoire received e-mailed comments about the No Surprises Act from the American Association of 50

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Orthopaedic Surgeons (AAOS), American College of Emergency Physicians (ACEP) and American Society of Anesthesiologists (ASA). Douglas W. Lundy, MD, MBA, FAAOS, Advocacy Council Chair, American Association of Orthopaedic Surgeons “AAOS believes that the patient protections afforded by the No Surprises Act are vital to improving access to care. While the manner in which the law was interpreted and subsequently finalized by the Departments is beyond the scope of the legislation that was passed with the support of AAOS, we remain committed to ensuring that our patients have access to the care they need and are held harmless for financial burdens that extend beyond their in-network cost-sharing.” Despite the February ruling in favor of physicians in the Texas Medical Association’s lawsuit, Lundy said that AAOS remains concerned with aspects of the IDR process. For example, the four-business-day time frame for initiating IDR following the end of the open negotiation period may be unreasonable should circumstances beyond the control of the physician to meet the deadline arise, he said. “Likewise, we are concerned that the timeline for the parties to jointly choose an IDR entity may not be sufficient to determine the appropriate IDR entity to oversee a payment determination. Underlying these matters is a concern that there needs to be disclosure of the IDR entity’s record if the Departments detect a pattern of consistently favoring one side or the other. “We encourage the Departments to consider the long-term impacts that the Provider-Patient Dispute Resolution process may have on self-pay and uninsured patients, particularly the underrepresented communities it is, in part, intended to serve. While the monetary threshold to access the provider-patient dispute resolution process was carefully considered during rulemaking, the time patients will have to spend going through the process may prove prohibitive or exclusionary.” Laura Wooster, senior vice president, advocacy and practice affairs, American College of Emergency Physicians “Emergency physicians have consistently advocated in support of solutions to stop surprise bills, promote transparency, and protect patients since earnest discussions about this issue began in Congress four years ago,” she said. “The ruling in Texas is a strong step in the right direction and one of the clearest indications

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TRENDS to date that policy granting unequal weight to the qualified payment amount (QPA) directly contradicts the language in the No Surprises Act. It also reaffirms the congressional intent of the law as noted in a November 2021 letter to the Administration signed by more than 150 members of Congress. “As HHS assesses its legal options and revises its guidance on IDR implementation, ACEP is hopeful that the department changes the policy permanently so that insurers are discouraged from narrowing networks, canceling contracts and pursuing tactics that make it harder for patients to access lifesaving emergency care.” Randall M. Clark, M.D., FASA, president of the American Society of Anesthesiologists “The ASA has long maintained that patients should be held harmless when there are disputes between physicians and insurers,” he said. “We have had the ability to put that into effect in many states for more than

20 years.” However, even with the favorable outcome of the current lawsuits, “the overall process will likely drive down physician payment over time. Insurers will have the ability to eliminate any contracts above the median, creating an immediate effect on at least half of physician contracts. “It won’t matter in the future if physicians are in network or out of network. Health insurers will be able to treat both groups exactly the same. Physicians will have little to no leverage to negotiate contracts above whatever an insurer calls the ‘median,’ which itself is subject to manipulation by the insurers.” The public should recognize that “the federal government is now regulating contracts between private parties in a way that has never been done before. This extends beyond asserting the parameters of how contracts should be managed, which one could argue is very appropriate, and now extends into what one private party pays another. This is unprecedented, in our opinion, and fraught with hazard.”

Hospitals wary of No Surprises Act Doctors aren’t the only ones who are disgruntled with the No Surprises Act. The nation’s hospitals have their own beef, citing the potential burden they face providing “good faith estimates” for services provided people without insurance or who self-pay. In a March 7 letter to Kathleen Cantwell, director, Office of Strategic Operations and Regulatory Affairs, Centers for Medicare & Medicaid Services, AHA Senior Vice President Ashley Thompson wrote, “Many hospitals already delivered pre-care estimates to uninsured and self-pay patients, but the new timeline and format

requirements necessitated workflow and other operational changes, including from even the most sophisticated hospitals. While these efforts have generally allowed hospitals to meet the requirements in place today, our members report that the ongoing burden is significant. The estimates regularly take between 10-15 minutes to produce, and though hospitals are looking at ways to introduce additional automation, it will be difficult to fully automate given the individualized nature of the estimates.” AHA expressed further concern about yet-to-be-implemented rules for good faith estimates set to

‘ There is currently no method for unaffiliated providers or facilities to share good faith estimates with a convening provider or facility in an automated manner.’

