JHC June18 by BOC design Inc

Providing Insight, Understanding and Community

June 2018 | Vol.14 No.3

Flu Fighters

The 2018-2019 flu season is coming. Already.

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CONTENTS »» JUNE 2018 The Journal of Healthcare Contracting is published bi-monthly by Share Moving Media 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Phone: 770/263-5262 FAX: 770/236-8023 e-mail: info@jhconline.com www.jhconline.com

Editorial Staff

Editor Mark Thill mthill@sharemovingmedia.com Managing Editor Graham Garrison ggarrison@sharemovingmedia.com Art Director Brent Cashman bcashman@sharemovingmedia.com Publisher John Pritchard jpritchard@sharemovingmedia.com Vice President of Sales Jessica McKeever jmckeever@sharemovingmedia.com Director of Business Development Alicia O’Donnell aodonnell@sharemovingmedia.com

Chris Meyers Janda:

Sales Executive Tyler Moss tmoss@sharemovingmedia.com

Still on a learning curve

Sales Executive Lizette Anthonijs Lizette@sharemovingmedia.com

2007 Contracting Professional of the Year is always up for a good challenge

Circulation Wai Bun Cheung wcheung@sharemovingmedia.com The Journal of Healthcare Contracting (ISSN 1548-4165) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2018 by Share Moving Media. All rights reserved. Subscriptions: $48 per year. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

Chris Meyers Janda

6 Speak Up!

38 Chris Meyers Janda: Still on a learning curve

12 Flu Fighters

42 Staying Power

Publisher’s Letter As multistate systems become more commonplace, supply chain leaders need to speak with a louder voice The 2018-2019 flu season is coming. Already.

20 Training Tomorrow’s Leaders

Spectrum Health has created a culture of learning

26 Premier Introduces SURPASS

New program seeks best pricing in return for highest commitment

28 Infection Rates Down

Providers are making progress on reducing healthcare-associated infections

35 The Triclosan Ban

The Journal of Healthcare Contracting | June 2018

2007 Contracting Professional of the Year is always up for a good challenge Atrium Health helps Central American countries create sustainable medical programs

46 HSCA How can we navigate injectable narcotic shortages?

47 Overcome Staffing Needs By Leveraging Distribution Services 48 Calendar of Events 49 Industry News 50 Observation Deck: Who’s on the hot seat now?

PUBLISHER’S LETTER

John Pritchard

Providing Insight, Understanding and Community Here we are, at the end of May, and it feels like we have already had a years’ worth of news in the healthcare contracting arena. Things seem to be happening so fast and in such huge measure, yet no one appears surprised. I guess that is a good thing, because every time a major system has acquired another system, or a great Supply Chain Leader left for a new IDN – or Amazon did anything – we’d have to put down whatever we are working on to read all about it! I’m proud of the stories we bring to the industry that showcase a contracting or supply chain best practice. It is always my hope that some Supply Chain Leader out there learns something and it makes life better for them, their IDN and hopefully their patients. It is important that The Journal of Healthcare Contracting helps in the sharing and adoption of best practices by showcasing valuable Insight. We constantly cover the initiatives that world class IDNs have successfully implemented in their organization. Whether it’s about capital, pharma, purchased services or a litany of other topics, it’s gratifying to be at the intersection of such a valuable information exchange. We never take it lightly how important our role in the healthcare contracting arena is in helping steward the pursuit of Understanding. As a publisher, the most satisfying part of my job is making connections between people, whether they are trade partners or peers. Now over 14 years since launching, we have made a lot of connections, including Contracting Professionals of the Year, Ten People to Watch, and Supply Chain Leaders. Yes, day in day out I love how we have built such a robust Community. Since day one in early 2004, our tagline has been Providing Insight, Understanding and Community. I’m very proud that we have enjoyed the longevity of being the only owner and operator of The Journal of Healthcare Contracting, the only publication that is solely devoted to the contracting arena. Thanks for reading this issue of The Journal of Healthcare Contracting.

June 2018 | The Journal of Healthcare Contracting

EXECUTIVE INTERVIEW Kathryn Carpenter

Speak Up! As multistate systems become more commonplace, supply chain leaders need to speak with a louder voice

The bigger the organization, the bigger the challenge of effecting change. Unlike standalone facilities or small IDNs, multistate healthcare systems bring more voices to the table, each with their own opinions, preferences and interpretation of facts. To be heard, one needs to speak forcefully, clearly, simply and reasonably. A skilled, respected leader is needed to bring those many voices together. Why shouldnâ&#x20AC;&#x2122;t that person be a supply chain executive?

June 2018 | The Journal of Healthcare Contracting

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EXECUTIVE INTERVIEW

“There used to be a saying among supply chain personnel that if we were doing a good job, clinicians wouldn’t even know we were there,” says Kathryn Carpenter, vice president of clinical strategy for Catholic Health Initiatives Supply Chain, based in Denver, Colorado. “As long as everyone got what they wanted, there would be no controversy. “Now, case margins have become extremely tight, and hospital systems are struggling. Supply chain has a responsibility to be front and center in discussions of quality, patient outcomes and financial margin.” That’s exactly where Carpenter finds herself – front and center. With more than 100 hospitals in 18 states, CHI is a diverse system, comprising large academic medical centers in large urban areas, as well as dozens of critical access facilities, each with different stressors and patient needs.

“It was a grave responsibility to make sure that every single product – and there were thousands – was on the shelf and available if a patient needed it,” she says. “In addition, it was important to have exactly the right quantity there – enough, but not too much. “It sounds simple now, but without much direction or data infrastructure, it was a daunting task. The most immediate difference was that product descriptions made no difference. It was the product code language that mattered. There was very little oversight of my work, and the ERP system was complicated.” From her new vantage point in supply chain, Carpenter got a different perspective on sales reps. “As a clinician, the reps were quite helpful during procedures, but as a materials manager, they were salesmen.” She also got a close-up look at pricing, something she had had very little to do with as a clinician. “As a materials manager, one sees the cost of each product, and that can be sobering. Together with managing inventory, cost and savings became the paramount concern. It was a priority for me to educate the clinicians on just how much these products were costing the institution. It was a powerful tool that allowed me to start to change behavior.”

“ Supply chain has a responsibility to be front and center in discussions of quality, patient outcomes and financial margin.” Street cred Carpenter was a practicing RN for more than 30 years, most of them in the “heart of the hospital,” that is, the OR. She also worked in the cardiac ICU, “so I certainly have an appreciation for how important product availability is for intense practice areas.” During her years on the front lines, supply chain was not what she woke up thinking about. “As a clinician I had very little pricing knowledge. Savings was always an idea, but not a priority. “I never gave a thought to how products got on the shelf, but I experienced the disruption that occurs when any product change was not communicated to me. Even a change in packaging for commodity products felt like a safety issue. Was this the same product I used yesterday or not? “To that end, I was quite dissatisfied as a nurse when a product change would occur and I had no knowledge of the rationale for it, nor had I been asked to be part of the decision.” In 2010, Carpenter left OR nursing to join the materials management team at St. Agnes Hospital in Baltimore. It was a leap of faith, she says. She learned quickly what it meant to be on what physicians sometimes call “the dark side.”

Critical products manager In 2012, Carpenter became a critical products manager at Ascension. In that position, she and her peers were engaged in product selection and utilization for highcost, high-utilization products. The position proved instrumental in driving change across a system as large as Ascension, which today spans 22 states. “All new product introductions would come through the critical products manager, who as a clinical person would be able

June 2018 | The Journal of Healthcare Contracting

to communicate with the nurses and physicians on a peer level rather than having inventory managers without clinical backgrounds make supply changes,” she says. The critical products managers were also responsible for implementing at the facility level all national contract changes that involved highly sensitive clinical touches. “As the role evolved, it became a pivotal point for communication in both directions, that is, product feedback was relayed back to the national team as well. “The conception of this idea – that nurses would relay change management messages to physicians and nurses – bridged a gap that had not been addressed before. The fact that I had worked in their shoes was an instant source of trust, which allowed change to go forward a bit more easily.”

The link In 2017, Carpenter became vice president of clinical strategy for Catholic Health Initiatives, reporting to the senior vice president of operations for supply chain, Dan DeLay. “The vision and mission of this role is to provide the link at a national level between cost savings change and clinical practice change,” she says. “Each healthcare facility has a comprehensive view that exists in a small space. Each facility will say that their patients have special needs, that they have special financial and reimbursement needs, that they have staffing constraints that are unique.” In her role as vice president of clinical strategy, Carpenter brings the perspective of the entire system “to illustrate that we are not all that different, and that behaving in different ways costs us a great deal.” Local committees had succeeded in making local clinicians aware of cost, which continues to be the No. 1 thing physicians ask for when engaging supply chain, she says But regional leaders don’t always control costs well

The Journal of Healthcare Contracting | June 2018

“ I was quite dissatisfied as a nurse when a product change would occur and I had no knowledge of the rationale for it, nor had I been asked to be part of the decision.” because they are rightly concerned about revenue and volume, and they sign contracts that ultimately tie them to margin-negative cases, she says. “Local facilities are often saddled with limitations in analytics to support that work. They are also subject to marketing campaigns, and they may leap to be the first in the market with a product that may or may not actually help patients at a cost premium. The national supply chain perspective and national data analytic capability can help in these decisions.”

