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vol.26 no.3 â&#x20AC;˘ March 2018

Paul Julian:

To the Point For McKesson Medical-Surgical executive, actions speak louder than words

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MARCH 2018 • VOLUME 26 • ISSUE 3

PUBLISHER’S LETTER Believe in the Value of the Rep............................ 6

PHYSICIAN OFFICE LAB Patient Treatment Plans

Begin with the end in mind.....................................................8

ADVISORY BOARD Editorial Advisory Board............................................... 12

CONTRACTING EXECUTIVE PROFILE

Paul Julian: To the Point

24 John Horne: Senior vice president, chief supply chain officer, OSF HealthCare, Peoria, Illinois................................ 20

TRENDS

Stop Making

Sense

Industry experts share their insights into recent headlines of acquisitions, mergers in healthcare.

Fee-for-service still reigns

But alternative payment methods are catching on

page

repertoire magazine (ISSN 1520-7587) 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: $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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March 2018

MARCH 2018 • VOLUME 26 • ISSUE 3

HEALTH FOCUS

WINDSHIELD Automotive-related news.................................... 52

QUICK BYTES

Colorectal Cancer Early detection is key

Technology news.................................................................... 54

REP CORNER

Lee Crane: Sales Pro

HEALTHY REPS

58 HIDA GOVERNMENT AFFAIRS UPDATE

Health news and notes 4

March 2018

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Resources and Recommendations

HIDA, AHRMM, and HMMC to debut new UDI resources and education campaign........................... 62

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INDUSTRY NEWS News........................................................................................... 66

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PUBLISHER’S LETTER

Believe in the Value of the Rep It is our annual Hall of Fame issue, and I am happy to say this year’s inductee, McKesson

Medical Surgical’s Paul Julian, was a straight commission rep calling on primary care. In his day, reps made a huge difference in the med/surg industry. I spoke with Gary Keeler about Paul a few weeks ago, and he emphasized how important it was that people know Paul was a rep who carried a bag and believed in the value of the rep. Do the people who carry a bag still matter as much now? For the past few years, we have watched the supplier community move away from the rep and focus more on health systems. Given the acquisition of practices and changes in policy, I can’t blame them for this strategy. It made sense, as long as practices were selling and systems were creating formularies and driving compliance. Except, that’s not what happened. The truth is that perhaps 30 percent of practices are on formulary, and that is being kind. Over the last 4-6 months, I have seen a growing trend of manufacturers reinvesting in the distribution channel. New alternate site sales teams are being formed, and national sales meetings are themed around best practices when riding with a dealer rep. This is very encouraging. Practices trust their rep. The rep shows up every week and takes care of their needs. She knows the practice owner’s family, she personally delivers product when a practice runs out, she finds a substitute EKG when one is being repaired, she takes bad product back, and so many other things. 2018 is the year of the comeback for the dealer rep. I have spoken at five national sales meetings since November on working with reps. Very large, best-in-class suppliers like Welch Allyn, Midmark, BD, Abbott, and Roche are all dedicating time back into the field with distribution. This is more than a trend – it’s a reality. The dealer still controls the business. To the dealer rep, I would challenge you to work with you suppliers again and show them that at the end of the day you control the accounts. I am excited for this year’s Hall of Fame, where we honor an individual that carried a bag and made a difference.

Scott Adams

Dedicated to our 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; www.sharemovingmedia.com

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Mark Thill lthill@sharemovingmedia.com managing editor

Graham Garrison ggarrison@sharemovingmedia.com editor-in-chief, Dail-eNews

Alan Cherry acherry@sharemovingmedia.com art director

Brent Cashman bcashman@sharemovingmedia.com

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vice president of sales

Jessica McKeever

jmckeever@sharemovingmedia.com (800) 536.5312 x5271 director of business development

Alicia O’Donnell

aodonnell@sharemovingmedia.com (800) 536.5312 x5261 sales executive

Tyler Moss

tmoss@sharemovingmedia.com (800) 536.5312 x5279 sales executive

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publisher

Scott Adams sadams@ sharemovingmedia.com (800) 536.5312 x5256 founder

Brian Taylor

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2018 editorial board Richard Bigham: IMCO

Eddie Dienes: McKesson Medical-Surgical

btaylor@ sharemovingmedia.com

Joan Eliasek: McKesson Medical-Surgical

circulation

Doug Harper: NDC Homecare

Ty Ford: Henry Schein

Laura Gantert

Mark Kline: NDC

lgantert@ sharemovingmedia.com

Bob Ortiz: Medline Pam Wedow: IMCO Home Care

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PHYSICIAN OFFICE LAB

Patient Treatment Plans Begin with the end in mind

By Jim Poggi

In the case of patient treatment plans, the end is always

the same. It may not be fun to think about, but a disease, an accident or an act by the patient themselves ends their life. We may not think in these terms, or face this somewhat grim reality every day, but the physicians and care givers who are our customers and prospects are faced with the mortality of their patients every day, and with every decision they make. Their mission is to provide their patients with the best quality of life possible, and help patients to make personal healthcare and lifestyle decisions to provide a long and healthy life. So, how does knowing this help us?

Practice perspective First of all, it helps to ground our mindset and try to see the daily activities of our clients through their eyes and daily experience. Since 70 percent of all medical decisions involve a lab result, this information is critical to patient treatment plans.

Whether the caregiver is using lab tests to provide insight while conducting routine screening, screening for patients at risk, conducting routine follow up for a chronic condition, or taking acute intervention for a respiratory illness, what they need to know, how to get the information and how to communicate it to the patient to assure the best health outcome and encourage patient compliance is an everyday concern. By knowing the diseases and disorders our clients face and understanding the role of lab testing to provide this critical information at the point of care, we become more valuable and more respected as useful allies. In addition, now more than ever, market realities including emphasis on improving patient outcomes and satisfaction, coupled with patients becoming more savvy healthcare consumers and an expanding array of care setting and care choices, adds importance to our consultation with current and prospective customers to keep them in the know and help them remain competitive.

The role of lab testing First, letâ&#x20AC;&#x2122;s look at why physicians see patients and the role of lab testing in these situations: Who and why?

Tests that help

General screening

Annual physical, new job, school change, patient request Patients who meet the criteria for predisposition to be at risk for a health condition Patients under treatment for a chronic condition

Urinalysis, glucose, lipids, CBC, basic and comprehensive metabolic panel FOBT/FIT for patients over 50, Lipids for Yes patients who present with weight or cardiac symptoms, Glucose related to weight, life style or personal or family history, Lead for children in older homes Glucose, CBC, PT/INR, CMP, BMP, lipids, Most; this is the urinalysis, organ test panels broadest menu of tests applicable in primary care related to typical patient diseases and conditions Flu, strep, RSV, pneumonia tests Yes; pneumonia is the typical exception

At-risk patient screening

Treatment plan follow up

Acute respiratory symptoms

Are these tests waived? All with the exception of most CBCs

Clinical situation

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PHYSICIAN OFFICE LAB So, how does why the physician sees patients relate to the most common causes of disease and death? The answer is in every primary care waiting room. Look around as you get ready to talk to your client. You will see patients who are experiencing treatment for one of the chronic conditions we are about to explore, because primary care is where they show up. The patient mix and ratio of diseases may shift a bit from practice to practice, but the reality is, this is what our clients see every day and the treatment programs they need to initiate and manage.

While the average primary care practice experiences a number of patient visits for wellness and routine check ups, the real challenge is in managing patients with chronic diseases, or patients who are on their way to chronic diseases due to risk factors in their life style, family history or both. Even with patients who are in apparent good health, the physician and caregiver need to think ahead to reduce the patient’s risk of illness. In addition to classic history, physical and vital signs, lab testing completes the picture.

Starting point The most common causes of illness and death in the United States Rank Clinical condition

Lab Tests

Screen/Follow up/Both Waived?

Heart disease

Glucose, BNP, lipids, PT/ INR, BMP and CMP

Both

Yes

Cancer

Organ panels, tumor markers, CBC

Both

Some organ panels

Chronic lower respiratory disease

Electrolytes, CBC, CMP, Blood gases

Both

Some electrolytes and CMP

Unintentional injuries

N/A

Stroke

Electrolytes, CBC, CMP, Blood gases, PT/INR

Both

Yes, except blood gases and most CBC

Alzheimer’s disease

N/A

Diabetes mellitus

Glucose, glycosylated hemoglobin, urinalysis, albumin, creatinine

Both

Yes

Influenza and pneumonia

Tests for flu, strep, RSV, pneumonia

Screen

Most; some pneumonia is not

Nephritis, other kidney disease

Creatinine, BUN, CMP, Both urinalysis, microalbumin

Yes

Suicide

N/A

As you get your head around why your customers see patients and develop treatment plans, and what diseases and disorders they see most frequently, you can focus your efforts on being a useful resource to help them think about the value of testing in general and patient specific testing for the conditions they see most often.

March 2018

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N/A

The result? You, your clients and their patients all have improved outcomes – faster, better care and increased care giver and patient satisfaction. And most likely, an improvement in office efficiency and patient convenience by providing needed tests at the point of care during the patient visit. That’s a big win for everyone involved in patient care.

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ADVISORY BOARD

Editorial Advisory Board Repertoire would like to welcome the following people to the magazine’s editorial advisory

board for 2018/2019.

Richard Bigham Vice President, Primary Care Market IMCO With more than 30 years experience in medical distribution, Richard Bigham has held leadership roles in sales, sales management, vendor relations, marketing, and private brand portfolio development. He has developed a thorough understanding of the dynamics of medical distribution, having gained perspective working with both an independent, regional distributor and a large national distributor. Prior to joining IMCO in 2014, he spent the previous 20 years with PSS World Medical. He holds a bachelor’s degree in business with a concentration in health care management from Appalachian State University. Eddie Dienes President, Primary Care Sales McKesson Medical-Surgical Eddie Dienes began his healthcare career as a sales representative with Standard Crescent City Surgical in New Orleans. The company was acquired by Physician Sales & Service in 1988. He held several leadership roles with PSS, including senior vice president of sales and marketing and, immediately prior to PSS’s integration with McKesson in 2013, president of PSS’s physician business. He and his wife, Beth, live in New Orleans and have three children Patrick (and his wife, Katie), Betsy and Caroline; and a new granddaughter, Hunter Grace.