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become effective on Jan. 1, 2023. At that time, providers will be expected to include projected charges from unaffiliated providers or facilities. “There is currently no method for unaffiliated providers or facilities to share good faith estimates with a convening provider or facility in an automated manner,” wrote Thompson. “In order to share this information, billing systems would need to be able to request and transmit billing rates, discounts and other necessary information for the good faith estimates between providers/ facilities. This is not something that practice management systems can generally do, since billing information is traditionally sent to health insurers and clearinghouses, not other providers/facilities. “We urge HHS to refrain from enforcing the comprehensive good faith estimate requirement until a technical solution for exchanging this information is developed and implemented across all providers.”

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HEALTH NEWS

Health news and notes Survey: Pandemic creating far-reaching and negative impacts on those with chronic back or leg pain A new survey commissioned by Medtronic and conducted by public opinion research firm The Harris Poll, finds nearly half (44%) of current chronic back and leg pain sufferers have experienced care delays during the COVID-19 pandemic, despite 87% reporting that their pain has not improved or even worsened since the pandemic began in March 2020. The national survey, “Painful Pandemic: How a Healthcare System Under Strain Impacts Chronic Pain Patients,” of 810 U.S. adults who currently experience chronic back or leg pain finds far-reaching impacts of this debilitating condition on patient lifestyle, everyday activities, and mental state, further exacerbated by the pandemic’s impact on stressed health systems and the ability of patients to seek timely care.

Of those who report worsening chronic pain during the pandemic, more than half (52%) cite challenges in receiving appropriate medical care as a contributing factor. Additionally, 44% say since the pandemic began, they have experienced care delays, including postponed, rescheduled, or canceled appointments or procedures for their pain. Of those who proactively postponed their medical care, more than half (55%) cited COVID-19 fears as a contributing factor. Most people currently living with chronic back or leg pain report numerous detrimental physical and mental impacts. When listing physical challenges associated with chronic pain, sleep, exercise habits, sense of mobility/function, and ability to enjoy hobbies are aspects of life most negatively impacted. Chronic back or leg pain sufferers under age 55 are more likely than those 55+ to report that their ability to work has been impacted (36% vs. 22%, respectively), while those over age 55 are more likely than those age 35-54 to say their sense of mobility/ function has been impacted (58% vs. 46%, respectively).

UPMC study suggests malaria drug could combat chemo-resistant head and neck cancers A new study suggests that the malaria drug hydroxychloroquine inhibits pathways that drive resistance to the chemotherapy agent cisplatin in head and neck cancers and restores tumor-killing effects of cisplatin in animal models. The findings, published in Proceedings of the National Academy of Sciences by University of Pittsburgh and UPMC scientists, pave the way for a clinical trial that combines cisplatin and hydroxychloroquine to treat chemotherapyresistant head and neck cancers. “When caring for patients with head and neck cancers, I often see chemotherapy fail. Cisplatin is a very important chemotherapy drug, but tumor resistance to cisplatin is a huge problem,” said co-senior author Umamaheswar Duvvuri, M.D., Ph.D., head and neck surgeon at UPMC Hillman Cancer Center and professor of otolaryngology in Pitt’s School of Medicine. “My lab is interested in understanding the mechanisms of resistance so that we can find better ways to treat these patients.” Previous research showed that a protein called TMEM16A is linked with cisplatin resistance in patient tumors. Overexpression of this protein, which occurs in about 30% of head and neck cancers, is also associated with decreased survival. 54

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MARKETING MINUTE

Content Marketing Insights for Healthcare Brands Staying ahead of today’s trends will help you address

your audience’s challenges as they occur. Your content is one of the most powerful tools for accomplishing this. Thankfully you don’t have to guess what those trends will be because experts have already shared some of the most valuable content marketing insights for healthcare manufacturers and other B2B companies. Today we will look at the most relevant insights from experts for healthcare content marketing in 2022.