EXECUTIVE INTERVIEW

For the future

“The vision and mission of this role is to provide the link at a national level between cost savings change and clinical practice change.”

Every system will need to address how communication with practitioners occurs in a more sophisticated way, says Carpenter. “I happen to think this clinical strategy model is here to stay for this reason: Many executives and supply chain people are afraid to talk with physicians about products, margin and cost. Often physicians are hesitant to address their colleague’s product choice, even if it is more expensive. If the supply chain can create that conversation by bringing data, clinical evidence and the authenticity that nurses provide in this role, we will be able to create change on a large scale. “Physicians read the Wall Street Journal too, and they are becoming increasingly interested in the business side of medicine,” she continues. “They are stakeholders in the decisions around the practice of medicine, and they

need to be invited to the conversation. As the practice of medicine becomes more technical and less invasive, supply chain will need to offer a strategy for financial success that involves the total picture of an episode of care. The cost, the revenue, the correct utilization and the applications of criteria for the correct patient become the pieces of our decision-making. The more complex administering healthcare becomes, the more collaborative supply chain will need to be with our physicians. “As systems merge, as suppliers merge, as payers merge, it will be imperative that we set up processes and functional teams with our physicians and nurses. The larger we become, the more crucial it will be to create result-oriented conversations and focused discussions about how we interface with our suppliers, who are challenged to do the same thing.”

Walk a mile in their shoes Without clinical experience, supply chain executives may have difficulty anticipating the potential repercussions of product changes, whether that product is a glove, sterile gauze or monitoring equipment, says Kathryn Carpenter, vice president of clinical strategy for Catholic Health Initiatives Supply Chain. As an OR nurse, “even the change in packaging for commodity products felt like a safety issue,” she recalls. “In surgery, predictability is everything. You want everything to work perfectly, just as it did before. You get into a routine; you open products, they look the same. If something has been pulled for you, or you have to replace something in the middle of a case, it makes you pause. If it’s a marking pen, no harm, no foul. But if it’s a biliary catheter, wow.

“Any change in capital equipment or the addition of a new procedure certainly impacted my practice, and the quality of the vendor community in instructing the staff was a major factor in successful deployment or not.” Carpenter was in the OR during the switch from open techniques to laparoscopic procedures. “It was probably the most impactful change, as physicians had a huge learning curve,” she recalls. “It was interesting to observe which ones made the transition and which ones were not able to do so. I think about this now when I ask physicians to change products. The conclusion I have come to is this: If physicians are motivated to accept the change, it will happen more easily than if the change is forced upon them. “It’s not change itself that people dislike; it’s being forced to change that is disagreeable.”

June 2018 | The Journal of Healthcare Contracting

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Flu Fighters

The 2018-2019 flu season is coming. Already.

June 2018 | The Journal of Healthcare Contracting

It’s summertime. For many, that means weekend trips to the beach, outdoor concerts, baseball under the stars, and such. But for supply chain executives, it’s time to seriously prepare for the 2018-2019 flu season. At least, it should be, given the suddenness and severity of the 20172018 season, which many consider to have been the worst in years. “According to the Centers for Disease Control and Prevention, [the 2017-2018] flu season was dominated by the H3N2 strain, which has a propensity to be more severe in nature and with an increase in mortality related to the virus,” says Kristi Kuper, PharmD, BCPS, senior clinical manager, infectious diseases center for pharmacy practice excellence, Vizient. “What was somewhat unusual was that this strain not only affected those most vulnerable – such as the elderly and children, those with chronic health conditions, and the immunocompromised – but there were also flu-related deaths in patients with no reported underlying health conditions. “Although we did not see as many influenza cases and deaths as we did during the 2009-2010 H1N1 (pandemic) flu season, this season was one of the busiest on record,” she continues. “What was unique about this past season was the timing of the disease. Typically, we see a gradual increase in flu diagnoses as it geographically spreads across the country. However, this year, almost every state and territory was reporting widespread flu activity by the end of 2017, so it basically hit the U.S. all at once.” Says Steve Ellis, director, corporate supply chain services, Palomar Medical Center Escondido (California), “This was the worst flu season in memory, eclipsing even the H1N1 pandemic in 2009. The flu hit early, with patients flooding the Emergency Department shortly after Christmas. We saw an average increase of about 60 to 100 patients per day for several weeks following the initial surge.”

to accommodate patients needing initial screening, diagnosis and treatment,” says Ellis. The tent – which was set up by the hospital’s facilities management and emergency management teams – was in place for three weeks during the extreme peak period, beginning Dec. 30. “It felt like it happened overnight,” says Ellis, referring to flu onset. “There was no gradual increase. One weekend, I went in to the ER in our busiest facility; it was overflowing; standing room only. The demand was so high, with limited space to triage folks doing initial diagnoses, we set up the tent primarily for triage purposes. We would process quickly those with the most severe situations.”

“ The market continues to move toward premium influenza vaccine products, such as high dose, which contributes to the year over year cost increase to vaccinate a population.”– Tim Franke

Surge tents Palomar Medical Center was one of many facilities around the country that set up surge tents to assist with triage efforts. “Our EDs experienced considerable volume increases, causing longer wait times and challenges with space needed

The Journal of Healthcare Contracting | June 2018

Meeting demand Keeping up with the demand for flu-related products and protective wear kept supply chain officers busy in the first quarter of 2018. The difficulty of keeping clinical areas supplied was exacerbated by product shortages from hurricane-stricken Puerto Rico, as well as the depleted ranks of supply chain departments, themselves succumbing to flu and flu-like illness. “Various market factors – including hurricane damage to Puerto Rico-based manufacturing facilities – constrained the availability of IV solutions, resulting in manufacturers imposing limited allocations on products in order to manage inventory and mitigate shortages,” says Stephanne Hale, PhD, RN, senior clinical manager, sourcing operations, Vizient. “The already serious IV solutions shortages were exacerbated by a surge in demand caused by the season’s

FLU FIGHTERS “So our patient volume was much higher than usual, widespread flu activity and associated hospitalizations and and we had a less than optimal workforce.” need for IV medication and fluids for patient treatment. Health systems demonstrated creativity not only in “In addition, some pharmacies, especially in the retail sourcing supplies, but in using them efficiently. And they setting, reported difficulty obtaining oseltamivir [Tamiflu], got help doing so. which is the most common antiviral for treating influenza,” Christi Guess, senior director, member input and clinishe says. “On the positive side, we did not see any shortages cal solutions for Vizient, says that the GPO was able to of the flu vaccine or personal protective equipment, includserve as a “vital intermediary” between members, suppliers ing masks and gloves.” and distributors. “We provided various resources to memPalomar’s purchasing and distribution teams exerted bers, including clinical guidance on conservation strategies “substantial effort” to source products and replenish the for IV solutions, which resulted in reported reduction in surge tent and other areas within Palomar Health hospiutilization well in excess of 25 percent for many providers. tals, says Ellis. Products in demand included hand sanitizer, We partnered with our members in escalating urgent needs personal protective equipment (masks, gowns, gloves, etc.), with manufacturers and in prioritizing urgent shipments. disinfectant wipes/cleaners and lab supplies (influenza test“We served as a unified ing kits), he says. voice to industry in pressing for Despite the fact that Paloconcerted mitigation strategies, mar maintained a substanwhich resulted in suppliers astial safety stock of protective sessing their own vulnerabilities masks in its warehouse, “we in the face of shortages and were going through them alconstrained supplies caused by most quicker than we could both disaster and the flu-related source them,” says Ellis. “It surge in patient demand.” wasn’t a doubling or even triAs a result of efforts such as pling of normal usage; it was these, some suppliers obtained 10 to 20 times normal.” Usage FDA approval to import prodof the masks soared not only ucts from manufacturing sites among clinical staff and hospioverseas, and to extend the tal employees, but visitors too. shelf life of certain products, Any visitor presenting with flu– Kristi Kuper says Guess. Others ramped up or cold-like symptoms, such as production at other manufacturing sites in North America coughing and sneezing, were given masks. Influenza test and allocated shipments based on historical purchases. kits presented significant challenges as well, he says. “We were exhausting our regular suppliers, so we sourced from a variety of resources.” Lessons learned All the while the Palomar team was hustling to fill deIf the 2017-2018 flu season had any kind of silver lining, it mand, they were doing so with a proverbial hand tied bewas in the lessons learned by providers and suppliers. hind their backs. “Organizations should have an influenza shortage miti“Part of the challenge we experienced with supplying gation strategy in place that addresses and triages needs the tent and other locations involved our staffing levels, as from the various care settings,” says Tim Franke, RPh, sewe were not exempt from the flu or flu-like illness,” says Elnior director, pharmacy, laboratory and imaging contractlis. “From time to time, staffing levels within Supply Chain ing, Intalere. “That includes prioritization of patient types, and other departments were affected due to illness as well. influenza vaccination settings, intra-company product alloI don’t know of many people who were able to stay healthy cation, and vaccine logistics within a centralized or decenthrough it all,” himself included. tralized distribution model.