March 2018

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Joan Eliasek President, Extended Care Sales McKesson Medical-Surgical Joan Eliasek began her career in healthcare manufacturing and distribution at Baxter Healthcare Corporation, where she held management positions in field operations. In 1995, she joined McKesson Medical-Surgical as the director of market services, where she established a department designed to drive implementation of new business. Prior to the merger with PSS World Medical, she was senior vice president of marketing and supplier management. Immediately prior to her current role, she was the senior vice president of product strategy and supplier partnerships. Eliasek serves as executive sponsor of the Richmond Women’s Employee Resource Group, OWN IT. She has previously served as diversity champion for the Med-Surg business as well as a board member of the McKesson Political Action Committee. She is an advisory board member of Professional Women in Healthcare, and served on the board of the HIDA Educational Foundation from 2010-2015, and on the HIDA board of directors from 2015-2016. She lives in Richmond, Virginia, with her husband and their three children. Ty Ford Vice President, Sales, Western U.S. Henry Schein Ty Ford joined Henry Schein in 2002 as a field sales consultant. In 2005, he assumed the role of regional sales manager, and in 2009, became a health care services strategic account manager, focusing on strategic account management inclusive of IDNs. In 2012, he was promoted to healthcare services general manager where he led Henry Schein’s Western strategic account sales force. He helped advance a number of the Medical Group’s upmarket programs. In his current role, he is responsible for the strategic and operational direction of U.S. Medical’s Western Area, which includes Henry Schein’s field sales force and strategic account management teams. Doug Harper President IMCO Homecare Doug Harper has been in the medical distribution/medical device industry for over 30 years. He founded MedCo Systems, a New England-based physician supply distributor, which was later purchased by Physician Sales & Services. He was retained by PSS and served as senior vice president of sales and marketing, and president. He also served as president of Brewer Medical and group vice president of North America for the Invacare Corp. He is currently the president of NDC Homecare, serves on four medical industry boards, and is an advisor to healthcare private equity firms and investment bankers. He resides on Cape Cod with his wife, Cathy. Mark Kline Chief Sales Officer, Medical NDC Inc. Mark Kline joined NDC in 2016 with over 17 years experience as a sales leader for Invacare Corp., a worldwide leader in the manufacturing and distribution of home medical and long-term-care equipment. As vice president of sales, he was responsible for strategic sales planning and execution, new business development, account management, lead generation, sales forecasting/reporting/ compensation, and CRM. He and his wife, Jill, are the parents of two sons, Brandon and Bryan.

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March 2018

ADVISORY BOARD Bob Ortiz Senior Vice President, Physician Office Division Medline Bob Ortiz has worked in healthcare distribution sales since August 1991, when he was hired by General Medical Corp. (now McKesson Medical-Surgical). In 2005, he moved to Chicago with McKesson as a regional sales manager, covering Wisconsin, Illinois and Indiana. He has served in his current role with Medline since December 2010, when he was hired to launch the company’s physician office venture. In the late 1980s he was an Active Duty Army Officer for five years, assigned to the 25th Infantry Division in Hawaii. He was an Army Captain when he separated from the military. His first sales job was with Procter & Gamble, selling food and beverage products, including Jif Peanut Butter, Pringles Potato Chips, Duncan Hines Cake Mixes, and Folger’s Coffee. (He proudly displays in his office a plaque with the Jif nameplate for selling “The World’s Largest Display of Peanut Butter – 4000 Cases” in 1989.) He and his wife, Debbie, live just north of Chicago in Lake Bluff, Illinois, with their two sons Nick (18) and Alex (17). Pam Wedow Vice President & General Manager IMCO Home Care Pam Wedow became IMCO Home Care’s vice president and general manager in January 2014, with responsibility for overseeing vendor contracting, member recruitment and member services, and helping members expand their product offering and improve their profitability while improving their customers’ quality of life at home. At the end of 2016 she was elevated to managing partner and given shares in IHC for her work. Prior to IMCO Home Care, she worked for The Palm Tree Group for 14 years. There, she developed and managed the Master Distribution Program, which included managing distributor and vendor relationships as well as day-to-day operations for their 4-PL services. Prior to that, Wedow held positions with PSS World Medical, including vice president of operations for Gulf South Medical Supply, regional operations manager for PSS, Minneapolis branch manager, and director of contracts and rebate compliance. She is a founding member and past chair of Professional Women in Healthcare. She sits on HIDA’s Extended Care Advisory Council and their newly formed Home Care Advisory Group, as well as the MAMES Retail Sales Committee.

Thank You Repertoire would like to thank the outgoing members of the magazine’s editorial advisory board.

•B ill McLaughlin Jr., IMCO

• Jim Poggi, Tested Insights LLC

•B ob Miller, Gericare Medical Supply

• Brad Thompson, NDC

• L inda Rouse O’Neill, HIDA

• Chris Verhulst, Henry Schein

March 2018

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ADVISORY BOARD

How to improve healthcare delivery Repertoire asked its incoming editorial advisory board members to respond to this question: “In your opinion, what are the 2-3 most promising ways to improve healthcare delivery in the United States?” Some common themes: Consumerism, transparency, technology, competition. See if you agree. Richard Bigham, Vice President, Primary Care Market, IMCO Focus on prevention through expanded utilization and compensation of primary care providers. A large percentage of overall annual spend is for specialized treatment of conditions that may have been largely preventable if effectively managed through early intervention. As individuals share a larger burden of cost through higher deductibles and copays, increased transparency in costs and outcomes will result. Through market forces, drive consumers to the most efficacious option. Collection and publication of pertinent data will facilitate consumer decision-making. Minimize the administrative bur– Joan Eliasek, McKesson den placed on providers. Regulations and reporting requirements must be tied to improved outcomes and not just a matter of collecting data to “check the box.”

“DNA testing and the pipeline of new, more effective biologic drugs has the potential to change care methods and improve outcomes.”

Joan Eliasek, President, Extended Care Sales, McKesson Medical-Surgical Consumerism, that is, the ability of patients to have a choice and a voice in their care. A bettereducated patient and advocate, as well as a natural supply-and-demand dynamic, will force providers to share more information, improve their delivery of care and drive better outcomes.

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Use and application of technology to care has the potential to streamline processes, improve patient interactions and improve the healthcare system. DNA testing and the pipeline of new, more effective biologic drugs has the potential to change care methods and improve outcomes. Ty Ford, Vice President, Sales, Western U.S., Henry Schein Integrated information: Management of information is vital in order to fully transition to an evidence-based delivery system. Information must be considered a key component of the workflow process and must be used in “real time” in order to provide improvements in how care is delivered. Actionable data will result in improved decisions, which will lead to better outcomes. Alignment of care delivery with communities: In order to achieve this, organizations must prioritize the needs of the patients from a population health perspective. This is achieved through an increase in responsibility for a “whole person” design. How does the system design a delivery of care “around” the patient instead of expecting the patients to adapt to the system. Embrace consumerism of healthcare: In order to successfully deliver quality care to a “population,” providers must understand the needs that are required to effectively improve the patient experience. Technology and transparency are the fundamentals needed to improve behavioral and social determinants. Prioritization of removing cost out of the delivery model. This will be achieved through the migration of care outside the four walls of the hospital, focus on prevention and wellness, and focus on operational efficiencies.

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ADVISORY BOARD

Doug Harper, President, IMCO Homecare All US. citizens should be entitled to healthcare. The U.S. economy has always thrived on capitalism and competition, but due to the lobbying power of the pharmaceutical and insurance industries and the AMA, intense competition does not exist in the U.S. healthcare system. Increased utilization of physician assistants, nurse practitioners and telehealth are examples of how we could provide more essential “basic care” to everyone at a much lower cost, as well as allow our MDs to focus on more serious health issues.

all share in the ongoing development of technology and service to improve healthcare delivery to the most important customer – the patient. Bob Ortiz, Senior Vice President, Physician Office Division, Medline While I believe that we already do an excellent job of delivering high quality healthcare in the U.S., there is always room for improvement.

Some ideas: We must simplify payment and incentive models (traditional, MACRA, HEDIS, PAMA, MIPS). There is so much confusion at the private practice level “ Today, like never before, we have the today that they are somewhat paralyzed, and only ability to use technology to communicate the larger systems have the the latest product offerings that have the resources to truly underbest possible outcomes for healthcare stand and navigate all of the models and measures. providers and their patients.” We must further support – Mark Kline, NDC competition and insurance across state lines, which I would suggest that if more individuals keeps multiple options open for patients to (who have the ability to) pay for some of their maintain competitive insurance coverage. own prescription drugs, consumer demand for Continuity in supply sources helps with lower costs could possibly drive prices down. consistent care delivery throughout a network Regarding the significant spend on potentially (consistent training and adherence to policy), and controllable health issues, should individuals brings about economies of scale in purchasing. carry financial responsibility for their healthcare costs associated with such things as obePam Wedow, Vice President & sity, alcohol, tobacco and drug abuse? General Manager, IMCO Home Care One of the most promising opportunities in Mark Kline, Chief Sales Officer, healthcare today is helping all of us age in Medical, NDC Inc. place. We’re not getting any younger! Honestly, When thinking about improving healthcare as a cohesive group, our industry has an oppordelivery, it’s important to look at it from the tunity to get the right products and know-how patient perspective. Today, like never before, we into the hands of the caregivers – both profeshave the ability to use technology to communisional and family members – to facilitate the cate the latest product offerings that have the baby boomers’ stay at home. We also have an best possible outcomes for healthcare providers opportunity to get manufacturers into this fastand their patients. The utilization of communicagrowing but fractured marketplace. tion technology such as social media and cusIt’s not easy, but it’s certainly worthwhile tomer relationship management (CRM) is only as work; none of us would be in this business if good as the individual providing that service. We we liked easy.

March 2018

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IDN OPPORTUNITIES

Contracting Executive Profile John Horne: Senior vice president, chief supply chain officer, OSF HealthCare, Peoria, Illinois

Editor’s note: John Horne was selected as one of the “Ten People to Watch in Healthcare Contracting by the Journal of Healthcare Contracting, a sister publication of Repertoire

To align the care delivery system more closely with physicians, OSF

HealthCare developed clinical service lines in cardiac services, neurosciences and pediatrics. OSF employs 738 providers in more than 100 locations; owns an extensive network of home health services known as OSF Home Care Services; owns OSF Saint Francis, Inc., comprised of healthcare-related businesses; and OSF Healthcare Foundation, the philanthropic arm for OSF HealthCare System and OSF Home Care Services. OSF has a state of the art innovation and simulation center at Saint Francis Medical Center, in collaboration with Illinois College of Medicine at Peoria.

John Horne has been in healthcare supply chain since 1987, and has served as chief supply chain officer at OSF for four years. For 11 years prior to joining OSF, he was corporate director materials management for Health Management Associates, a for-profit company that operated 71 hospitals in 16 states before being acquired in 2013 by Community Health Systems. At OSF, Horne coordinates oversight and management for over $350 million annual supply and pharmacy expense, and over $150 million in purchased services. He oversees the OSF Sponsored Affiliate Program, comprised of over 40 nonowned affiliate hospitals and other providers, representing approximately $110 million in annual supply expense. Supply Chain has consolidated purchasing and contract management for the organization, and its service line comprises

Owned and operated by The Sisters of the Third Order of St. Francis, Peoria, Illinois, OSF Healthcare System consists of 11 acute care facilities, comprising 1,553 beds; one long-term care facility; and two colleges of nursing, located in Peoria and Rockford, Illinois. OSF HealthCare also has a physician organization – OSF Medical Group. John Horne

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38 ministry-based mission partners (employees), and approximately 210 field-based mission partners. Journal of Healthcare Contracting: What has been the most challenging and/or rewarding supplychain-related project in which you have been involved in the past 12-18 months? John Horne: In 2016 we began due diligence on a GPO change as part of our overall service line Functional Transformation, that is, a program intended to transform OSF from a (decentralized) holding company to a (centralized) operating company. We commenced a full RFI and RFP process, and awarded a contract to Premier. Over the past 18 months, OSF has implemented cost savings of over $30 million with support from Premier. In order to create a highly compliant commodity contract portfolio across the Ministry, we have built strong nursing and physician collaborations, and have streamlined the product selection, communication and conversion processes.