Why is content marketing important for healthcare? About 50% of B2B marketing content is focused on creating brand awareness and interest. That means your content shouldn’t be a lengthy sales pitch. Instead, it should be empathetic and authentically connect with healthcare workers. However, healthcare is changing very quickly, affecting how facilities connect to distributors and manufacturers. As their needs change, your content should also shift to continue to meet their new needs. You can use content marketing insights to: ʯ Understand your audience and their needs ʯ Connect to healthcare facilities using the most effective channels ʯ Remain relevant in 2022 through innovative strategies ʯ Make more accurate budget forecasts for resource allocation

Top content marketing insights for healthcare suppliers and manufacturers The Content Marketing Institute (CMI) provides annual reports and predictions about content marketing by consulting the leaders in the industry. Here are some of the most significant insights healthcare manufacturers can use to improve their healthcare content marketing strategy in 2022 based on the advice of over 100 content marketing experts. 1. Connect to Your Audience Make 2022 the year you ditch your transactional mentality. Instead, exchange it for a relationship-building focus. One

report showed 87% of B2B marketers today prioritize their audience’s needs over their sales message. Your content is a way to connect in unique ways with your audience to include them in your marketing process. For example, consider using a live stream to let your customers ask questions about your company or products. 2. Use Data to Build your Content Data should be the building blocks of your healthcare marketing guidelines. The internet is filled with valuable data on your customers and their typical behavior, such as common searches, pain points, needs, and more. Your content team should use that data to create content based on actual numbers instead of guessing what healthcare facilities want. 3. Stay on Top of Trends B2B marketing doesn’t have to be stiff and formal – you and your audience are both humans. That’s why you shouldn’t be afraid to use current trends to help promote your business and products. Consider sharing memes, using filters, and embracing social media campaigns to mix fun trends with your professional content. 4. Keep Your Content Empathetic Today healthcare workers face more challenges than in the past and require a higher level of empathy. Your content can be a safe space for them by showing you recognize their struggles and feel for their situation instead of only focusing on your brand and agenda.

Create an effective content marketing strategy Are you ready to create quality and valuable content for your healthcare supply business? You shouldn’t settle with content that blends in with your competitors. Instead, take your content marketing strategy into the new age of technology and authentic customer interactions using the latest healthcare marketing insights. To view the complete article with more strategies, visit https://sharemovingmedia.com/category/blog www.repertoiremag.com

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REP CORNER

A Custom Connection As dedicated sales reps, Cardinal Health’s Jeff Ledbetter and Taylor Graffeo share a common goal to connect with their customers and provide the best possible solutions. When your solution impacts the medical care of thousands of patients, Jeff Ledbetter is adamant: “You need to

get it right.” Fifteen years of sales experience and the support of some great mentors have certainly set him on the right track. In spite of how the industry has changed since he got his start in 2007, he remains confident that being a successful salesperson still requires connecting with the customer. That means asking probing questions to better understand their business and personal objectives, he adds.

“Selling is in my genes,” says Ledbetter. “My father was an entrepreneur and sold real estate for many years.” Later, when he began his first sales position in the healthcare industry, he was fortunate to work for a terrific manager, he points out. So, when she left that company and joined HLS MedFreight, he jumped on the opportunity to

join her a few months later. HLS MedFreight was acquired by Cardinal Health in 2010 and became part of Cardinal’s OptiFreight® Logistics business unit. While the transition from a small-company environment to that of a Fortune 20 company took some adjustment, he recalls immediately feeling at ease given the welcoming Cardinal Health work

culture that embraced a healthy work-life balance. “I’ve never even thought about leaving Cardinal Health,” he says.

The day-to-day Each customer has a unique set of circumstances and processes, and the challenge is to develop the optimal delivery solution, notes Ledbetter.

Jeff Ledbetter

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“OptiFreight® Logistics focuses on getting customers’ packages to the destination as efficiently as possible. Some providers need their packages within hours, while others can wait several days for it to arrive. This variance means bringing an open mind and a blank slate to the initial conversation. What the customer is doing today may be far different from their optimal solution. My role as their trusted advisor is to guide them to the best solution. Doing so is my greatest personal reward. “Cardinal Health is very good at educating its employees and ensuring that each of us understands the impact of what we do, every day,” he continues. “OptiFreight® Logistics is a trusted and premier total healthcare logistics solution built on three pillars: Tailored Solutions, Committed Experts and Innovation and Insights. Regardless of the size or complexity of the provider, we can create a customized solution that solves their shipping issues. Being part of Cardinal Health enables me to provide a one-stop partnership for all of my healthcare provider customers.” In turn, Ledbetter and his OptiFreight® Logistics colleagues depend heavily on local couriers, regional and national parcel carriers and ocean barge companies for the timely delivery of products. “We need them to perform flawlessly in order for us to excel for our customers,” he explains. However, the growth of eCommerce businesses over the last five years, as well as pandemic-related shipping challenges, has placed an extreme strain on the overall supply chain, including shipping and mail services. “Our challenge is to create a solution for our customers that works in today’s market, and is flexible enough to be adjusted as future market conditions