“Hospitals and health departments learn from every outbreak, whether it is the flu or something more deadly, such as Ebola.”

June 2018 | The Journal of Healthcare Contracting

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FLU FIGHTERS “Developing and improving engagement strategies with caregivers, particularly in the ambulatory setting, will enable greater visibility into the needs of those clinicians and more predictability in forecasting demand for the upcoming influenza season,” he adds. Sharon Carlson, director of emergency preparedness for Sharp HealthCare, says, “We practice for a ‘surge of patients’ consistently, and we need to continue to do so.” Sharp Grossmont Hospital in La Mesa, California, set up a surge tent for a short time this winter to screen incoming patients with flu-like symptoms. “Supplies may run low,” she continues. “Sometimes it may be supplies that one doesn’t plan to run short of. We ran low on blood culture tubes, but were able to work with vendors and share with other hospitals.” The 2017-2018 flu season validated some practices already in place at Palomar, says Ellis. Those practices include: • Have a good emergency management plan with an upto-date call list. “The increased volume began around the Christmas and New Year’s holidays. Much of the

work involved management and staff not scheduled to work due to the holidays.” • Make sure supply reorder points/quantities of basic and normally needed supplies have an adequate safety level built to accommodate periodic spikes in usage. Create emergency stock within your inventory location if the space is available or with key distributors. • Maintain flexibility within the support services areas to create awareness on the core mission with capabilities to flex and respond to urgent situations to meet community needs. Christi Guess from Vizient points out that Vizient’s contracts require suppliers to have a business continuity plan. “In general, most medical device and product manufacturers do have contingency plans and redundant supply chain strategies in place,” she says. But surges such as those experienced in the most recent flu season can uncover weaknesses in those strategies. “In these cases, including this most recent episode, Vizient has joined with members to formally challenge our supplier partners to improve, and we

H3N2 a formidable foe A Rice University study predicts that this fall’s flu vaccine – a new H3N2 formulation – will likely have the same reduced efficacy against the dominant circulating strain of influenza A as the vaccine given in 2016 and 2017, due to viral mutations related to vaccine production in eggs. “The vaccine has been changed for 2018-19, but unfortunately it still contains two critical mutations that arise from the egg-based vaccine production process,” Michael Deem, Rice’s John W. Cox Professor in Biochemical and Genetic Engineering and professor of physics and astronomy, was quoted as saying “Our study found that these same mutations halved the efficacy of flu vaccines in the past two seasons, and we expect they will lower the efficacy of the next vaccine in a similar manner.” Annual flu vaccines are formulated to protect against one type of influenza B and two strains of

influenza A, one H3N2 strain and one H1N1 strain, according to Rice. The H and N refer to hemagglutinin and neuraminidase, two proteins that cover the outside of invading flu particles that can cause infection when inhaled. The human immune system targets these particles for destruction based on their H and N sequences, and flu viruses constantly evolve the sequence of amino acids in these proteins to evade detection. Most flu vaccines are produced with a decadesold process that involves culturing viruses in hundreds of millions of chicken eggs. Because the strain of flu that infects people is often difficult to grow in eggs, vaccine producers must make compromises to produce enough egg-based vaccine in time for fall flu shots, according to Rice. Unintended effects of this process have reduced vaccine efficacy against H3N2 the past two years, Deem said.

June 2018 | The Journal of Healthcare Contracting

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FLU FIGHTERS ensure influenza vaccine is available for patient care,” says will hold them accountable to do so now and in the context Franke. “Healthcare providers need to find the appropriate of future competitive bids.” balance of those two sometimes competing forces. Adds Kuper, the 2017-2018 flu season demonstrated “The market continues to move toward premium influthe need for healthcare facilities to review current policies enza vaccine products, such as high dose, which contribregarding preparedness and prevention efforts, and enutes to the year over year cost increase to vaccinate a pophance them as necessary. ulation,” he continues. (The high-dose vaccine, approved “Patients and staff need to get an annual flu vaccine,” she for use in the United States in 2009, says. “Even though the vaccine’s effectiveis designed specifically for people 65 ness against the predominantly circulatand over and contains four times the ing strain was low this year, it still protects antigen as the regular flu shot.) “It is against other circulating strains, e.g., H1N1 imperative that healthcare providers and influenza B, which can cause flu. develop and implement an evidence“Hospitals and health departments based vaccination approach to effeclearn from every outbreak, whether it is tively manage the various patient segthe flu or something more deadly, such ments and associated costs.” as Ebola,” she says. “They are sharing Says Stephanne Hale, “Flu preventheir experiences and refining their aption and treatment during outbreaks is proach to treating patients and protecta collaborative effort. Identify all of the ing the health of their communities.” – Stephanne Hale key stakeholders and engage them as early as possible. Convene a group of experts to review how A look to 2018-2019 the hospital managed the 2017-2018 season. This would inContracting professionals and their teams should prepare clude evaluating the supply of personal protective equipment for the upcoming flu season with adapability, creativity and and the accessibility by staff. In addition, work with Pharmacy hard work, according to those with whom the Journal of to assess antiviral stock and availability in the wholesaler. This Healthcare Contracting spoke. should help identify opportunities for improvement. “While influenza vaccine suppliers continue to focus on “It is important to do this over the summer so that the incentivizing healthcare organizations to standardize their health system is well prepared before the 2018-2019 season influenza vaccine selection, there is inherent value in diverbegins this fall.” sifying product selection to mitigate product shortages and

“It is important to do this over the summer so that the health system is well prepared before the 2018-2019 season begins this fall.”

Nasal vaccine gets CDC backing for 2018-2019 After refusing to recommend the nasal flu vaccine FLUMIST® QUADRIVALENT for the past two flu seasons, the Centers for Disease Control and Prevention is recommending it (in addition to injectable flu shots) for the 2018-2019 flu season. The recommendation follows the presentation of positive results from a U.S. study in children between the ages of 2 to <4 years evaluating the shedding and antibody responses of the H1N1 strain in the live

attenuated influenza vaccine, according to drug company AstraZeneca. FLUMIST QUADRIVALENT is a vaccine that is sprayed into the nose to help protect against influenza. It can be used in children, adolescents, and adults ages 2 through 49. FLUMIST QUADRIVALENT is similar to MedImmune’s trivalent influenza vaccine, except FLUMIST QUADRIVALENT provides protection against an additional influenza strain.

June 2018 | The Journal of Healthcare Contracting

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MODEL OF THE FUTURE

Training Tomorrow’s Leaders Spectrum Health has created a culture of learning Stallions run with stallions. That’s a favorite expression of an HR director with whom Bill Selles used to work. “It means, if you can create an environment where people feel they are making progress, more people will want to join,” he says. “It’s energizing. And those who don’t want to run too fast – they tend to self-select.”

June 2018 | The Journal of Healthcare Contracting

Selles works to keeps the energy flowing in his current role as director of supply chain sourcing at Spectrum Health, based in Grand Rapids, Michigan. He gets plenty of help from the IDN, with its strong culture of learning, training and development; and he credits some key people and organizations in his past with helping out as well.

Consumer world Selles’ passion for training and development comes from years of experience, beginning with Pizza Hut in Grand Rapids, Michigan, where he was an assistant manager. “The restaurant was set for closure within six months from when I started, and the other leaders and I were able to turn it into a top 25 restaurant nationally for three consecutive years,” he says. “This was accomplished through establishing standards, hiring and training to those standards, and engaging the team in improving operations and results. “My key learning at this phase was how to meet people with their specific training needs and tailor communication. Many employees had less than a high school education and several did not speak English, meaning training had to be very individual. One-to-one training improves engagement, but is a major investment in time.” In 2006, he joined Target, assuming management positions in stores in Grand Rapids, Kalamazoo and metro Detroit. Target proved to be a great learning environment, for several reasons. The company believed in helping managers improve not just what they said during training sessions, but how they said it. “Target has a robust feedback culture,” says Selles. “When you finish delivering a training session, you get graded on it.” Target insists that its managers pay attention to “housekeeping” items associated with training presentations. Examples: How

The Journal of Healthcare Contracting | June 2018

do you keep people from getting distracted? How do you let your audience know when they should be taking notes? How do you “reset” the session if things start to go off the rails? How do you get people back to their seats after what was supposed to be a 5-minute break? “They also talked a lot about frame of reference,” says Selles. “It’s very easy for someone who knows a subject to assume that everyone else does too. But I’ve been to training sessions in which people got lost in jargon within the first three minutes.” He learned something else at Target – the value of investing in the “average” employee or leader. “Most leaders closely manage the bottom 10 percent (out of necessity), and the high-performing top 10 percent (out of enjoyment), leaving the vast majority of employees with little skill growth. “Target graciously put me through a program to certify me as a field trainer and equipped me with formal training skills. That certification and the structure of Target Corporation gave me the skill set and desire to coach the 80 percent. I’ve subsequently leveraged that to identify specific competencies needed for success Bill Selles in roles, and grow them through foundational learning blocks and reinforcement over time.”