Horne: My greatest lesson learned during my tenure at OSF Healthcare has been to understand the need to find ways to collaborate with physicians, nursing and clinicians. We must allow physicians and clinicians to select the products and devices that are optimal for patient care; then and only then can we drive high contract compliance and improved costs. We have created a simple swim-lane approach to product and device selection to help drive a more efficient contract conversion process. Swim-lane 1 items are highly commoditized goods, which require least review and adoption in order to change. Swim-lane 2 items are more complex, requiring more analysis and review.

My greatest lesson learned during my tenure at OSF Healthcare has been to understand the need to find ways to collaborate with physicians, nursing and clinicians. We must allow physicians and clinicians to select the products and devices that are optimal for patient care; then and only then can we drive high contract compliance and improved costs.

JHC: Please describe a project on which you look forward to working on in the next year. Horne: OSF Supply Chain is leading development of consolidated distribution of med/surg and pharmacy, with projected commencement of operations beginning in 2019. We recently acquired a building in Peoria, Illinois, which contains 270,000 square feet of finished warehouse space and approximately 70,000 square feet of office space. Our intent is to create a self-distributed, LUM model to provide supplies and drugs to all of our hospitals, physician practices, home care patients, and other entities, with a view to supplying OSF Affiliates in a couple of years. Along with traditional distribution, we are contemplating consolidated oversight and delivery of other services, such as SPD, cook-chill, equipment management and repair, and ERP procure-to-pay outsourcing and management. JHC: How have you improved the way you approach your job or profession in the last 5-10 years?

Swim-lane 3 devices are either highly physician-preference, or are tied to specific equipment or department use â&#x20AC;&#x201C; e.g., lab analyzers and reagents. Lane 3 products require a more thorough, multidisciplinary review and conversion process. JHC: What do you need/want to do to become a better supply chain executive in the coming year(s)? Horne: I must find ways to improve interaction and partnership with our suppliers and manufacturers. Suppliers and providers must learn to trust one another, more readily exchange data, and work together to drive more efficiency through the supply chain. I believe we have lessons to learn from retail distribution (e.g,, Wal-Mart, Amazon, etc.) to remove added costs.

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Paul Julian:

To the Point For McKesson Medical-Surgical executive, actions speak louder than words

aul Julian gets things done. He built McKesson MedicalSurgical into a nationwide distributor for the non-acute market. He did it with speed, efficiency, discipline, leadership and focus. Julian was a key player in McKessonâ&#x20AC;&#x2122;s 1997 acquisition of General Medical, the 1998 acquisition of Red Line Healthcare (now McKesson Extended Care), the sale of its acutecare business to Owens & Minor in 2006, and its acquisition of PSS World Medical in 2013.

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Medical Distribution Hall of Fame

in the alternate site markets. Not only did he drive the financial performance, he was responsible for successfully acquiring companies, attracting talent, and building and developing a team and a performance-based culture. The performance of the company and its people are Paul’s legacy.”

21-year-old kid out of school, he says. There was a company car, an expense account and even a salary. But he didn’t see himself building a career there. Concluding that healthcare sales would be a good career choice, Julian went on some interviews and got a job with United States Surgical Corp. (now part of Medtronic), which, under the leadership of founder Leon Hirsch, had captured the U.S. market for surgical staplers. Roughly two years later, he joined IVAC Corp., then a division of Eli Lilly (and now part of Becton Dickinson), selling infusion pumps to the acute-care market. When at U.S. Surgical, Julian had struck up a friendship with Elliot Brodsky, owner of Eastern Hospital Supply in Stoneham, Massachusetts. It was Brodsky who convinced him to leave IVAC and become sales manager for Eastern Scientific, which was Eastern’s non-hospital business. “I had people reporting to me, some who had a lot more experience in distribution than I did,” Julian recalls. “But people would tell you I always have had a high level of confidence. I wasn’t intimidated by the people, the job, the products. I went in and did the best I could. I stayed focused and tenacious. And it paid off.” When Greensburg, Pennsylva– Rick Frey nia-based Stuart Medical acquired Eastern, Julian moved to Greensburg and ultimately became chief operating officer of Stuart. In 1994, Owens & Minor acquired Stuart, and Julian moved back East, to Boston, as senior vice president. In 1996, he joined McKesson in San Francisco, which was under the leadership of an old friend and fellow medical salesperson, John Hammergren.

Confident, not cocky

A bigger footprint

Julian was born and raised in Boston. His father, Albert, was a junior-high and high-school teacher; his mother, Dorothy, a homemaker. He graduated from Salem State University in Salem, Massachusetts, with a bachelor’s degree in education. After graduation he went to work for Faberge, selling the company’s shampoos and fragrances to drug stores, department stores, independents and mass merchandisers throughout New England. It was a great job for a

“I went to San Francisco recognizing McKesson wanted to build its healthcare (non-retail) footprint,” he says. “And they had the balance sheet to do it. So John and I looked at various assets.” Their first acquisition was Automated Healthcare, which manufactured automated pharmaceutical dispensing equipment for hospitals. The following year, in 1997, the company made a big leap into the medical market with the acquisition of Richmond, Virginia-based General

He also played a key role in strengthening and expanding McKesson’s presence in pharmaceutical distribution and operations, both in the United States and abroad. Julian, who, in January 2018 retired as executive vice president and group president, Distribution Solutions, for McKesson Corp., will be inducted into the Medical Distribution Hall of Fame in April. “He has brought tremendous discipline to our industry vis-à-vis the focus he has demanded within McKesson, which has set healthy bars within the marketplace,” says Stanton McComb, president, McKesson MedicalSurgical. “He reshaped the industry with dozens of massive acquisitions, e.g., US Oncology, PSS World Medical, Per-Se/RelayHealth, Celesio, to name only a few.” Says Rick Frey, president, Moore Medical LLC, “Clearly, Paul was the driving force in developing and executing the strategy to be in the No. 1 market position

“ If you look not only around McKesson and its various companies, but into the healthcare industry, there are numerous people whom Paul hired or developed into the leaders they are today.”

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Medical Distribution Hall of Fame Medical. Julian moved to Richmond to oversee General Medical (then called McKesson General Medical) for three years. More growth followed. “I can’t even tell you how many acquisitions we did over the course of the years,” he says. They included Parks Inc, Atlantic Healthcare, Red Line Healthcare (now McKesson Extended Care), US Oncology and, in 2013, PSS World Medical. “We bought companies with good people and strong customer bases, and we maintained a balance between McKesson people and those from the acquired companies,” he says. “When you’re trying to integrate two cultures, you need representation from both sides in order to create a new culture.” Proof that the integration process worked well is the list of McKesson Medical-Surgical leaders who came from acquired companies, including Gary Keeler, president, sales and marketing (from Red Line); Eddie Dienes, president, primary care sales (from PSS); Brad – Paul Julian Hilton, senior vice president, customer experience (from PSS); Joan Eliasek, president, extended care sales (from General Medical); Rick Frey and many others.

“ When you’re trying to integrate two cultures, you need representation from both sides in order to create a new culture.”

National vision “General Medical was a regional medical-surgical distributor,” says Eliasek, who worked with or for Julian in various roles from the time of the General Medical acquisition. “Paul came in with a vision to create a leading national distributor. He used General Medical as a platform to build what we are today. He is responsible for much of the talent in our company – identifying them, bringing them in and training them to be great leaders.” Says Frey, “Although I had heard of Paul years earlier, as we both worked in the healthcare distribution

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industry in New England, I first met him in 1996. At that time I was vice president of primary care with General Medical, and Paul was with McKesson Corporation. I was part of the General Medical due-diligence team presenting our respective markets to potential buyers of the company. “The team had been in New York City presenting to a potential buyer when we were told to head to Phoenix to meet with two individuals from McKesson – Paul Julian and John Hammergren. That was my first experience of Paul Julian drilling down on every detail. Shortly afterward, McKesson acquired General Medical and named Paul Julian as president. “One of Paul’s unique skills is to have the vision to understand what the customers’ needs will be in the future and build out the competencies to meet those needs. If you look not only around McKesson and its various companies, but into the healthcare industry, there are numerous people whom Paul hired or developed into the leaders they are today. I doubt you could find anyone who worked directly for Paul that doesn’t feel he made significant contributions to their professional growth.” Says McComb, “Paul has helped broker healthy forms of collaboration and partnership even between competitors. He has the courage to promote and ask for value where value has been delivered. And he has done a lot to make sure we are not just box movers or commodity brokers, both with our collective customers and manufacturing partners. “He has also envisioned and initiated multiple major industry shifts, e.g., shift to fee-for-service; investment in Rx technologies; recommitment and reinvigoration of independent pharmacy programs, like Health Mart (a franchise program for independent pharmacies); and massive investments in generic pharmaceuticals and private-label medical/surgical supplies. “He brought and promoted Six Sigma to McKesson, which reflects his drive around operational excellence and which sparked healthy continuous improvement across the industry.”

Don’t stop now “The healthcare industry is going to continue to evolve,” says Julian, noting recent merger announcements involving

Medical Distribution Hall of Fame learn and was the best I could be, CVS and Aetna, UnitedHealth and all the time. I would also say I had a DaVita, Dignity Health and Catholic very strong work ethic. And because Health Initiatives, and others. “Even of that focus, another opportunity as you look back over the past 20 always emerged.” years, you’ve seen big acquisitions. When asked what people who And due to cost pressures and evolvworked for him would say about his ing patient needs, companies are gomanagement style, Julian believes ing to continue to evolve and expand they might say this: “Tough, fair, a their offerings. good listener; but he insists that you “Scale matters, footprint matbe prepared when you are in a meetters, control matters. I don’t think ing with him. And if you don’t know you’ve seen the end of this.” something, tell him you don’t know Retired at age 62, Julian has opit, and then go find the answer.” tions to consider. Few in the industry No doubt Julian is proud of his would be surprised if his next stop role in building McKesson Corp. to had something to do with healthcare. – Paul Julian what it is today. But he seems espeIf so, he’s certain to bring with him cially satisfied with the role he has enthusiasm, discipline and focus. played in peoples’ lives. “The secret sauce to me was this: I always focused “I’m loyal,” he says. “Most people who worked for on doing a good job at the job I had; I wasn’t focused me have done very well.” on the next one,” he says. “I learned everything I could

“The secret sauce to me was this: I always focused on doing a good job at the job I had; I wasn’t focused on the next one”

Critical lessons McKesson Medical-Surgical President Stanton McComb met Paul Julian in 2002 and started working directly for him around 2005. “I reported to Paul and helped him and McKesson grow our pharmacy systems and medical-surgical businesses over a 12-year period,” he says. During that time, Julian taught McComb and 70,000-plus other people at McKesson some critical lessons, he says, including these: • When we build strategies and programs, we really have to understand our Customers and put their practical needs First. • We have to continuously work towards levels of Operational Excellence. We have to pick, pack, and ship with the highest levels of quality and value every time, so that we can earn the right to keep

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our customers’ business AND talk about value-added programs. •A sincere results orientation and accountability. With Paul, you had better hit your numbers! • The importance of building great teams, developing people, and coaching people and teams towards ever-higher levels of performance and achievement. McComb says he learned something else about Julian. “Paul is famous for demanding very fast and short business dinners,” he says. “If the dinner does not wrap up, he will wrap it up for you. Likewise, he is famous for demanding short presentations. Even if you have one slide in your presentation, his advice would still be ‘Less is More.’”