Taylor Graffeo

dictate. We can’t simply be a set-andforget solution when it comes to our customers or our partners.”

Smarter and smarter Over the past 15 years, Ledbetter has watched customers – from hospitals to health systems, pharmacies, ambulatory surgery centers, clinical laboratories and physician offices – become increasingly adept at navigating the healthcare marketplace independently of their sales rep’s guidance. “Today, customers have the online tools to do more marketplace research ahead of engaging their sales rep,” he says. “They are smarter and know more about what they want, earlier in the typical sales cycle. Sales reps must

bring value and demonstrate their expertise early on in order to stay engaged with potential customers. This environment makes it that much tougher to earn customers’ trust, and then remain a trusted advisor to them. “Throughout my time in sales, it has always been about making a personal connection to support the trust my customers have placed in me and to deliver a solution that meets or exceeds their expectations,” he continues. “Ten years ago, I made that connection through phone conversations and personal visits.” Today, in addition to traditional means of connecting, he must reach out through social media. “Sales reps are expected to communicate with their customers via online www.repertoiremag.com

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REP CORNER platforms, such as LinkedIn, and through messages and videos.” While his approach to sales has evolved, however, the pleasure Ledbetter receives from providing his customers with the best possible solutions has remained constant through the years. “I follow two guiding principles,” he says. “Be authentic and have fun.” Indeed, this attitude has enabled him to exceed his sales quota year after year, as well as become a Cardinal Health Champions Club member. “I am a humble person whose goal is to solve the needs of my customers and always provide maximum value to them. I strive to ensure that authenticity shows through every solution we create.” This isn’t something you can fake, he adds. “My friends and family would say that same authenticity carries over to my personal relationships outside of work.” Enjoyment and fun are essential in life, he points out. “And it’s possible to find them, even when you are dealing with the delivery of lifesavings medical products.”

A big difference Taylor Graffeo is a newcomer to healthcare sales, with 2 ½ years in the business. “I joined the healthcare industry in 2019, when I started as an inside sales rep for Cardinal Health OptiFreight® Logistics,” he says. Prior to this role, he gained experience in energy supply sales and 3PL sales as a freight broker. And while he technically sells a service, rather than a product, as with his medical product sales counterparts, the challenges keep him on his toes and make his work all the more interesting. “The day-to-day challenges are what keep my role exciting,” says Graffeo. Working across different markets means he must consider a 58

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variety of nuances. “If you work in the healthcare industry, you likely are motivated to provide a better quality of life for patients. This looks different with each role. With OptiFreight® Logistics, we provide more visibility, control and analytics to the logistics side of healthcare, which ultimately leads to products and supplies getting to the right place faster at a lower cost. I think that makes a big difference.

he is in a key position to provide his customers with Cardinal Health’s versatile tools and team of committed experts.

More important than ever Staying connected with customers is more important than ever before, notes Graffeo. “With new businesses starting every day, it is imperative to be part of the reason my customers want to stay with OptiFreight®

Today’s customers are smarter and know more about what they want, earlier in the typical sales cycle. “What makes OptiFreight® Logistics unique is our comprehensive, custom approach to each customer,” he continues. “While other companies may ship similarly, we look at every aspect of our customers’ logistics operations, taking a consultative approach to process improvement and cost savings, while focusing ultimately on the patient.” That said, Graffeo will be the first to admit there will always exist the possibility of error. “My previous role as a freight broker has prepared me for my current role by helping me understand it’s possible for anything and everything to go wrong in the world of shipping.” His experience communicating directly with carriers, working through their issues and understanding their frustrations, however, helps him be more proactive. “Because I understand what happens at an operational level, I can ask the right questions early in the sales cycle.” Additionally, as an energy supply consultant who sold a savings and value opportunity, rather than a tangible product, he believes