“Leaders who invest in creating a culture of development will win the talent arms race taking place as boomers retire.”

Creating healthcare leaders In 2012, Selles joined Priority Health, a Michigan-based nonprofit health plan. There, he gained still more insights about training and development. “I joined an organization with significant longevity among both front-line staff and leaders. Employees had incredible knowledge, but

MODEL OF THE FUTURE

professed most jobs took years to learn and longer for mastery – a problem in a growth environment. “I specifically worked to automate low-skill tasks and strip away complexity from roles by creating more job aids, resources and standard work, which allowed new employees to become successful in a much shorter time. This allowed the business to be more nimble and attractive to younger employees. “Not to forget the top 10 percent, we also created a development cohort to feed a pipeline of future leaders, and used cross-functional subject matter experts to train on essential skills needed for higher level roles in the organization. We then tied that work to succession plans and mentoring relationships to close the development loop.” Selles became director of supply chain sourcing at Spectrum Health in February 2017. Spectrum Health comprises 12 hospitals and 180 ambulatory care locations in western Michigan. There, he leads sourcing and procurement, and has responsibility for $700M+ in total spend for medical, surgical

he says. He put together a list of 26 attributes and skills, then asked each person in the department to rank their proficiency in each. From there, he began building solutions. For example, he sought help from Jennifer Dunn, PhD, in the department of management at Michigan State University, who offered training on negotiation skills. Presentation skills, communication skills and change management were – and remain – areas of concentration. Each member of the team also selects a quarterly development focus – a hard skill or soft skill – and zeroes in on that for 90 days. Selles records these and looks for opportunities to engage people in that activity through stretch assignments, books and articles or

“ If you can create an environment where people feel they are making progress, more people will want to join.” and pharmaceutical products as well as purchased services. Responsibilities also include value analysis and supply chain analytics. Turns out he came to the right place. The IDN has what it calls Spectrum Health University, which offers training workshops on professional presence, communication skills, change management and providing feedback. At Spectrum Health, Selles has seven direct reports – two managers, two RNs who lead value analysis, two analysts and one project manager. Total staff numbers approximately 40 FTEs, comprised mostly of buyers and sourcing specialists. “As we’ve added more value, this team grew by about five last year and will grow by about five more this year,” he says.

Breadth and depth “Sourcing professionals are called upon to leverage an incredibly broad skill set and carry out a wide range of tasks, and they often have to shift quickly from one initiative to the next,” he points out. “Training to breadth and depth is important.” “When I came to the department, the team had deep product expertise, but needed training on some of the core skills associated with sourcing,”

work groups. “This ensures that while the team builds new skills as a cohort, each individual also has an opportunity to develop the specific skills necessary to grow in their current role or progress to a next-level position.” When it comes to communicating the value of training, Selles leverages a cartoon. Two guys are sitting at a table. The first guy says, “What if we train them and they leave?” The other guy answers, “What if we don’t … and they stay?” “As I recruit the next generation of supply chain leaders into entry level roles on my team, the top two questions I consistently get from millennials are, ‘What is the culture like?’ and ‘What kind of development programs do you have in place?’” he says. “Leaders who invest in creating a culture of development will win the talent arms race taking place as boomers retire.”

June 2018 | The Journal of Healthcare Contracting

SPONSORED: WELCH ALLYN

as EMR integration can be, too often it results in longer workflows for clinicians. Count the clicks your clinicians are making today, and make sure that number goes down with the new solution. Otherwise, you may be opening yourself up to workarounds or, worse, outright rejection from users.

2. Who has access? Robust, network-capable devices like vital signs monitors and ECGs are often distributed throughout a hospital or practice. Since they not only capture patient information but also transmit it to the EMR, device access control is important. However, too often, increased security measures introduce additional workflows or cumbersome tasks for clinicians. Ask your provider if roles-based user authentication is available to help ensure users can only access functions they need based on their job. Rutherford cites a common example: “CNAs may be needed to take vitals or conduct ECGs, but rights to edit data in the EMR should be reserved for RNs and physicians. Make sure your care and support teams are accounted for so your system manages user rights both securely and appropriately.”

3. Who is controlling cybersecurity? Solutions requiring non-standard infrastructure or security practices are not practical in today’s healthcare IT environments. You need to secure the devices on your network your way. “It’s easy to find a device that will connect to an EMR,” says Rutherford. “Unfortunately, it’s also easy for that communication to happen in a non-secure way. Asking the right questions upfront can make all the difference.”

Ask your provider if roles-based user authentication is available to help ensure users can only access functions they need based on their job.

Rutherford suggests asking your vendor: •W hat encryption methods are used to protect Protected Health Information (PHI)? • Does the solution support your existing security policies for cyber hygiene; scans, upgrades and patches? • What is your cybersecurity risk management policy for devices both in the field and in development? Accurate, diagnostic-quality data can save a patient’s life. By involving the right team, asking the right questions and paying attention to security, you are starting down the path to making the best decision for your patients and your clinicians.

June 2018 | The Journal of Healthcare Contracting

Better, faster. It’s what we want for patients.

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Connecting vital signs monitors to the EMR has been shown to: Y

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Welch Allyn partners with leading EMRs to send data from the Connex® family of vital signs devices directly to the patient’s record. Our goal is simple: help your clinicians work better, faster so they can focus on getting patients better, faster.

Start today at www.welchallyn.com. 1 CIN: Computers, Informatics, Nursing: Eliminating Errors in Vital Signs Documentation, FIELER, VICKIE K. PhD, RN, AOCN; JAGLOWSKI, THOMAS BSN, RN; RICHARDS, KAREN DNP, RN, NE-BC, 2013. The paper vital signs recording had an error rate of 18.75%. 2 JHIM FALL 2010 Volume 24:Number 4, Vital Time Savings: Evaluating the Use of an Automated Vital Signs Documentation System on a Medical/Surgical Unit 3 Going One Step Further at Scott & White Medical Center—Temple: Eliminating manual vital signs documentation to prioritize value-added care. 2017 Welch Allyn. www.welchallyn.com 4 CareAware® VitalsLink: Eliminating Data Latency & Manual Documentation at Naples Hospital. Prepared by Cerner, 2013. © 2017 Welch Allyn

MC14605

PURCHASING PROGRAM

savings at a correspondingly higher level of commitment. ASCEND represents more than 120,000 acute-care beds and a combined purchasing volume of more than $18 billion. The program will also use Premier’s PACER (Partnership for the Advancement of Comparative Effectiveness Review) methodology, which brings together clinically led groups to make decisions about physician preference items, says Pam Daigle, vice president, strategic sourcing (who will head up SURPASS). In fact, many of the core members in SURPASS will be those that have also participated in PACER, she says. Currently, the core members have created their initial product portfolio and bid calendar and are actively awarding SURPASS agreements, says New program seeks best pricing Daigle. “It’s a member-led group. in return for highest commitment We’ll continue to let them define the process. We will use our data to show them where the opportunities lie, but Best-in-market pricing, improved product quality and patient outthey will figure out what makes the comes are three key aims of Premier’s SURPASS, a new, highly committed purmost sense for them.” chasing program. “Many members are “Yes, it’s about cost. Yes it’s about standardiza“What differentiates looking at this as a plattion. Yes it’s about utilization,” says David Hargraves, form to get to the next Premier’s senior vice president of supply chain. “But this program from level of cost transformawhat differentiates this program from others is that others is that we are we are going into negotiations with a very specific going into negotiations tion; they see it as a way to lead change in their and detailed focus on clinical effectiveness. Does the with a very specific organizations,” says Harproduct make a demonstrable difference in outcomes? and detailed focus on graves. “Unquestionably, Is it clinically efficacious?” clinical effectiveness. they are looking for bestThe program will be led by a group of core members Does the product in-market pricing coupled with significant aggregated spend that can achieve and make a demonstrable with intelligent product maintain compliance across their facilities, according to difference in decisions – based not just Premier. This group will develop and drive the strategy on acquisition cost, but for the program, as well as make all contracting decioutcomes? Is it on total cost of care. And sions. Additional participating members will be invited clinically efficacious?” they expect to see an upto join the program following the initial launch. – David Hargraves, Premier’s tick in terms of improved SURPASS is intended to complement Premier’s exsenior vice president of supply chain quality and outcomes.” isting ASCEND performance group by offering greater