Honor roll Repertoire launched the Medical Distribution Hall of Fame in 2001. Read their stories at www.repertoiremag.com 2001 • George Blowers, Welch Allyn • Jim Stover (William T. Stover), National Distribution & Contracting • DeWight Titus, F.D. Titus & Sons

2009 • John Sasen, PSS

2002 • Bob Barnes, Durr-Fillauer • K arl Bays, American Hospital Supply • Pat Kelly, PSS • Ron Stephenson, Indiana University

2011 • Scott Fanning and Don Kitzmiller, Midmark Corp.

2003 • John McGuire Sr., Colonial Hospital Supply • Haworth Parks, Parks Inc. 2004 • Bill McKnight, McKnight Medical Communications • George Ransdell, Ransdell Surgical 2005 • Max Goodloe, General Medical 2006 • Gil Minor III, Owens & Minor

2010 • John Moran, Welch Allyn

2012 • Ted Almon, Claflin Co. • Cindy Juhas, Hospital Associates 2013 • Rob Saron, Bovie Medical Corp. 2014 • Bill McLaughlin, IMCO • Yates Farris, IMCO 2015 • Brian Taylor, Medical Distribution Solutions Inc. 2016 • Brad Connett, Henry Schein Medical

2007 • Elliot Werber, Kendall Corp., F. D. Titus & Sons, Bergen Brunswig

2017 • Dick Moorman, Midmark • M ike Carver, GOJO Industries • Tony Melaro, Welch Allyn

2008 • Bill and Lew Allyn, Welch Allyn

2018 • Paul Julian, McKesson Corp.

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TRENDS

Fee-for-service still reigns But alternative payment methods are catching on Fee-for-service may be on a decline, but it maintains a strong grip on phy-

sician practices, at least for now. At the same time, participation in accountable care organizations and medical homes is on the upswing.

Despite participation in alternative payment models, the results show that such models accounted for a relatively small s hare of revenue.

Last fall, the American Medical Association’s Division of Economic and Health Policy Research released the results of its 2016 Physician Practice Benchmark Survey, which focuses on the practice arrangements and payment methodologies of physicians who take care of patients for at least 20 hours per week and who don’t work for the federal government. Benchmark surveys had previously been conducted in 2012 and 2014. The first section of the report focuses on the extent to which physicians are in practices that belong to medical homes and Medicare, Medicaid, and commercial accountable care organizations (ACOs), as well as how that participation varies across practice attributes and how it has changed over time. The second section examines practice involvement in various payment models such as fee-for-service (FFS) and alternative payment

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models, including pay-for-performance, bundled payments, shared savings, and capitation.

Medical homes and ACOs At the end of the first quarter of 2017, ACOs covered more than 10 percent of the U.S. population. ACOs have steadily grown, with a 2.2 million increase in covered lives and a net increase of 92 ACOs from the end of the first quarter in 2016 through the same period in 2017.

In 2016: • 25.7 percent of physicians worked in practices that belonged to a medical home. • 3 1.8 percent belonged to a Medicare ACO. • 2 0.9 percent belonged to a Medicaid ACO. • 3 1.7 percent belonged to a commercial ACO. Overall, 44 percent of physicians were in practices that belonged to at least one type of ACO. Although earlier data on Medicaid and commercial ACO participation were not

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available, AMA found that participation in medical homes and Medicare ACOs was up slightly (by 2 to 3 percentage points) from 2014. Despite the increase in participation, awareness about participation remained the same as in 2014. For both medical homes and Medicare ACOs, about 25 percent of physicians did not know whether their practice was part of that particular model.

Payment methods The AMA study examined the percentage of physicians in practices that received fee-for-service and/or alternative payment models in 2016, trends in receiving payment from FFS from 2012 to 2016, and whether receiving FFS or alternative models appeared to be related to participation in medical homes and ACOs. Although FFS was the method reported most often by physicians (83.6 percent), receiving revenue through alternative models was not uncommon. In fact, 59.1 percent of physicians were in practices that received payment by at least one alternative payment model. Payfor-performance and bundled payments had the highest

11/30/17 11:27 AM

participation rates of the alternative models examined – approximately 35 percent. Despite participation in alternative payment models, the results show that such models accounted for a relatively small share of revenue. On average, pay-forperformance and capitation made up close to 7 percent of practice revenue, while bundled payments accounted for almost 9 percent and shared shavings only 2 percent. Thus, FFS dominated with the highest participation rate as well as a much higher share of practice revenue at an average of 70.8 percent. As with their participation in medical homes and ACOs, some physicians were unaware of whether their practice received revenue through certain payment models. While only 10.6 percent of physicians were unaware of whether their practice received payment through FFS, the level of unawareness about receiving payment through alternative payment models ranged from around 20 percent for pay-for-performance, capitation, and bundled payments, to almost 30 percent for shared savings.

Source: AMA Economic and Health Policy Research, “Payment and Delivery in 2016: The Prevalence of Medical Homes, Accountable Care Organizations, and Payment Methods Reported by Physicians,” https://www.ama-assn.org/sites/default/files/media-browser/ public/health-policy/prp-medical-home-aco-payment.pdf

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TRENDS

Stop Making Sense Industry experts share their insights into recent headlines of acquisitions, mergers in healthcare.

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“Stop making sense.”

The title of the afore-mentioned 1984 Talking Heads movie comes to mind when trying to interpret this winter’s flurry of healthcare-related announcements: • CVS Health to acquire Aetna (Dec 3). • Advocate Health to merge with Aurora Health Care (Dec 4). • UnitedHealth Group to acquire DaVita Medical Group (Dec 6). • Dignity Health to merge with Catholic Health Initiatives (Dec 7). • Ascension rumored to be talking merger with Providence St. Joseph (Dec 10). • Humana Inc./Kindred at acquire Home Division of Kindred Healthcare (Dec 19).

What do these events mean for physician practices? Retail clinics? Healthcare systems? Long-term-care and home care providers? Health insurers? Distributors and manufacturers of medical products and equipment?

IDNs. And, they are the insurer, so they presumably can direct more of their appropriate patient volume to those physicians and contracted facilities. Thus, keepage is higher (or leakage is lower).”

Repertoire couldn’t make sense of it all, so we asked the following experts and observers to try to do so for us, and our readers: • Mark Dixon, president, The Mark Dixon Group LLC, Edina, Minnesota. • Ted Almon, chairman, Claflin Co, Warwick, Rhode Island. • Blair Childs, senior vice president of public affairs, Premier Inc. • John Pritchard, publisher, Journal of Healthcare Contracting (supply chain publication from Share Moving Media, publisher of Repertoire). • Tom Charland, founder and chief executive officer, Merchant Medicine, a management consulting firm (who passed to Repertoire an article from the company’s January 2018 “January ConvUrgentCare® Market Report.”) • Melinda Hatton, general counsel, American Hospital Association.

Chaotic

The ‘asset-light provider’ “The CVS/Aetna agreement is all about consumerism and redefining where care will be delivered in a more convenient way and at a lower cost,” says Mark Dixon. “Much of healthcare is organized around doctors and hospitals, and this transaction will appeal to younger consumers and redefine where people receive their care.” The United/DaVita deal is “another very fascinating merger,” he adds. United/Optum has quietly hired 30,000 physicians over the past several years in the U.S., he points out. “This acquisition doubles that and dramatically increases their provider footprint. This has the potential of also redefining insurers as asset-light providers. They can purchase, on a fee-for-service basis, the hospitals and other expensive services as they need them. It has the potential to lower costs and also redefine/possibly diminish the role of large health systems due to their leverage as both insurer and physician provider.” Insurers such as UnitedHealth “have not built up a large asset base of hospitals and operating room suites that need to be filled to make them profitable,” says Dixon. “Thus, they are asset-light in comparison to large

“Certainly, this level of consolidation in all segments of the industry is unprecedented, and it is taking place not only among players in various segments of the vast industry, but across some seemingly significant barriers, and between players of all sizes and types,” notes Ted Almon, chairman of Claflin Co. “It certainly defies any simplistic analyses of singular changes in the market.

“ In the final analysis, a single question still looms: Are the new and much larger players who arise from the combinations going to be more capable of integrating and organizing healthcare in a new and possibly more efficient way?” – Ted Almon In fact, while individual deals all have apparent rationales behind them, collectively, the activity could best be described as chaotic.” “Without any political editorializing at all, it is hard to avoid the coincidence of the Trump election and all this activity,” says Almon. “There is no doubt that profound uncertainty over the direction of health policy in the country has provided much of the energy driving the merger mania. Some of it may be a perceived opportunity to set policy direction in the seeming void that exists, but that much of it arises out of fear seems at least as likely. In the final analysis, a single question still looms: Are the new and much larger players who arise from the combinations going to be more capable of integrating and organizing healthcare in a new and possibly more efficient way, thus possibly creating some savings opportunities?

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March 2018

TRENDS Or are they merely going to create pricing leverage over a payment system no longer capable of contracting around them, possibly driving up costs even further? The CVS/Aetna combination is worth watching, continues Almon. “Certainly, it is the vertical aspect of the deal – CVS being a giant pharmacy retail chain, Aetna a health insurance company – that is most interesting. In wake of the failed Aetna/ Humana merger (attempted in February 2017), such business combinations have historically not drawn much regulatory attention. But what is the strategy behind the deal? Where is the potential synergy? One

is emerging, and providers need to take note,” says Blair Childs, Premier Inc. “The CVS/Aetna merger is based on the belief that the combined company will be able to disrupt the system with a retail, pharmacy and e-enabled highvalue provider network. “These mergers and acquisitions are being driven by a need for scale and vertical integration. Healthcare leaders see that the movement to value-based care and population health is here to stay in the public sector, and private companies are now getting on board. Companies are seeking to 1) find more cost-effective, convenient and high-quality ways to manage a population, 2) organize high-value providers networks, and 3) attract, engage and retain their patient population. All of these companies are trying to get closer to the patient, a position hospitals already enjoy. “Health systems are also seeking scale and vertical integration, – Ted Almon and are increasingly partnering with private payers and other health systems to continue to develop high-value provider and financing networks. These will be organized and run by competing health systems, insurers, physicians, and retail establishments. “To ultimately succeed, healthcare leaders need to, above all else, excel at using data to cost-effectively manage a population, and create systems to attract and engage patients and consumers,” says Childs. “It is important that Washington not impede the development of this new era of competition through zealous antitrust regulation or harmful policies.”