Logistics,” he says. “The strategy for connecting with customers has changed over the years as technology has advanced.” Whereas he once might have flown across the country for a business meeting, today it’s standard to set up a video call. “That means less time away from my family. Video calls are much quicker, less expensive and arguably more effective than in-person meetings. In the course of a day, I can exchange a smile in meetings all over the world and still be home with my family for dinner.” He is also a fan of online tools such as LinkedIn for connecting with his customers. “LinkedIn is a powerful and useful tool that has paid relational dividends to me over the years. “In my short career, I have discovered that relationships are one of the most important things in this world,” says Graffeo. “As a result, I’ve slowed down and taken time to connect with others as a colleague, friend and husband. I believe there is something to learn from everyone if we just connect.”

HIDA

Transportation Delays and Inflation Woes Persist in Medical Supply Chain Since December 2021, the Health Industry Distributors Association (HIDA) has monitored

delays in the healthcare supply chain. We’ve canvassed our member companies to get their first-hand experience in how their goods are moving by sea, by rail, and by truck. Unfortunately, transportation delays persist, and they have been compounded by increases in shipping and raw material costs. By Linda Rouse O’Neill, Vice President, Supply Chain Policy and Executive Branch Relations, Health Industry Distributors Association

The latest research from HIDA has found persistent delays in the healthcare supply chain. ʯ Despite a modest drop in delay times since December 2021 (from 37 to 27 days), transportation times are still 440% longer than they were before the pandemic. ʯ The volume of medical supply containers awaiting delivery has increased 13% in the last three months. Approximately 9,000 to 14,000 containers remain delayed. ʯ As West Coast ports remain congested, the volume of medical supply containers at East Coast ports has skyrocketed. The ports of New York (+124%) and Charleston (+84%) seeing the greatest increase in container volume of medical supplies. ʯ When surveyed about the trend in transportation delays, 61% of medical distributors have seen no appreciable improvement, while 21% say delays have worsened.

Transportation issues in healthcare products distribution aren’t just a matter of days and delays. It is also a matter of dollars and cents as transportation costs are rising quickly worldwide. ʯ Shipping Costs: Container freight rates between Asia and the U.S. West Coast exceeded $15,000 in January 2022, more than a 250% increase. ʯ Trucking Costs: A lack of available drivers, trucks, and trailers is increasing costs for shippers and making it more difficult for carriers to haul more freight. ʯ Parcel Freight: Higher annual rate increases and expanded surcharges will make 2022 an even more expensive year for unprepared parcel shippers. Furthermore, volatility in commodity markets is a key factor putting pressure on the cost of producing medical supplies. While transportation

costs impact the cost of distribution, commodity price spikes impact the cost of manufacturing medical supplies. ʯ Aluminum shortages have raised prices to their highest point in over a decade. A lack of crutches, walkers, and wheelchairs have forced providers to ask for donations. ʯ Nickel is key to the manufacture of medical instruments. Russia is the world’s third-largest producer of nickel. Market volatility following the Russian invasion of Ukraine has caused nickel prices to spike. At one point, nickel prices doubled in a matter of hours to over $100,000 per ton. ʯ Chromium is a component of stainless steel surgical probes. War in Ukraine has disrupted shipping routes from key suppliers of chromium in Central Asia. In the first three weeks of March, prices for ferrochrome ore increased more than 40%. ʯ Silicon chip shortages have been exacerbated by rising demand for medical devices used to treat COVID-19 in emergency rooms and intensive care units. These issues aren’t going away. The healthcare supply chain should remain top of mind for policymakers. At HIDA, we are advocating for solutions like a “fast pass” that would prioritize the handling of medical supplies at our nation’s ports. Shipments of critical medical products cannot wait for supply chain congestion to resolve itself. As long as these supply chain disruptions persist, HIDA will continue to stress the importance of getting life-saving medical supplies into the hands of front-line healthcare providers. www.repertoiremag.com

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TRENDS

Breaking the Rules of Healthcare: Restoring the Value of Primary Care If status in medicine were determined by saving lives, primary care physicians would quickly re-ascend the hierarchy. By Dr. Robert Pearl

In most professions, the pecking

order is clear, even when there’s no formal designation. Take pro football. Although nothing in the rulebook grants status or authority to certain players, everyone knows the starting quarterback is the most valuable person on the field. That’s because no other player can do more to win (or lose) a game.