Premier Introduces SURPASS

June 2018 | The Journal of Healthcare Contracting

INFECTION PREVENTION

Infection Rates Down

Providers are making progress on reducing healthcare-associated infections Healthcare in the U.S. is safer now than it was 10 years ago, according to recent data compiled by the Centers for Disease Control and Prevention. The incidence of central-line-associated bloodstream infections (CLABSIs) dropped significantly between 2008 and 2016, while catheter-associated urinary tract infections (CAUTIs) have dropped as well, most markedly in non-ICU locations. And while surgical site infections are on the decline, progress may be slowing following some procedures. The data was published recently by CDC in “Healthcare-associated Infections in the United States, 2006-2016: A Story of Progress.” “Infection preventionists nationwide are seeing the positive effects of HAI [healthcare-associated infection] reduction efforts initiated in the early 2000s,” says Marie H. Wilson, BSN, BS, RN, CIC, infection preventionist at Methodist Dallas Medical Center. Figure 1. Changes over time in CLABSI SIR (standardized infection ratio) in US hospitals using 2006-8 baseline, NHSN 2006-2016

Figure 2. Proportion of CLABSIs by location in US hospitals, NHSN 2015 (N=26,029)

“CDC’s National Healthcare Safety Network – NHSN – established a new baseline comparison for HAI Standardized Infection Ratios – SIRs – with data aggregated from 2015,” says Wilson, who is a member of the communications committee of the Association for Professionals in Infection Control and Epidemiology. “As a result of this ‘rebaseline,’ it’s now harder to achieve lower

“Carefully determining the necessity of central lines before insertion is a CLABSI prevention strategy.” SIRs – a sign that fewer infections are predicted. This is a direct result of HAI prevention initiatives seen nationwide, including safer and reduced use of indwelling devices and antimicrobial stewardship programs.” “The CDC’s report confirms we’re driving the needle of change toward zero HAIs.”

National action plan In 2009, the U.S. Department of Health and Human Services published the “National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination,” which set five-year goals for HAI prevention. CDC publishes yearly reports to help each state identify its progress and target areas that

June 2018 | The Journal of Healthcare Contracting

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need assistance. The data used in these reports comes from two surveillance systems: the National Healthcare Safety Network (NHSN) and the Emerging Infections Program Healthcare-Associated Infections Community-Interface (EIP HAIC). In addition, CDC and other federal agencies, such as Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality and the Office of the Assistant Secretary for Health, work together to develop tools, recommendations, and programs that offer infection prevention strategies. Figure 3. Changes over time in non-yeast CAUTI SIR in US hospitals using 2009 baseline, NHSN 2009-2016

“Carefully determining the necessity of central lines before insertion is a CLABSI prevention strategy,” points out CDC. The magnitude of SIR (standardized infection ratio) declines from 2012-2014 leveled off, a trend that was more pronounced on wards, to which the majority of CLABSIs were attributed in 2015, says CDC. And recent unpublished data suggests that, at least among adult intensive care unit (ICU) patients, declines in CLABSIs caused by Staphylococcus and Enterococcus spp. have outpaced declines in infections caused by gram negative and fungal pathogens.

Catheter-associated Urinary Tract Infection (CAUTI)

Figure 4. Changes over time in catheterization utilization ratio (urinary catheter days per patient days) in U.S hospitals, 2010-2016

In its most recent report, CDC examines the nation’s progress preventing five of the most common infections: • Central-line-associated bloodstream infections (CLABSI). • Catheter-associated urinary tract infections (CAUTI). • Select surgical site infections (SSI). • Hospital-onset Clostridium difficile infections (CDI). • Hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) bacteremia (bloodstream infections).

After an early lack of progress, CAUTIs have been steadily declining over the past few years. The gains have been most marked in non-ICU locations, but recent years have seen progress in ICUs as well. Data also indicates a reduction in urinary catheter usage – a key prevention strategy for CAUTI. Although CAUTIs that include those caused by yeast declined on wards from 2012 through 2014, they failed to decline in ICUs. However, using the more clinically relevant CAUTI definition, which no longer includes yeast, and applying this retrospectively as well as in the new baseline, there were yearto-year declines in CAUTIs in both ICUs and wards from 2012 through 2016. The removal of yeast from CAUTI reports from 2009 through 2014 shows that reductions in wards – to which a slight majority of CAUTIs were attributed in 2015 – were more pronounced. However, there were also declines in the ICU SIR, resulting in successive yearly relative declines of 6-8 percent in the CAUTI SIR from 2012 through 2014.

Surgical site Infections Central Line-Associated Bloodstream Infection (CLABSI) Nationally, CLABSIs dropped roughly 50 percent between 2008 and 2016. The data also shows a reduction in the use of central lines.

Overall, the incidence of surgical site infections has dropped since 2010. That said, progress may be slowing following some procedures.

June 2018 | The Journal of Healthcare Contracting

INFECTION PREVENTION

Figure 5. Changes over time in SSI SIR after any of 10 surgical care improvement project procedures in US hospitals using 2006-8 baseline, NHSN 2010-2014

SCIP procedures are: vascular (i.e., abdominal aortic aneurysm repair or peripheral vascular bypass surgery), coronary artery bypass graft, other cardiac surgery, colon surgery (colon or rectal), hip arthroplasty, abdominal hysterectomy, knee arthroplasty and vaginal hysterectomy. Figure 6. Proportion of MRSA bacteremia events by type of onset, NHSN 2015 (N=72,852)

Figure 7. Changes over time in crude incidence of community-associated (CA) and healthcare-associated (HA) CDI among the 10 EIP sites, 2012-2015

Clostridium difficile Infection (CDI) Crude rates of healthcare-associated CDI are decreasing, reflecting declines in nursing home-onset infections along with some declines in hospital-onset CDI, says CDC. An assessment of CDI events reported to NHSN demonstrates that nearly 70 percent of reported events had their onset in the community in 2015.

Methicillin-resistant Staphylococcus aureus Bacteremia (MRSA Bacteremia) There has been major progress since 2005 in preventing MRSA bacteremia due to declines in hospital-onset and community-onset, healthcare-associated bacteremia. Much of the progress reflects improvements in preventing insertion-related CLABSIs. More than 80 percent of reported events in 2015 had their onset in the community. There has been little or no decline in communityassociated MRSA bacteremia, suggesting a need for a comprehensive, multidisciplinary, community-based public health approach to prevention of invasive infections caused by this common skin organism, says CDC. “The fact that the community burden of MRSA bloodstream infections isn’t worsening is a testament to the work infection preventionists are doing in collaboration with physicians and pharmacists on antimicrobial stewardship programs,” says Wilson. “CDC’s National Action Plan for Combating Antibiotic-Resistant Bacteria (2015) outlines several goals and objectives many groups and individuals can employ to reduce the impact of multidrug-resistant organisms across the board.”

Source for featured figures: “Healthcare-associated Infections in the United States, 2006-2016: A Story of Progress,” Centers for Disease Control and Prevention. Editors note: “Healthcare-associated Infections in the United States, 2006-2016: A Story of Progress” may be accessed at https://www.cdc.gov/hai/surveillance/data-reports/data-summary-assessing-progress.html

June 2018 | The Journal of Healthcare Contracting

INFECTION PREVENTION

The Triclosan Ban Triclosan. Sounds like something that might be mentioned in a Marvel superhero movie. In reality, it’s much more prosaic. Triclosan is a commonly used ingredient in antibacterial soap products. In December 2017, the U.S. Food and Drug Administration banned it as an active ingredient because of a lack of data provided on its safety and efficacy. Manufacturers have until December 2018 to reformulate their soap products or remove the triclosan-based products from the market. “Healthcare facilities with excess inventory of triclosan-based soaps may deplete it after December 2018, or simply discard it”, says Megan DiGiorgio, MSN, RN, CIC, FAPIC, clinical manager, GOJO Industries.

Choosing a soap “Some facilities are unaware of the type of soap they are using,” says DiGiorgio. “The focus of many hand hygiene programs is – rightly so – hand sanitizer, because it is the preferred method for cleaning hands that are not visibly soiled. Less attention has been given to soap in the past, so these changes are an opportunity to evaluate current products.” Many healthcare facilities are unsure of whether to use an antimicrobial soap or a non-antimicrobial soap, and frequently wonder what is allowed in healthcare, she says.

Hand hygiene guidelines from the Centers for Disease Control and Prevention and the World Health Organization allow the use of either an antimicrobial or a non-antimicrobial soap, says DiGiorgio. Due to a lack of evidence demonstrating their clinical benefit (i.e., resulting reduction of infection rates), neither organization recommends one over the other. However, published studies of bacterial reduction on the hands demonstrate that alcoholbased hand rub is most efficacious, followed by antimicrobial soap, followed by non-antimicrobial soap as least efficacious. A good way to approach the decision of whether to choose an antimicrobial or a non-antimicrobial soap is to consider risk reduction, says DiGiorgio. “The greatest risk reduction will be achieved by using an antimicrobial soap, which will result in a higher log reduction of bacteria on hands,” she says. “Non-antimicrobial soap will result in a lower log reduction of bacteria on hands and leave more bacteria behind, which could potentially mean pathogens are transmitted to patients.” Other factors that should be considered when selecting a soap include: • Does the product meet FDA efficacy requirements? • Is it gentle to healthcare workers’ skin with repeated use? Do healthcare workers like aspects of the soap, such as its lather, scent, and rinsing factor?