“ With the seemingly endless assault of Amazon, could one imagine that CVS plans for the day when their prime real estate locations could be used for something more profitable than selling paper towels and greeting cards?” must take a pretty high-level perspective to guess where this combination is going. Remember that CVS voluntarily exited the presumably profitable business of selling tobacco products over a year ago, announcing its intention to become a ‘healthcare company.’ Assuming this move follows on that, and combining it with the company’s industry-leading 1,100 MinuteClinic locations in its stores, could a whole new model of delivering care be the vision? “Or how about a health plan that integrates the retail clinics into its primary care coverage, avoiding some more expensive sites in the traditional model? With the seemingly endless assault of Amazon, could one imagine that CVS plans for the day when their prime real estate locations could be used for something more profitable than selling paper towels and greeting cards? For now, we will just have to wait and see.”

Closer to the patient “The CVS/Aetna deal and other mega deals are all sending a clear message: A new form of healthcare competition

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Who wins? The potential mergers among the six large IDNs (Dignity Health/Catholic Health Initiatives, Advocate Health Care/Aurora Health Care, and Ascension/Providence St. Joseph) bring to mind the question, How big is big enough? says John Pritchard of the Journal of Healthcare Contracting. “Whatever constitutes true scale must be ever-rising,” he says.

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TRENDS But these IDNs aren’t pursuing scale in order to gain leverage and purchasing clout, Pritchard says. That may be an unintended consequence, “but that’s not why they’re doing it. They are absolutely merging to gain greater negotiating power vis a vis payers.” The supply chain implications of such mergers are fascinating, says Pritchard. As they come together, IDN leaders have to make big decisions: Will one of the system’s supply chain processes prevail? If so, whose? Will they run autonomously for a period of time? How long? And then what? “The other question I “ This has the would ask is, ‘Who is all this potential of good for?’” he says. “Is it the also redefining shareholder? The patient? insurers as The payer? As the healthcare systems, in particular, asset-light merge, will their larger footproviders. They prints allow them to scale up can purchase, world-class healthcare? I’d on a fee-forlike to think so, but that may be tough to do for a period service basis, the of time.”

Retail clinics

hospitals and other expensive services as they need them.”

“One line of thought, highlighted by most articles on the subject, is the prospect – Mark Dixon that Aetna and CVS intend to leverage the MinuteClinic platform to deliver lower-cost healthcare,” writes Charland in his January report. “Two aspects of the MinuteClinic footprint would indicate that this has nothing to do with the merger. “First, CVS has more than 8,000 stores. Only 1,104 of them have a MinuteClinic, and those are concentrated in the largest 100 metro areas in the United States. It will take a much greater footprint of MinuteClinic locations and a much wider scope of services to pull off a full court press on lowering costs using this strategy. “Second, there was no evidence of MinuteClinic expansion in 2017 to go along with this merger. “What is more likely is that CVS Health is aiming to compete directly with UnitedHealth Group in terms of the integration of pharmacy and medical benefits.” Regarding medical benefits integration, Charland suggests comparing the CVS/Aetna proposed merger with that of UnitedHealth Group and Da Vita Medical Group.

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“This company (that is, UnitedHealth Group) has an insurance arm – United Healthcare – which looks a lot like Aetna; and a healthcare services arm – Optum – that has a [pharmacy benefit management provider] that looks a lot like CVS’ Caremark subsidiary. Optum also has a clinic/provider network that is significantly larger than what CVS has right now. “If we were to predict what happens from here, it would be that CVS Health begins to expand its clinic and provider network well beyond the retail clinic space, i.e. urgent care, primary care and specialty care expansion. The next big wave in healthcare will be the move to at-risk payment models sold directly to employers and government. “CVS Health, Aetna, Optum and UnitedHealthcare are extremely adept at selling to those channels. As their provider networks expand, this will be a major threat to hospital systems across the country. These companies will nip away at the profitable ambulatory care services while leaving hospitals with their not-so-profitable inpatient services. Notice Optum is not acquiring hospitals!”

Hospitals and health systems are prepared “Rapid changes in the healthcare field are leading many hospitals and health systems to explore new ways to improve quality, reduce costs, and provide more convenient access to care to meet their patients’ needs,” says Melinda Hatton, general counsel, American Hospital Association. “Hospitals aren’t alone: The decision by CVS to acquire health insurer Aetna is being defended on the grounds that it will build a care system closer to consumers that is more responsive to their needs. “Those same goals are driving some hospitals and health systems to join together. According to a 2017 economic study from Charles River Associates, hospital mergers result in significant cost savings and appreciable quality improvements that cannot be replicated by looser affiliations. They can also expand the types of services available to patients and communities, and provide a stable foundation on which to deliver more comprehensive, coordinated, and convenient care. In some communities, mergers may be the only practical way to preserve services and enhance quality. As hospitals and health systems realign to meet these goals, they have been leaders in controlling costs, with hospital price growth, as measured by the Hospital Producer Price Index, just 1.2 percent in 2016, the second-slowest rate since 1998 and down from 3.5 percent in 2007.”

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TRENDS

Fast and furious The merger and acquisition announcements came fast and furious in the weeks leading up to Christmas. December 3: CVS and Aetna. CVS Health and Aetna announced the execution of a definitive merger agreement under which CVS Health would acquire all outstanding shares of Aetna for a combination of cash and stock. A “personalized healthcare experience” will be delivered by connecting Aetna’s provider network with greater consumer access through CVS Health, according to the two companies. This includes more than 9,700 CVS Pharmacy locations and 1,100 MinuteClinic walk-in clinics as well as further extensions into the community through Omnicare’s senior pharmacy solutions, Coram’s infusion services, and the more than 4,000 CVS Health nursing professionals providing in-clinic and home-based care across the nation.

“With medical groups in California, Colorado, Florida, Nevada, New Mexico and Washington, DaVita Medical Group will expand the market reach of Optum’s strategic care delivery portfolio, including Surgical Care Affiliates, MedExpress and HouseCalls,” the companies said. December 7: Dignity Health and Catholic Health Initiatives. Englewood, Colo.-based Dignity Health and San Francisco-based CHI announced their intention to merge, creating a system encompassing more than 700 care sites and 139 hospitals across 28 states.

December 4: Advocate Health Care and Aurora Health Care. Chicago-based Advocate and Milwaukeebased Aurora announced their intention to merge. The new organization would operate 27 hospitals, more than 500 sites of care, and employ more than 3,300 physicians and 70,000 associates and caregivers.

December 10: Ascension and Providence St. Joseph. The Wall Street Journal reported that the two hospital systems were discussing a merger that would create an entity encompassing 191 hospitals in 27 states and annual revenue of $44.8 billion. Ascension operates across 22 states and the District of Columbia, including Texas and Washington, where Providence also operates. Providence also has hospitals in Alaska, California, Montana, New Mexico and Oregon.

December 6: UnitedHealth Group and DaVita Medical Group. Optum, part of UnitedHealth Group, announced its intention to acquire DaVita Medical Group, one of the nation’s leading independent medical groups and a subsidiary of DaVita Inc., for approximately $4.9 billion in cash. DaVita Medical Group serves approximately 1.7 million patients per year through nearly 300 medical clinics, 35 urgent-care centers and six outpatient surgery centers.

December 19: Humana and Kindred Healthcare. Humana Inc. announced it signed a definitive agreement to acquire a 40 percent minority interest in the Kindred at Home Division of Kindred Healthcare, Inc., said to be the nation’s largest home health provider and second largest hospice operator, for approximately $800 million. Currently, nearly 40,000 caregivers serve approximately 130,000 patients daily in Kindred at Home with annual revenues of approximately $2.5 billion.

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HEALTH FOCUS

Colorectal Cancer Early detection is key

in colorectal cancer screening strategies may increase screening uptake. cer death in the United States, according to the U.S. PreThe benefit of early detection of and intervention ventive Services Task Force. In 2016, when the USPSTF for colorectal cancer declines after age 75 years, says issued its most recent set of screening recommendaUSPSTF. Among older adults who have been previously tions, an estimated 134,000 persons were likely to be screened for colorectal cancer, there is at best a moderdiagnosed with the disease, and about 49,000 were exate benefit to continuing screening pected to die from it. There is convincing during the ages of 76 to 85 years. Colorectal cancer is most freevidence that colorectal However, adults in this age group quently diagnosed among adults who have never been screened for aged 65 to 74 years; the median age cancer screening colorectal cancer are more likely to at death from colorectal cancer is substantially reduces benefit than those who have been 73 years. deaths from the disease previously screened. The USPSTF found convincamong adults aged 50 The time between detection and ing evidence that screening for to 75 years, and that not treatment of colorectal cancer and colorectal cancer in adults aged 50 realization of a subsequent mortality to 75 years reduces colorectal canenough adults in the benefit can be substantial. As such, the cer mortality. However, about oneUnited States are benefit of early detection of and interthird of eligible adults in the United using this effective vention for colorectal cancer in adults States have never been screened for preventive intervention. 86 years and older is at most small. colorectal cancer. Offering choice Colorectal cancer is the second-leading cause of can-

March 2018

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Screening recommendations In June 2016, the U.S. Preventive Services Task Force

updated its recommendations regarding colorectal cancer screening. Eight years earlier, the USPSTF had recommended screening with colonoscopy every 10 years, annual FIT, annual high-sensitivity FOBT, or flexible sigmoidoscopy every five years combined with high-sensitivity FOBT every three years. In the current recommendation (below), instead of emphasizing specific screening approaches, the USPSTF chose to highlight the convincing evidence that 1)

colorectal cancer screening substantially reduces deaths from the disease among adults aged 50 to 75 years, and 2) not enough adults in the United States are using this effective preventive intervention. Note that recommendations made by the U.S. Preventive Services Task Force are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Population

Recommendation

Grade

Adults aged 50 to 75 years

The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years.

A (There is a high certainty that the net benefit is substantial.)

Adults aged 76 to 85 years

The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history. • Adults in this age group who have never been screened for colorectal cancer are more likely to benefit. • Screening would be most appropriate among adults who 1) are healthy enough to undergo treatment if colorectal cancer is detected and 2) do not have comorbid conditions that would significantly limit their life expectancy.

C (The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.)