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You might assume the same type of logic applies to medicine. If saving a life is the most valuable thing a doctor can do, then surely the physicians who save the most lives would garner the most esteem. That’s not the case. Instead, the relative rank of specialties is decided by an unwritten and outdated rule – the fourth such rule highlighted in this series, “Breaking the Rules of Healthcare.”

Rule No. 4: Doctors achieve high status by doing the impossible Throughout history, desperate patients have come to doctors hoping for a miracle. Physicians responded with incredible acts of healing – at times seeming to possess supernatural powers that defy known science. Doing the impossible not only elevated the prestige of the medical profession, it has also become the criterion for ranking people within it. This explains why, for most of the 20th century, primary care (internal medicine) doctors were held in highest esteem. Their superpower, which set them apart from colleagues, was the ability to unravel medical mysteries. When cardiologists, pulmonologists or orthopedists couldn’t diagnose an ailment, they turned to primary care for expertise. Time and again, these brilliant diagnosticians did the impossible and, in doing so, held their position atop medicine’s hierarchy. However, this unwritten rule – the one that enshrined primary care in the 20th century – is the same rule that sent the specialty crashing down in the 21st.

The rise of the specialist, the fall of primary care The 20th century ended with an eruption of medical innovation.

This period brought about the widespread use of MRIs and CT scanners, along with improvements in the quality of ultrasounds. These tools digitized diagnosis and radically improved medical practice. But they also turned a renowned skill of primary care doctors into an average and unremarkable ability. Meanwhile, surgeons and interventional subspecialists had embarked on a period of relentless innovation – boosting their status in medicine by doing what was once thought impossible.

The unwritten rule of status makes no sense today As medicine evolved in modern times, so did the needs of patients. Today, our nation now faces a growing epidemic of chronic diseases (heart disease, diabetes and asthma). These lifelong illnesses account for 7 in 10 American deaths and have caused the relative flatlining of life expectancy over the past two decades. This deadly healthcare crisis won’t be solved with surgeries and procedures of ever-greater complexity. It will be solved by doctors who

Primary care’s focus on preventive medicine and chronic-disease management may not inspire awe quite like cutting into the heart or brain, but these approaches can and do save more lives. Orthopedists, whose 20th-century job was to reset and cast broken bones, could suddenly replace hip and knee joints with space-age implants. Ophthalmologists, who historically wrote prescriptions for eyeglasses, invented a way to restore the vision of patients with cataracts by removing the opaque lens. And incredibly, interventional cardiologists could now reverse myocardial infarctions by passing catheters into the heart, unblocking the occluded blood vessels. These unbelievable advancements flipped the healthcare hierarchy on its head. Specialists were now seen as heroes, capable of impossible feats, while primary care physicians were demoted in both status and pay. Today, specialists earn two to three times more than internal and family medicine doctors.

can prevent disease, improve overall health and preserve life. To make it happen, physicians must first break the outdated rule of status.

Breaking the rule: Achieving high status by saving lives If status in medicine were determined by saving lives (rather than doing the impossible), primary care physicians would quickly re-ascend the hierarchy. Consider the results of a study by Harvard and Stanford researchers in 2019. The team found that adding 10 specialists to a population of 100,000 people correlates with an average life-expectancy increase of 19.2 days. But when adding an equal number of primary care physicians, longevity increased by 51.5 days. That’s an increase of 250%. This happens because primary care doctors don’t just treat medical www.repertoiremag.com

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TRENDS problems as they arise. They also help patients avoid heart attacks, cancer and strokes in the first place. Primary care’s focus on preventive medicine and chronic-disease management may not inspire awe quite like cutting into the heart or brain, but these approaches can and do save more lives.

Restoring the value of primary care In any profession, those with power and privilege are slow to cede either. But hierarchical change is possible. Returning to football, there was a time when offensive linemen were as undervalued as primary care physicians are today. Sometime in the last century, some smart coaches realized that a skilled left tackle was central to a team’s success. After all, this player’s job is to protect the quarterback’s blindside and prevent a potentially season-ending injury. With this realization, offensive tackles were soon being selected in the first round of the NFL draft. Today, they’re the highest paid players on offense. Once the basis for status in medicine shifts to saving lives, primary care will receive the esteem and income it deserves.