Additional resources: “5 Things to Know About Triclosan,” https://www.fda.gov/ForConsumers/ConsumerUpdates/ ucm205999.htm; and a free whitepaper on the science of soap from GOJO Industries, at http://gojo.com/HealthcareSolutions.

The Journal of Healthcare Contracting | June 2018

SPONSORED: HEALTH O METER® PROFESSIONAL SCALES

Beyond the Product How company culture influences supplier performance

In a market saturated with options, it can be difficult to distinguish between suppliers and know which brand to trust. You want to get the product that meets your needs but you also want the purchasing, delivery, and usage of that product to be easy and aligned with your business goals. When evaluating products and brands, consider how the supplier does business: • How quickly and thoroughly does the supplier respond to a customer’s question? • Was the product in stock and delivered on time? • Is the supplier listening to the market and developing products and policies for healthcare providers and distributors? • Does the supplier have local representatives available as a resource? Depending on the supplier, its company culture can dictate how these concerns are handled. A strong culture with defined values creates an expectation for a supplier’s employees and drives every aspect of the business. But having a strong company culture is only a good thing if that culture is positive and focused on providing a superior experience for customers.

Customer-focused culture

Focusing on the goal of making things weigh easier influences what Health o meter® Professional Scales offers and how it performs.

For nearly 100 years Health o meter® Professional Scales has operated by a strong customer-focused culture with customer feedback frequently affirming the brand offers easy to use products and is the easiest scale company to work with. In acknowledgment of this feedback, Health o meter® Professional Scales has formally named its company culture Weigh Easier®. The Weigh Easier® name encapsulates the company’s standards and systems that consistently strive to do what is weigh easier for the customer – whether the customer is a physician, healthcare system, distributor, or sales team. Focusing on the goal of making things weigh easier influences what Health o meter® Professional Scales offers and how it performs, including: •P roducts designed to improve workflow and patient care, without the added cost of impractical and unreliable technologies

•E fficient and timely responses to customer inquiries and requests • Fast on-time shipping and industry-leading fill rates • Nationwide support from over 100+ field representatives • Continuous improvement initiatives utilizing customer and employee feedback programs and formal performance metrics • Policies and procedures that protect end users and distributors – ScaleSurance Extended Warranty Program, Distributor Protection Guarantee, internet Minimum Advertised Pricing (MAP) policy, company pledge of No Direct Sales, balanced GPO pricing strategy These attributes uphold Health o meter® Professional Scales’ superior service and support, which extends beyond end users and includes anyone that interacts with the company, at any level. And it’s because of these guiding principles that the company has achieved the status of the No. 1 medical scale brand in the United States. Choosing the right scale brand doesn’t have to be overwhelming. Make it weigh easier to decide by choosing the brand that makes it weigh easier for you, Health o meter® Professional Scales. To view the comprehensive product line or to learn more about this industryleading brand visit www.homscales.com or call 1-800-815-6615.

June 2018 | The Journal of Healthcare Contracting

Who do you want to do business with

At Health o meter ® Professional Scales we are dedicated to making healthcare for you and your customers. • Products designed to improve workflow and patient care, without the added cost of impractical and unreliable technologies • Efficient and timely responses to customer inquiries and requests • Fast on-time shipping and industry-leading fill rates • Nationwide support from over 100+ field representatives • Continuous improvement initiatives • Policies and procedures that protect end users and distributors: • ScaleSurance Extended Warranty Program • Distributor Protection Guarantee • Internet Minimum Advertised Pricing (MAP) Policy • Company Pledge of No Direct Sales • Balanced GPO Pricing Strategy We want to hear from you! Send us a story about when Health o meter ® Professional Scales made things for you or your customer. Submit your story to weigheasier@homscales.com.

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CONTRACTING PROFESSIONALS REVISITED

Chris Meyers Janda: Still on a learning curve

2007 Contracting Professional of the Year is always up for a good challenge Editor’s note: Where do JHC’s past Contracting Professionals of the Year go? Up. We are checking in with the people we’ve recognized since 2007, starting with our first Contracting Professional of the Year – Chris Meyers Janda.

Eleven years after being named JHC’s first Contracting Professional of the Year, Chris Meyers Janda still takes joy in learning, and in helping others do the same. And, as far as she’s concerned, there’s always something to learn in healthcare delivery. Meyers Janda is vice president, Central Region, for Premier. Eleven years ago, she was vice president of supply chain at Fairview Health Services in Minneapolis. Prior to joining Fairview in 2002, she was the supply chain director at Allina Health. She transitioned from Fairview supply chain in 2008, and became vice president of perioperative services at the University of Minnesota Medical Center and Amplatz Children’s Hospital, part of the Fairview system. She joined Premier in 2014. “In my current role, I work with health system executives to address the challenges they face as they transform into high-quality, cost-effective organizations, leveraging our capabilities in cost management, quality, integrated pharmacy and value-based care,” she says. “Working with health system executives, I’m driven to understand their key strategic priorities and the problems they’re trying to solve, and then align our expertise and solutions to assist them in closing the gaps. “As I’ve made career decisions over the years, I’ve been thoughtful and pursued opportunities based on the difference I can make, and the potential value for patients, providers and the organization. I like a good challenge and my leadership experiences have provided that to me, especially the work I’ve done in perioperative services.”

June 2018 | The Journal of Healthcare Contracting

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CONTRACTING PROFESSIONALS REVISITED

Perioperative services has also been her window into supply chain and healthcare administration. “We create the most durable solutions for our patients and providers when we’ve either been a patient or walked in the experience of the patient,” she says. “There is no better way to gain the understanding and level of compassion needed to thrive in healthcare than to work in a clinical setting. I still encourage those I mentor to seek these experiences during their career.”

Continuous improvement For years, Meyers Janda has been a student of continuous quality improvement. While at Fairview, she earned a Green Belt in quality through the Juran Center at the University of Minnesota. She maintains an interest in continuous improvement today, but with a twist. “My commitment to solving problems within a process improvement framework has not changed, and I continue to apply that today,” she says. “With that said, I’ve become more aware that those with whom you work, and their level of passion in solving important problems, make all the difference in being able to achieve excellence. “My thinking around the role that culture, conflict and change play in our healthcare journey has matured as well. While ‘all work is a process,’ you have to effectively manage the transition and address the people challenges with as much intent as the process change itself. “Maybe I always took that into consideration without even knowing it,” she says. “With ever increasing complexity in our environment today, it’s essential for us to be in tune with both the pace and magnitude of change, and its impact on people. Sometimes I’m not sure if we’re well-equipped to deal with this magnitude of change demanded of us. So, paying attention to the people side of the equation is critical. “I’ve found that when I haven’t done that, things don’t always stick.” Meyers Janda believes that over the years, she has grown to better understand herself and the difference she wants to make in the world. “I’m also able to more effectively assess a situation to determine potential courses of action. Of course, as a parent of two young adults, and after 20 years of marriage, my family is my rock and their support and unconditional love grounds me personally.”

“There is no better way to gain the understanding and level of compassion needed to thrive in healthcare than to work in a clinical setting.”

Supply chain and the future She continues to believe that supply chain is an important component of the healthcare system. “I mentor graduate students at the University of Minnesota Master in Healthcare Administration Program and actively help them determine where their skills and interests reside. Supply chain is always one of my sugges-

tions to them. Given the complexity of healthcare, we need varied and fresh talent pursuing this field as we make our transition to value-based care, which requires new ways of thinking about supply chain’s role in driving excellent patient outcomes.” And she believes that in order to be effective, supply chain professionals need to stay plugged into the clinical side of the house. “Gain experience in a clinical setting and enterprise analytics,” she advises those early in their careers. Further, she encourages supply chain professionals to study the transition to value-based care, as they will play a pivotal role in assisting providers and their organizations through this transition. Meanwhile, she’s going to keep learning. And there’s plenty of that to do. For example, at press time, she was helping a client with a Medicare accountable care organization gather enterprise data on its ACO population. “We’re helping them ask and answer some big questions about that population,” she says. “We’re asking questions like, ‘How well is their care being managed?’ ‘Of their attributed lives, who is seeking care elsewhere?’ “Then it’s a matter of stepping back, asking what’s been learned, and determining what’s next. For me, the greatest success is achieved when working as a team to solve problems together, maximizing the varied expertise that everyone brings to the table. “In this part of my journey, I’m doing all I can to learn about value-based care and reduction of unwarranted clinical and non-clinical variation, in hopes of driving as much value as possible for the health systems I serve.”