Source: U.S. Preventive Services Task Force, June 2016 (www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2#tab)

What’s ahead for FIT? Testing for novel protein biomarkers in stool finds signifi-

cantly more colorectal cancers (CRC) and advanced adenomas (precursors to cancer) compared to testing for hemoglobin alone, according to researchers from the Netherlands Cancer Institute and VU University Medical Center, and published in Annals of Internal Medicine in November 2017. The proteins can be detected in a small sample of the fecal immunochemical test (FIT), which suggests that they can be applied in population screening. The researchers sought to identify novel protein biomarkers in stool that could outperform or complement hemoglobin in detecting CRC and advanced adenomas. They used mass spectrometry to search for proteins that

were present in stool specimens from persons with CRC or advanced adenomas, and which were virtually absent from stool specimens from controls. By using a combination of four novel protein biomarkers, in this study the investigators found that they were able to detect almost twice as many colorectal cancers and five times as many advanced adenomas, compared to using hemoglobin alone. According to the researchers, this new test has the potential to be easily integrated into population-wide screening programs upon successful clinical validation. Because it uses the same technology as the current standard stool-based test, few adjustments to the screening program would be needed.

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March 2018

HEALTH FOCUS

Colorectal cancer screening strategies Screening Method

Frequency

Evidence of Efficacy

Other Considerations

gFOBT

Every year

High-sensitivity versions have superior test performance characteristics than older tests.

Does not require bowel preparation, anesthesia, or transportation to and from the screening examination (test is performed at home)

FITc

Every year

Improved accuracy compared with gFOBT. Can be done with a single specimen

Does not require bowel preparation, anesthesia, or transportation to and from the screening examination (test is performed at home)

FIT-DNA

Every 1 or 3 years

Specificity is lower than for FIT, resulting in more false-positive results, more diagnostic colonoscopies, and more associated adverse events per screening test. Improved sensitivity compared with FIT per single screening test

There is insufficient evidence about appropriate longitudinal follow-up of abnormal findings after a negative diagnostic colonoscopy; may potentially lead to overly intensive surveillance due to provider and patient concerns over the genetic component of the test.

Stool-Based Tests

Direct Visualization Tests Colonoscopyc

Every 10 years

Requires less frequent screening. Screening and diagnostic followup of positive results can be performed during the same examination.

CT colonographye

Every 5 years

There is insufficient evidence about the potential harms of associated extracolonic findings, which are common

Flexible sigmoidoscopy

Every 5 years

Flexible sigmoidoscopy with FITc

Flexible sigmoidoscopy every 10 years plus FIT every year

Modeling suggests it provides less benefit than when combined with FIT or compared with other strategies

Test availability has declined in the United States

Test availability has declined in the United States. Potentially attractive option for patients who want endoscopic screening but want to limit exposure to colonoscopy.

Abbreviations: FIT=fecal immunochemical test; FIT-DNA=multitargeted stool DNA test; gFOBT=guaiac-based fecal occult blood test. Source: U.S. Preventive Services Task Force, June 2016 (www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/colorectal-cancer-screening2#tab)

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How well do you know your customers? What keeps your customers up at night?

Provista – the nation’s largest non-acute supply chain partner – recently asked that question to a sampling of our customers in physician practices, clinics and surgery centers. They told us their top five concerns (respondents were asked to check up to three) are:

42%

40%

Pharmaceutical shortages or spikes in pricing

Shortage of qualified staff

35%

33%

29%

Rising cost of supplies

Maintaining or improving profitability

Inventory shortages that hinder customer service or patient care

Would you have said the same? We asked Repertoire to survey a sampling of its distributor readers to identify the top three issues they think are keeping their physician customers up at night. Their responses?

58%

40%

30%

Reimbursement Healthcare Pharmaceutical changes reform impacting shortages or business models spikes in pricing

30%

28%

Maintaining or improving profitability

Rising cost of supplies

Not a perfect match, but close. Providers and distributors are agreed that financial issues are of great concern to non-acute providers. Declining reimbursement, high healthcare costs and reform requirements can put a strain on your customers’ profits. As a leader in the supply chain industry, Provista can help you increase your customers’ profitability…. and yours. Best of all, there is no cost or commitment for your customers to join Provista. Provista, working with our distributor partners, has built our customer base to include: • 120,000 diagnostic and preventive care providers (e.g., physician practices, diagnostic imaging centers, urgent care centers, etc.). • 18,000 surgical care customers. • 13,000 extended care customers. And we want to keep growing with you. Provista is committed to helping you reach your goals. Our dedicated teams can assist you with contract connections, confirmation of price accuracy, recruiting new customers, and ultimately, growing your market share. With more than 70 field and customer service representatives, Provista offers you direct support that lifts administrative work – allowing you to focus on achieving your goals. Our dedicated resources work directly with your customers’ implementation and contract teams to ensure you’re getting the maximum value from Provista.

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HEALTHY REPS

Health news and notes

A spoonful of trehalose

Keep it real

Over the past 15 years or so, some makers of ice cream and other processed foods – from pasta to ground beef products – have changed their recipes to swap out some of the table sugar (sucrose) with a sweetening/texturizing ingredient called trehalose, which depresses the freezing point of food. Both sucrose and trehalose are “disaccharides.” Though they have different chemical linkages, both get broken down into glucose in the body. A study in the journal Nature indicates that trehaloseladen food may have helped fuel the recent epidemic spread of Clostridium difficile (C. diff.), which is a microbe that can cause life-threatening gastrointestinal distress, especially in older patients getting antibiotics and antacid medicines. In laboratory experiments, a National Institutes of Health-funded team found that the two strains of C. diff. most likely to make people sick possess an unusual ability to thrive on trehalose, even at very low levels. What’s more, a diet containing trehalose significantly increased the severity of symptoms in a mouse model of C. diff. infection.

The LinkSquare is a magic marker-sized scanner that can tell if meat is rotten, whether alcohol is fake, or prescription pills are what they’re supposed to be, reports USA Today in a report about the Consumer Electronics Show (CES) in Las Vegas in January. It can even tell if the money in your pocket is counterfeit. It pairs with an app on your phone. Price is $300.

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Protect your skin Another gadget worth noting at the Consumer Electronics Show was L’Oreal’s UV Sense, a wearable small enough to fit on your fingertip, reports USA Today. The dot tells you UV, pollen, humidity, temperature and air quality levels. It pairs with an app on your smartphone and can give you reminders to put on more sunscreen (L’Oreal is suggested!) or stay out of the sun altogether. Costs about $40.

Dieting? Watch the clock Don’t focus so much on how much you eat, but rather, on when you eat. That’s the concept behind time-restricted

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HEALTHY REPS feeding, or TRF, a strategy increasingly being studied by researchers as a tool for weight loss, diabetes prevention and even longevity, according to Sumathi Reddy of the Wall Street Journal. In TRF, you can eat whatever you want and as much as you want – just not whenever you want, she writes. (That doesn’t mean you can stuff yourself with goodies; rather, eat as you normally would.) Daily food intake should be limited to a 12-hour window, and ideally cut down to eight to 10 hours. Despite a lack of dietary restrictions, most people following TRF end up consum-

DASH is a healthy eating plan that supports long-term lifestyle changes, according to NIH. It is low in saturated fat, trans fat, and cholesterol. It emphasizes fruits, vegetables, and lowfat dairy foods, and includes whole grains, poultry, fish, lean meats, beans, and nuts.

ing fewer calories and lose weight. Preliminary evidence also shows other health benefits of fasting for 12 hours or more, including lower blood pressure and improved glucose levels, and physiological changes linked to slowing the aging process.

DASH ranked best diet For the eighth consecutive year, U.S. News and World Report ranked the National Institutes of Health-developed DASH Diet “best overall” diet among nearly 40 it reviewed. The announcement came as new research suggests that combining DASH, or Dietary Approaches to Stop Hypertension, with a low-sodium diet has the potential to lower blood pressure as well as or better than many

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anti-hypertension medications. DASH is a healthy eating plan that supports long-term lifestyle changes, according to NIH. It is low in saturated fat, trans fat, and cholesterol. It emphasizes fruits, vegetables, and low-fat dairy foods, and includes whole grains, poultry, fish, lean meats, beans, and nuts. It is rich in potassium, calcium, and magnesium, as well as protein and fiber. However, it calls for a reduction in high fat red meat, sweets, and sugary beverages. To read more about DASH, go to www.nhlbi.nih.gov/ health-topics/dash-eating-plan.

Even the frail can benefit Physicians should prescribe physical activity to all older patients, regardless of frailty status, according to researchers at the USDA Human Nutrition Research Center on Aging at Tufts University and Geneva University Hospitals. Although a structured, moderate-intensity physical activity program was not associated with a reduced risk for frailty over two years among sedentary older adults, it did reduce major mobility disability in both frail and nonfrail patients. Study participants were randomly assigned to a program consisting of aerobic, resistance, and flexibility activities or a health education program consisting of workshops and stretching exercise. Findings from a secondary analysis of the LIFE (Lifestyle Interventions and Independence for Elders) trial are published in Annals of Internal Medicine.

Bummer Vitamin D and calcium supplements do not seem to be warranted to prevent bone breaks or hip fractures in adults over the age of 50, according to a study published in the Journal of the American Medical Association on Dec. 26. Such supplements had no clear benefit regardless of dose, the gender of the patient, history of fractures or the amount of calcium in the diet, reports the Washington Post. The analysis, conducted by Jia-Guo Zhao of Tianjin Hospital in China, was focused on older adults who live in the general community and did not include those in nursing homes, hospitals and other facilities.

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

Automotive-related news Crash avoidance technologies

A thousand moral decisions

Most automakers offer crash-avoidance systems on 2018 models, reports the Insurance Institute for Highway Safety. IIHS studies of police-reported crashes and Highway Loss Data Institute analyses of insurance losses have found that many of these features are reducing crashes in the real world, including: •F ront crash prevention systems, which include forward collision warning and autobrake. Warning systems alert you if you get too close to a car in front. Autobrake systems can brake if you don’t respond in time. •L ane-departure warning and lane-keeping assist, which help prevent lane-departure crashes. •B lind-spot detection, which alerts drivers to nearby vehicles they might not see. • Park-assist systems, which help reduce backing crashes. •C urve-adaptive headlights, which shift direction with steering to help you see better on curves in the dark. •H igh-beam assist technology, which automatically switches between high beams and low beams.

New York Times columnist David Brooks took a philosophical and spiritual look at driving in a Jan. 4 column called “How Would Jesus Drive?” “As Richard Reeves of the Brookings Institution points out, driving is precisely the sort of everyday activity through which people mold the culture of their community,” writes Brooks. “If you speed up so I can’t merge into your lane, you’re teaching me that the society around here is basically competitive, not cooperative. “Driving puts you in a If, on the other hand, constant position of you give me a friendly asking, Are we in a wave after I let you in, you’re teaching me that place where there this is a place where a is a system of self-restraint, or are we kindness is recognized and gratitude is exin a place where it’s pressed. If you feel dog eat dog?” perfectly fine doing a three-point turn in the middle of a busy street, blocking everybody else going both ways, you teach me that people here are selfish and feel entitled. But if you get over to the right and wait your turn in a crowded highway exit lane, rather than cutting in at the last moment, that teaches me that there’s a sense of fairness and equality, and that people feel embedded in the group. “Driving means making a thousand small moral decisions: whether to tailgate to push the slowpoke faster, or to give space; whether to honk only as a warning or constantly as your all-purpose show of contempt for humanity. Driving puts you in a constant position of asking, Are we in a place where there is a system of self-restraint, or are we in a place where it’s dog eat dog?”