How to break the rule To update the rule of status for the 21st century, health insurers and doctors will need to institute two important changes: 1. Adequately fund primary care To effectively prevent and battle chronic disease, doctors need more

resources. Today, however, only 6% of healthcare spending goes to primary care. Bumping the total to 9% (a 50% increase) would allow these physicians to hire more support staff, spend more time with each patient and help people manage their chronic illnesses. The resulting improvements in patient health would drive down overall healthcare costs.

programs) failed to lower mortality rates. The incentive structure forced doctors to focus on only a few clinical areas; usually the ones with the highest incentives. A better approach ties incentives to improvements in longevity and overall health. Artificial intelligence (AI) could help with that. AI apps can analyze

This deadly healthcare crisis won’t be solved with surgeries and procedures of ever-greater complexity. It will be solved by doctors who can prevent disease, improve overall health and preserve life. The hard part will be convincing public and private insurers to foot the bill. Payers will demand reliable performance data that tie their financial investment directly to lives and dollars saved. This brings us to the second change. 2. I dentify and reward the physicians who save the most lives Not all primary care doctors achieve the same life-saving outcomes. In fact, some U.S. physicians are 30% more effective at preventing deaths from stroke, heart attack, or cancer than others. Because of this gap in outcomes, insurers won’t be willing to increase primary care payments across the board. They’ll want to reward doctors who achieve the best results. Unfortunately, past attempts at this (via “pay for performance”

tens of thousands of medical journals to identify approaches that most effectively increase life expectancy. It could then compare the performance of physicians against these opportunities. And instead of rewarding doctors for testing for high blood pressure or enrolling people in diabetes-management programs, AI would assess whether the patient’s blood pressure and blood sugar were normalized. Over time, AI will develop greater predictive accuracy: tying lifesaving approaches to lives saved. As more patients participate – and fewer people develop complications from chronic disease – insurers will see fit to invest more in primary care. Over time, with better pay and greater recognition, primary care’s status will increase – and so will the life expectancy of all Americans.

Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a Forbes contributor, bestselling author, Stanford University professor, and host of two healthcare podcasts. Pearl’s newest book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” is available now. All profits from the book go to Doctors Without Borders. For more information or to sign up for his newsletter, visit robertpearlmd.com. 62

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NEWS Primary Care News How does U.S. primary care stack up? International research group examines Among high-income countries, U.S. adults were the second least likely to have a regular doctor or place to go for care, ahead of only Sweden, according to the Commonwealth Fund data. The majority of adults in all 11 countries reported having a regular doctor or place of care, but adults in the U.S. and Sweden reported this at significantly lower rates than adults in most of the countries, Commonwealth reported in a recent examination of how the U.S. compares in primary care. Some of the other findings: ʯ U.S. adults are the least likely to have a longstanding relationship with a primary care provider. ʯ Access to home visits or after-hours care is lowest in the U.S. ʯ U.S. primary care providers are the most likely to screen for social service needs. ʯ One-third of U.S. primary care physicians have mental health providers in their practice, compared with nearly all in the Netherlands and Sweden. ʯ Half of U.S. primary care physicians report adequate coordination with specialists and hospitals – around the average for the 11 countries studied. “While there is a shortage of health workers globally, our analysis demonstrates that the U.S. primary care system trails far behind those of other countries in many areas, particularly when it comes to health care access and continuity,” The Commonwealth Fund said in its conclusion. To read the full report, as well as several policy option suggestions for U.S. policymakers to consider as they work to improve primary care visit www.commonwealthfund.org/ publications/issue-briefs/2022/mar/primary-care-highincome-countries-how-united-states-compares.

areas, where either the proportion of family physicians and primary care physicians is too low or there are no primary care physicians whatsoever, according to Kaiser Family Foundation data, said Dr. Jennifer Aloff, a family physician at Midland Family Physicians.

Expanding access to care in Indiana The United Health Foundation has launched a partnership with HealthNet, a nonprofit health care provider serving Indiana, to expand access to primary and behavioral health care in Morgan and Monroe counties in Indiana, as well as low-income areas in Indianapolis. The $2 million, three-year grant will allow HealthNet to bring medical professionals and a mobile health vehicle to neighborhoods in Indianapolis, and Morgan and Monroe counties four days a week. The program will address health disparities by: ʯ Bringing primary care, preventive services and mental health screenings to underserved communities. ʯ Providing high-risk patients with at-home monitoring devices to track their own health. ʯ Making referrals to dental care, substance use disorder treatment, specialty care and other health supports for patients.