June 2018 | The Journal of Healthcare Contracting

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SUSTAINABLE MEDICAL PROGRAMS

Staying Power

Atrium Health helps Central American countries create sustainable medical programs

Medical missions – where teams of physicians and support staff travel to developing nations and deliver intensive medical care for a week or two – save lives and give hope to people. And they are gratifying to those who make the trip. Donating equipment and supplies for such missions? Ditto. But for more than 40 years, Atrium Health (formerly Carolinas HealthCare System) has been doing something different. Still looking to save lives and give hope to people in need, the Charlotte, North Carolina-based IDN works with Central American surgeons, technicians and governments to create sustainable medical proJim Olsen grams in countries where before there were none.

“We try to build programs with longevity,” says Jim Olsen, senior vice president and chief purchasing officer. “So it’s not a situation where we go down, donate equipment, and then six months later, it’s rusted and not working.” Equipment and consumables are, of course, essential components of sustainable medical programs. That’s where Atrium’s International Medical Outreach comes in. But just as important is the training of surgeons and others on how to use that equipment.

June 2018 | The Journal of Healthcare Contracting

1971 In 1971, Francis Robicsek, a Charlotte-area heart surgeon with an avid interest in the lost Mayan civilization of Guatemala, was introduced to then-Guatemalan President Carlos Arano Osorio, who also had an interest in pre-Columbian culture. As the two got to know each other, the president asked Robicsek – who had fled a failed revolution in Hungary in 1956 – if he could help Guatemala set up a heart surgery program. Robicsek would be well-suited for the task, as he was a renowned cardiac surgeon who had performed the first bypass and first heart transplant in Charlotte. The Guatemalan Ministry of Health assigned a young Baylor-trained Guatemalan surgeon, Dr. Raul Cruz Molina, as the future head of the cardiac program, explained Robicsek in a 2014 bylined article in the Bulletin of the American College of Surgeons. Dr. Cruz flew to Charlotte for an intensive 18-month cardiac surgical fellowship. Simultaneously, a team of Guatemalan cardiologists, anesthesiologists, perfusionists and intensive care nurses traveled to Charlotte to train at Carolinas Medical Center (then known as Charlotte Memorial Hospital). At the same time, Robicsek and the Carolinas team gathered used and refurbished perfusion equipment and vital-sign monitors. In 1974, supported by a grant from the Heineman Foundation of Charlotte, Robicsek returned with the Guatemalan team to Guatemala and selected as their first surgical candidates some patients with relatively simple anomalies, such as atrial and ventricular septal defects and pure mitral stenosis. The diagnostic studies were conducted in Charlotte, but the first procedures themselves were performed by Guatemalans, backed by a Charlotte team of eight. Dr. Cruz gradually accepted more and more complex cases, but soon, organizers realized that sending Guatemalan patients to

Charlotte for diagnostic studies would exhaust the financial resources of the group. So with aid from President Orano Osorio, a Guatemalan Air Force transport plane regularly carried between 35 and 40 patients in need of diagnostic studies to Charlotte. Those who required additional testing underwent heart catheterizations around the clock. After being diagnosed, the patients were flown back to Guatemala, where those in need of surgery were operated on by Dr. Cruz and his team, still actively supported by a cardiac team from Charlotte. In 1976, a cardiac program under the direction of Dr. Cruz was established in Guatemala City at the Roosevelt Hospital, the largest health institution in Guatemala. The team at Carolinas Medical Center continued its supportive role but, within a year, the number of visiting clinicians from Charlotte gradually decreased from eight to three and, finally, to none.

“ I noticed that the unit we had installed two years earlier still looked good. The same thing was true for the pediatric unit. To me, this looked like something that could really help people.”

The Journal of Healthcare Contracting | June 2018

During the next three decades the cardiac program in Guatemala City grew into a Department of Cardiac Surgery. In 1989, UNICAR, the Guatemalan Heart Institute, was opened in a building on the Roosevelt Hospital Campus. The Cardiology-Cardiac Surgery Program gained momentum as the core of UNICAR, which today serves patients in Guatemala, Honduras, Belize and Nicaragua.

Honduras “My first trip with Dr. Robicsek was to Honduras,” recalls Olsen. “We were in a hospital where, two years earlier, we had replaced the pediatric ward. A year before, we had installed an intensive care unit, and we were opening a cardiac cath unit. I was impressed from the beginning: I noticed that the unit we had put in two years earlier still looked good. The same thing was true for the pediatric unit. To me, this looked like something that could really help people.” From that point on, he became fully engaged with the program. Most recently, Olsen was involved in the opening of a neonatal ICU and a pediatric ICU in Escuintla, Guatemala.

SUSTAINABLE MEDICAL PROGRAMS

“We sat down with the people there to design the two units and to make sure the pediatricians were well-trained,” he says. “Toward the end of the process, we asked if we could send someone to Escuintla to teach CPR to 35-or-so people. One of our pediatricians and some nurses went down. When they got there, 350 people were waiting to take the class, including doctors and nurses who worked in the emergency department and cardiac catheterization units.

“It’s not a situation where we go down, donate equipment, and then six months later, it’s rusted and not working.”

All 350 were trained through around-the-clock sessions. So, sometimes the healthcare-related needs in Central America are very, very basic, by U.S. standards. “But at the same time, we equipped those units with technology that is at the highest level found in Guatemala. It was 10- or 12-year-old equipment that we had replaced. We brought it up to specifications and shipped it down, along with a biomedical engineer from the U.S. to make sure it was installed properly.” Amidst the successes are the inevitable challenges. “We take equipment down to Central America, make sure it is installed properly, and train technicians how to use it,” Olsen says. “But if it breaks, what do you do? In a lot of cases, we can help by sending a spare part. But the basic infrastructure of equipment repair there is very broken. We’re trying to figure out a way to train bioengineers to maintain equipment on their own.” Atrium Health has sponsored success in other Central American countries as well. Within a three-year span, for example, Belize City – the largest city in Belize – opened a cardiac cath lab, a non-interventional diagnostics lab, and an open heart surgery program with equipment from Atrium Health. “So we have big wins, and we have medium wins,” says Olsen. “The key thing from my standpoint is this: We take equipment that we don’t need anymore, make sure it’s functional, and develop programs that are sustainable internally, that is, not simply with people from the United States. We persist, and those programs get stronger over time.”

Editor’s note: Journal of Healthcare Contracting readers interested in donating equipment to International Medical Outreach can contact Jim Olsen at jim.olsen@atriumhealth.org. Major equipment needs are: • Ventilators •P atient monitors with cables • Transport incubators • I nfant warmers

• EKG/ECG machines • Phototherapy/bili lights

• Incubators

June 2018 | The Journal of Healthcare Contracting

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HSCA

How can we navigate injectable narcotic shortages? Despite some progress and a decline in the number of new shortages, critical drug shortages continue to jeopardize patient access to medications. These shortages have been exacerbated by several natural disasters and some manufacturing delays that have occurred over the past year. Healthcare group purchasing organizations (GPOs) are important partners in helping hospitals and providers navigate these drug shortages to provide patient care. Our By Todd Ebert unique line of sight into all aspects of the healthcare supply chain allows us to help our healthcare provider customers anticipate and navigate ongoing drug shortages. Recently, a manufacturing delay caused hospitals and other healthcare providers to experience critical shortages of a number of injectable narcotics that are an essential element of treatment for post-surgical and medical pain management. If hospitals and providers don’t have the necessary injectable opioids available, many medical procedures will have to be postponed or cancelled, jeopardizing the well-being of patients across the country. Other manufacturers who were willing to come to the table to produce these medications to help mitigate the shortages were initially unable to do so due to DEA production quotas for narcotics. Many organizations, including the Healthcare Supply Chain Association, publicly called on the DEA to temporarily adjust production quotas to allow the other manufacturers to step in. The DEA subsequently did lift the production quotas for certain manufacturers, an important step for mitigating potential shortages. Controlling narcotics use – particularly outpatient prescription opioid abuse – remains a public health priority, which HSCA supports. The DEA recently issued a proposed rule on opioid production limits. In recent comments to the DEA, HSCA offered recommendations to help control narcotics use while also protecting provider access to injectable opioids, which are critical to patient care. Those recommendations included: 1. Differentiating oral opioids and inpatient/injectable opioids. HSCA and its members share DEA’s commitment to reducing opioid diversion; however, when making adjustments to production limits, the DEA should

differentiate between outpatient/ oral opioids and those injectable opioids used in an inpatient hospital and healthcare provider setting. Injectable opioids are critical to a wide variety of practices in the inpatient setting where it is not clinically appropriate to use oral opioids, including for treatment of some acute and chronic pain; sedation; pain management and in intensive care units. 2. DEA should outline a process for quickly adjusting production quotas in the event of shortages. The DEA should outline a process for quickly identifying and rectifying potential problems, including a timeframe for how quickly the DEA will move to adjust production quotas in the event of potential shortages. 3. D EA should use available data to inform decisions about adjustments to quotas. DEA already has access to information that would be helpful in addressing production quotas in the event of drug shortages. As such, the DEA should establish processes to ensure that all available data is being used in a timely fashion to help anticipate and address potential shortages. HSCA and its members will continue to work with the administration, hospitals, and all healthcare stakeholders to mitigate drug shortages and identify solutions to protect patient access to care.