In the zone Distracted driving is no joke. The National Highway Traffic Safety Administration reports that distracted driving led to 3,450 of 37,461 fatalities in 2016. Fatal distracted driving crashes are up 8.5 percent since 2014. Despite it all, you have to laugh at some of the excuses drivers make up while getting collared for texting while driving. Here’s one from a driver in Niles, Illinois, as reported by the Chicago Tribune: “It was a call from an indigent guy who’s calling me looking for work.” Many people claim the phone call was an emergency. And the Tribune writes this about one of Niles police Officer John Gaba’s collars: “A young woman beside his squad car was so absorbed in texting that he had to sound his horn repeatedly – she looked up as if coming out of a dream.” Says Gaba, “They get in a zone.”

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QUICK BYTES Editor’s note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, Repertoire will profile the latest developments in software and gadgets that reps can use for work and play.

Technology news

It’s about being everywhere

TV lexicon

It was Google versus Alexa at the Consumer Electronics Show in Las Vegas, reports Wired. “Right now, by all accounts, Amazon’s Alexa is winning the virtual assistant battle,” its editors report. “It was in hundreds of third-party devices at last year’s CES, and though Amazon doesn’t release specific sales figures beyond the ‘tens of millions’ statement from CEO Jeff Bezos, Echo devices appear to outsell Google Homes by a wide margin. Not only that, Amazon’s working with a growing list of partners to embed Alexa in other devices as well. Google needs to catch up fast if it wants to compete. Its Google Home products – the Home, Mini and Max – are solid enough, but they’re just the beginning of the ecosystem. The winning virtual assistant will be the one that first achieves ubiquity. It’s about doing everything, and being everywhere. Once people pick an assistant and start using it in their lives, they’re not likely to switch. The stakes are high, and immediate.”

New TVs are coming, with an alphabet soup of features designed to get you to spend more money, reports the Associated Press. Some terms to keep in mind: • HD, 4K, 8K: Lots and lots of pixels, for some sharp viewing. • OLED: Stands for Organic, light-emitting diodes. Self-illuminating pixels, so that images can have truly black areas, not just really dark ones (which, we guess, is a good thing?). • MicroLED: Micro light-emitting diodes, said to offer the same benefits of OLED without the potential “burn-in.” • HDR and HDR10: High dynamic range using 10 “bits” to represent color gradations. Said to include the brightest bright parts and the darkest dark parts without either dominating the image. • Dolby Vision and HDR10+: Sixty-nine billion color variations.

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QUICK BYTES Science can’t beat the human heart when it comes to love, according to the Advertising Standards Authority in London. A billboard ad on a London Underground platform for the online dating service, eHarmony, seen on July 4, 2017, featured the headline claim “Step aside, fate. It’s time science had a go at love,” according to the ASA. • Quantum dots, QLED, QDEF: Quantum dots are tiny particles that emit sharp colors based on their particular size, leading to very accurate colors.

Toilet talk

Chicago Tribune columnist Rex Huppke says he doesn’t want to have anything to do with talking toilets, such as the Kohler Numi toilet, displayed at the Consumer Electronics Show in Las Vegas. Conversations could lead to hard feelings. Example: Toilet: “Hello Rex, welcome to the bathroom. What can I do for you?” Huppke: “Raise the seat, please.” Toilet: “Sure! How is your day go … HEY! WHAT ARE YOU DOING? OH GOD, THIS IS TERRIBLE!!!”

Love at first algorithm Science can’t beat the human heart when it comes to love, according to the Advertising Standards Authority in London. A billboard ad on a London Underground platform for the online dating service, eHarmony, seen on July 4, 2017, featured the headline claim “Step aside, fate. It’s time science had a go at love,” according to the ASA. Further text stated “Imagine being able to stack the odds of finding lasting love entirely in your favour. eHarmony’s scientifically proven matching system decodes the mystery of compatibility and chemistry so you don’t have to. Why leave the most important search of your life to chance? Try something different today. Join eharmony.co.uk”. A complaint was lodged, claiming that it is not possible to hold scientific proof about a dating system. In its assessment, the ASA wrote, “The ASA considered that consumers were likely to appreciate that the advertised dating website would not be able to guarantee that they would be able to find lasting love. However, we considered that consumers would interpret the claim ‘scientifically proven matching system’ to mean that scientific studies had demonstrated that the website offered users

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a significantly greater chance of finding lasting love than what could be achieved if they didn’t use the service.” The ruling? The ad must not appear again in its current form. “We told eHarmony to remove the claim ‘scientifically proven matching system’ and not to use similar claims with the same meaning, unless they had adequate evidence that their website offered users a significantly greater chance of finding lasting love than what could be achieved if they didn’t use the service.”

Poolside Wi-Fi Extend your Wi-Fi coverage outdoors up to an additional 2,500 square feet with the Orbi™ Outdoor Satellite from NETGEAR. Users connect the Orbi router to an Internet modem or service provider gateway, and place the Orbi satellite somewhere central to the area of intended Wi-Fi coverage. Depending upon the Orbi System installed, the Wi-Fi coverage area can range from 3,500 square feet up to 5,000 feet around your property. By adding an Orbi Outdoor Satellite to an existing Orbi WiFi System, the range of the WiFi mesh coverage zone can be expanded to another 2,500 square feet extending to the farthest perimeter of your property for Wi-Fi at the pool, guest house, garage and the grill. Designed to withstand rough outdoor weather conditions including sub-zero temperatures, Orbi Outdoor Satellite has an international standard IP56 rating for dust and water-resistance, according to the manufacturer. Cost: $330.

Whip it good With its 700-watt motor, Braun’s latest immersion blender “blows through foodstuffs that lesser sticks can’t crack – ice cubes, raw potatoes, or even a peeled avocado with pit (if you crave those bitter tannins),” reports Wired. The device sells for $150. “Below the soft grip is a compression zone – push down and the spinning slicer moves closer to the bottom of your vessel, ensuring every last bit of basil and garlic becomes pesto,” reports the magazine. “Squeezing the trigger speeds up the blades and takes your mix from chunky to smooth. No apron? No problem. Those funkily shaped feet are designed to keep splatter to a minimum.”

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corner

Sales Pro Unhappy customers have one thing in common: They have long memories.

It’s a lesson Lee Crane learned years ago as a golf pro, and one he keeps in mind today as a territory manager for MedPro Associates, the national contracted sales firm specializing in the healthcare industry.

Crane lives in Houston and services South Texas and Louisiana, but it’s still Sweet Home Alabama for him. “Most of my family – both immediate and extended – still live in Tuscaloosa and Montgomery,” he says. His father, Greg Crane, an accomplished musician, has been a worship pastor (that is, he provides music at church services) for 30plus years. His mother, Melanie, plays the piano. And his brother, Nick, 11 months older than Lee, is also musically inclined. Though Lee enjoys listening to music, he never developed an interest in playing it. But he did develop an interest in golf. “I played golf a couple of times a year with my dad,” he recalls. “I think that seeing him enjoy his time on the course with his friends was what started it for me.” Riding in the golf cart was pretty cool too.

Hooked on golf

Lee Crane (r) with Alabama friends West Hamm and Blake Hall.

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“I started to pursue golf more and more in high school. I would go to the course and goof off with friends. At that point I was hooked on the game. I was terrible, but I loved it! And I think that was the driving force behind it.” In fact, golf stirred in young Crane an instinct that would serve him well on the links and later, in the physician’s office – a competitive spirit.

“Growing up, I always thought I was a pretty good athlete,” he says. “Then I was humbled by golf, and I knew it was something I wanted to be better at. I think the competitor in me doesn’t like being bad at anything, and I was willing to put the work in to get better. Golf is a challenge, even today. If you want to be good at it, you have to work at it. It’s the same thing with sales; if you’re not constantly learning and adapting, you’ll be stuck in the mud.” In high school, Crane applied for a summer job at the Tuscaloosa course as a cart boy, and he picked the driving range daily. During the summer after graduation, he played every day before or after work, and became “a pretty decent player.” The Pro asked the young golfer for help with some of the golf tournaments, and soon named him assistant professional. Half a year later, the Pro left. After passing his playing ability test for the PGA of America, Crane became the Head Golf Professional. He was 21. As a golf pro, he was responsible for teaching, merchandising, golf outings and other day-to-day operations. When his father took a job at First Baptist Church in St. Petersburg, Florida, Crane decided to look for work in Florida. Through a family friend, he got an opportunity to interview with golf industry legend Jay Overton, who was Pro at Innisbrook in Tampa. Crane was hired as one of 15 Golf Professionals on staff. In 2009, he was promoted to Head Golf Professional at the Copperhead course, where he got to host his first PGA Tour event. Overton was a demanding boss, recalls Crane. “He would say, ‘If you’re five minutes early, you’re 10 minutes late.’ But I wouldn’t go back and change any of it.”

always say he would love to see myself and a few other golf pros at Innisbrook get into sales. At first, I hesitated, because I had never been in sales. “Billy gave me lots of advice,” he continues. “One thing that still sticks with me today is, ‘Do what you say when you say you are going to do it.’ It sounds simple, but I try to keep that in mind every day.” In 2010, he joined MedPro Associates, and he soon realized that the skills he developed as a golf pro would suit him well in medical sales.

“When I was at Innisbrook, customer service was always important, and I still keep that in mind to this day. Sales is customer service. An unhappy customer will remember the bad far longer than they remember the good. “I learned at an early age that when people come to play golf at a nice course, they’re there for the right experience,” he continues. Accommodating golfers’ preferences was part of the customer service experience. “I learned that the way you carry yourself, the way you represent what you have, speaks volumes about you.” Crane is grateful he landed with MedPro. “I have the best management a rep could ask for. Under the guidance of Bill Sparks, Manny Losada and the management team, MedPro has developed a culture that lets me be successful. They have allowed a guy like me to come in; they provide me with incredible manufacturers to represent; and they support us with whatever we need to be successful in the field.”

“Sales is customer service. An unhappy customer will remember the bad far longer than they remember the good.”

The switch “We had a great group of members at Innisbrook,” says Crane. Among them were Billy Harris (now CEO of Ventyv) and Scott Adams (now publisher of Repertoire). “Billy would

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corner Three things to keep in mind Lee Crane, MedPro Associates, believes that working hard and building relationships have been key to his success in medical sales. His top three lessons learned: 1. A nswer the phone and return emails. “Distributor reps have a lot of options out there, and when you get an opportunity, you never want to waste it.” 2. K now your products; help your customers identify what they want and really need;

offer solutions. “A happy customer will remember you for helping find the solution they need, rather than just selling them something that may not be what they need.” 3. Work with the rep who brings you the lead. “I have the privilege of working with quite a few distributors in different markets, and it can be difficult managing some of the situations that come about because of the multiple distributors one customer may have associated with their account.”