Michigan experiencing primary care decline According to the Detroit Free Press, Michigan is experiencing a decline in the number of primary care physicians, with more shortages expected by 2030, particularly impacting residents in underserved areas. The shortages can be curbed, in part, by beefing up state funding for existing programs to recruit, train and retain physicians in that field, a group of family medicine physicians told the Free Press. Michigan has 269 health professional shortage

The HealthNet-United Health Foundation partnership is expected to improve adult and child immunization rates, breast cancer screenings and colorectal cancer screenings by 15% as well as improve cervical cancer screenings by 20% over baseline, according to a release. Additionally, the partnership aims to improve health outcomes of individuals with chronic conditions such as diabetes and hypertension. www.repertoiremag.com

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NEWS Industry News PWH announces John Sasen Memorial Scholarship Recipient PWH announced the recipient of the 2022 John Sasen Memorial Scholarship, Saran Ross, Sr. ManSaran Ross ager, RX Sales Administration at McKesson. She is dedicated to improving, diversifying and providing equity in the health experience of others and is excited to join the PWH network. Congratulations Saran, on your well-deserved scholarship. Several women were considered for this award that honors someone in the healthcare industry that is an inspiring individual, demonstrates leadership and is an ambassador to the industry. The scholarship is awarded to one woman each year and includes a one-year PWH membership as well as attendance to the HIDA Executive Conference.

Yankee Alliance and The Claflin Company establish exclusive distribution agreement Yankee Alliance and The Claflin Company have established an exclusive distribution agreement to provide Yankee Members access to Claflin’s wide range of logistics programs along with enhanced savings opportunities for Yankee aggregated contracts. The agreement, which will continue to add aggregations opportunities, will aim to provide Yankee members with the most aggressive customized contracting options in the industry. “This agreement will allow Yankee Members to achieve further savings opportunities and explore 64

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sourcing diversity in the post pandemic supply chain. Claflin is very excited to be partnered with such a forward-thinking organization like Yankee.” Alex Caldwell, Claflin VP Sales & Marketing.

Midmark evolves and expands training program with new leadership hire Midmark Corp., the only clinical environmental design company providing medical, dental and veterinary Jaclyn Smith solutions that enable a better experience at the point of care, announced the hiring of Jaclyn Smith as director of education and development. The hiring signals an evolution of the current program, which will expand and take on a larger role within the company, advancing Midmark’s clinical and non-clinical training for Midmark teammates and customers. Capitalizing on her robust understanding of the market landscape and educational programming, Smith will develop and provide oversight of Midmark’s clinical education, sales, training, and customer engagement resources. She will also work to ensure Midmark stays current with industry best practices and develop a network of external resources, including industry leaders and peer groups, to build content that augments the curriculum. Additionally, Smith will support the investment in team member development to strengthen this critical component of the organization’s

continued success by partnering with business leaders and Human Resources to proactively identify and respond to organizational development opportunities with solutions based on best practices in organizational development. With more than 20 years of experience in leading and implementing training and learning programs, Smith most recently designed the first enterprise learning strategy aligning learning with strategic outcomes for the 711/Human Performance Wing at Wright-Patterson Air Force Base. Before that, she led a 32-member performance consulting group responsible for the design and delivery of corporate university programs and services, which in 2019, was ranked 16th nationally, for approximately 5,000 staff members at CareSource. Smith will join a well-established professional education team that has been transforming Midmark’s training offering into a program that is informative, engaging and encourages attendees to apply what they have learned. The program takes a blended approach that features many informative and interactive components, including video, e-learning modules, live presentations, Q&A sessions, hands-on training and gamification modules. The program is used to ensure Midmark teammates understand the patient and provider experience and how medical, dental and animal health customers can use certain equipment and technologies to enhance the quality of care. For Midmark customers, the training program is focused on helping them understand how best to integrate our offerings into their facilities and workflows to ensure a better care experience and better patient outcomes.

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Midmark 626 Barrier-Free® Examination Chair with Patient Support Rails+ and IQvitals® Zone™ Vital Signs Monitor shown.

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