Todd Ebert, R.Ph., is president and CEO of the Healthcare Supply Chain Association (HSCA). 46

June 2018 | The Journal of Healthcare Contracting

By Jeff Girardi, HIDA Getting the Most from Your Most Important Supplier

Overcome Staffing Needs By Leveraging Distribution Services In many regions across the U.S., particularly rural areas, there just aren’t enough healthcare workers. Greater access to health insurance, combined with an aging population, is driving increased demand for healthcare services. Unfortunately, the supply of registered nurses (RNs), certified nursing assistants (CNAs), and even physicians isn’t keeping up. The projected U.S. physician shortfall could reach 121,300 by 2030, according to the Association of American Medical Colleges. A recent survey also showed more than one-third of chief nursing officers believe nursing shortages negatively affect patient care. It’s been well documented; employee turnover is high in healthcare. Nurses and other workers have demanding, physical jobs. If they see the opportunity to move for higher pay or less stress, they are likely to take it. This problem isn’t likely to improve, since more than half of RNs in the U.S. are over age 55. As more nurses retire than enter the workforce, understaffing could create dissatisfaction among your employees, leading them to leave their job or profession. Based on various meetings I’ve attended where providers share some of their biggest pain points, this issue is probably top-of-mind for your organization. Staff shortages aren’t limited to nurses and doctors; consider drivers, technicians, warehouse employees – you name it. There’s no area from which providers are immune to crucial staffing needs.

Time savers The good news is that you don’t have to solve this problem on your own. In fact, a significant part of healthcare distribution’s value is saving customer staff time. By utilizing reliable supplier services, you can spend less time ordering, receiving, managing, and even paying for medical supplies. Here are some key areas where your partners can help alleviate staffing needs: • Products – Whether it’s their maintenance, required training, or convoluted purchasing systems to access them, product concerns often lead to staff dissatisfaction. Your trusted rep should be able to provide or coordinate in-service clinical staff training, ensuring correct and efficient product use. Given high turnover rates, this is an ongoing need. Be sure to look for quick, simple, and on demand training solutions for new hires.

The Journal of Healthcare Contracting | June 2018

HIDA PRIME VENDOR

• Processes – Talk with your distribution partners to see if their inventory management programs can help reduce non-clinical or redundant work for staff. Low-unit-of-measure programs, Kanban systems, and other solutions can free up valuable staff resources. When reviewing processes, think less about “What can I eliminate and what can you eliminate?” in favor of “What can be done that makes us better together?” • People – Anything that lessens your busy employees’ workloads is likely to be appreciated. Staff and patients alike are human, and want healthcare visits to be quick and easy. Work with your rep to identify people-friendly products that reduce effort. Maybe it’s a new incontinence or skin and wound care product that decreases the number of changes or likelihood of future complications. Or a rapid test that’s a big time-saver but also easy-to-use. Safety is also important; patient lift devices can help prevent common nursing injuries, for example. Consider including your entire staff ’s input – not just your RNs or physicians – when making decisions that can ultimately enhance the quality of their care and work environment. When staff feel valued, they often provide more valuable feedback that helps you achieve sustainable improvements. Using distribution partners to help meet your staffing needs ensures you can focus on the key services provided within the walls of your organization.

Send all upcoming events to Graham Garrison, managing editor, at ggarrison@sharemovingmedia.com

CALENDAR Association for Healthcare Resource & Materials Management (AHRMM) The AHRMM Conference & Exhibition Aug. 12-15, 2018 Chicago, Ill.

Federation of American Hospitals Public Policy Conference & Business Exposition March 3-5, 2019 Marriott Wardman Park Hotel

HealthTrust HealthTrust University Conference 2018 July 23-25, 2018 Nashville, Tenn.

IDN Summit & Reverse Expo Fall 2018 IDN Summit & Reverse Expo September 17-19, 2018 Phoenix, Ariz.

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Sept. 25-27, 2018

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June 2018 | The Journal of Healthcare Contracting

NEWS

Industry News Intalere launches Accreditation Readiness Solution Intalere (St. Louis, MO) announced a new Accreditation Readiness Consulting Solution designed to help member organizations improve quality, enhance patient safety, and positively impact reimbursement. Intalere’s Accreditation Readiness Consulting Solution offers a collaborative process with the organization to develop a personalized agenda to meet their specific goals. Each organization receives a formalized report and recommendations on ways to accelerate organizational performance improvement and accreditation strategies. Key focal points of Intalere’s Accreditation Readiness Consulting Solution include: compliance with federal, state, and local laws; education; policies/

procedures; quality assessment and performance improvement; and staffing.

Banner Health has $1.7B worth of construction projects in the works Banner Health (Phoenix, AZ) has 386 active construction projects across its markets, totaling $1.7 billion. Not all of the $1.7 billion will be spent in this calendar year since many of the projects are ongoing and will take multiple years to complete. Much of the $1.4 billion in active construction projects in Arizona are part of major projects that began in 2015 and 2016 at two of Banner’s hospitals in Phoenix and Tucson. Kip Edwards, VP of facilities services at Banner, said he expects Banner to continue the same building pace into 2019.

LETTER TO THE EDITOR

Trained for Battle To the Editor: Thank you for continuing to publish an informative and supportive magazine for healthcare supply chain professionals. I just read “The Third Degree” (April 2018 Journal of Healthcare Contracting) and while I agree with most of the points, I’d like to suggest that you do a follow-up piece about the supply chain education program of the Army Medical Service Corps. In September 1968, I was commissioned as a Second Lieutenant in the Army Medical Service Corps, and in 1969 I was selected for the prestigious Supply and Services School. It was 10 weeks of 40 hours/ week intensive training to prepare us for any supply/ services/logistics position that we were assigned after the school. This program was far more difficult than earning my master’s degree in hospital administration, and I still use many of the logistics principles in my consulting practice today.

The Journal of Healthcare Contracting | June 2018

We had case studies/presentations, fundamentals of supply storage in combat and non-combat situations, equipment control (imagine being accountable for every piece of medical equipment in a hospital or in a combat medical battalion), complete knowledge of the federal supply catalog with the ability to immediately locate the properties of any med or medical supply, and the ability to plan the supply and petroleum requirements for troop movement from point A to Point B. After graduation, I was assigned as the Division Medical Supply Officer for the Second Infantry Division in South Korea, and I was responsible for all the medical supply operations for the Division. I am forever grateful for the education and the service experience in the Army. Walt Justice, CEO Justice Healthcare Management Group Ft. Myers, Florida

OBSERVATION DECK

Who’s on the hot seat now? Frustration breeds scapegoats. Chicago sports fans know this better than anyone. So do the many players in the healthcare industry – payers, policy-makers, physicians, the public, healthcare administrators, supply chain and contracting professionals. Their frustration goes along these lines: “No matter what we do, we can’t seem to improve the quality of healthcare, lower cost and increase access to care. And we’ve tried everything – DRGs, HMOs, ACOs, GPOs, bundled payment, individual mandates.” Mark Thill

When things don’t work, people look for solutions … until they don’t. Then we look for someone to blame. The latest healthcare villains appear to be pharmacy benefit managers. And boy, do the accusations against PBMs sound like those leveled at GPOs from time to time. PBMs are companies with whom payers contract to negotiate drug prices and formulate drug benefits programs.

For years, opponents of group purchasing have argued that because GPOs get a percentage of sales, they profit when manufacturers keep their prices high. So where’s the incentive to lower prices? Speaking at the American Hospital Association Annual Membership Meeting in May, CMS Administrator Seema Verma described how PBMs work: “In Part D, a group of negotiators works on behalf of Medicare, to get a good deal for our beneficiaries. Plans hire PBMs to manage their drug benefit and to negotiate with drug manufacturers. PBMs negotiate with drug manufacturers by extracting rebates in

exchange for putting the manufacturers’ drugs on the plan’s formulary. The manufacturer has an incentive to pay the PBM a rebate, because if the manufacturer’s drug does not get on a plan’s formulary, then the manufacture loses market share.” So far so good. Then she went on to say: “ ... PBMs are serving two customers – being paid both by manufacturers for getting on formularies and by plans for managing their drug benefit. This makes it unclear who they’re actually aligned with. “The higher a manufacturer’s list price, the larger a rebate will be, since rebates are calculated as a percentage of list price. And the higher the rebate, the more money that plans and PBMs get. The bottom line is that all of the incentives are lined up for manufacturers to set higher and higher prices.” Her concerns were echoed in the administration’s “American Patients First” plan, designed to lower drug prices. If all this sounds familiar, it should. For years, opponents of group purchasing have argued that because GPOs get a percentage of sales, they profit when manufacturers keep their prices high. So where’s the incentive to lower prices? Who are GPOs representing? Health systems, or manufacturers?” Drug prices are a concern. No doubt about it. But is eliminating PBMs the answer?

June 2018 | The Journal of Healthcare Contracting

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