In times of trouble Taking care of customers is a driving force for Lee Crane, territory manager, MedPro Associates. Taking care of hurricane victims? That too. “I moved to Houston about eight years ago, and this was the first hurricane I had to live through,” says Crane, speaking of Hurricane Harvey, which made landfall in Texas on Aug. 25, 2017. “When Harvey first developed, I thought, ‘We will probably get heavy rain,’” says Crane. In fact, South Houston, where Crane lives, got 47 inches. “I didn’t have any damage to my house, but less than two miles away, there was complete devastation. It was heartbreaking. I didn’t know what to do, but I knew I wanted to help.” In response, Crane and a friend, Russell Lala, brought together 10, 15 sometimes 20 people a day to cook and deliver meals for those who had suffered in the hurricane. They ended up serving more than 200 families in League City and Dickinson, and raising over $10,000.

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“We couldn’t have done any of this without the folks in our community pulling together, donating their time, food and money to the people who needed it more than ever,” says Crane. “As word got out that we were feeding the community, it was so incredibly awesome to see people join together without even knowing one another, with a common goal of helping our community, who just lost everything. “I can remember several times as we were outside cooking, cars pulling up and asking what we were doing. They would either ask to help deliver, or they would donate cash or food, without asking where or who it was going to. At a time where there was so much work to be done, having our community pull together was an experience I will never forget for the rest of my life. “There is still a lot of work to be done. But if there is one thing I have learned about living in Texas, it is the sense of community and pride here. I have no doubt that the city of Houston will be back and better than ever.”

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HIDA GOVERNMENT AFFAIRS UPDATE

Resources and Recommendations HIDA, AHRMM, and HMMC to debut new UDI resources and education campaign Low-unit-of-measure (LUM) programs can pose a challenge for manufacturers

and distributors working to comply with the Food and Drug Administration’s (FDA) unique device identifier (UDI) rule. With LUM programs, distributors break down product to reduce the customer’s need to buy and hold large quantities of inventory. While the manufacturers’ original packaging may have UDI-compliant labeling, the smaller packages may not, risking non-compliance with the UDI rules.

By Linda Rouse O’Neill, Vice President, Government Affairs, HIDA

There’s no one-size-fits-all solution to this challenge. Instead, HIDA and its partners at the Association for Healthcare Resource and Materials Management (AHRMM) and the Healthcare Manufacturers Management Council (HMMC) have developed a set of recommendations that distributors and their trading partners can follow. Here is a summary of these steps: 1. Initiate trading partner discussions. The distributor needs to make sure the manufacturer fully understands the LUM program they offer. Due to antitrust concerns, these conversations must be conducted one-on-one between individual trading partners. 2. Share key data. The distributor must then share a list of products distributed in their LUM programs.

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The UDI compliance deadline for certain class II devices is September 24 of this year. The deadline had originally been September 24, 2016, but the FDA extended this to give the supply chain more time to ensure compliance. 3. Analyze. The manufacturer reviews the distributor’s data and gathers up-to-date UDI implementation plans from their product teams. The manufacturer then determines if there are any gaps in UDI compliance because of the distributor’s programs.

4. Dialogue. The manufacturer presents the distributor with a plan for how products can remain UDI compliant when they are sold via a LUM program. During this step, the manufacturer may require additional information, and the distributor may need to gather input from their provider customers.

In addition to releasing the best practices, HIDA, AHRMM, HMMC, and the FDA, working together as a part of a new UDI Coalition, are developing a series of webinars through the spring and summer. Speakers will include leading policy and industry experts who can offer practical tips for ensuring all members of the supply chain comply with UDI requirements. Keep an eye out for these by visiting www.HIDA.org/ webinars.

5. Develop a plan. In this step, manufacturers and distributors decide on how to implement the necessary changes to comply with UDI requirements, and how to communicate necessary information to customers.

6. Continued dialogue. Distributors and manufacturers should maintain an open dialogue to ensure that UDI requirements are met as customer needs change.

Looking ahead The UDI compliance deadline for certain class II devices is September 24 of this year. The deadline had originally been September 24, 2016, but the FDA extended this to give the supply chain more time to ensure compliance. The deadline for class I and unclassified devices is September 24, 2022. For more information on upcoming deadlines, the best practices, or other UDI resources, please contact us at HIDAGovAffairs@HIDA.org.

Background In September 2014, the FDA issued its final UDI rule to identify medical devices as they move from the manufacturer through to the provider down to patient use. The UDI is required to include information about the product’s origin, through a sequence of letters and numbers you are provided with the product identifier (brand name and item) and for class II & III devices the production information (lot/batch/ expiry date/etc.). In addition to requiring that the UDI information is shown on the medical device packaging, device labelers need to

make sure this information is entered into the Global Unique Device Identification Database (GUDID). The GUDID is intended to be a public portal making product information easily available to the medical community. UDI rules have been particularly challenging for all members of the supply chain, especially since many providers receive medical supplies as part of a low-unit-of-measure or just-in-time program. Ensuring UDI compliance as products are separated into smaller collections is a key challenge the best practices aim to address.

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SMART SELLING

DISTRIBUTOR SALES STRATEGIES FROM HIDA

To Win ASCs’ Business,

Understand Their Unique Needs

By Elizabeth Hilla, Senior Vice President, HIDA

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Ambulatory surgery centers (ASCs) in-

What’s happening in the sector

creasingly deliver complex medical care, as more procedures move from inpatient to outpatient settings. Surgery centers are projected to increase their share of all outpatient surgery types by the end of the decade. As with any customer, the key to winning ASCs’ business is to understand and meet their unique needs. While ASCs increasingly handle complex cases, they are not mini-hospitals. Their needs are different from those of hospital ORs and from physician practices.

HIDA’s ASC Market Report contains a number of useful insights for understanding ASC market shifts. These include: • The sector is rapidly expanding. More than half (58%) of outpatient surgeries were performed by ASCs, up from 41% in 2005. ASCs’ share of outpatient surgery is expected to grow to 60% by 2020. • Surgeries are shifting from inpatient to outpatient settings. In 2005, 58% of surgeries were performed in an

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outpatient setting, and that figure is expected to reach 64% by 2020. • Gastroenterology is the most common ASC specialty. These procedures account for 25% of cases, followed by ophthalmology (20%), orthopedics (16%), and pain management (16%).

How you can help Distributor reps have many resources and services that can help ASCs flourish. Consider talking with ASC customers about: •T he benefits of a single supplier. I’ve heard from many salespeople that ASCs often buy individual products here and there directly from the manufacturer. These providers usually end up paying a

premium for low volume, or buying larger quantities than they need, paying high shipping costs, and waiting a long time for delivery. Ask your prospect if they are buying anything direct and, if it is a manufacturer you work with, see if you can save the ASC time and money by getting it for them. • More appropriate order size. Reps who call on this market tell me that most ASCs have one small inventory room. To optimize space and availability, offer to help analyze historical usage and establish a suitable product ordering frequency. Suggest perpetual inventory (getting weekly supply orders delivered at a set time) or recommend smaller, more frequent just-in-time deliveries. • Training for new revenue-boosting procedures. Your manufacturer representative partners often provide training to ASC doctors for revenueboosting procedures, especially if their product can be used for this purpose. Find ways to coordinate and facilitate these sessions. • Consensus building for new product introductions. If the purchasing person thinks it is too much effort to get a group of doctors to agree on which new product to try, offer to build consensus by making a presentation at their next staff meeting. • Targeted value-added services. Position yourself as a business partner by first asking the administrator what his or her goals and challenges are, then using this information to add value. • Obtaining hard-to-find products. A common situation is for a doctor to say to the person buying supplies, “I use product x at the hospital, can you get it for me here?” Or, “I just read about product y, can you get me some more information?” In these cases, the buyer may not know where to turn for expert assistance. You can position yourself as a key asset by offering to bring samples or literature, or to set up demonstrations. Once your ASC customer sees that you understand their unique challenges and characteristics, you can position yourself to gain their trust, respect, and repeated business.

To learn more about HIDA’s ASC Market Report, or any of the other market reports we offer, please visit www.HIDA.org/MarketReports. And if you would like more tips on selling to ASC customers, be sure to check out the course “Selling to Surgery Center Customers,” offered by HIDA’s AMS Sales Training Program (www.HIDAAMS.org).

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Industry news Henry Schein Medical launches web-based comprehensive cardiac care resource center Henry Schein Medical, the U.S. medical business of Henry Schein Inc (Melville, NY) announced the launch of its Comprehensive Cardiac Care resource center, a web-based hub designed to emphasize the importance of preventive cardiac care to physicians and patients. The webpage was created in recognition of February as Heart Health Month. The Comprehensive Cardiac Care page features information on preventive treatments, screenings, and solutions for six topics related to heart health “Heart Health Month is an opportunity to raise awareness of the importance of preventive care, as well as an ideal time for physicians to speak with their patients about maintaining good cardiovascular health,” said Bridget Ross, President of the Henry Schein Global Medical Group. “We at Henry Schein are committed to our role as a total solutions provider that our customers can rely on for information and education, and we encourage practitioners and their staff to explore our Comprehensive Cardiac Care resource center this February and throughout the year.”

Amazon, Berkshire Hathaway, JPMorgan Chase to launch new healthcare company Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. are partnering on ways to address healthcare for their U.S. employees, with the aim of improving employee satisfaction and reducing costs. The three companies will create “an independent company that is free from profitmaking incentives and constraints.” Initially, the focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality, and transparent healthcare at a reasonable cost. The effort announced is in its early planning stages. The longer-term management team, headquarters location and key operational details will be communicated in due course. “The ballooning costs of healthcare act

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as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable. Rather, we share the belief that putting our collective resources behind the country’s best talent can, in time, check the rise in health costs while concurrently enhancing patient satisfaction and outcomes,” said Berkshire Hathaway chairman and CEO, Warren Buffett.

McKesson Medical-Surgical to be exclusive distribution partner for Sysmex’s new XW-100 automated hematology analyzer McKesson Medical-Surgical and Sysmex America announced that McKesson will be the exclusive distribution partner for Sysmex’s new XW-100 automated hematology analyzer. According to the company, the XW-100 is the first CLIA-waived, complete blood count (CBC) diagnostic instrument. Once prepared for each day’s use, the Sysmex XW-100 allows healthcare professionals to provide patients with blood test results in as few as 3 minutes. The XW-100 will be introduced in select medical practices next month and a full launch is expected this spring. McKesson Medical-Surgical and Sysmex are developing a sales process that will allow the two companies to fulfill customer demand as smoothly and quickly as possible once device shipments begin.

Hospitals overwhelmed by flu patients are treating them in tents Hospitals in every state are making herculean efforts to adequately respond to this year’s flu epidemic. Hospitals California and Pennsylvania have set up “surge tents” outside emergency departments to accommodate and treat influenza patients. SSM Health St. Clare HospitalFenton (Missouri) opened its emergency overflow wing, outpatient centers, and surgical holding centers to make more beds available for flu patients, according to a report from Time.

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